Heart failure is one of the great challenges of modern medicine today. It is a chronic, progressive disease associated with frequent hospitalizations and a profound impact on patients' lives . " Each hospitalization worsens the prognosis," explains cardiologist Cândida Fonseca . "Therefore, it is essential to intervene early, in a structured and differentiated way ." It was precisely to meet this need that the Heart Failure Day Hospital at Hospital da Luz was created. What is the Heart Failure Day Hospital? Current international recommendations emphasize the need to develop and implement specialized units for the evaluation and treatment of heart failure on an outpatient basis. The Heart Failure Day Hospital is precisely that: a specialized service where patients with heart failure are evaluated, treated, and monitored without the need for hospitalization .. Here, a multidisciplinary team focuses on an early, integrated, and patient-centered approach to avoid readmissions and improve quality of life . It functions as a open door for patients with heart failure, allowing for rapid treatment of decompensations , avoiding unnecessary trips to the emergency room, and reducing readmissions.. “ Heart failure is the leading cause of medical hospitalization after age 65,” emphasizes internist Pedro Morais Sarmento. “We know that readmissions are very frequent, especially in the first three months after discharge. That's exactly where we want to intervene. ” How the Heart Failure Day Hospital Works The model is simple in its logic, but demanding in its execution.. When there is hospitalization Follow-up focused on heart failure begins during hospitalization, with education for the patient and caregiver about the disease, medications, and warning signs. After discharge, reassessment happens quickly – ideally within the first 15 days – something that conventional consultations can hardly guarantee. This is where the Day Hospital comes in. The patient returns for a clinical and analytical evaluation, medication doses are adjusted, and self-care education is reinforced.“ “ Today we know that disease-modifying drugs should be started early, all simultaneously, even if in small doses,” explains Cândida Fonseca . “Titration is done later, but it has to be close .” Whenever there are warning signs The Day Hospital also functions as an open door. Previously diagnosed patients know they can contact the team if symptoms such as rapid weight gain, shortness of breath, or edema arise . “ Often, a simple phone call is enough for us to adjust the medication ” explains the internist. " About 30% of the activity involves this direct contact with patients and caregivers ." One of the great advantages of this model is the possibility of performing intravenous treatments on an outpatient basis, without the need for hospitalization. If the patient presents with fluid retention or worsening symptoms, they can receive treatment on the same day and return home . “ If treated early, hospitalization is not necessary ,” reinforces Pedro Morais Sarmento. Everything happens in conjunction with the Cardiology Service and other services. Blood tests, electrocardiograms, echocardiograms, and referrals to arrhythmology or interventional cardiology are performed immediately. “ Heart failure is the end of a long journey,” explains Pedro Morais Sarmento. “ Heart attack, hypertension, diabetes, arrhythmias – everything can lead to this point .” Personalized follow-up The approach is always personalized. There are sessions dedicated to medication adjustment, sessions for urgent treatment, and scheduled sessions, such as intravenous correction of iron deficiencies. A patient may stay for only three hours or spend the entire day in treatment, depending on the severity of the situation. The experience of the first private unit of this kind in Portugal The Heart Failure Day Hospital at Hospital da Luz Lisboa was the first private unit of its kind in Portugal. Coordinated by cardiologist Cândida Fonseca, this service has its own physical space and team, composed of cardiologists, internists, nurses, and nursing assistants, and provides specific and differentiated care to patients with heart failure. Most of the patients we follow here are over 65 years old, many nearing 80, with multiple associated illnesses . But there are also young patients, some in their 30s or 40s , who arrive after a viral infection, early heart attack, or arrhythmia. "When we see a young patient recover and return to normal life, it's extremely rewarding," says Cândida Fonseca. The patients' feedback is marked by tranquility . Knowing that there is an accessible team that responds quickly and closely monitors them makes all the difference. The same is true for colleagues who refer patients to us. “ The Day Hospital is just one piece of the heart failure clinic, but perhaps the most important,” concludes Pedro Morais Sarmento. “It allows intervention at the right time, prevents complications and, above all, improves the lives of patients.” The numbers are impressive: It is estimated that 16% of the Portuguses population over 50 years of age has heart failure, a percentage that increases significantly with age. And more than 90% don't know they have the disease. Recognizing the symptoms - fatigue, shortness of breath, difficulty sleeping lying down - is essential, but the diagnosis is only confirmed with tests that prove cardiac dysfunction.
