Feasibility of a heart failure disease management program in Eastern Europe: Tbilisi, Georgia

Kathy Hebert, Henry C. Quevedo, Ilia Gogichaishvili, Nino Nozadze, Ekaterine Sagirashvili, Patrick Trahan, Nicholas Kipshidze, Lee M. Arcement

Research output: Contribution to journalArticle

8 Scopus citations

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 ≥40% 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 10.2±3.5 months. β-Blocker prescriptions increased from 7.4-80.7% (P<0.001), angiotensinconverting enzyme inhibitor prescriptions increased from 18.4-92.6% (P<0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (P<0.001). 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% (n=70) 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.

Original languageEnglish (US)
Pages (from-to)763-769
Number of pages7
JournalCirculation: Heart Failure
Volume4
Issue number6
DOIs
StatePublished - Nov 1 2011

Keywords

  • Compliance/adherence
  • Ethics and policy
  • Health policy
  • Medication adherence
  • Outcome assessment
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Hebert, K., Quevedo, H. C., Gogichaishvili, I., Nozadze, N., Sagirashvili, E., Trahan, P., Kipshidze, N., & Arcement, L. M. (2011). Feasibility of a heart failure disease management program in Eastern Europe: Tbilisi, Georgia. Circulation: Heart Failure, 4(6), 763-769. https://doi.org/10.1161/CIRCHEARTFAILURE.111.962431