부산대학교 도서관

Preventive Rehabilitative Cardiology (CPR) is a possible ideal setting for a Heart Failure (HF) Outpatient Clinic because it allows a specialized multidisciplinary team to be involved in the follow–up of the patient with Chronic Heart Failure (CHF). In the ESC 2021 Heart Failure Guidelines, two cornerstones in the management of patients with CHF are multidisciplinarity (meant as taking charge of the patient not only by the cardiologist but by several health figures, medical and non–medical, through the creation of a team) and the precocity and completeness of therapeutic optimization interventions. These two aspects of the process of taking care of patients with CHF are prerogatives widely developed in CPR. Outpatient cardiac rehabilitation pathways have developed effectively, albeit marginally, in CPR. In an increasingly clear differentiation of roles and in the perspective of the creation of a HF network, in order to optimize paths and resources, it therefore seems useful that CPR takes charge of the chronicity of the HF patient also through its continued outpatient management in the context of a HF Outpatient Clinic. The CPR of Castellanza–Multimedica has adopted a PDTA that aims to guarantee a multidisciplinary management for the patient suffering heart failure. Educational materials and working documents have been produced to encourage an exchange among professionals, and a framework of multidisciplinarity. Future work objectives include the structuring of an increasingly effective and two–way network with level II and III centres not belonging to Multimedica Group and direct access to the clinic not only upon referral from the GP, with whom active collaboration projects are underway, but also directly from the local DEAs, as well as the activation of televisit and teleconsultation programs. A first pilot study was performed to compare endurance versus interval physical training cycles in outpatients with HFrEF. RESULTS: in 5 years of activity, 196 patients were treated: 33 patients (16,8%) were sent to other centres or lost to follow–up, 16 (8,1%) were discharged with re–referral to the GP and Level I outpatient clinics or to the chronic disease programme (PAI), 29 (14,7%) died. Of the 119 patients with active follow–up as of 31/12/2023, 109 (91,5%) are on beta–blocker therapy, 70 (58,8%) on ARNI, 32 (26,8%) on ACEI–sartane for a total of 102 (85,7%) on RAASI, 106 (89,0%) patients on MRA, 87 (73,1%) on glyphozine, 73 (61,3%) on quadruple therapy.