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 language | English |
|---|---|
| Pages (from-to) | 763-769 |
| Number of pages | 7 |
| Journal | Circulation: Heart Failure |
| Volume | 4 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2011 |
| Externally published | Yes |
Fingerprint
Keywords
- Compliance/adherence
- Ethics and policy
- Health policy
- Medication adherence
- Outcome assessment
- Treatment
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
Feasibility of a heart failure disease management program in Eastern Europe : Tbilisi, Georgia. / Hebert, Kathy; Quevedo, Henry C.; Gogichaishvili, Ilia; Nozadze, Nino; Sagirashvili, Ekaterine; Trahan, Patrick; Kipshidze, Nicholas; Arcement, Lee M.
In: Circulation: Heart Failure, Vol. 4, No. 6, 01.11.2011, p. 763-769.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Feasibility of a heart failure disease management program in Eastern Europe
T2 - Tbilisi, Georgia
AU - Hebert, Kathy
AU - Quevedo, Henry C.
AU - Gogichaishvili, Ilia
AU - Nozadze, Nino
AU - Sagirashvili, Ekaterine
AU - Trahan, Patrick
AU - Kipshidze, Nicholas
AU - Arcement, Lee M.
PY - 2011/11/1
Y1 - 2011/11/1
N2 - 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.
AB - 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.
KW - Compliance/adherence
KW - Ethics and policy
KW - Health policy
KW - Medication adherence
KW - Outcome assessment
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84855609811&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855609811&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.111.962431
DO - 10.1161/CIRCHEARTFAILURE.111.962431
M3 - Article
C2 - 21900187
AN - SCOPUS:84855609811
VL - 4
SP - 763
EP - 769
JO - Circulation. Heart failure
JF - Circulation. Heart failure
SN - 1941-3297
IS - 6
ER -