title: Health outcomes in decompensated congestive heart failure: a comparison of tertiary hospitals in Brazil and United States.
abstract: BACKGROUND
  Few international studies prospectively compared evidence-based practices and health outcomes among congestive heart failure (CHF) cohorts from countries with different cultural and economic backgrounds.
  
  
  METHODS
  Patients consecutively admitted with congestive heart failure to tertiary care teaching hospitals in Brazil and in the United States (U.S.) were systematically evaluated using a structured data form. Follow-up data 3 months after discharge were obtained using chart review and telephone interviews.
  
  
  RESULTS
  U.S. patients were older (p < 0.01), had higher prevalence of ischemic etiology (p < 0.01) and less previous hospitalizations for congestive heart failure (p = 0.03) than Brazilian patients, but similar Charlson comorbidity scores (p = 0.54) and left ventricular (LV) function (p = 0.45). Prescription of angiotensin-converting enzyme inhibitors at discharge was lower at the U.S. hospital (57% vs. 68%; p = 0.03), but beta-blockers prescription was higher (37% vs. 10%; p < 0.01). Length-of-stay was significantly shorter (5 [interquartile range, 3-9] vs. 11 [6-19] days; p < 0.001) and in-hospital mortality was lower (2.4% vs. 13%; p < 0.001) in the U.S. cohort, but fewer clinical events within 3 months after discharge were observed in Brazilian patients (42% vs. 54%; p = 0.02). Combined clinical outcomes within 3 months, including overall mortality and hospital readmission, were similar between cohorts (57% vs. 55%; p = 0.80). In multivariate analysis, hospital site remained significantly associated with health outcomes.
  
  
  CONCLUSIONS
  Medical practice and health-related outcomes were different between U.S. and Brazilian congestive heart failure patients. In order to improve management worldwide, potential factors (structural, cultural or disease-related) that might be associated with these differences need to be evaluated in future studies.
authors.affiliation: Heart Failure and Cardiac Transplantation Units, Divisions of Cardiology at the Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul Medical School, Porto Alegre, Brazil. lerohde@terra.com.br
authors.forename: Luis E
authors.initials: LE
authors.lastname: Rohde
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Jorge Pinto
authors.initials: JP
authors.lastname: Ribeiro
authors.forename: Lívia
authors.initials: L
authors.lastname: Goldraich
authors.forename: Rafael
authors.initials: R
authors.lastname: Netto
authors.forename: G
authors.initials: G
authors.lastname: William Dec
authors.forename: Thomas G
authors.initials: TG
authors.lastname: DiSalvo
authors.forename: Carísi A
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors