Background: Chronic diseases represent a major clinical and social problem. Both institutions and professionals are called upon to provide accurate and efficient care at all stages in the clinical pathway. Heart failure (HF) is one of the most chronic diseases with the highest impact on survival, quality of life, and overall costs and assistance. However, healthcare support is often fragmented and with little attention to coordination through the different stages of the clinical pathway.
Methods: On the basis of the synergistic approach for implementation of clinical pathways between the Regional Healthcare Agency of the Marche Region and the consensus document of the Italian Federation of Cardiology, we decided to conduct a survey on assistance programs to patients with HF in the Marche Region. The questionnaire was modeled on one developed by the Italian Association of Hospital Cardiologists (ANMCO) during the years 2004-2005, and was sent to all facilities participating in the Cardiology Network of the Marche Region; all the 15 facilities surveyed answered correctly.
Results: An outpatient HF clinic is available only in 5 of the 15 facilities surveyed. Five facilities have dedicated medical staff, whereas only 3 facilities have nursing staff. A clinical pathway is planned with general practitioners only in 2. The discharge letter is well structured and also provides a direct management of follow-up controls. None of the facilities offer medical or nursing staff to support patients at home.
Conclusions: In the Marche Region, although few in number, outpatient HF clinics provide good-quality care. Clinical pathways are currently implemented in 2 facilities. Another clinical pathway, however, is going to be developed including all hospital facilities (Cardiology, Internal Medicine, Geriatrics) and out-of-hospital healthcare providers (local care planning, general practitioners, outpatient specialists) with the active participation of all professionals involved in the clinical pathways of HF patients.