Survival benefit in patients with heart failure treated in specialized heart failure center within the community

Background: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. A heart failure center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. Objectives: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. Methods: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the usual care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. Results: The study comprised 430 heart failure patients; 82 were treated at a heart failure center and 348 under usual care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in the heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in a heart failure center compared with those receiving usual care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. Conclusions: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.