Insuficiência Cardíaca HCor - 2015 · Insuficiência Cardíaca HCor - 2015 . ... Felix Ramires Julia Fernandes Caldas Frayha ... Renata Andrade Gomes Melissa Ferreira

Disease Management Program Heart Failure

Felix Ramires

Professor Livre-Docente FMUSP

Coordenador do Programa de IC HCor

[email protected]

Insuficiência Cardíaca HCor - 2015

Mozaffarian D, et al. Circulation, 2015

36% Any-mention of death

Heart Failure - Epidemiology

Mozaffarian D, et al. Circulation, 2015



Prevalence Hospital discharge

Go A S, et al. Circulation, 2014

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


Hospitalization - Brazil

Bo

ch

i EA

, et a

l. JA

AC

, 20

13


Latin America

Arq Bras Cardiol, 2014

Brazilian Registry

Heart Failure

Disease Management Program Heart Failure

He

art

Fa

iulu

re P

rogra

m

PIC

- H

Cor

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


Interventions

Monthly meetings

Heart Failure Meetings and

Scientific Sessions

Literature distribution for

each specific area


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


PIC-HCor


Guidelines


Benchmark


Benchmark

Time for

Rehospitalization

Survival Get With

The Guidelines


Evaluation

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


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


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


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


Mortality

Dia

s


Time to Hospitalization

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


Insuficiência Cardíaca HCor - 2015 · Insuficiência Cardíaca HCor - 2015 . ... Felix Ramires Julia Fernandes Caldas Frayha ... Renata Andrade Gomes Melissa Ferreira

Documents