RESUMEN
The care of patients presenting to hospitals with acute decompensated heart failure remains a challenging and multifaceted dilemma across the continuum of care. The combination of improved survival rates for and rising incidence of heart failure has created both a clinical and economic burden for hospitals of epidemic proportion. With limited clinical resources, hospitals are expected to provide efficient, comprehensive, and quality care to a population laden with multiple comorbidities and social constraints. Further, this care must be provided in the setting of a volatile economic climate heavily affected by prolonged length of stays, high readmission rates, and changing healthcare policy. Although problems continue to mount, solutions remain scarce. In an effort to help hospitals identify gaps in care, control costs, streamline processes, and ultimately improve outcomes for these patients, the Society of Chest Pain Centers launched Heart Failure Accreditation in July 2009. Rooted in process improvement science, the Society's approach includes utilization of a tiered Accreditation tool to identify best practices, facilitate an internal gap analysis, and generate opportunities for improvement. In contrast to other organizations that require compliance with predetermined specifications, the Society's Heart Failure Accreditation focuses on the overall process including the continuum of care from emergency medical services, emergency department care, inpatient management, transition from hospital to home, and community outreach. As partners in the process, the Society strives to build relationships with facilities and share best practices with the ultimate goal to improve outcomes for heart failure patients.
Asunto(s)
Continuidad de la Atención al Paciente , Vías Clínicas/normas , Servicio de Urgencia en Hospital , Insuficiencia Cardíaca , Hospitalización , Sociedades Médicas/organización & administración , Enfermedad Aguda , Continuidad de la Atención al Paciente/economía , Continuidad de la Atención al Paciente/normas , Continuidad de la Atención al Paciente/tendencias , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/tendencias , Costos de la Atención en Salud , Recursos en Salud/estadística & datos numéricos , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Hospitalización/economía , Hospitalización/tendencias , Humanos , Incidencia , Evaluación de Procesos y Resultados en Atención de Salud , Indicadores de Calidad de la Atención de Salud , Tasa de SupervivenciaRESUMEN
Left ventricular dysfunction and renal dysfunction are common chronic conditions that frequently coexist in the same individual, and both are associated with significant morbidity and mortality. Disorders in 1 organ generally lead to dysfunction in the other, and this bidirectional interaction serves as the pathophysiological basis for cardiorenal syndrome (CRS). Until recently, CRS has been neither well defined nor well understood, making its diagnosis and treatment challenging for clinicians. This article presents the pathophysiology of CRS and the new classification for types of CRS, therapeutic interventions targeting CRS, and novel therapies on the basis of the 2010 Acute Dialysis Quality Initiative consensus conference recommendations.