Disease Management Program Heart Failure

Felix Ramires

Professor Livre-Docente FMUSP

Coordenador do Programa de IC HCor

felix.ramires@incor.usp.br

Insuficiência Cardíaca HCor - 2015

Mozaffarian D, et al. Circulation, 2015

36% Any-mention of death

Heart Failure - Epidemiology

Mozaffarian D, et al. Circulation, 2015

Heart Failure - Epidemiology

Heart Failure - Epidemiology

Prevalence Hospital discharge

Go A S, et al. Circulation, 2014

DATASUS 2007

CV

Total

•Total Admission: 11.450.000

•CV Admission: 1.170.264

•HF Admission: 386.676

HF

CV

Heart Failure – Epidemiology

Hospitalization - Brazil

Brazil - population: 169.799.170

Hospitalization on 2002:

1- Pregnancy, delivery and puerperium

2- Respiratory diseases

3- CV Diseases

Clinical causes:

1- Pneumonia

2- Asthma

3- Heart Failure

Albanesi Filho FM. Arq Bras Cardiol 2005; 85:155-6

Heart Failure – Epidemiology

Hospitalization - Brazil

Bo

ch

i EA

, et a

l. JA

AC

, 20

13

Heart Failure – Epidemiology

Latin America

Arq Bras Cardiol, 2014

Brazilian Registry

Heart Failure

Disease Management Program Heart Failure

He

art

Fa

iulu

re P

rogra

m

PIC

- H

Cor

VISIT 1- Any Unit

Medical Condition Stable Unstable

Checked the Inclusion / Exclusion Criteria

Patient approach:

-Presenting PIC-HCor

-inclusion into the program

-multidisciplinary team alert

-start to fill the chart data

Contact to the Assistant Physisian for Science / Consent

Family approach:

-Presenting PIC-HCor

-inclusion into the program

-multidisciplinary team alert

-start to fill the chart data

Medical Condition Stable

VISIT 2 - Inpatient Unit Approaching the patient and / or Family

-Delivery all guidance material, and guiding about it

-Clarifying the disease

-Self-care orientation

-strengthening in adherence to pharmacological and non-pharmacological

-orientation to discharge

VISIT 3 - Inpatient Unit -By demand

DISCHARGE FOLLOW-UP

phone

Heart Failure Program

Nurse

Heart Failure Program

Interventions

Monthly meetings

Heart Failure Meetings and

Scientific Sessions

Literature distribution for

each specific area

Heart Failure Program

Team Training

Sex HF Etiology

Mean age: 73.6 years (29-98)

Median Age: 75 years

421 Patients Included 1114 Hospitalizations

In 2014: 243 hospitalizations Until April 2015: 90 admissions

69%

31%

Masculino

Feminino

23%

61%

12%

1% 1% 0% 1% 1%

MCDI

Isquemica

Valvar

Chagássica

Inflamatória

Infiltrativa

Tóxica

Puerperal

Heart Failure Program

PIC-HCor

Heart Failure Program

Guidelines

Heart Failure Program

Benchmark

Heart Failure Program

Benchmark

Time for

Rehospitalization

Survival Get With

The Guidelines

Heart Failure Program

Evaluation

6%

96%

88%

82%

67%

76%

86%

77%

66%72%

94% 95% 95% 94% 93%97% 97%

100%

85% 83%88%

0%

20%

40%

60%

80%

100%

120%

56%

80% 88% 92% 89% 100% 90% 96% 100%

0%

20%

40%

60%

80%

100%

Betabloqueador Meta

56% 65%

74% 74% 76% 73% 82% 80% 78%

0%

20%

40%

60%

80%

100%

Prescrição de IECA/BRA Meta

64%

91% 95% 98% 98% 89% 100% 96% 89%

0%

20%

40%

60%

80%

100%

Ecocardiograma Meta

Heart Failure Program

Quality Indicators Hospital discharge instructions Beta-blocker at discharge

ACE/ARB at discharge LV assessment

47%

69% 80% 81% 82% 86%

100% 92% 100%

0%

20%

40%

60%

80%

100%

Antagonista de Aldosterona Meta

19%

37%

53%

68%

83%

67%

50%

88% 100%

0%

20%

40%

60%

80%

100%

ACO em FA Meta

100% 100% 100% 100% 100%

* *

100%

* 0%

20%

40%

60%

80%

100%

Aconselhamento Cessação de Tabagismo Meta

Heart Failure Program

Quality Indicators Espironolactone at discharge OAC at discharge

Smoking cessation

100% 100% 100% 100%

0%

20%

40%

60%

80%

100%

jan/15 fev/15 mar/15 abr/15

Betabloqueador Meta

100% 100% 100% 100%

0%

20%

40%

60%

80%

100%

jan/15 fev/15 mar/15 abr/15

IECA/BRA Meta

80%

99% 86%

100% 100%

80%

100%

0%

20%

40%

60%

80%

100%

2012 2013 2014 jan/15 fev/15 mar/15 abr/15

Procurou atendimento médico Meta

Heart Failure Program

Quality Indicators – Follow-up Keeping Beta-blocker at home Keeping ACE/ARB at home

Get to the ER when adivised to

9,0%

6,0%

5,0% 5,0% 5,2% 5,5%

4,5%

0,0%

11,1%

3,2%

4,4% 4,4% 4,4% 4,4% 4,4% 4,4% 4,4% 4,4%

9,1% 9,1% 9,1%

6,7% 6,2%

6,6% 6,6% 6,6% 6,6%

12,60% 12,60% 12,60% 12,60% 12,60%

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

2010 2011 2012 2013 2014 jan/15 fev/15 mar/15 abr/15

Mortalidade ADHERE ANAHP BREATHE

Heart Failure Program

Mortality

Dia

s

Heart Failure Program

Time to Hospitalization

Médico: Psicologia:

Felix Ramires Julia Fernandes Caldas Frayha

Victor Issa Viviane dos S. Gonçalves Ribeiro

Paulo Pego

Fabio Jatene

Enfermeira: Assistência Social:

Carolina Padrão Amorim Elaine Cristina Dalcin Seviero

Barbara Tamburim Simone Aparecida Gonçalves

Karla Aparecida da Silva

Ricardo Cunha

Fisioterapia: Farmácia:

Gizela Galacho Evelyn Cristina Torreta Menezes

Lucas Thiago Sampaio Correia Karen Priscila da Silva

Renata Andrade Gomes Melissa Ferreira

Laura Carraro Renata Baccaro Madeu

Ana Carolina Cinanena

Cihtya Ramos

Nutrição:

Fernanda Dalpicolo

Camila Moreno

Fernanda Giuditta Orciolli

Rafaela Emi Hasegawa

Heart Failure Program