ABC | Volume 114, Nº2, February 2020

Short Editorial Arq Bras Cardiol. 2020; 114(2):232-233 Timóteo Heart failure trends in Paraíba 1. Ponikowsky P, Anker SD, AlHabib KF, Cowle MR, Force TL, Hu S, et al. Heart Failure: preventing disease and death worldwide. ESC Heart Fail.2014;1(1):4-25. 2. Savarese G, Lund LH. Global public health burden of heart failure. Cardiac Fail Rev. 2017;3(1):7-11. 3. Chen J, Ross JS, CarlsonMD, Lin Z, Normand SL, BernheimSM, et al. Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction. Am J Med. 2012;125(1):100e1-9. 4. Cook C, ColeG, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171(3):368-76. 5. Fonseca C, Brás D, Araújo I, Ceia F. insuficiência cardíaca em números: estimativasparaoséculoXXIemPortugal.RevPortCardiol.2018;37(2):97-104. 6. Gouveia M, Ascenção R, Fiorentino F, Costa J, Caldeira D, Broeiro-Gonves P, et al. The current and future burden of heart failure in Portugal. ESCHeart Fail.2016;6(2):254-61. 7. Lee WC, Chavez YE, Baker T, Luce BR. Economic burden of heart failure: a summary of recent literature. Heart and Lung; J Critical Care. 2004;33(6):362-71. 8. Crespo-LeiroMG, Anker SD, Maggioni AP, Coats AJ, Filipatos G, Ruschitzka F, et al. European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016;1(6):613-25. 9. Fernandes ADF, Fernandes GC, MazzaMR, Knijnik LM, Fernandes GS, Vilela AT. Insuficiência cardíaca no Brasil subdesenvolvido: análise e tendência de dez anos. Arq Bras Cardiol. 2020; 114(2):222-231. 10. Callender T,WoodwardM, RothG, Farzadfar F, LeMarie JC, Glicquel S, et al. Heart failure care in low- andmiddle-income countries: a systematic review and meta-analysis. PLoS Med. 2014;11():e1001699. 11. McMurray JJ, O´Connor C. Lessons from the TOPCAT trial. N Engl J Med 2014 Apr 10; 370:1453-4. References This is an open-access article distributed under the terms of the Creative Commons Attribution License dominant in the coming years, because in the past 20 years, trends have been reported on the increasing proportion of patients with HFpEF and relatively stable/decreasing rates of HFrEF 2 . In fact, the increase in HF prevalence might not be related to an increase in incidence. The aging of the population, together with improved HF survival, particularly in HFrEF, due to advancements in treatment is a likely explanation. 2 In addition, prevention programs might be reducing the incidence, with lower severity and better treatment of ischemic heart disease. 2 However, risk factors for coronary artery disease are still increasing. Thus, a reduction in HFrEF is expected, as well as an increase in HFpEF with consequent more cases of HF admissions due to HFpEF, with a lower mortality compared to HFrEF. 2 The reduction in hospital admissions must also be clarified. Information regarding HF disease management program availability or the use of implantable devices (involving patient characteristics but also resource availability and reimbursement structure) can explain that reduction. 1,3 Another possible explanation is that HF patients might be detected earlier in the course of disease, and with that, premature hospital admissions can be avoided. If they are treated according to guidelines, this can also delay and reduce hospital admissions and mortality. 1 Early diagnosis and optimal treatment are important quality indicators for the treatment of HF, and this is also a question to be addressed. Is the medical assistance in Paraíba significantly different from that in the rest of the country? Is it mostly private practice or a public system of health care? What is patient accessibility to healthcare like and what were the improvements obtained (if any) in the last years? If feasible, all those questions about socio-economic conditions and healthcare data should be analyzed from 2008 to 2017 to see what the trend is and to better identify the main specificities that require investment. 233