1. Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
- Author
-
Edval Gomes dos Santos, Luís Beck da Silva, Fernando Carvalho Neuenschwander, Otavio Rizzi Coelho Filho, Ricardo Mourilhe-Rocha, Henrique T. Moreira, Lucia Brandão de Oliveira, Sergio Emanuel Kaiser, Luiz Cláudio Danzmann, Felipe da Silva Paulitsch, Flavio de Souza Brito, José Albuquerque de Figueiredo Neto, Priscila Raupp-da-Rosa, Lilia Nigro Maia, Andre Rodrigues Duraes, Marcus Andrade, Carolina Maria Nogueira Pinto, Silvia Marinho Martins, Lucimir Maia, Erwin Soliva Junior, Juliano Novaes Cardoso, Edimar Alcides Bocchi, Ariane Vieira Scarlatelli Macedo, Antonio Delduque de Araujo Ravessa, Costantino Roberto Costantini, Paulo Frederico Esteves, Antonio Carlos Pereira-Barretto, Laercio Uemura, Maria Christiane Valeria Braga Braile-Sternieri, João Mariano Sepulveda, Vitor Sérgio Kawabata, Luis Henrique W. Gowdak, Altamiro Reis da Costa, Juliana Sanajotti Nakamuta, Heno Ferreira Lopes, Ruy Felipe Melo Viégas, Maria da Consolação Vieira Moreira, Sandrigo Mangili, Estevão Lanna Figueiredo, Amberson Vieira de Assis, Olimpio R França Neto, Ricardo Jorge de Queiroz e Silva, Marcus Vinicius Simões, Dirceu R. Almeida, José Carlos Aidar Ayoub, Alberto de Almeida Las Casas, Felipe Neves de Albuquerque, Lidia Zytynski Moura, Humberto Villacorta, Salvador Rassi, José F. Vilela-Martin, João David de Souza Neto, Bruno Biselli, and Conrado Roberto Hoffmann Filho
- Subjects
medicine.medical_specialty ,Medicine (General) ,medicine.medical_treatment ,Disease Management Program ,Clinical Decision-Making ,Education Monitoring ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Drug treatment ,0302 clinical medicine ,R5-920 ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Multidisciplinary Treatment ,030212 general & internal medicine ,Heart Failure ,Rehabilitation ,business.industry ,Disease Management ,General Medicine ,Baseline data ,medicine.disease ,Clinical Practice ,Cross-Sectional Studies ,Private practice ,Heart failure ,Multicenter survey ,Observational study ,Original Article ,business ,Brazil - 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