Abstract Background The prevalence of heart failure (HF) is increasing worldwide, and rehospitalizations due to exacerbations remain a major clinical and economic burden. Beyond medical triggers, insufficient patient understanding and inadequate self-management often contribute to recurrent admissions. The Kurume-HEARTS program was developed to provide regular planned hospitalizations incorporating structured education, cardiac rehabilitation, and medication adjustment for patients with recurrent HF. Objective To retrospectively evaluate the clinical and economic impact of the Kurume-HEARTS program. Methods We enrolled consecutive patients with recurrent HF hospitalizations who underwent the program at Kurume University Hospital between January 2020 and October 2025. Outcomes compared planned versus unplanned hospitalizations within the same patients. Co-primary endpoints were total hospitalization cost and total length of stay per person-year. Secondary endpoints included per-hospitalization cost, length of stay, unplanned and planned admission frequency, and NT-proBNP levels at admission. Results Of 31 screened patients, 20 with recurrent heart failure were included. During a median follow-up of 27.1 months, 135 hospitalizations occurred (69 unplanned and 66 program-based). Total hospitalization cost per person-year was significantly lower during the Kurume-HEARTS program than during unplanned hospitalizations, while length of stay per person-year tended to be shorter. Per-admission cost and length of stay were significantly lower with the program, without differences in admission frequency. NT-proBNP levels at admission were higher during unplanned hospitalizations, indicating greater clinical instability. Conclusions The Kurume-HEARTS program can help reduce the cost and hospitalization length of unplanned admissions by enabling earlier intervention and structured inpatient management. Graphical Abstract Concept of the Kurume-HEARTS program for preventing unplanned heart failure hospitalizations The upper panel illustrates conventional care, where patients with chronic heart failure frequently experience recurrent unplanned hospitalizations due to acute decompensation. The lower panel shows the planned strategy implemented in the Kurume-HEARTS program, in which patients undergo regularly planned hospitalizations for comprehensive multidisciplinary management before clinical worsening. This program includes patient education, nutritional guidance, medication optimization, exercise therapy, self-care instruction, and advance care planning. Through this proactive approach, the Kurume-HEARTS program may reduce the frequency/length of unplanned hospitalizations and hospitalization medical costs, contributing to more stable long-term disease management.
