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Multicenter Study
. 2021 Jan 20:76:e1991.
doi: 10.6061/clinics/2021/e1991. eCollection 2021.

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

Edimar Alcides Bocchi  1 , Henrique Turin Moreira  2 , Juliana Sanajotti Nakamuta  3 , Marcus Vinicius Simões  2 ; CLIMB-HF Study Group; Alberto de Almeida Las Casas  4 , Altamiro Reis da Costa  5 , Amberson Vieira de Assis  6 , André Rodrigues Durães  7 , Antonio Carlos Pereira-Barretto  8 , Antonio Delduque de Araujo Ravessa  9 , Ariane Vieira Scarlatelli Macedo  10 , Bruno Biselli  11 , Carolina Maria Nogueira Pinto  12 , Conrado Roberto Hoffmann Filho  13 , Costantino Roberto Costantini  14 , Dirceu Rodrigues Almeida  15 , Edval Gomes Dos Santos Jr  16 , Erwin Soliva Junior  17 , Estevão Lanna Figueiredo  18 , Felipe Neves de Albuquerque  19 , Felipe Paulitsch  20 , Fernando Carvalho Neuenschwander  21 , José Albuquerque de Figueiredo Neto  22 , Flavio de Souza Brito  12 , Heno Ferreira Lopes  8 , Humberto Villacorta  23 , João David de Souza Neto  24 , João Mariano Sepulveda  25 , José Carlos Aidar Ayoub  26 , José F Vilela-Martin  27 , Juliano Novaes Cardoso  28 , Laercio Uemura  29 , Lidia Zytynski Moura  30 , Lilia Nigro Maia  31 , Lucia Brandão de Oliveira  32 , Lucimir Maia  33 , Luís Beck da Silva  34 , Luís Henrique Wolff Gowdak  8 , Luiz Claudio Danzmann  35 , Marcus Andrade  36 , Maria Christiane Valeria Braga Braile-Sternieri  37 , Maria da Consolação Vieira Moreira  38 , Olimpio R França Neto  39 , Otavio Rizzi Coelho Filho  40 , Paulo Frederico Esteves  41 , Priscila Raupp-da-Rosa  42 , Ricardo Jorge de Queiroz E Silva  43 , Ricardo Mourilhe-Rocha  44 , Ruy Felipe Melo Viégas  45 , Salvador Rassi  46 , Sandrigo Mangili  47 , Sergio Emanuel Kaiser  48 , Silvia Marinho Martins  49 , Vitor Sergio Kawabata  50
Affiliations
Multicenter Study

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

Edimar Alcides Bocchi et al. Clinics (Sao Paulo). .

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.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1. Perceptions of doctors in centers treating heart failure (HF) regarding a criteria for evaluation of HF disease progression using a score in total, private, and public HF patients in HF specialized and all centers.
Figure 2
Figure 2. Perceptions of doctors in centers treating heart failure (HF) patients about goals of HF treatment using a score for total, private, and public settings.
Figure 3
Figure 3. Perceptions of doctors in centers treating heart failure (HF) regarding the greatest medical problems of HF patients using a score for total, private, and public settings.
Figure 4
Figure 4. Perceptions of doctors in centers treating heart failure (HF) regarding instructions considered more difficult to provide according to percent in total, private, and public settings.
Figure 5
Figure 5. Perceptions of doctors in centers treating heart failure (HF) regarding the importance of conditions that lead to change in the management of HF patients.
See this image and copyright information in PMC

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