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Official websites use. Share sensitive information only on official, secure websites. Heart failure HF represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics HFCs and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6 min walking test. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. Heart failure HF has an immense socioeconomic impact, and its management still needs a lot of attention. This was echoed by an The aim of this paper is to provide the Egyptian cardiology community with a detailed review on HFCs and propose a model to be incorporated in the Egyptian cardiac healthcare system. A panel comprising 10 reputable experts in cardiology with clinical experience in the public and private healthcare sectors in Egypt ranging from 20 to 30 years met on 13 January to discuss the current status of HF management in Egypt. A literature search was conducted in Medline via PubMed database to identify articles discussing the infrastructure of HFCs and how they are incorporated within healthcare systems, and the experts selected articles that best suited the objective of the project. The retrieved articles were discussed along with the professional opinions and experiences of the panel. Based on this discussion, the panel proposed preliminary model of a HF programme in Egypt based on the essential unit of a HFC. Current published literature describes various models of HFCs that were proven to be of considerable benefit to HF patients and healthcare systems. We propose that the clinic model is defined through the following aspects:. Proposed infrastructure of the essential HF clinic and other components of a comprehensive HF programme model. HF patients can be enrolled to the clinic primarily through referral from primary care physicians, internists, endocrinologists, nephrologists, general cardiologists, inpatient hospitals, or emergency care units. Summary of guidelines' recommendations on the role of multidisciplinary teamin the management of HF. The national institute for health and care excellence states that the core HF MDT should comprise a lead physician usually a consultant cardiologist who is responsible for clinical diagnosis and a specialist HF nurse. Other suggested members include pharmacists, physiotherapists, psychologists, occupational therapists, palliative care specialists, and administrators. MDT members should be accessible to the patient during both routine and emergency care. We defined a specialized HF nurse as a graduate of a faculty of nursing with a specialized advanced training in the assessment, diagnosis, and management of HF. Specialized HS nurses should work closely with cardiologists, and their main job is to assess the Kansas City Cardiomyopathy Questionnaire score, conduct the 6 min walking test 6MWT , measure the patient's weight, pulse, and blood pressure, assess the doses of diuretics, and uptitrate or downtitrate them accordingly. They are also the main personnel involved in monitoring patients through home visits. This role comes in consistence with that framed by Savarese et al. Although pivotal integrants to the HF MDT, specialized HF nurses as per the mentioned definition are rare in the Egyptian healthcare system; hence, more dedicated efforts should be done in effectively training nurses. We suggest conducting special training programmes such as continuous medical education; some of which should be dedicated to rehabilitation programmes, titration of drugs, and managing side effects. These could be done in collaboration with the healthcare regulatory authorities in Egypt. Many studies report the beneficiary outcomes of including a dietician in the HF MDT; decreased rates of readmission and complications and more optimized care were observed. The false and outdated belief that HF patients should avoid exercise in general calls for the integration of physical therapy into the HF disease management programme implemented in the HFC. Depression is markedly prevalent in HF patients. Hence, HFCs should have close contact with said specialists. The integration of electronic medical records EMRs in healthcare programmes aims primarily at increasing the accuracy and efficiency of documentation, resulting in improving patient care and enhancing other operational aspects including cost reductions and more accurate billing and charging systems. The main structural points that should be included in the EMR are basic medical information, demographic data, medical history, and visits' record outpatient, inpatient, and other special visits. Each visit record should specify clinical data, laboratory investigations, drug therapy, inpatient interventions, medical instructions or prescriptions including medications, referrals, or further laboratory investigations required, and next appointment date and time. The enrollment of a HF patient to the clinic starts by confirming HF diagnosis or assessing an already confirmed diagnosis. Patient history including familial history, exercise tolerance, current and past disorders, and drugs or any toxic agents' intake should be obtained from the patient, their family, and caregivers. Physical examination of the lungs, abdomen, and heart should be done, and blood pressure and jugular venous pressure should be measured. Accordingly, it is mandatory for a HFC to be able to conduct these tests or provide means of conducting them to patients. Main HF investigations include. This continuous monitoring of electrocardiography can be used for establishing reasons for any deterioration or improvement and providing diagnostic and prognostic assessments accordingly. It is recommended to be performed in all patients clinically suspected to have cardiac impairment