ABC | Volume 114, Nº2, February 2020

Original Article Fernandes et al. Heart failure trends in Less developed Brazil Arq Bras Cardiol. 2020; 114(2):222-231 1. LamCS,DonalE,Kraigher-KrainerE,VasanRS.Epidemiologyandclinicalcourse ofheartfailurewithpreservedejectionfraction.EurJHeartFail.2011;13(1):18-28. 2. BocchiEA.HeartfailureinSouthAmerica.CurrCardiolRev.2013;9(2):147-56. 3. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63(12):1123-33. 4. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization andmortality rates forMedicare beneficiaries, 1998-2008. JAMA. 2011;306(15):1669-78. 5. Brazilian Institute of Geography and Statistics (IBGE) [Cited in 2019 Apr 12]. Available from: https://cidades.ibge.gov.br/brasil/pb/panorama. 6. Brasil.Ministerio da Saude .Departamento de Informatica do SUS. DATASUS [Internet].2018[Cited2018jan31]Availablefrom: http://datasus.saude.gov.br/. 7. Gaui EN, Oliveira GM, Klein CH. Mortality by heart failure and ischemic heart disease in Brazil from 1996 to 2011. Arq Bras Cardiol. 2014;102(6):557-65. 8. Albuquerque DC, Soza Neto JD, Bacal F, Rohde LEP, Bernardez-Pereira S, Berwanger O, et al. I Brazilian Registry of Heart Failure - Clinical Aspects, Care QualityandHospitalizationOutcomes.ArqBrasCardiol.2015;104(6):433-42. 9. IBM support 2018 [Cited in 2018 Feb 13]. Available from: http://www-01. ibm.com/support/docview.wss?uid=swg21480127. 10. Ciapponi A, Alcaraz A, Calderon M, Matta MG, Chaparro M, Soto N, et al. Burden of Heart Failure in Latin America: A Systematic Review and Meta- analysis. Rev Esp Cardiol (Engl Ed). 2016;69(11):1051-60. 11. Blecker S, Paul M, Taksler G, Ogedegbe G, Katz S. Heart failure-associated hospitalizations intheUnitedStates.JAmCollCardiol.2013;61(12):1259-67. 12. Fang J,MensahGA,Croft JB,KeenanNL.Heart failure-relatedhospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol. 2008;52(6):428-34. 13. AkintoyeE,BriasoulisA,EgbeA,DunlaySM,KushwahaS,LevineD,etal.National TrendsinAdmissionandIn-HospitalMortalityofPatientsWithHeartFailureinthe UnitedStates(2001-2014).JAmHeartAssoc.2017;6(12):piie006955 14. Godoy HL, Silveira JA, Segalla E, Almeida DR. Hospitalization and mortality rates for heart failure in public hospitals in Sao Paulo. Arq Bras Cardiol. 2011;97(5):402-7. 15. Mansur Ade P, Favarato D. Mortality due to cardiovascular diseases in Brazil and in themetropolitan region of Sao Paulo: a 2011 update. Arq Bras Cardiol. 2012;99(2):755-61. 16. Braunschweig F, CowieMR, Auricchio A.What are the costs of heart failure? Europace. 2011;13 Suppl 2:ii13-7. References (1992-1993) to 11.3 days (2008-2009) in Brazil. In the U.S., two authors reported a decrease in the length of stay due to HF, from 8.8 to 6.3 days (1993-2008) 21 and from 6.8 days (1999-2000) to 6.4 days (2007-2008). 4 In the U.S., the per capita cost with healthcare was greater than the per capita gross domestic product of Paraiba (US$8,364.00 and US$3,594.94, respectively). 24 The lower socioeconomic status in Paraiba may represent a risk factor for the high morbidity and mortality observed in our study, because the population has limited access to effective HF treatment. 24 In the U.S., 52.5% of people with a household income less than US$10,000 suffer from a cardiovascular disease 20,25 and Eapen et al. 26 found that a higher income was associated with lower odds of 30-day mortality after a HF admission. Limitations This is a retrospective and observational study, and the lack of patient-level data limited our ability to establish relationship between variables. Since our data was derived from a national database, it is likely that underreporting and misreporting of data have occurred. Also, since readmissions are not considered in the total number of HF hospitalizations, in-hospital mortality rate may have been underestimated. Conclusions This is the first study to analyze the epidemiology of HF in Paraiba, a less developed state of Brazil, and to compare the results with national and international data. Over the last 10 years, the increase of the in-hospital mortality rate for HF in Paraiba and in Brazil followed the LAC trend, whereas the increase in the duration of hospitalization for HF is opposite to the decrease seen in the U.S.. In Paraiba and Brazil, we observed a decrease in admission for HF as primary diagnosis as well as in the absolute in-hospital deaths for HF, agreeing with the LAC and U.S.. More than 87% of the HF deaths in Paraiba and Brazil involved patients older than 60 years old. There was a higher frequency of woman admitted for HF, both in Paraiba and Brazil, with similarmortality rates when compared tomen. Sincewomen are generally underrepresented in clinical trials, there is a need for more studies focusing on that population. Hospital-based clinical studies should be performed to identify the causes for the trend of increase in in-hospital mortality rate for HF. Author contributions Conception and design of the research: Fernandes ADF; Acquisition of data: Fernandes ADF, Knijnik LM, Fernandes GS; Analysis and interpretation of the data: Fernandes ADF, Fernandes GC, Knijnik LM; Statistical analysis: Fernandes ADF, FernandesGC, MazzaMR;Writing of themanuscript: Fernandes ADF, Fernandes GC, MazzaMR, Knijnik LM, Fernandes GS; Critical revision of the manuscript for intellectual content: Fernandes ADF, FernandesGC, Mazza MR, Knijnik LM, Vilela AT, Badiye A, Chaparro SV. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 230