22.5.2016

Designs Systems for

Heart Failure Care

Dr. Ramón Corbalán H.

Facultad de Medicina

División de Enfermedades

Cardiovasculares

Pontificia Universidad Católica de Chile

Prognostic variables at 1-wk postdischarge visit

• Hospitalized patients

(LVEF <40%, n=1528

from the EVEREST trial)

Combination of physical

examination, laboratory,

and KCCQ & use of beta-blocker : c-statistic

0.749 for

rehospitalization and

death.

•

Shannon M. Dunlay et al EJHF 2010;12:367-374

Potential Benefits of a HF Program

• Decrease readmissions and costs

• Decrease short and long term mortality

• Improve the quality of care and life of HF patients:

– Adherence to tretament

– Optimize access to health care facilities

Characteristics and components of HF

management programmes

• The content and structure of HF management programmes may varyin different countries

HF services should be easily accessible to the patient and his/her

family and care providers.

A telephone helpline may facilitate access to professional advice.

Should employ a multidisciplinary approach: cardiologists, primary care physicians, trained nurses, physical therapists, dieticians, social workers, etc

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•

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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Objectives and components of HF

management programmes

• Emphasis on education and support for patient and family self care:

Check daily body weight, diuresis, low sodium diet, fluid intake, flexible use of diuretics, adherence and timing of medications;

Facilitate access to health care, early first visit

Weekly or monthly monitoring of Lab Tests: Hb, Cratinine,electrolytes,etc

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•

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Optimize Medical Therapy

• Dose titration of different drugs and consider interaction: Diuretics, betablockers, vasodilators, anticoagulants, etc

Consider that drug intolerance or adverse response could be a marker of circulatory failure

Consider new therapies available

Consider alternative therapies in case of refractoriness: Support devices, intermitent inotrope infusions, bridge to transplant, others

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Compare/Contrast North America to South America approach to HF Patient Management

Inequalities in the Access to Advanced Therapy in Heart Failure

Gross domestic product (at purchasing power parity) per capita: GDP PPP

International Monetary Fund, 2014

Country Int$

USA 54,629

Canada 44,926

Chile 23,057

Argentina 22,302

Brazil 16,155

Colombia 13,480

Health Expenditure as a share of GDP,

OECD 2013

Discharge therapies

Adaptado de Ambrosy A. JACC 2014;1123PC

Socio Cultural Levels and Therapies in Chile

53

23

15

51

7

20

49

31

24

59

11

36

97

44

25

53

20

47

0

10

20

30

40

50

60

70

80

90

100

IECA+ARA II Betablockers Spironolactona Diuretics Amiodarona Anticoagulants

Low Intermediate High

%

Rev Chil Cardiol 2009;28:51-62

Hub Model

Diagnóstico•Hemodinamia

• Imágenes

Terapias avanzadas

•Trasplante

•VAD

• ICD/CRT

•Cardiocirugía

Especialidades•Psiquiatra

•Nutrición

•Paliativos

Clínica de Insuficiencia

cardiaca

Derivación interna

Fast track Cardio-oncologia