IJCS | Volume 32, Nº6, November / December 2019

600 Figure 5 - Mean per-patient cost of an HF-related hospitalization in the period from 2007 to 2016 in Brazil, RS and Porto Alegre. Source: Elaborated by the author based on data obtained from DATASUS (2017). Nicolao et al. Heart failure: morbidity and mortality Int J Cardiovasc Sci. 2019;32(6):596-604 Original Article In the assessment of proportional mortality due to heart failure, all regions studied showed a reduction in in-hospital mortality. Rio Grande do Sul and Brazil showed a decrease in mortality rates to 25% and 19%, respectively. A more significant decrease was observed in Porto Alegre, where the percentage change reduced to 61%, during the period studied, as shown by Figure 6. Discussion This study presents an overview of the morbidity and mortality due to heart failure in the Unified Health System, over a 10-year period in Brazil, in Rio Grande do Sul and Porto Alegre. This overview shows, in general terms, a decrease in admissions and mortality rates due to heart failure over the years. Even though Porto Alegre has the longest length of hospital stay and, therefore, higher costs, it still presents the lowest admission rates and less mortality. The age range followed a similar trend in all regions. Finally, it is worth to mention that, over time, more men than women have been affected by HF, since there was a male predominance in two out of the three regions studied. As for the percentage of admissions for diseases of the circulatory system, a decrease in HF hospitalizations was observed in Brazil in the period studied. This data suggests that the treatment of HF patients has been effective in the national territory. However, the BREATHE study shows that there is a considerable gap in HF treatment in Brazil, since treatments do not follow the guidelines currently published. 8 On the contrary, the decrease in the percentage of admission has an impact on the aspects that characterize HF as a chronic disease with high morbidity and mortality, since the decrease in admissions expresses an improvement in the assistance provided to the patients in the last years. Similarly, data from Rio Grande do Sul and Porto Alegre suggest that local institutions are in consonance with the latest guidelines published. In addition, greater population access to medication and patient education about drug and non-drug treatment may explain the decrease in hospitalizations over the years. It is well known that adherence to treatment has an impact on the prognosis of HF patients. 10 A previous study that assessed admissions for HF through theGlobal Health database and theWorldHealth Organization (WHO) database showed that admissions due to HF account for 2.9% of admissions in developing countries, including Brazil. In low-income countries, HF admissions account for 31% of hospitalizations in public healthcare. 11 A previous study that assessed HF admissions for 12 years in Brazil reported that, even