Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia

Abstract

Background-Little is known about the importation of a heart failure disease management program (HFDMP) into lowand middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses. Methods and Results-Patients with ejection fraction Յ40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists. Medications, emergency department use, hospital admissions, and mortality were assessed by interviews with patients or their families. Screening resulted in 400 patients who were followed for 10.2Ϯ3.5 months. ␤-Blocker prescriptions increased from 7.4 -80.7% (PϽ0.001), angiotensinconverting enzyme inhibitor prescriptions increased from 18.4 -92.6% (PϽ0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (PϽ0.001). Patients visiting the emergency department and hospitalizations were lowered by 40.7% and 52.5%, respectively, but were also influenced by the outbreak of war, during which 17.5% (nϭ70) of patients received follow-up in refugee tents. All-cause mortality extended to 7% of patients, with 12 of 28 deaths caused by war-related events. Conclusions-Importation of a Western HFDMP was demonstrated to be feasible, with a 5-fold increase in the use of recommended therapies, reduction of blood pressure, decrease of emergency department visits, and hospitalizations for heart failure. These measures could result in substantial cost savings in resource-limited settings, but assessment is complicated in unstable areas. Translating effective interventions to low-and middle-income countries requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions. (Circ Heart Fail. 2011;4:763-769.)

Organization of heart failure management in European Society of Cardiology member countries: survey of the Heart Failure Association of the European Society of Cardiology in collaboration with the Heart Failure National Societies/Working Groups

“…reducing delay for cardiac imaging procedures, promotion of HF awareness, and establishment and improvement of nationwide HF databases. It has been demonstrated that a low‐cost HF management programme (patient education, diet, activity, and evidence‐based medical therapy) can be successfully implemented in low‐ and middle‐income countries . The benefits of such programmes are: an increase in the use of evidence‐based therapies, reduction of blood pressure, decrease in emergency department visits and HF hospitalizations, as well as improvement in depression and quality of life of HF patients ,…”

“…It has been demonstrated that a low-cost HF management programme (patient education, diet, activity, and evidence-based medical therapy) can be successfully implemented in low-and middle-income countries. 15 The benefits of such programmes are: an increase in the use of evidence-based therapies, reduction of blood pressure, decrease in emergency department visits and HF hospitalizations, as well as improvement in depression and quality of life of HF patients. 15 This survey suggests that there is substantial heterogeneity in the availability of echocardiography and natriuretic peptide assays for acute HF patients.…”

“…15 The benefits of such programmes are: an increase in the use of evidence-based therapies, reduction of blood pressure, decrease in emergency department visits and HF hospitalizations, as well as improvement in depression and quality of life of HF patients. 15 This survey suggests that there is substantial heterogeneity in the availability of echocardiography and natriuretic peptide assays for acute HF patients. Data reported from the EuroHeart Failure survey programme 17 revealed that 66% of the enrolled patients had echocardiography during hospitalization for acute HF.…”

Utilidad de los programas de intervención en el control evolutivo de los pacientes con insuficiencia cardiaca

“…En nuestro entorno se observan resultados similares en proyectos realizados de forma conjunta entre el medio hospitalario y atención primaria, apreciándose descensos en la tasa de mortalidad menores que en nuestro estudio, pero disminuyendo de manera significativa el número de reingresos 19,20 . Inclusive, algunos estudios hablan de una relación directa entre el nú-mero de reingresos y el mayor uso de BB 21 . Esto difiere de nuestro trabajo, aunque puede deberse a las diferencias en las muestras y a la escasa duración del seguimiento.…”

Geographic variation in heart failure—a matter of celebration or condemnation?

“…Although no data on prescribed therapies were available, differences in the use of evidence‐based therapies and devices may further explain this discordance in hospitalization rates. It may be easy to conclude that altering health‐care systems or additional interventions might change these rates, but it must be recognized that what is found to be effective in one region may not be as easy to institute or effective in another region (or even within a region) . Understanding the local epidemiology of heart failure and the underlying causes behind the trends is therefore crucial before embarking on changes to a health‐care system.…”