RESUMEN
BACKGROUND: Worsening Heart Failure (WHF) is associated with adverse prognosis. Identifying novel prognostic markers in WHF is crucial. Gait speed (GS), a validated frailty index, is an easily obtainable parameter that may aid in reclassifying the risk of HF patients. We assessed the independent prognostic role of GS in WHF patients. METHODS: We studied 171 patients with chronic HF with worsening congestion symptoms and inadequate response to standard therapies, requiring intravenous diuretic treatment. The primary outcome was a composite of all-cause mortality or HF hospitalization. We assessed the association and the incremental value of GS, as compared to other clinical confounders, with the primary outcome. RESULTS: The mean age was 76±11 years, 66 % were male, median BNP was 481 pg/ml, and median ejection fraction was 40 %. Over a median follow-up of 11.3 months, 71 events occurred. Lower GS was significantly associated with a higher risk of events (HR of 4.03, 95 % CI 2.25-7.21), along with neutrophil to lymphocyte ratio, BNP, QRS duration, natremia, and previous myocardial infarction. When added to the MAGGIC risk score and the other significant confounders identified, GS significantly enhanced the model risk prediction (Harrell's C-index 0.75 vs 0.71, p < 0.001). At Classification And Regression Tree analysis, GS≤0.8 m/s was the first parameter to be considered to risk stratify the population. CONCLUSIONS: GS, an easily obtainable marker of frailty, may contribute to improve the risk stratification of patients with WHF.
RESUMEN
Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.
