Patients with chronic illness benefit from care with less travel-associated pain as well as those bedside technological improvements which facilitate the management of their disease [1]. Heart failure (HF) and chronic heart failure (CHF) are becoming a real social emergency both in Western and developing countries [2]. In fact, with the growth in population aging, the prevalence of HF/CHF in aged patients is greater than 10%. Although enormous treatment advances and despite optical medication therapies or use of the most up-to-date implantable devices, decompensated CHF is a critical health issue with 4% of inhospital mortality and, after discharge, mortality tends to worsen with rates of 10%, 22%, and 42% at 30 days, 1 year, and 5 years. Furthermore, although repeat hospitalizations are the consequence of complicated and multifactorial situations, some events could be prevented by patient care [3].
Several studies and clinical trials have focused on the transitional care from hospital to home. Particular emphasis was shed on early outpatient follow-up, home visits, structured phone support, telemedicine, access to HF specialists, collaborative care and the use of point-of-care (PoC) devices for immediate diagnosis [4]. Within this landscape, nurses’ activities and coordination are of paramount importance. Anecdotal reports pinpoint the beneficial effects of nurses’ interventions on HF/CHF patients’ long-term outcomes. In order to clear this elusive picture, Zhang et al. [5] in the paper entitled “Influence of Comprehensive Nursing Care on Heart Failure Patient Management: A Systematic Review and Meta-Analysis” impressively reviewed and analyzed 693 studies (included clinical trials and observational studies) on comprehensive nursing care treatments for HF patients. Results showed an impressive success for the patients’ survival outcomes. In depth: “the comprehensive nursing care reduced HF-related readmissions considerably when compared to conventional therapy (odds ratio [OR] 0.77 [95% CI 0.66–0.88], p = 0.0002). Additionally, there was a significant difference in all-cause mortality (OR 0.76 [95% CI: 0.60–0.97], p = 0.03), but comprehensive treatment enhanced quality of life and functional status (standardized mean difference −0.05, 95% CI: –0.21 to 0.10, p = 0.49).” Of note, among the nurses-led activities that significantly impacted HF-related readmission rates, all-cause readmission, and mortality rates in patients with HF, authors mentioned (a) telemedicine and (b) PoC devices.
Telemedicine consultations and, more in general, remote monitoring of patients with chronic illness witnessed a surge in adoption following the COVID-19 pandemic [6]. Despite issues regarding privacy, reliability, safety and accessibility when using remote consultation means, the continuous interest from investors, researchers, and stakeholders indicates that such modalities are being actively considered as valid options within the national health care systems beyond the pandemic phase. Besides the cardiologist consultations and the nurse educational programs, remote monitoring includes (a) the possibility of intercepting failures in the end-diastolic or filling pressures leading to decompensation/rehospitalization and (b) monitoring electrical abnormalities by means of implantable devices [1].
Additionally, in order to intercept disease exacerbation, blood/saliva biomarkers are also meaningful [7]. Essential features of biomarkers are easy accessibility, highest levels of both specificity and sensitivity, and, last but not least, predictive values. Under this light, NT-proBNP and troponins are widely used. Both biomarkers can be conveniently tested at the patients’ bedside, during the cardiologist’ visits, at home or even at the pharmacies as it happens in most European countries by means of PoC devices [8]. Those portable instrumentations, by exploiting the advancements in the area of microfluidics and nanotechnology, deliver results that can immediately incorporate into the clinical workflow thus allowing precise, fast, and tailored patients’ management [9]. Furthermore, the COVID-19 pandemic prompted the nurses to make an increased familiarity with classical laboratory instrumentation, thus lowering cultural barriers when adopting these diagnostic tools.
Although the meta-analysis by Dr. Zhang et al. [5] at first glance could reveal that “the emperor is naked,” in reality, they proved scientifically that by coupling the present state-of-the art devices (either cardiological or laboratory-based) with educational programs led by nurses, on the one hand, HF/CHF patients are more effectively autonomous and on the other hand, the disease exacerbation leading to rehospitalization events is extremely reduced.
Additionally, telemedicine too contributed to better HF/CHF patients’ outcomes. This consulting modality emerged to be highly appreciated by patients with noncommunicable chronic conditions and their health care professionals and, as such, can be considered as a viable option for follow-up visits after hospital discharge.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
The authors have not received any financial support.
Author Contributions
N.M. and G.G. conceived and wrote the manuscript.
