[Heart failure clinics: the Brazilian experience]

Abstract

The treatment of congestive heart failure (CHF) is complex due to the need for multiple drugs and many surgical options. The accuracy, time of diagnosis, the introduction of treatment based on evidence, the detection of co-morbidities, and follow-up to improve prognosis are fundamental. Many studies have demonstrated that specialized centers in the treatment of CHF are superior and show better cost/benefit relation in comparison with usual treatment. The complexity of CHF treatment also requires a sub-specialist in CHF. The programs of CHF clinics include intensive education of family/patients and a careful follow-up performed by nurses and the multidisciplinary team. In a prospective randomized study in the CHF clinics of the Heart Institute (InCor) this program reduced the number of hospitalizations by 38%, the number of days during the hospitalizations by 71%, and necessity of emergency care by 27%. Published studies have demonstrated tendency or reduction of mortality, reduction of mortality associated with hospitalizations, reduction of hospitalizations, with sustained effects during a long-term follow-up and consequent reduction of costs. In the treatment of CHF it is necessary to include patients in programs of CHF clinics.