Establishing an Outreach Referral Network

Transcription

1 Establishing an Outreach Referral Network

2 Rheumatic Fever people around the world, Children and young adults, deaths /year Thousands desabilities Risk Factor Under development

3 Prevalence of Valvopaties 5001 patients in 25 european countries European Heart Journal (2003) 24,

4 Fertility: Population by age and gender IBGE 4,4 to 2,3 children/ woman Increase population > 60yo - 107% < 14 yo - 14%

5 Elderly Pts with Severe Aortic Stenosis Dante Pazzanese

6 VHD x young patients Asimptomatic, Women in reproductive age Social problems Need prophilaxis for long period of time Problems with durability of prosthesis Problems with anticoagulation Warrantee long life and good quality

7 VHD x elderly Elderly, frequently above 80 year old Multiple Comorbidities, Frail, with disabilities, cognitive dysfunction New technologies Difficult to decide what kind of intervention Heart team is frequently necessary

8 Symptomatic severe AS EHJ, 2005, 26;

9 Indicação cirúrgica versus idade EAo EHJ, 2005, 26;

10 Indicação cirúrgica versus Função ventricular esquerda EAo EHJ, 2005, 26;

11 Symptomatic severe MR EHJ (2007) 28,

12 Indicação cirúrgica versus idade IM EHJ (2007) 28,

13 Indicação cirúrgica versus Função ventricular esquerda IM EHJ (2007) 28,

14 Reasons Nowadays the patients are followed-up by generalists or general cardiologists Informations and educations are frequently rare and wrong There remain a number of patients who are referred for intervention too late in the course of their disease or not referred at all There is a real gap between the existing guidelines and their effective application

15 ESC Guidelines European Heart Journal (2013) 34,

16 The Heart Valve Team and Heart Valve Centers of Excellence Recommendations COR LOE Patients with severe VHD should be evaluated by a multidisciplinary Heart Valve Team when intervention I C is considered Consultation with or referral to a Heart Valve Center of Excellence is reasonable when discussing treatment options for 1) asymptomatic patients with severe VHD, 2) patients who may benefit from valve repair versus valve replacement, or 3) patients with multiple comorbidities for whom valve intervention is considered IIa C

17 1. Health professionals with cardiology and valvopaty expertise 2. Offer all treatment options for diagnosis and treatment. 3. Specialists in Dopller-ecocardiography TT, TE e 3D, CT, MRI, Cardiac cath 4. Surgeons expertise in valve repair and replacement 5. Interventionists expertise in trancatheter procedure 6. Be part of locals and nationals Registry 7. Follow-up the patients 8. Follow the Guidelines Valve Center 9. Publish rates of mortality and success 10.Program of teaching, researching and assistence

18 Mannagement according Guidelines 1- decrease unnecessary testing, 2- optimize timing of intervention, 3- best handle other problems such as operations for complex multivalve disease, multiple reoperations, and complex IE. 4- Wacthing Wainting strategy is much more safe 5- The chance of valve repair increase 6- The patients s outcome iimprove

19 Surgical Results 1-Surgical outcomes depend on the expertise and experience of the surgeons. 2-Decision on Mitral valve repair or mitral valve replacement 3-The rate of successful mitral valve repair dependent on the experience of the surgeon as well as the surgical volume. 4-Optimal outcomes are best achieved in Heart Valve Centers of Excellence dedicated to the management and treatment of patients with VHD

20 Dante Pazzanese Valve Center Primary health care Center- VHD suspected Doppler-echocardiogram CROSS system (Central de Regulação de Ofertas de Serviços de Saúde) Excellence Valve Center Echo, Cath, CT, MRI, if necessary Decision make- clinical, surgical, percutaneous treatment Complex cases - Heart team

21 Dante Pazzanese- Valve Centre 8000 appointments a year- valve disease 30 beds for valve disease Balloon mitral valvotomy: 80 /year Valve surgery: 500/ year TAVI, percutaneous treatment leak Almost half of referral patients come from the clinics with atrial fibrilation, pulmonary hypertension, LV dysfuntion Waiting list for surgery

22 Conclusions The goals of Stabilishing an outreach referral network: burden of VHD To Teach the community about valve disease To Improve prophylaxis of Rheumatic valve disease To Teach pediatrics, geriatrics, general cardiologists to recognize valve heart disease To Teach general cardiologists to referral patiens in the correct time To Offer consultation and best treatment in valve centers with expertise Create more Valve centers to avoid overbooked and waiting list

23 Improving outreach Traditional Methods New Media Methods Educate Your Base - Lectures/Grand Rounds Marketing Letters to referring MD s - Advertise - Earned Media Stories Internet Search Optimization - Google your program Website Design - Connect with patient and family Facebook/Twitter - There is traffic - Believe it or not! YouTube Videos

24 Thank You!