Abstract 20389: Heterogeneity of Heart Failure Management Program Components May Affect Delivery of Care for Heart Failure

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Abstract

Introduction: Guidelines have been recommended heart failure (HF) disease management programs (DMP) for HF, despite conflicting results attributed to variations in interventions. Also, there is not data about HF-DMP components in practice in real world.

Hypothesis: This observational, cross-sectional study based on a survey applied to cardiologists tested the hypothesis that HF-DMP components may influence the delivered care in HF-DMP in real word.

Methods: The survey consisted of 29 questions addressing demography, structure, HF clinical practice and performance indicators. Statistical analysis is presented as odds ratio (OR), 95% CI for how many times public was superior to private or multidisciplinary team (M) HF-DMP superior to non-MHF-DMP.

Results: Data were obtained from 98 centers (58% public and 42% private practice) with 200 (interquartile 100-600) HF patients under follow-up by center. Public HF-DMP compared to private HF-DMP was associated to higher percentage of HF specialized HF-DMP-dedicated service [79% vs 24%, OR 12, 95%CI(94,34)], MHF-DMP [84% vs 65%, OR 3, 95%CI(1,8)], HF educational programs [49% vs 18%, OR 4, 95%CI(1,2)], written instructions before hospital discharge [83% vs 76%, OR 1, 95%CI(0,5)], rehabilitation [69% vs 39%, OR 3, 95%CI(1,9)], monitoring [44% vs 29%, OR 2 95%CI (1,5)], HF Guidelines use [(94% vs 85%, OR 3, 95%CI(0,15)], and less BNP use [73% vs 88%, OR 3, 95%CI(1,9)], and key performances [37% vs 60%, OR 3, 95%CI(1,7)]. Among the centers with MHF-DMP the participants were cardiologists (92%), nurses (86%), nutritionists (80%), physiotherapists (70%), psychologists (67%), social workers 962%), and pharmacists (53%). MHF-DMP in comparison to non-MH-DMP was associated to more education [42% vs 6%, OR 12, 95%CI(1,97)], written instructions [83% vs 68%, OR 2, 95%CI(1,7)], rehabilitation [69% vs 17%, OR 11, 95%CI(3,44)], monitoring [47% vs 6%, OR 14 95% IC(2,115)], Guidelines use [92% vs 83%, OR 3, 95%CI(0,15)], BNP use [84% vs 70%, OR 2, 95%CI(1,8)], and key performances [51% vs 35%,OR 2, 95%CI 91,6)].

Conclusion: In real world HF-DMP is heterogeneous and still underutilized with a worse scenario in private practice. To provide more complete delivery of care for HF, multidisciplinary HF-DMP should be encouraged.

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