title: Clinical and demographic profile and quality indicators for heart failure in a rural area.
abstract: BACKGROUND
  data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics.
  
  
  OBJECTIVE
  To establish the clinical and demographic profile and quality indicators for HF in rural areas.
  
  
  METHODS
  Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fisher's exact tests were used for analysis of proportion, as well as the Student's t-test for numeric variables, in order to establish the population's characteristics.
  
  
  RESULTS
  Mean age was 61+/-14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant.
  
  
  CONCLUSIONS
  In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.
authors.affiliation: Faculdade de Medicina de Valença, Valença, RJ, Brasil.
authors.forename: Henrique Miller
authors.initials: HM
authors.lastname: Balieiro
authors.forename: Raphael Kasuo
authors.initials: RK
authors.lastname: Osugue
authors.forename: Samuel Pereira
authors.initials: SP
authors.lastname: Rangel
authors.forename: Raphael
authors.initials: R
authors.lastname: Brandão
authors.forename: Tatiana Leal
authors.initials: TL
authors.lastname: Balieiro
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bernardez
authors.forename: Evandro Tinoco
authors.initials: ET
authors.lastname: Mesquita
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012423:Rural Health; D012424:Rural Population; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013318:Stroke Volume / Q000502:physiology