Institutionalized-Care Recommendations for Older Patients with Heart Failure

Abstract

Background: Heart failure (HF) is a leading cause of hospitalization in older adults, and patients discharged to nursing homes and sociosanitary centers represent a growing and often overlooked population. The self-care recommendations of the European guidelines on HF were designed for ambulatory patients and are frequently difficult to apply to institutionalized patients, in whom these actions are largely delivered by professional caregivers rather than by the patient. The objective of this work was to adapt the self-care recommendations of the European guidelines on HF to the institutional setting and to frame them as supported, caregiver-delivered self-care. Methods: A multidisciplinary panel of 13 members (nurses and physicians from Cardiology, Geriatrics and Internal Medicine) reviewed the self-care recommendations of the 2021 ESC Guidelines on acute and chronic heart failure and their 2023 focused update, the evidence on self-management interventions, and the recent scientific statement of the Heart Failure Association of the ESC on therapeutic inertia and adherence. Each recommendation was assessed for applicability to patients living permanently in residential centers, considering patient-dependent and center-dependent barriers, and was adapted and simplified accordingly. A final decalogue of ten recommendations and a simplified care algorithm were agreed by consensus. This was an expert adaptation based on a narrative, non-systematic selection of the cited sources; no formal Delphi technique, nominal-group method, or predefined consensus threshold was used, and the results should therefore be interpreted as expert consensus rather than as a formally structured consensus process. Results: Ten recommendations grouped into six domains were defined: supervised pharmacological treatment; adaptation of nutrition and hydration; monitoring of weight and diuresis; prevention through vaccination and adapted physical activity; daily surveillance for early detection of decompensation; and a stepwise protocol for the management of decompensation and escalation to the reference HF unit. The care algorithm integrates these recommendations into a practical flow suitable for the resources of a sociosanitary center, limiting transfer to the emergency department to patients with signs of severity. For transparency, each recommendation is accompanied by its supporting sources and by an indication of whether it represents direct guideline guidance or an expert adaptation. Conclusions: The proposed recommendations provide an adapted, practical framework intended to improve supported self-care in institutionalized patients with HF and to facilitate earlier detection of decompensation, with the potential to reduce avoidable hospital utilization and improve quality of life. The establishment of specific circuits between HF units and sociosanitary centers is required for their effective implementation. Prospective evaluation is needed to establish their effects on clinical outcomes and quality of life.