ABC | Volume 113, Nº1, July 2019

Editorial Mesquita et al. Heart failure awareness day Arq Bras Cardiol. 2019; 113(1):5-8 Figure 1 – A) The ten thousand Brazilian cruzados note in honor of Carlos Chagas – “The notable physician in his laboratory” – launched in 1988. B) Stamp commemorating the 35th Brazilian Conference on Cardiology in honor of Carlos Chagas, 1979. C) Commemorative Stamp of the National Health Day – Chagas’ Disease, 1980. of Private Hospitals (ANAHP) on patients admitted due to HF in a group of hospitals with accreditation and protocols to serve this population. Data from the 2019 Observatory reveal, 11 in 2017 and 2018, respectively, a median of stay of 7.56 and 6.72 (SD = 3.72), inpatient mortality of 7.49% and 5.26%, rate of use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARA) on discharge of 89.43% and 88.41% (SD = 17.40%) and rate of use of betablockers at discharge of eligible patients of 93.29% and 94.29% (SD = 10.09%). Being aware of this variability in healthcare and outcomes of HF is important for us to help improve the quality of care in our country. Through the BREATHE registry, DEIC has studied patients from different regions of the country and verified the high in-hospital mortality among those admitted with acute HF associated with low rate of prescription of evidence-based medicines in Brazil. 12 Fonseca et al. 13 have found that through the demographic changes observed over the years in continental Portugal and the clinical practices currently employed, in about 40 years, the country will have half a million patients undergoing treatment for HF, highlighting the extreme need for raising people’s awareness, improving reference levels and healthcare so that the burden of the syndrome in the country may have its representativity diminished. They also stress the importance of optimizing healthcare strategies, organizing essential healthcare services, promoting adjustments while respecting regional characteristics, by avoiding a single model of work, reiterating the need for organized discussions at all levels of healthcare to the population. 14 Corroborating this need for adjusting and regionalizing healthcare, Kaufman et al. 15 argue that, considering the last 12 years of HF in Brazil, the Southeast region presented the highest number of hospital admissions, accounting for 41.4% of hospital admissions according to DATASUS data. In the characterization of this population in South America, Brazil contributes with most of the studies, accounting for 64% of the production of published data, being the only one to present its incidence in a population study. 16 DEIC/SBC has continuously used its Acute and Chronic Heart Failure Guideline published in 2018 to ensure the best scientific evidence available on diagnosis and treatment. 3 Regarding the role of diagnosis and beginning of treatment, many patients are still diagnosed during their first admission for acute HF. This demonstrates the need for greater investment in the continuing education of general practitioners, clinicians and cardiologists working at family clinics, basic health units and practices, and in the multidisciplinary and organized healthcare, in order to coordinate the line of care, palliative care protocols, in short, medical care based on HF teams. In the experience of Germany, 63.2% of the new cases were identified in a doctor’s office and 94% of diagnosed patients received their first prescription from the general practitioner. Cases of HF in hospitalized patients, where previous diagnosis was given by a non-specialist in 70.7%, reaffirm the strategy of investing in mechanisms of recognition of the disease in this group of professionals. 17 In our country, we do not have a healthcare process based on the full care of patients in a standardized way, which leads to delayed diagnosis in many patients, without the recognition of signs and symptoms by individuals and caregivers. This said, the process of education, recognition of the main symptoms and treatment are imperative needs, and initiatives that can promote knowledge about HF are fundamental for improving the quality of care. Besides those, access to complementary tests that demonstrate the objective presence of HF, such as the biomarkers brain natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT pro-BNP), and imaging scans for the correct handling of these patients. It is necessary to emphasize the importance of obtaining population registries to draw up a global picture of HF. China, Malaysia and South Africa, involved in the International Congestive Heart Failure (Inter-CHF) study, show that although socioeconomic similarities are distinct in etiology, comorbidities, sociodemographic characteristics and outcomes, 18 some comorbidities, such as diabetes mellitus, atrial fibrillation and chronic kidney disease, have been shown to be independent factors associated with hospital admissions and mortality in some samples. Hospital admissions and visits to the emergency roomwere also shown to be associated with outcomes in several studies. 19 Despite these well-established comorbidities correlated to outcomes, we found a group whose role is not yet properly characterized, such as sleep apnea, iron deficiency, sarcopenia and chronic obstructive pulmonary disease. Further studies regarding the contribution of these comorbidities in mortality still need to be developed. 20 Learning about disparate socioeconomic conditions that modify the incidence of HF in different regions in the same country can also be derived from population registries. Even in health systems such as that of the UK, it can be 6