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and the role of comorbidities&#44; particularly in the elderly&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#8211;4</span></a> In Portugal&#44; the estimated prevalence of HF is 4&#46;4&#37;&#44; reaching 8&#37; in the seventh decade of life&#44; a higher prevalence than the European average&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the therapeutic advances achieved in recent decades&#44; especially with respect to reductions in sudden cardiac death&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a> the mortality attributed to HF remains high&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">8&#44;9</span></a> This is especially true following hospitalization due to decompensated HF&#44; when reported mortality is 17-24&#37; during the year after discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The importance of hospitalization for HF is due not only to the associated mortality&#44; but also to the high readmission rate&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> which imposes a significant economic burden on the health system &#8211; 80&#37; of the costs related to the syndrome<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a> &#8211; and poor quality of life for patients with HF&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The readmission rate is particularly high in the vulnerable phase &#40;the first months after discharge&#41;&#44; with one-fourth of patients being readmitted in the first month after discharge and two-thirds in the following year&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;13</span></a> The transition phase &#40;pre- and post-discharge&#41; is therefore of particular importance in terms of care&#44; planning and follow-up&#44; since one of the main factors responsible for early readmission is lack of coordination of care after hospital discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#44;14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Several post-discharge follow-up strategies have been proposed&#44; although not all have shown a significant impact on outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#8211;17</span></a> Structured follow-up programs based on hospital consultations are often associated with a reduction in readmissions during the first year &#40;relative risk reduction &#91;RRR&#93; of 19-30&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#44;16&#44;18</span></a> and also in the risk of death&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#8211;17</span></a> The inclusion of patients with HF in such programs is therefore recommended by the European Society of Cardiology &#40;ESC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a> However&#44; much of the evidence on which this recommendation is based derives from a time when some contemporary therapies&#44; particularly cardiac resynchronization therapy &#40;CRT&#41; and implantable cardioverter defibrillators &#40;ICD&#41;&#44; were not widely available&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#8211;17</span></a> There is also no evidence on the impact of the implementation of such programs in Portugal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of this single-center study was to assess the results of implementing a structured follow-up program for HF patients on readmission and mortality rates and on quality of life&#44; after an episode of hospitalization due to the syndrome&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design and population</span><p id="par0040" class="elsevierStylePara elsevierViewall">This was a quasi-experimental design study carried out in a single center &#40;the cardiology department of Santa Maria University Hospital&#44; Lisbon&#44; Portugal&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study population consisted of 50 consecutive patients admitted for acute heart failure &#40;AHF&#41;&#44; defined as new-onset AHF or decompensated chronic heart failure&#44; to the general cardiology ward &#40;index hospitalization&#41;&#44; who were discharged after the implementation of a protocol-based follow-up program &#40;beginning in April 2016&#41;&#46; The diagnosis of HF was established according to the ESC guidelines&#44; through the identification of symptoms and&#47;or signs of HF caused by a structural and&#47;or functional cardiac abnormality&#44; resulting in reduced cardiac output and&#47;or elevated intracardiac pressures&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The control group consisted of patients selected from a cohort hospitalized for AHF in the same cardiology ward immediately before the beginning of the program &#40;from October 2014 to April 2016&#41;&#46; Patients from both cohorts &#40;study group and control group&#41; were classified according to New York Heart Association functional class &#40;NYHA&#41; at discharge &#40;NYHA I vs&#46; NYHA II vs&#46; NYHA III or IV&#41;&#44; left ventricular ejection fraction &#40;LVEF&#41; &#40;tertiles&#41;&#44; and age &#40;tertiles&#41;&#46; For each of the patients in the study group a patient from the control cohort with similar scores in each of the three variables was randomly selected&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Demographic&#44; clinical&#44; laboratory&#44; echocardiographic&#44; electrocardiographic and therapeutic data regarding the index hospitalization and the follow-up period after discharge were collected for the study group and for all patients who constituted the control cohort&#46; Quality of life was assessed at discharge and at six-month follow-up using the validated Portuguese version of the Kansas City Cardiomyopathy Questionnaire &#40;KCCQ&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Interventions differentiating the study group</span><p id="par0060" class="elsevierStylePara elsevierViewall">The main differentiating intervention in the protocol-based follow-up program was consultations by a cardiologist at days 7-10 and the first&#44; third&#44; sixth and 12th month after discharge &#40;and