IJCS | Volume 32, Nº6, November / December 2019

606 1. Benjamin EJ, Muntner P, AlonsoA, BittencourtMS, CallawayCW, Carson AP, et al. Heart disease and stroke statistics–2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528. 2. LesyukW, Kriza C, Kolominsky-Rabas P. Cost-of-illness studies in heart failure: a systematic review 2004-2016. BMC Cardiovasc Disord. 2018 May 2;18(1):74. 3. Ribeiro AL, Duncan BB, Brant LC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular Health in Brazil: Trends and Perspectives. Circulation. 2016 Jan 26;133(4):422-33. 4. Nicolao CZ, Ferreira BJ, Paz AA, Linch GFC, Rover M, de Souza EN. Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul. Int J Cardiovasc Sci. 2019;32(6):596-604. 5. Albuquerque DC, Neto JD, Bacal F, Rohde LE, Bernardez-Pereira S, Berwanger O, et al; Investigadores Estudo BREATHE. I Brazilian Registry of Heart Failure - Clinical aspects, care quality and hospitalization outcomes. Arq Bras Cardiol. 2015;104(6):433-42 6. Bocchi EA, Arias A, VerdejoH, DiezM, Gómez E, Castro P; Interamerican Society of Cardiology. The reality of heart failure in Latin America. J Am Coll Cardiol. 2013 ;62(11):949-58. 7. Kristensen SL, Martinez F, Jhund PS, Arango JL, Bĕlohlávek J, Boytsov S. Geographic variations in the PARADIGM-HF heart failure trial. Eur Heart J. 2016;37(41):3167-3174. References Scolari & Biolo Epidemiology of heart failure in Brazil Int J Cardiovasc Sci. 2019;32(6):605-606 Editorial the Central-West region, but only 2% in the South. 5 In a continental country like Brazil, there are also important discrepancies in terms of access to public health system and educational levels between states. These findings help understand differences in hospitalization and mortality rates between Rio Grande do Sul state and Brazil. Complex cases are usually referred to the largest hospitals in Rio Grande do Sul, located in Porto Alegre, whichmay explain the longest length of stay and highest costs in this city. The city has three public hospitals with heart failure and transplant teams, which may promote better care and lower mortality rate. The authors also showed that the increase in costs over time occurred in parallel to a decrease in mortality, and that might reflect improvement in quality of care. It is not known whether costs increased due to greater investment in health system or to economic inflation. Only about two-thirds of patients in Brazil receive guideline-based treatment on hospital discharge. 3 Public policies are needed to increase the rate of guideline- based treatment in heart failure patients not only in Brazil but also in Latin America. Our continent has the highest rates of mortality (8.2 events per 100 patients- year) in comparison with others, such as the Western Europe, with 4.8 events per 100-patients year. 7 The recent incorporation of sacubitril/valsartan to the list of medications available in the Brazilian public health systemmay have a positive impact on the outcome rates in the next decade, but still, there is a lot of work to be done. Control of Chagas disease vector, treatment of hypertension according to recent guidelines, and lower obesity/physical inactivity rates are important goals to be achieved to reduce the burden of heart failure in our country. In addition, a better care during the vulnerable phase after hospital discharge could help avoid readmissions. In conclusion, the authors showed that trends in heart failure have changed in the last decade. Although the cost of heart failure has increased, hospitalization and mortality rates decreased over time, especially in Porto Alegre city. By knowing these regional differences, a more organized network could be built to offer more specialized care to the sickest patient. There is an urgent need for more studies on the epidemiology of cardiovascular disease and heart failure in Brazil and its regions, to optimize the provision of funds and development of policies to improve the care provided to these patients and outcomes achieved. So far, the lower mortality rates observed point towards a better, not just more expensive, care. This is an open-access article distributed under the terms of the Creative Commons Attribution License