Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers

Lídia Zytynski Moura ,Maria da Consolação Vieira Moreira,Alberto de Almeida Las Casas,Otavio Rizzi Coelho Filho,Sílvia Marinho Martins ,Priscila Raupp-da-Rosa,Lília Nigro Maia ,André Rodrigues Durães,Humberto Villacorta,Luís Henrique Wolff Gowdak,Ricardo Jorge de Queiroz e Silva,Edimar Alcides Bocchi,João David De Souza Neto ,José Albuquerque De Figueiredo Neto ,Ruy F. Viegas ,Fernando Carvalho Neuenschwander,João Mariano Sepulveda,Laercio Uemura,Salvador Rassi,Valéria B. Braile Sternieri ,Felipe Da Silva Paulitsch ,Lucimir Maia,Marcus Vinícius Santos Andrade ,Marcus Vinı́cius Simões ,Felipe N. Albuquerque ,Paulo Frederico Esteves,Luiz Cláudio Danzmann ,Erwin Soliva,Dirceu Rodrigues Almeida,Antônio Carlos Pereira-Barretto ,Lúcia Brandão De Oliveira ,Olímpio Ribeiro França Neto ,Heno Ferreira Lopes,Henrique Turin Moreira,José Carlos Aidar Ayoub,Vitor Sérgio Kawabata ,Sérgio Kaiser ,Altamiro Reis da Costa,Juliana Sanajotti Nakamuta,Estêvão Lanna Figueiredo ,Antonio Delduque de Araujo Ravessa,Amberson Vieira de Assis,Flávio De Souza Brito ,Juliano N. Cardoso ,Conrado Roberto Hoffmann Filho,Bruno Biselli,Sandrigo Mangili,Luís Beck-Da-Silva ,Edval Gomes dos Santos,Ariane Vieira Scarlatelli Macedo,José Fernando Vilela-Martin ,Costantino Costantini ,Ricardo Mourilhe-Rocha,C Pinto

doi:10.6061/clinics/2021/e1991

Abstract

OBJECTIVES:This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil.METHODS:The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment.RESULTS:Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment.CONCLUSION:HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

Highlights

Heart failure (HF) is the leading cause of hospital admission and readmissions in the United States among adults aged X65 years, creating a significant healthcare burden [1]
Public HF-disease management programs (DMPs) compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7)
In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), guideline-directed medical therapy for HF (GDMT-HF) (92% vs 83%; OR: 3; 95% CI: 0-15)

Summary

Introduction

Heart failure (HF) is the leading cause of hospital admission and readmissions in the United States among adults aged X65 years, creating a significant healthcare burden [1]. Despite the undeniable progress in HF treatment over the past few years, the number of hospital readmissions and associated healthcare costs remain very high [2]. Received for publication on May 6, 2020. Accepted for publication on October 15, 2020. In clinical practice, the association of each component with the effectiveness of the HF-DMP has not been studied and HF care models in low- and middle-income countries remain unknown. This study aimed to evaluate HF care models and HF-DMPs in a middle-income country

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Discussion

Conclusion