additionally&#44; whenever considered necessary&#41; with pre-specified procedures&#46; These included&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical assessment aimed at identifying signs or symptoms of HF decompensation&#44; residual congestion or low cardiac output&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Laboratory assessment&#44; including monitoring of plasma N-terminal pro-brain natriuretic peptide &#40;NT-proBNP&#41; level&#44; end-organ dysfunction&#44; and development of common comorbidities in HF patients &#40;diabetes&#44; chronic pulmonary disease&#44; dyslipidemia&#44; thyroid dysfunction&#44; anemia&#44; iron deficiency&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Electrocardiogram at every visit&#44; and transthoracic echocardiogram between the third and sixth months and every 12 months of follow-up&#59; when considered necessary&#44; cardiac magnetic resonance imaging study was requested&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Assessment of adherence and tolerance to therapy&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Individualized titration of therapy in accordance with the ESC guidelines<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Patient education regarding self-care&#44; lifestyle modifications&#44; and management of HF decompensation&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study outcomes</span><p id="par0095" class="elsevierStylePara elsevierViewall">The primary outcome was all-cause readmission&#46; HF readmission&#44; death and the composite endpoint of all-cause readmission or death were secondary outcomes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the structured follow-up program group&#44; changes in quality of life parameters was also considered a secondary outcome&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Also&#44; in the study group&#44; LVEF change was assessed in the subgroup of patients with LVEF &#60;50&#37;&#44; and the prescription rate of neurohormonal antagonists and changes in their respective doses during follow-up was assessed in the subgroup of patients with HF with reduced LVEF &#40;HFrEF&#41; &#40;LVEF &#60;40&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Assuming that the estimated annual rate of all-cause readmission would be 65&#37; in the control group and 35&#37; in the study group &#40;based on HF populational studies<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;13</span></a> and HF post-discharge programs studies&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a> respectively&#41;&#44; it was estimated that 42 patients would need to be followed in each group for 12 months to provide the study with a power of 80&#37; to detect a significant relative reduction in the risk of all-cause readmission in the follow-up program group&#44; at an overall two-sided alpha level of 0&#46;05&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using IBM SPSS&#174; Statistics version 20 &#40;Chicago&#44; IL&#44; USA&#41;&#46; Categorical variables are reported as absolute number and percentage and continuous variables are reported as mean and standard deviation or median and interquartile range&#46; The impact of inclusion in the structured follow-up program on readmission and mortality rates was assessed using Cox regression and Kaplan-Meier survival analysis&#46; Wilcoxon&#39;s test was used to assess the impact of the follow-up program on quality of life&#44; doses of neurohormonal antagonists and LVEF&#46; Differences between the groups regarding demographic&#44; clinical and therapeutic data were established using the Mann-Whitney&#44; Student&#39;s t&#44; chi-square&#44; one-way ANOVA and Fisher&#39;s exact tests&#46; p values of &#60;0&#46;05 were considered to indicate statistical significance&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical considerations</span><p id="par0120" class="elsevierStylePara elsevierViewall">The study was approved by the local ethics committee and by the national Data Protection Authority&#46; Patient confidentiality was ensured through anonymization of the collected data&#46; All study procedures were carried out in accordance with the ethical principles expressed in the 2013 revision of the Declaration of Helsinki&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Population characteristics</span><p id="par0125" class="elsevierStylePara elsevierViewall">The first patient was enrolled in the protocol-based follow-up program in April 2016 and the 50th patient in November 2017&#46; The mean follow-up was 11&#177;5&#46;3 months in the study group and 10&#46;9&#177;5&#46;5 months in the control group &#40;p&#61;0&#46;81&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Patients&#8217; demographic and clinical characteristics at discharge are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The mean age of the follow-up program group was 67&#46;1&#177;11&#46;2 years and 38 patients &#40;76&#37;&#41; were male&#46; Most patients were in NYHA I &#40;30&#37;&#41; or II &#40;64&#37;&#41; at discharge&#59; all patients were in NYHA III &#40;52&#37;&#41; or IV &#40;48&#37;&#41; on admission &#40;index hospitalization&#41;&#46; The median LVEF documented at discharge was 27&#37; &#40;19&#46;8-35&#46;3&#41;&#44; and 43 &#40;86&#37;&#41; patients had HFrEF&#46; There were no significant differences between the two groups regarding age&#44; NYHA or LVEF&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The most frequent HF etiology in both groups was idiopathic dilated cardiomyopathy &#40;56&#37; vs&#46; 40&#37;&#41;&#44; followed by ischemic heart disease &#40;28&#37; vs&#46; 28&#37;&#41;&#46; Overall&#44; 70&#37; of the patients had a history of hypertension&#44; making it the most common comorbidity in both groups&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Median length of stay and median plasma NT-proBNP at discharge did not differ significantly between groups&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Mortality and readmission rates</span><p id="par0150" class="elsevierStylePara elsevierViewall">Compared to