Lean management of heart failure candidates for heart replacement therapies and post-heart transplant patients.

Cardiovascular disease is a leading cause of morbidity and mortality, according to the most recent reports from the World Health Organization. The development of increasingly effective pharmacological and interventional therapeutic approaches, the increasing average age of the population, and the increased incidence of metabolic disorders have led to a veritable pandemic in the chronicity of cardiovascular disease, particularly in the prevalence of patients with heart failure. Cardiac rehabilitation is a multidisciplinary care program that plays a key role in supporting heart failure patients, their caregivers, and the national healthcare system. However, until now, available clinical studies have almost exclusively investigated the role of exercise in stable patients, with inadequate management guidelines and supported by engagement methods that are not always consistent with patient clinical status. In some Italian rehabilitation centers, attempts have been made to develop a new model in clinical projects led by networks of professionals, in which rehabilitation management occurs early, compared with hospitalization in the acute setting. This new model also involves patients with potential clinical instability, but without the need for interventional procedures exclusive to the acute setting. From this perspective, the aim of the current project, which adopts a lean management approach, is to highlight the systemic waste and critical issues emerging from this new model.