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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
•
•
•
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
•
•
•
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
•
•
•
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