patients in the control group&#44; those included in the structured follow-up program showed a significant reduction in all-cause readmissions &#40;26&#37; vs&#46; 60&#37;&#59; hazard ratio &#91;HR&#93; 0&#46;38 &#91;0&#46;2-0&#46;73&#93;&#59; p&#61;0&#46;003&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; The RRR was 56&#46;7&#37; and the number needed to treat &#40;NNT&#41; was 2&#46;91&#46; A similar benefit was achieved in HF readmission &#40;RRR&#58; 64&#46;4&#37;&#59; NNT&#58; 3&#46;45&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Eighteen &#40;36&#37;&#41; patients in the control group were hospitalized due to AHF&#46; Implementation of the protocol-based follow-up program led to an HF readmission rate of 16&#37; &#40;eight patients&#41; &#40;HR 0&#46;4 &#91;0&#46;17-0&#46;92&#93;&#59; p&#61;0&#46;032&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Mortality was significantly lower in patients enrolled in the follow-up program &#40;4&#37; vs&#46; 20&#37;&#59; HR 0&#46;21 &#91;0&#46;05-0&#46;96&#93;&#59; p&#61;0&#46;044&#41;&#46; The RRR was 80&#37; and the NNT was 6&#46;25 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">During follow-up two &#40;4&#37;&#41; patients in the study group died&#44; one due to right ventricular failure in the immediate postoperative period following cardiac surgery&#44; and the other due to sudden death&#46; The latter patient underwent ICD implantation during the index hospitalization and sudden death occurred in the first week after hospital discharge&#44; before the first protocol-based follow-up visit&#46; Autopsy was not performed and interrogation of the ICD showed no dysrhythmia or evidence of device dysfunction&#46; In the control group&#44; two &#40;4&#37;&#41; patients died during HF hospitalization&#44; and four &#40;8&#37;&#41; during hospitalization due to other causes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The secondary outcome of death or all-cause hospitalization was significantly less frequent in the follow-up program group &#40;28&#37; vs&#46; 68&#37;&#59; HR 0&#46;36 &#91;0&#46;19-0&#46;67&#93;&#59; p&#61;0&#46;001&#41;&#44; with an NNT of only 2&#46;5 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Quality of life and functional class</span><p id="par0170" class="elsevierStylePara elsevierViewall">In the study group&#44; a significant improvement was observed in all KCCQ domains&#44; especially in the overall summary scores for symptoms &#40;67&#37; vs&#46; 89&#37;&#44; p&#60;0&#46;001&#41; and quality of life &#40;66&#37; vs&#46; 80&#37;&#44; p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Parallel to the improvement in the KCCQ symptoms domain reported by the patients&#44; there was a significant improvement in NYHA class documented by the cardiologist in the last follow-up visit compared to NYHA class at discharge&#46; In the last clinical assessment performed most patients were in NYHA I &#40;64&#37; vs&#46; 30&#37;&#44; p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Therapy with neurohormonal antagonists</span><p id="par0180" class="elsevierStylePara elsevierViewall">As stated above&#44; the majority of patients in both groups presented HFrEF&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> describes ongoing therapy &#40;neurohormonal antagonists and cardiac devices&#41; at the time of the last clinical assessment&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">The rate of prescription of beta-blockers&#44; mineralocorticoid receptor antagonists &#40;MRAs&#41; and ivabradine did not differ between the two groups&#46; However&#44; a significantly higher rate of prescription of angiotensin-converting enzyme inhibitors &#40;ACEIs&#41;&#47;angiotensin receptor blockers &#40;ARBs&#41; was observed in patients included in the follow-up program group compared to controls &#40;100&#37; vs&#46; 85&#37;&#44; p&#61;0&#46;01&#41;&#46; There were no significant differences regarding CRT or ICD implantation rates &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Considering the whole population&#44; there were no significant differences in diuretic therapy prescription between groups &#40;44 vs&#46; 47 patients&#44; p&#61;NS&#41;&#46; All these patients were medicated with loop diuretics&#59; four patients in the follow-up program group and six patients in the control group were under an association of a loop plus a thiazide diuretic &#40;p&#61;NS&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">There were no differences in myocardial revascularization procedures&#44; either percutaneous angioplasty &#40;6&#37; vs&#46; 8&#37;&#44; p&#61;NS&#41;&#44; or coronary artery bypass graft surgery &#40;2&#37; in both groups&#44; p&#61;NS&#41;&#46; Rates of aortic &#40;6&#37; vs&#46; 8&#37;&#44; p&#61;NS&#41; and mitral &#40;6&#37; vs&#46; 4&#37;&#44; p&#61;NS&#41; valve interventions &#40;percutaneous or surgical&#41; were also similar in both groups&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In the study group there was an effective optimization of treatment during follow-up&#44; including up-titration of recommended drugs&#46; Significant increases in the doses of ACEIs&#47;ARBs &#40;p&#61;0&#46;001&#41;&#44; beta-blockers &#40;p&#60;0&#46;001&#41; and MRAs &#40;p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A-C&#44; respectively&#41; were observed between admission and the last follow-up visit&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">In the subgroup of patients with HFrEF or HF with mid-range ejection fraction enrolled in the protocol-based follow-up program &#40;n&#61;49&#41;&#44; there was a significant improvement in LVEF during follow-up &#40;27&#37; &#91;19&#46;8-35&#46;3&#93; vs&#46; 39&#46;5&#37; &#91;29&#46;5-50&#93;&#59; p&#60;0&#46;001&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0210" class="elsevierStylePara elsevierViewall">The impact of hospitalizations on the natural history of HF is illustrated by the frequently reported increase in mortality during the period that follows a hospital admission due to the syndrome&#46; In this period&#44; not only