1. Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
- Author
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Edimar Alcides Bocchi, Henrique Turin Moreira, Juliana Sanajotti Nakamuta, Marcus Vinicius Simões, Alberto de Almeida Las Casas, Altamiro Reis da Costa, Amberson Vieira de Assis, André Rodrigues Durães, Antonio Carlos Pereira-Barretto, Antonio Delduque de Araujo Ravessa, Ariane Vieira Scarlatelli Macedo, Bruno Biselli, Carolina Maria Nogueira Pinto, Conrado Roberto Hoffmann Filho, Costantino Roberto Costantini, Dirceu Rodrigues Almeida, Edval Gomes dos Santos Jr, Erwin Soliva Junior, Estevão Lanna Figueiredo, Felipe Neves de Albuquerque, Felipe Paulitsch, Fernando Carvalho Neuenschwander, José Albuquerque de Figueiredo Neto, Flavio de Souza Brito, Heno Ferreira Lopes, Humberto Villacorta, João David de Souza Neto, João Mariano Sepulveda, José Carlos Aidar Ayoub, José F. Vilela-Martin, Juliano Novaes Cardoso, Laercio Uemura, Lidia Zytynski Moura, Lilia Nigro Maia, Lucia Brandão de Oliveira, Lucimir Maia, Luís Beck da Silva, Luís Henrique Wolff Gowdak, Luiz Claudio Danzmann, Marcus Andrade, Maria Christiane Valeria Braga Braile-Sternieri, Maria da Consolação Vieira Moreira, Olimpio R França Neto, Otavio Rizzi Coelho Filho, Paulo Frederico Esteves, Priscila Raupp-da-Rosa, Ricardo Jorge de Queiroz e Silva, Ricardo Mourilhe-Rocha, Ruy Felipe Melo Viégas, Salvador Rassi, Sandrigo Mangili, Sergio Emanuel Kaiser, Silvia Marinho Martins, and Vitor Sergio Kawabata
- Subjects
Heart Failure ,Disease Management Program ,Education Monitoring ,Clinical Decision-Making ,Multidisciplinary Treatment ,Medicine (General) ,R5-920 - 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.
- Published
- 2021
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