Health outcomes in decompensated congestive heart failure: a comparison of tertiary hospitals in Brazil and United States.

Rohde LE, Clausell N, Ribeiro JP, Goldraich L, Netto R, William Dec G, DiSalvo TG, Polanczyk CA
Int J Cardiol. 2005 102 (1): 71-7

PMID: 15939101 · DOI:10.1016/j.ijcard.2004.04.006

BACKGROUND - Few international studies prospectively compared evidence-based practices and health outcomes among congestive heart failure (CHF) cohorts from countries with different cultural and economic backgrounds.

METHODS - Patients consecutively admitted with congestive heart failure to tertiary care teaching hospitals in Brazil and in the United States (U.S.) were systematically evaluated using a structured data form. Follow-up data 3 months after discharge were obtained using chart review and telephone interviews.

RESULTS - U.S. patients were older (p < 0.01), had higher prevalence of ischemic etiology (p < 0.01) and less previous hospitalizations for congestive heart failure (p = 0.03) than Brazilian patients, but similar Charlson comorbidity scores (p = 0.54) and left ventricular (LV) function (p = 0.45). Prescription of angiotensin-converting enzyme inhibitors at discharge was lower at the U.S. hospital (57% vs. 68%; p = 0.03), but beta-blockers prescription was higher (37% vs. 10%; p < 0.01). Length-of-stay was significantly shorter (5 [interquartile range, 3-9] vs. 11 [6-19] days; p < 0.001) and in-hospital mortality was lower (2.4% vs. 13%; p < 0.001) in the U.S. cohort, but fewer clinical events within 3 months after discharge were observed in Brazilian patients (42% vs. 54%; p = 0.02). Combined clinical outcomes within 3 months, including overall mortality and hospital readmission, were similar between cohorts (57% vs. 55%; p = 0.80). In multivariate analysis, hospital site remained significantly associated with health outcomes.

CONCLUSIONS - Medical practice and health-related outcomes were different between U.S. and Brazilian congestive heart failure patients. In order to improve management worldwide, potential factors (structural, cultural or disease-related) that might be associated with these differences need to be evaluated in future studies.

MeSH Terms (23)

Adrenergic beta-Antagonists Aged Angiotensin-Converting Enzyme Inhibitors Brazil Drug Prescriptions Female Follow-Up Studies Heart Failure Hospital Mortality Hospitals, Teaching Humans Inpatients Length of Stay Male Myocardial Ischemia Outcome Assessment, Health Care Patient Discharge Patient Readmission Prevalence Prospective Studies Survival Rate Time Factors United States

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