does the mortality risk increase&#44; but a vicious cycle leading to further hospitalizations is triggered&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;22</span></a> This is of major importance at a time when&#44; despite all the therapeutic advances&#44; HF readmission rates continue to increase&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">9&#44;23</span></a> In Portugal&#44; according to the latest published report of the National Program for Cerebro-Cardiovascular Diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> the number of hospital admissions due to HF episodes was 19 434 in 2015 &#40;2365 deaths&#41;&#44; an increase of 4000 episodes compared to 2011 &#40;15 583 hospitalizations&#44; 2046 deaths&#41;&#44; making it imperative to establish strategies that may lead to a reduction in the &#40;re&#41;hospitalization rate&#44; and consequently in mortality&#44; in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">6</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">In this study we present the characteristics and results of a protocol-based follow-up program conducted at the cardiology department of a European tertiary hospital&#46; Prior to the implementation of the program&#44; on the basis of the frequency of major events in the control group&#44; readmission &#40;60&#37;&#41; and mortality &#40;20&#37;&#41; after hospital discharge in patients admitted for an HF episode were similar to or even higher than those reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11&#44;13</span></a> The HF readmission rate in our control population was similar to that reported in published data on Portuguese cohorts &#40;36&#37; vs&#46; 30&#46;5&#37;&#41;&#44; although mortality was lower &#40;20&#37; vs&#46; 34&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> However&#44; implementation of the structured follow-up program led to a marked reduction in all-cause readmission &#40;absolute risk reduction of 40&#37;&#41;&#44; and also to a considerable though smaller reduction in readmissions due to decompensated HF &#40;absolute risk reduction of 20&#37;&#41;&#46; Concomitantly a significant reduction in mortality was obtained &#40;from 20&#37; to 4&#37;&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The benefit of including patients in the follow-up program is evident when the secondary endpoint &#40;death or readmission&#41; is analyzed&#44; as the reduction of major events resulted in an NNT of 2&#46;5&#44; which is&#44; interestingly&#44; a better result than that reported for conventional HF therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">25&#8211;32</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Unlike various other follow-up or monitoring strategies designed to reduce hospitalizations and mortality in the HF population&#44; such as telemonitoring or follow-up programs based on telephone contacts&#44;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;34</span></a> protocol-based follow-up programs have demonstrated consistent benefits&#46; These benefits do&#44; however&#44; not reach the magnitude reported in this study&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#8211;17</span></a> One possible reason for this difference may be that most of the beneficial evidence from these follow-up programs goes back to a time when some of the current HF treatment options were not yet available&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Additionally&#44; the magnitude of benefit achieved may be related to the intrinsic characteristics of our protocol-based follow-up program&#46; At first&#44; during hospitalization and in the pre-discharge period&#44; a careful management plan was set up according to the patients&#8217; characteristics and needs&#46; The follow-up program after discharge was based on face-to-face consultations and on predefined procedures &#40;see Methods&#41; with demonstrated benefits in event reduction&#44; favoring a holistic approach based on international guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">It is important to highlight the frequency of the consultations&#44; with particular emphasis on the visits at days 7-10 and at one month after discharge&#46; Early post-discharge visits have important benefits for reducing readmission and mortality&#44; not only during the first month after discharge&#44; but also thereafter&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">18&#44;22&#44;35</span></a> This is related to the importance of the hospital-home transition and to the problems that patients usually face&#44; including difficulties in managing medication&#44; unfamiliarity with the necessary changes in lifestyle&#44; lack of knowledge about their disease&#44; and management of worsening symptoms&#46; The role of the early post-discharge consultations focuses on helping with these problems and&#44; when necessary&#44; on therapeutic optimization&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">At each visit&#44; the presence of symptoms or signs indicative of decompensation was carefully assessed and appropriate therapeutic measures were taken&#46; This may have contributed decisively to the marked reduction in HF readmission&#46; However&#44; it should be noted that much of the benefit derived from this program was seen in the reduction in all-cause readmissions&#46; To accomplish this&#44; it was crucial to pay particular attention to the monitoring and management of comorbidities&#44; which have a significant impact on HF patients&#8217; prognosis&#44; as most hospitalizations in this population are for non-cardiac causes&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">It is also worth emphasizing the effect of the program on the up-titration of neurohormonal antagonist doses&#44; as the vast majority of patients with HFrEF were treated with beta-blockers &#40;95&#46;3&#37;&#41;&#44; ACEIs&#47;ARBs &#40;100&#37;&#41;&#44; and MRAs &#40;79&#46;1&#37;&#41;&#44; and in many patients target doses were achieved &#40;46&#46;5&#37;&#44; 47&#46;5&#37; and 60&#46;5&#37;&#44; respectively&#41;&#46; The