Impact of a Specialized Heart Failure Unit on Patients Hospitalized for Acute Heart Failure: A 10-Year Experience

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Abstract

Background: Acute heart failure (HF) remains one of the leading causes of hospitalization, morbidity, and mortality worldwide. The implementation of specialized HF units has been shown to improve the quality of care and clinical outcomes; however, there is limited evidence about their sustained impact in Latin America.

Objective: The aim of this study is to evaluate the impact of a specialized HF unit on quality-of-care measures in patients hospitalized for acute heart failure.

Methods: We conducted a retrospective cohort study that included consecutive patients admitted with a primary diagnosis of acute HF between January 2014 and December 2024. The HF program included a critical path method, structured discharge checklist, full-time physicians, specialized nurses, dedicated administrative staff, discharge education with written instructions, structured post-discharge follow-up, priority consultations, periodic presentation of indicators, grand rounds for advanced management decisions, lung ultrasound-guided decongestion, telemonitoring, and a day hospital. Over the last two years, patients selected as low-risk and treated exclusively in the day hospital were excluded. The endpoints analyzed included annual in-hospital mortality, 30-day hospital readmission, and length of hospital stay. Two periods were analyzed: the initial phase (2014–2019) and the consolidation phase (2020–2024). 

Results: A total of 3368 hospitalizations for acute HF were analyzed. The annual volume of hospitalizations increased from 260 in 2014 to 463 in 2024 (p = 0.002). In-hospital mortality exhibited a slight, non-significant falling trend (from 5.0% to 3.9%). The 30-day hospital readmission rate remained stable, with less variability in the most recent years. Mean length of hospital stay decreased significantly from 9.3 days to 2.8 days (p < 0.001) and was significantly shorter during the consolidation phase (median 3.6 vs. 6.8 days; p = 0.004).
Conclusion: The implementation and consolidation of a specialized HF unit was associated with an increase in patient volume and sustained improvements in hospital efficiency, reflected in a significant reduction in length of hospital stay. The greater stability in mortality and hospital readmission rates during the consolidation phase suggests a sustained improvement in the quality of care, supporting the development of structured care models in Latin American health systems.