Insuficiência Cardíaca HCor - 2015 Disease Management Program Heart Failure Felix Ramires Professor Livre-Docente FMUSP Coordenador do Programa de IC HCor felix.ramires@incor.usp.br
Heart Failure - Epidemiology 36% Any-mention of death Mozaffarian D, et al. Circulation, 2015
Heart Failure - Epidemiology Mozaffarian D, et al. Circulation, 2015
Heart Failure - Epidemiology Prevalence Hospital discharge Go A S, et al. Circulation, 2014
Heart Failure Epidemiology Hospitalization - Brazil CV HF Total CV Total Admission: 11.450.000 CV Admission: 1.170.264 HF Admission: 386.676 DATASUS 2007
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 Latin America Bochi EA, et al. JAAC, 2013
Brazilian Registry Heart Failure Arq Bras Cardiol, 2014
Disease Management Program Heart Failure
Heart Faiulure Program PIC- HCor
Heart Failure Program Nurse VISIT 1- Any Unit Checked the Inclusion / Exclusion Criteria Contact to the Assistant Physisian for Science / Consent Medical Condition Stable Patient approach: -Presenting PIC-HCor -inclusion into the program -multidisciplinary team alert -start to fill the chart data Unstable 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 Interventions
Heart Failure Program Team Training Heart Failure Meetings and Scientific Sessions Monthly meetings Literature distribution for each specific area
Heart Failure Program PIC-HCor 421 Patients Included 1114 Hospitalizations In 2014: 243 hospitalizations Until April 2015: 90 admissions Sex HF Etiology 1% 1% 0% 1% 1% MCDI 31% 12% 23% Isquemica Valvar 69% Masculino Feminino 61% Chagássica Inflamatória Infiltrativa Tóxica Puerperal Mean age: 73.6 years (29-98) Median Age: 75 years
Heart Failure Program Guidelines
Heart Failure Program Benchmark
Heart Failure Program Benchmark
Heart Failure Program Evaluation Time for Rehospitalization Survival Get With The Guidelines
120% 100% 60% 40% 96% Heart Failure Program Quality Indicators Hospital discharge instructions 88% 82% 67% 76% 86% 77% 72% 66% 94% 95% 95% 94% 93% 97% 97% 100% 88% 85% 83% 100% 60% 40% 20% 0% 56% Beta-blocker at discharge 88% 92% 89% 100% 90% 96% 100% 20% 6% 0% Betabloqueador Meta ACE/ARB at discharge LV assessment 100% 60% 40% 20% 0% 56% 65% 74% 74% 76% 73% 82% 78% 100% 60% 40% 20% 0% 64% 91% 95% 98% 98% 89% 100% 96% 89% Prescrição de IECA/BRA Meta Ecocardiograma Meta
100% 60% 40% 20% 0% 47% 69% 81% 82% 86% Heart Failure Program Quality Indicators Espironolactone at discharge OAC at discharge 100% 92% 100% 100% 60% 40% 20% 0% 19% 37% 53% 68% 83% 67% 50% 88% 100% Antagonista de Aldosterona Meta ACO em FA Meta Smoking cessation 100% 60% 40% 20% 0% 100% 100% 100% 100% 100% * * 100% * Aconselhamento Cessação de Tabagismo Meta
100% 60% 40% 20% 0% 100% 100% 100% 100% jan/15 fev/15 mar/15 abr/15 Betabloqueador Heart Failure Program Quality Indicators Follow-up Keeping Beta-blocker at home Meta 100% 60% 40% 20% 0% Keeping ACE/ARB at home 100% 100% 100% 100% jan/15 fev/15 mar/15 abr/15 IECA/BRA Meta 100% 60% 40% 20% Get to the ER when adivised to 99% 100% 100% 100% 86% 0% 2012 2013 2014 jan/15 fev/15 mar/15 abr/15 Procurou atendimento médico Meta
Heart Failure Program Mortality 14,0% 12,0% 12,60% 12,60% 12,60% 12,60% 12,60% 11,1% 10,0% 9,0% 9,1% 9,1% 9,1% 8,0% 6,0% 4,0% 3,2% 6,7% 6,6% 6,6% 6,6% 6,6% 6,0% 6,2% 5,0% 5,0% 5,2% 5,5% 4,4% 4,4% 4,4% 4,4% 4,4% 4,5% 4,4% 4,4% 4,4% 2,0% 0,0% 2010 2011 2012 2013 2014 jan/15 fev/15 mar/15 abr/15 0,0% Mortalidade ADHERE ANAHP BREATHE
Dias Heart Failure Program Time to Hospitalization
Heart Failure Program Médico: Felix Ramires Victor Issa Paulo Pego Fabio Jatene Enfermeira: Carolina Padrão Amorim Barbara Tamburim Karla Aparecida da Silva Ricardo Cunha Fisioterapia: Gizela Galacho Lucas Thiago Sampaio Correia Renata Andrade Gomes Laura Carraro Ana Carolina Cinanena Cihtya Ramos Psicologia: Julia Fernandes Caldas Frayha Viviane dos S. Gonçalves Ribeiro Assistência Social: Elaine Cristina Dalcin Seviero Simone Aparecida Gonçalves Farmácia: Evelyn Cristina Torreta Menezes Karen Priscila da Silva Melissa Ferreira Renata Baccaro Madeu Nutrição: Fernanda Dalpicolo Camila Moreno Fernanda Giuditta Orciolli Rafaela Emi Hasegawa