Implications for clinical practice from a multicenter survey of heart failure management centers

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.

Causas de internaçöes por insuficiência cardíaca congestiva no Hospital de Base / Causes of hospitalization by congestive heart failure at the Base Hospital

A incidência de Insuficiência Cardíaca Congestiva (ICC) tem aumentado drasticamente na última década, com 400.000 novos casos diagnosticados por ano nos EUA, requerendo 900.000 internaçoes anuais. O objetivo deste estudo foi determinar a incidência de internaçoes devido à ICC no serviço de Cardiologia do Hospital de Base da FAMERP, especificando as etiologias e, dentro de cada uma, a média de idade e a distribuiçao entre os sexos. Analisando os resultados, verificou-se uma alta taxa de internaçoes por ICC (41,2 por cento), sendo a Doença de Chagas e a Hipertensao Arterial Sistêmica as etiologias mais frequentes. Com relaçao à distribuiçao entre os sexos e a média de idade, houve um predomínio do sexo masculino e da 5ª e 6ª década de vida, respectivamente.

Estudo aberto e prospectivo da eficacia e tolerabilidade da amlodipina e da nifedipina de liberacao programada(retard)no tratamento da hipertensao arterial leve e moderada / Open and prospective study on the efficacy and tolerability of amlodipine and programed release nifedipine(retard)for treatment of mild to moderate hypertension

Avaliar na preatica clinica a seguranca e a eficacia a curto prazo de amlodipina comparada a nifedipina de liberacao programada(retard)no tratamento de hipertensao essencial leve e a moderada.

Estudo multicêntrico nacional para avaliação da eficácia e tolerabilidade da nifedipina oros em hipertensão arterial leve a moderada / Multicenter National Study for the evaluation of the efficacy and tolerance of nifedipine oral release osmotic system in mild to moderate hypertension

PURPOSE--Evaluation of the efficacy and tolerability of nifedipine oros in patients with mild to moderate essential hypertension without major target organ damage and the anti-hypertensive effect along the 24 hours. METHODS--Two hundred and three patients were studied. After two weeks placebo running period single dose of nifedipine oros (30 mg/day) was administered for 8 weeks. At the end of the 4th week, the non-responders (diastolic blood pressure > 90 mmHg or reduction in diastolic pressure < 10 mmHg), had the dosage increased to 60 mg/day. Laboratory tests and 24h blood pressure monitoring (60 patients) were performed at the beginning and at the end of the study. RESULTS--One hundred and ninety one patients completed the study. Fifty nine percent were considered responders at the end of the 4th week with nifedipine oros 30 mg/day and 41 needed dosage increment to 60 mg/day. At the end of the 8th week, all patients were considered responders to nifedipine oros. The blood pressure control extended throughout the 24h of the day. The most common adverse events were edema (14.6) and headache (12.4). Good and very good tolerability were informed by 85 of the patients. CONCLUSION--Nifedipine oros was able to control blood pressure efficaciously along the 24h period without important side effects. The possibility of once day dosage, increases the patient adherence to anti-hypertensive therapy.

Acompanhamento de 991 pacientes portadores de marcapasso cardíaco artificial multiprogramável / Follow-up of 991 patients with multiprogrammable artificial cardiac pacemaker

É mostrada a experiência dos últimos 5 anos com o implante de 991 marcapassos cardíacos artificiais multiprogramáveis (66,1%) em pacientes portadores de miocardiopatia chagásica crônica) em freqüência de estimulaçäo, largura e amplitude de pulso, sensibilidade, período refratário e histerese. Em 684 pacientes (69%) houve necessidade de reprogramaçöes, na freqüência de estimulaçäo cardíaca artificial (27,9%), na largura e amplitude de pulso (46,5%), na sensibilidade 12,9%) e no período refratário e histerese (12,4%) neste período de acompanhamento. A multiprogramabilidade mostrou vantagens neste grupo de pacientes, principalmente em pacientes chagásicos, com complexos ventriculares aberrantes e, através de manobras näo-invasivas, evitou que 11,7% destes pacientes fossem reoperados