ABC | Volume 113, Nº1, July 2019

Editorial Heart Failure Awareness Day: A Tribute to the Genius Carlos Chagas Evandro Tinoco Mesquita, 1,2, 3 Aurea Lucia Alves de Azevedo Grippa de Souza, 1 Salvador Rassi 4,5 Universidade Federal Fluminense, 1 Niterói, RJ – Brazil Hospital Pró-Cardíaco, 2 Rio de Janeiro, RJ – Brazil Departamento de Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia (DEIC/SBC) - Diretoria Científica, 3 Rio de Janeiro, RJ – Brazil Universidade Federal de Goiás, 4 Goiânia, GO – Brazil Departamento de Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia (DEIC/SBC) - Presidência, 5 Rio de Janeiro, RJ – Brazil Mailing Address: Evandro Tinoco Mesquita • Ministro Otávio Kely, 500 1506, Icarái, Niterói, RJ – Brazil E-mail: etmesquita@gmail.com Keywords Heart Failure/epidemiology; Heart Failure /prevention and control; Risk Factors; Chagas Cardiomyopathy/physiopathology; Chagas Disease/epidemiology. DOI: 10.5935/abc.20190137 The purpose of the Brazilian Society of Cardiology (SBC) is to expand and disseminate knowledge on Cardiovascular Science and to make each cardiologist aware of the activities intended to promote cardiovascular health in Brazilian society. Since its foundation, SBC has been stimulating research and dissemination, among civil society, of epidemiological and preventive matters related to the treatment of cardiovascular diseases, including heart failure (HF). HF has been identified as a cardiovascular epidemic throughout the world and involves important aspects on morbidity, mortality and healthcare costs, being little recognized among individuals, members of our society, healthcare managers and policy makers. The increasing prevalence of HF is due to population aging and the growth of risk factors, such as obesity, systemic arterial hypertension and diabetes mellitus, as well as increased survival of patients with heart diseases, such as congenital heart disease and ischemic heart disease. Worldwide, about 26 million adults have HF and forecasts indicate that the prevalence tends to increase by 25% by 2030. 1 Within the scenario, it should be underscored that HF with preserved ejection fraction (HFPEF) needs greater recognition and prevention strategies by general practitioners, geriatricians and cardiologists. 2 The syndrome presents asymptomatic stages and a symptomatic form, and preventive and therapeutic measures are able to reduce the progression of the disease and morbimortality. Outbreaks of acute HF and decompensation promote recurrence in emergency rooms and hospital admissions that promote worsening of the condition, where the outcome can be abrupt due to pump failure or sudden death. 3 In this decade, initiatives in different countries, led by cardiology associations and societies, have promoted activities to warn the population and health professionals regarding early detection, complementary tests and access to medications and treatment based on scientific evidence. Under the leadership of the Department of Heart Failure of the Brazilian Society of Cardiology (DEIC/SBC), Brazil is engaged in promoting activities related to this topic, by creating the awareness day, to be celebrated each year on July 9 th , the data of birth of genius and pioneer cardiovascular translational scientist Carlos Justiniano Ribeiro das Chagas. This year, two dates are very remarkable: 140 years of the birth of professor and researcher Carlos Chagas and 110 years of the discovery of Chagas’ disease. A unique fact in the history of Medicine, in which a single researcher describes the vector, the etiological agent, identifies the hosts and attempts to identify the clinical forms of the disease. 4 The theme of Chagas’ disease, in our country, remains contemporary, not only in the search for new treatments, 5 vaccines and new forms of contamination, such as the oral route described in the north, northeast and south regions, involving sugarcane and açaí, reported this year in the Brazilian Archives of Cardiology, 6 but also in the current outbreak of acute Chagas’ disease in Pernambuco, still in the process of clarification. Tribute has been paid to scientist Carlos Chagas in Brazil in several ways (Figure 1), but we have identified that his contribution to cardiology and HF was definitive and important, representing his remarkable name for this noble cause in our country. With continental dimensions, our country has a great diversity of lifestyle, environmental, socioeconomic and cultural risk factors, as well as the composition of its health system (access, organization of the healthcare network, financing, availability of technological resources and professionals). IC clinics that can offer multiprofessional care have been shown to reduce admissions and improve quality of life. Cardiac rehabilitation has proven effectiveness, but it is not yet available, causing the low inclusion of people in these programs. Different factors may explain the variability of the number of hospital admissions, early retirement for HF and use of resources – heart transplantation, surgery, cardiac catheterization, pacemaker implantation, defibrillators and healthcare costs. According to Araujo et al., 7 the direct cost of treatment is represented mainly by hospitalization and costs with medication. However, indirect costs represent economic impacts similar to direct costs. A recent study estimates that about BRL 22.1 billion/US$ 6.8 billion were spent on the treatment of HF in our country in 2015 alone, 8 and could represent 68% of hospitalization costs, as seen in the USA and Europe, due to costly diagnostic techniques, high cost of medications, interventions and devices. Therefore, reducing hospital admissions is critical for reducing costs, in addition to the physical and psychological limitations that can be worsened in these patients, particularly depressive symptoms and anxiety. The increasing prevalence of hospital admissions, estimated in some centers at up to 25%, and high hospital morbidity and mortality rates, especially in the presence of comorbidities, such as renal failure, have been documented in different studies. 9,10 Private sector data are beginning to be described and published as those present at the Observatory of the National Association 5