IJCS | Volume 32, Nº6, November / December 2019

DOI: https://doi.org/10.36660/ijcs.20190160 605 EDITORIAL International Journal of Cardiovascular Sciences. 2019;32(6):605-606 Mailing Address: Andreia Biolo Universidade Federal do Rio Grande do Sul - Medicina Interna - Rua Ramiro Barcelos, 2350. Postal Code: 90040-060, Porto Alegre, Rio Grande do Sul, RS – Brazil E-mail: abiolo@hcpa.edu.br The Burden of Heart Failure in Brazil: Are we Providing Better Care or Just more Expensive Care? Fernando Luis Scolari 1, 2 a nd Andreia Biolo 1, 3 Hospital de Clínicas de Porto Alegre, 1 Rio Grande do Sul, RS – Brazil Hospital Moinhos de Vento, 2 Rio Grande do Sul, RS – Brazil Universidade Federal do Rio Grande do Sul, 3 Rio Grande do Sul, RS – Brazil Editorial related to the article: Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul Heart Failure/physiopathology; Heart Failure/ mortality; Epidemiology; Hospitalization; UnifiedHealth System; Health Systems Plans; Mortality & Morbidity. Keywords Heart failure is one of the leading causes of cardiovascular morbidity and mortality and affects 0.5 to 2% of the population, 1 with significant costs for the healthcare system. 2 In 2012, heart failure accounted for over 270,000 hospitalizations in Brazil, corresponding to a cost of more than 170 million US dollars. 3 The knowledge of the profile of heart failure patients and treatment outcomes is crucial for the development of health policies and interventions aimed at reducing costs, morbidity and mortality. In this issue, Nicolao et al., 4 published a retrospective analysis of data from the Brazilian public health system (DataSUS), evaluating morbidity, mortality, and costs related to heart failure in adult patients, considering three geographic dimensions: the state of Rio Grande do Sul, its capital Porto Alegre city, and Brazil. 4 A ten-year period was selected, January 2007 to November 2017. Heart failure accounted for over one-quarter (25.38%) of the hospitalizations in the public health system in Brazil in 2007, with a reduction to 19.4% in 2017, with similar trends in Rio Grande do Sul state (18.4%) and Porto Alegre city (13%). Most patients were older than 40 years, with an increasing incidence of heart failure until the age of 79. There was an increase in the sex ratio, towards male, for patients admitted due to heart failure, mainly in Porto Alegre. Hospital length of stay increased in about one day, from 6.4 to 7.4 days in Brazil and from 6.7 to 7.5 in Rio Grande do Sul. However, in Porto Alegre, hospital length of stay differed from the other series, reaching 10.1 days in 2007, and with a slight increase to 10.6 days in 2017. The costs of heart failure hospitalization increased in all series, and it was more costly in Porto Alegre than in Brazil and Rio Grande do Sul state. Finally, mortality rate reduced over time from 2.67% to 2.17% in Brazil and from 2.86% to 2.16% in Rio Grande do Sul. Porto Alegre showed a greater reduction, from 2.02% to 0.79%. Taken together, these findings might reflect on more heart failure patients referrals to tertiary centers in Porto Alegre. This study has some limitations. First, since it analyzes data obtained from a national database, it relies on the correct completion of the authorization for hospital admission form. Additionally, it does not contemplate patients diagnosed with heart failure during hospitalization. This method does not allow us to understand the reasons of the changes in hospitalizations, length of stay and mortality rates, or whether these reductions were associated with changes in etiology, rate of optimal medical treatment and public policies. An analysis of individual data would be needed to answer these questions. The BREATHE study revealed that heart failure etiology differs among Brazilian regions. 5 In Rio Grande do Sul state, ischemic cardiomyopathy was the most common etiology, with comparable rates of Brazil, although hypertensive etiology was about 63% more prevalent than in the rest of the country. Bocchi et al., 5 also highlighted these discrepancies, since hypertension as the cause of HF ranged from 7% to 25% in some series. 6 In addition, Chagas disease affects 42% of HF patients in