Implications for clinical practice from a multicenter survey of heart failure management centers
Clinics
; 76: e1991, 2021. tab, graf
Artículo
en Inglés
| LILACS
| ID: biblio-1153946
Biblioteca responsable:
BR1.1
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.
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
LILACS
Asunto principal:
Manejo de la Enfermedad
/
Insuficiencia Cardíaca
Tipo de estudio:
Ensayo clínico controlado
/
Guía de práctica clínica
/
Estudio observacional
/
Estudio de prevalencia
/
Estudio pronóstico
/
Investigación cualitativa
/
Factores de riesgo
Límite:
Humanos
País/Región como asunto:
America del Sur
/
Brasil
Idioma:
Inglés
Revista:
Clinics
Asunto de la revista:
Medicina
Año:
2021
Tipo del documento:
Artículo
País de afiliación:
Brasil
/
Suiza
Institución/País de afiliación:
Ambulatório de Doença de Chagas e Insuficiência Cardíaca - PROCAPE - Universidade de Pernambuco/BR
/
Centro Médico/BR
/
Clínica de Insuficiência Cardíaca do Centro Universitário Serra dos Órgãos (UNIFESO)/BR
/
Faculdade de Medicina de São José do Rio Preto (FAMERP)/BR
/
UFBa+BR
/
Hospital Cardiológico Costantini/BR
/
Hospital Divina Providência/BR
/
Hospital Dom Pedro de Alcântara/BR
/
Hospital Lifecenter/BR
/
Hospital Municipal da Vila Santa Catarina/BR