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Disease Management Program Heart Failure
Felix Ramires
Professor Livre-Docente FMUSP
Coordenador do Programa de IC HCor
Insuficiência Cardíaca HCor - 2015
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
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
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
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
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