frequency of hospital visits and assessment of therapeutic tolerance may have played a part in this achievement&#46; However&#44; although optimization of pharmacologic therapy may have had an important role in the observed marked reduction of events during follow-up&#44; it should also be noted that the number of patients treated with these drugs in the control group was also high&#44; even higher than previously reported in Portuguese HF cohorts&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> The rate of CRT and ICD implantation was similar between the two groups and similar to that reported in European cohorts&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> This finding supports the added benefit of this follow-up program with holistic interventions on top of the benefit associated with medical and device HF therapies&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The follow-up program was also associated with significant improvements in both NYHA functional class and quality of life and symptoms as assessed by the KCCQ&#46; The scores obtained in both domains at discharge were similar to those in the literature &#40;66&#37; and 67&#37; vs&#46; 56&#37; and 63&#37;&#44; respectively&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">36</span></a> whereas at the sixth month of follow-up the scores reported herein were significantly higher &#40;80&#37; and 89&#37;&#44; respectively&#41;&#46; Particular attention should be given to the &#8216;self-efficacy&#8217; sub-domain&#44; which assesses patients&#8217; perceived ability to manage their own symptoms&#46; The population included in the follow-up program had a relatively high self-efficacy score &#40;75&#37;&#41; at the time of discharge&#44; which may be due to the education on patient self-care provided during hospital stay&#46; Nevertheless&#44; a significant additional improvement &#40;90&#37;&#41; was observed during follow-up&#44; demonstrating the effectiveness of the HF self-care management and health-related education reinforcement carried out at each consultation&#46; This may also have accounted for the reduction in major adverse events&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">To our knowledge this is the first study reporting the efficacy of a protocol-based follow-up program in reducing readmission and mortality in a Portuguese population with HF&#44; filling an apparent evidence gap<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#44;37</span></a> and&#44; we hope&#44; perhaps helping to encourage the development of this type of program in other hospital centers&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Limitations</span><p id="par0260" class="elsevierStylePara elsevierViewall">The data reported should be interpreted in the light of certain limitations&#44; particularly the fact that this was not a randomized controlled study and that the sample size was small &#40;the first 50 patients enrolled and followed by protocol&#41;&#46; Besides&#44; only patients admitted to the cardiology department were included&#44; which naturally entails selection bias&#44; resulting in a population with a higher proportion of patients with HFrEF and younger than those reported in studies that included patients admitted to internal medicine departments&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> Additionally&#44; cost-effectiveness analysis was not performed&#44; so it is not possible to determine whether the reduction in events during the follow-up period was accompanied by a reduction in costs attributed to HF&#46; However&#44; as significant reductions in the admission rate were obtained&#44; this probably translated into reductions in costs related to the syndrome and to associated comorbidities&#46; Finally&#44; the study only included patients with a recent admission due to AHF&#44; so it is not possible to assess the impact of this follow-up program on stable patients with chronic HF but with no previous recent HF-related hospital admissions&#46; As reported&#44; most adverse events in HF patients occur in the first year after hospital discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11&#44;13</span></a> In fact&#44; despite the small number of patients who completed more than 12 months of follow-up in our population&#44; through the data obtained from the Kaplan-Meier survival curves &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A-D&#41;&#44; it may be assumed that the incidence of major adverse events during the second year of follow-up would have been low&#44; suggesting a reduced benefit of this type of program in stable patients&#44; as previously suggested&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">38&#44;39</span></a> However&#44; we consider that more evidence is needed in order to establish the ideal duration of this type of program&#44; according to patients&#8217; clinical profile and disease progression&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0265" class="elsevierStylePara elsevierViewall">Despite all the advances achieved in the treatment of patients with HF &#8211; including drugs designed to modify prognosis&#44; cardiac devices and management of comorbidities &#8211; morbidity and mortality attributed to the syndrome remain high&#46; Structured follow-up programs may have a key role in the management of these patients&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">This study reports the results of the implementation of such a program in the cardiology department of a tertiary hospital&#44; and is the first to document its benefits in a Portuguese population with HF&#46; The program was associated with marked reductions in HF readmission&#44; all-cause readmission and mortality&#44; and with significant improvements in functional class and in patients&#8217; self-reported quality of life&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">The results support the need for investment in this type of program as a means to improve the prognosis of patients with HF&#44; and consequently to reduce the burden attributed to the condition&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authors&#8217; contributions</span><p id="par0285" class="elsevierStylePara elsevierViewall">JRA and DB designed the protocol and wrote the manuscript&#46; JRA performed the statistical analysis&#46; All authors contributed similarly to data collection&#44; recording and interpretation&#44; reviewed the article and gave their final approval for the version to be published&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Sponsorship</span><p id="par0290" class="elsevierStylePara elsevierViewall">The study did not receive any sponsorship&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0295" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2018-06-22"