and should be repeated upon deterioration of the patient's clinical status. Natriuretic peptides immunoassays are necessary initial diagnostic tests in all patients with suspected HF. These include chest radiography to identify the presence of pulmonary causes and blood tests like serum troponin, renal function profile, thyroid function profile, liver function tests, lipid profile, glycated haemoglobin, complete blood picture, serum electrolytes, urinalysis and peak flow or spirometry. HFCs' disease management protocols should include standardized patient assessments and evaluations upon admission and on regular basis. These should include. This is a subjective I—IV class assessment that has been used for nearly a century to describe functional capacity of HF patients. This is a simple objective functional assessment that requires no special equipment and can be performed in clinics' corridors, provided they are flat and at least 30 m long. The presence of a drug therapy evaluation process in the clinic is essential. They also do not routinely follow treatment plans and have a hard time judging their signs and symptoms. The main goal of the first clinic visit is to confirm diagnosis, either through following diagnostic guidelines 19 or through assessing and confirming a previously proposed diagnosis by reviewing documents and imaging and by conducting any furtherly required investigations. In all cases, medication therapy should be thoroughly evaluated, and appropriate GDMT should be delivered. However, the second visit is usually recommended to be 7—10 days after the initial visit, and then the duration between visits can be increased to reach 6 months in medically stable patients. We propose that a stable patient's second visit takes place 1 month after the first visit, the third visit 2 months after the second visit, and the fourth visit 3 months after the third visit. In total, the number of regular visits for a stable HF patient should be between 4 and 5 per year. We believe that a total of eight to nine visits per year is optimal for fragile patients. If the patient suffers from acute decompensation, then an echo should also be done in subsequent visits until the decompensation is resolved. In Egypt, telemonitoring was evaluated in cardiac care and showed favourable results 66 ; however, medical personnel may face difficulty in assessing symptoms virtually. Additionally, many elderly patients may lack the technology literacy needed to communicate through virtual visits. Home visits constitute another important means of care delivery. With the general lack of coordination in patient care, HF patients may find it difficult to access HFCs. Thus, more rural regions may have more limited access to clinics compared with other regions. This calls for the incorporation of telemonitoring and virtual and home visits as discussed earlier. Moreover, the lack of a national definition and certification programmes for HF consultants and HF nurses in the country complicate the staffing process for HFCs. Our proposed model of HF clinics and programme in Egypt could be integrated in the healthcare system of the country with the collaborative efforts of the Egyptian Society of Cardiology, the Egyptian Minsitry of Health and Population, and HF patient societies and associations. The HF management system in Egypt needs further adjustments to meet patients' needs, limit HF prevalence, and lessen the burden on patients, physicians, caregivers, and the Egyptian healthcare system. In this paper, we propose an infrastructural model for a HF programme model based on the essential cornerstone of the HFC. Establishing new HFCs across the country may be the solution to the growing gap between the needs and the provided care. Further research directed at optimization and development of this model is recommended. Hassanein, M. ESC Heart Failure, — As a library, NLM provides access to scientific literature. ESC Heart Fail. Current status of outpatient heart failure management in Egypt and recommendations for the future Mahmoud Hassanein Mahmoud Hassanein 1 Alexandria University, Alexandria, Egypt. Find articles by Mahmoud Hassanein. Find articles by Ahmed Tageldien. Find articles by Haitham Badran. Find articles by Hany Samir. Find articles by Wassam Eldin Elshafey. Find articles by Mohamed Hassan. Find articles by Moheb Magdy. Find articles by Osama Louis. Find articles by Magdy Abdelhamid. Open in a new tab. KCCQ Not necessarily 6. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Multidisciplinary clinic including internist, nephrologist, diabetologist … Therapeutic nutrition clinic led by dietitian Clinical pharmacist support programme Mental rehabilitation clinic led by psychologist Physical rehabilitation clinic led by physiotherapists Exercise stress test ECG exam Holter ECG service Cardiac implantable electronic devices programming lab Advanced echocardiography lab Dedicated laboratory service. Inpatient ward service. Intensive care unit. Dedicated laboratory service. Advanced radiology service, including computed tomography … Inpatient physical rehabilitation programme led by physiotherapists Call centre for access facilitation. Electronic medical record system Inpatients' group support programme. Intervention service Joint or integrated services. Cardiac catheterization lab Cardiac implantable electronic devices implantation capabilities. It is recommended that HF patients are enrolled in a multidisciplinary HF management programme to reduce the risk of HF hospitalization and mortality. Physical examination including weight measurement. Electrolytes including sodium and potassium. Complete blood count. NYHA functional class.

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