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          "palabras" => array:4 [
            0 => "Insufici&#234;ncia card&#237;aca"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Heart failure is associated with high rates of readmission and mortality&#44; and there is a need for measures to improve outcomes&#46; This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A quasi-experimental study was performed&#44; with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure&#46; The study group was followed by a cardiologist at days 7-10 and the first&#44; third&#44; sixth and 12th month after discharge&#44; with predefined procedures&#46; The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No significant differences were observed between the two groups regarding mean age &#40;67&#46;1&#177;11&#46;2 vs&#46; 65&#46;8&#177;13&#46;4 years&#44; p&#61;0&#46;5&#41;&#44; NYHA functional class &#40;p&#61;0&#46;37&#41;&#44; or median left ventricular ejection fraction &#40;27&#37; &#91;19&#46;8-35&#46;3&#93; vs&#46; 29&#37; &#91;23&#46;5-40&#93;&#59; p&#61;0&#46;23&#41; at discharge&#46; Mean follow-up after discharge was similar &#40;11&#177;5&#46;3 vs&#46; 10&#46;9&#177;5&#46;5 months&#44; p&#61;0&#46;81&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The protocol-based follow-up program was associated with a significant reduction in all-cause readmission &#40;26&#37; vs&#46; 60&#37;&#44; p&#61;0&#46;003&#41;&#44; heart failure readmission &#40;16&#37; vs&#46; 36&#37;&#44; p&#61;0&#46;032&#41;&#44; and mortality &#40;4&#37; vs&#46; 20&#37;&#44; p&#61;0&#46;044&#41;&#46; In the study group there was a significant improvement in all quality of life measures &#40;p&#60;0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates&#44; and was associated with better quality of life&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os doentes com insufici&#234;ncia card&#237;aca &#40;IC&#41; apresentam taxas elevadas de reinternamento e mortalidade&#44; tornando necess&#225;ria a implementa&#231;&#227;o de medidas que conduzam &#224; sua redu&#231;&#227;o&#46; Avaliou-se o impacto da implementa&#231;&#227;o de um programa de seguimento estruturado de doentes com IC nas taxas de reinternamento e mortalidade e na qualidade de vida&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudo quasi-experimental&#44; de registo prospetivo&#44; que incluiu 50 doentes consecutivos com alta ap&#243;s internamento por insufici&#234;ncia card&#237;aca aguda&#46; Os doentes iniciaram seguimento protocolado ap&#243;s alta&#44; por cardiologista&#44; com consulta aos 7-10 dias&#44; 1&#44; 3&#44; 6 e 12 meses&#44; com procedimentos pr&#233;-definidos&#46; O grupo-controlo foi constitu&#237;do por doentes internados por insufici&#234;ncia card&#237;aca previamente &#224; implementa&#231;&#227;o do programa&#44; seguidos ap&#243;s a alta em consultas de rotina&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">N&#227;o houve diferen&#231;as entre ambos os grupos no respeitante &#224; idade m&#233;dia &#40;67&#44;1&#177;11&#44;2 <span class="elsevierStyleItalic">versus</span> 65&#44;8&#177;13&#44;4 anos&#59; p&#61;0&#44;5&#41;&#44; classe funcional da NYHA &#40;p&#61;0&#44;37&#41; e mediana da fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#91;27&#37; &#40;19&#44;8-35&#44;3&#41; <span class="elsevierStyleItalic">versus</span> 29&#37; &#40;23&#44;5-40&#41;&#59; p&#61;0&#44;23&#93; &#224; data da alta&#59; o tempo de seguimento m&#233;dio foi id&#234;ntico &#40;11&#177;5&#44;3 <span class="elsevierStyleItalic">versus</span> 10&#44;9&#177;5&#44;5 meses&#59; p&#61;0&#44;81&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O seguimento protocolado associou-se a redu&#231;&#227;o significativa das taxas de reinternamento por qualquer causa &#40;26&#37; <span class="elsevierStyleItalic">versus</span> 60&#37;&#44; p&#61;0&#44;003&#41;&#44; reinternamento por insufici&#234;ncia card&#237;aca &#40;16&#37; <span class="elsevierStyleItalic">versus</span> 36&#37;&#44; p&#61;0&#44;032&#41; e mortalidade total &#40;4&#37; <span class="elsevierStyleItalic">versus</span> 20&#37;&#44; p&#61;0&#44;044&#41;&#46; No grupo em estudo verificou-se melhoria significativa em todos os par&#226;metros de qualidade de vida &#40;p&#60;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Um programa de seguimento protocolado de doentes com insufici&#234;ncia card&#237;aca permitiu redu&#231;&#227;o significativa nas taxas de reinternamento e mortalidade e associou-se a melhoria da qualidade de vida&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Median LVEF&#44; &#37; &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Etiology&#44; n &#40;&#37;&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DCM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ischemic CMP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Valvular CMP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Median NT-proBNP&#44; pg&#47;ml &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">New-onset AHF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Decompensated CHF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline assessment<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> &#40;n&#61;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">69 &#40;39-89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Severity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89 &#40;72-94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recent change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;67-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subtotal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Global quality of life</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Self-efficacy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;50-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;75-95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quality of life&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;40-75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;67-87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;37-85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;60-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subtotal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;49-77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;70-89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;49-81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">84 &#40;72-91&#41;&nbsp;\t\t\t\t\t\t\n
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28679089"
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                      "titulo" => "Trends in death attributed to heart failure over the past two decades in Europe"
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                            0 => "S&#46; Laribi"
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                            2 => "M&#46; Nikolaou"
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                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "234"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22237388"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Relat&#243;rio do Programa Nacional para as Doen&#231;as C&#233;rebro-Cardiovasculares"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "EURObservational Research Programme&#58; regional differences and 1-year follow-up results of the Heart Failure Pilot Survey &#40;ESC-HF Pilot&#41;"
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                            2 => "G&#46; Filippatos"
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                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hft050"
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                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "808"
                        "paginaFinal" => "817"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23537547"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Multicenter prospective observational study on acute and chronic heart failure&#58; one-year follow-up results of IN-HF &#40;Italian Network on Heart Failure&#41; outcome registry"
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                          "etal" => true
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                            2 => "M&#46; Metra"
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.112.000161"
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                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "473"
                        "paginaFinal" => "481"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23476054"
                            "web" => "Medline"
                          ]
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                ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National hospital discharge survey&#58; 2007 summary"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Hall"
                            1 => "C&#46;J&#46; DeFrances"
                            2 => "S&#46;N&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Natl Health Stat Rep"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "1"
                        "paginaFinal" => "20"
                      ]
                    ]
                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Improving care for patients with acute heart failure&#58; before&#44; during and after hospitalization"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Cowie"
                            1 => "S&#46;D&#46; Anker"
                            2 => "J&#46; Cleland"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
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              "identificador" => "bib0265"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proportion of hospital readmissions deemed avoidable&#58; a systematic review"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Van Walraven"
                            1 => "C&#46; Bennett"
                            2 => "A&#46; Jennings"
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                    0 => array:2 [
                      "doi" => "10.1503/cmaj.101860"
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                        "tituloSerie" => "CMAJ"
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                        "volumen" => "183"
                        "paginaInicial" => "E391"
                        "paginaFinal" => "E402"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21444623"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure&#58; a meta-analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "D&#46;E&#46; Kern"
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                        "volumen" => "291"
                        "paginaInicial" => "1358"
                        "paginaFinal" => "1367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15026403"
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                    0 => array:2 [
                      "titulo" => "Multidisciplinary strategies for the management of heart failure patients at high risk for admission&#58; a systematic review of randomized trials"
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                          "autores" => array:3 [
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                            2 => "S&#46; Ferrua"
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                    0 => array:2 [
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                        "tituloSerie" => "J Am Coll Cardiol"
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                        "paginaInicial" => "810"
                        "paginaFinal" => "819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15312864"
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transitional care interventions to prevent readmissions for persons with heart failure&#58; a systematic review and meta-analysis"
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                    0 => array:2 [
                      "doi" => "10.7326/M14-0083"
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                        "tituloSerie" => "Ann Intern Med"
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                        "paginaInicial" => "774"
                        "paginaFinal" => "784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862840"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "An early post-discharge intervention planned to reduce 30-day readmissions in old and frail heart failure patients remains beneficial at 1 year"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Esp Cardiol"
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                ]
              ]
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              "identificador" => "bib0290"
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                0 => array:2 [
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                      "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure&#58; the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology &#40;ESC&#41;&#46; Developed with the special contribution of the Heart Failure Association &#40;HFA&#41; of the ESC"
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                        "tituloSerie" => "Eur Heart J"
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                        "paginaInicial" => "2129"
                        "paginaFinal" => "2200"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819"
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                          0 => array:2 [
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                        "tituloSerie" => "Rev Port Cardiol"
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                        "paginaFinal" => "438"
                        "link" => array:1 [
                          0 => array:2 [
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                        "tituloSerie" => "N Engl J Med"
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                        "paginaFinal" => "1658"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11386263"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure"
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                        "paginaFinal" => "1456"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7654275"
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                      "titulo" => "Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors&#58; the CHARM-Alternative trial"
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                        "tituloSerie" => "Lancet"
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                        "paginaInicial" => "772"
                        "paginaFinal" => "776"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13678870"
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                      "titulo" => "The effect of spironolactone on morbidity and mortality in patients with severe heart failure"
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                      "titulo" => "Angiotensin-neprilysin inhibition versus enalapril in heart failure"
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                        "paginaInicial" => "993"
                        "paginaFinal" => "1004"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "885"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20801500"
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                        0 => array:2 [
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                          "autores" => array:3 [
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                        "tituloSerie" => "N Engl J Med"
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                        "volumen" => "352"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1549"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15753115"
                            "web" => "Medline"
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                ]
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                      "titulo" => "Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials&#46; AVID&#44; CASH and CIDS studies&#46; Antiarrhythmics vs Implantable Defibrillator study&#46; Cardiac Arrest Study Hamburg&#46; Canadian Implantable Defibrillator Study"
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                        ]
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                    ]
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                    0 => array:1 [
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                        "paginaInicial" => "2071"
                        "paginaFinal" => "2078"
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                    ]
                  ]
                ]
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                        "paginaFinal" => "444"
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                        "paginaFinal" => "638"
                        "link" => array:1 [
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                      "titulo" => "Comparable performance of the Kansas City Cardiomyopathy Questionnaire in heart failure patients with preserved and reduced ejection fraction"
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