title: Feasibility of a heart failure disease management program in eastern Europe: Tbilisi, Georgia.
abstract: BACKGROUND
  Little is known about the importation of a heart failure disease management program (HFDMP) into low- and middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses.
  
  
  RESULTS
  Patients with ejection fraction ≤40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists. Medications, emergency department use, hospital admissions, and mortality were assessed by interviews with patients or their families. Screening resulted in 400 patients who were followed for 10.2±3.5 months. β-Blocker prescriptions increased from 7.4-80.7% (P<0.001), angiotensin-converting enzyme inhibitor prescriptions increased from 18.4-92.6% (P<0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (P<0.001). Patients visiting the emergency department and hospitalizations were lowered by 40.7% and 52.5%, respectively, but were also influenced by the outbreak of war, during which 17.5% (n=70) of patients received follow-up in refugee tents. All-cause mortality extended to 7% of patients, with 12 of 28 deaths caused by war-related events.
  
  
  CONCLUSIONS
  Importation of a Western HFDMP was demonstrated to be feasible, with a 5-fold increase in the use of recommended therapies, reduction of blood pressure, decrease of emergency department visits, and hospitalizations for heart failure. These measures could result in substantial cost savings in resource-limited settings, but assessment is complicated in unstable areas. Translating effective interventions to low- and middle-income countries requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions.
authors: Cardiovascular Division, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA. Khebert1@gmail.com
authors: Kathy
authors: K
authors: Hebert
authors: Henry C
authors: HC
authors: Quevedo
authors: Ilia
authors: I
authors: Gogichaishvili
authors: Nino
authors: N
authors: Nozadze
authors: Ekaterine
authors: E
authors: Sagirashvili
authors: Patrick
authors: P
authors: Trahan
authors: Nicholas
authors: N
authors: Kipshidze
authors: Lee M
authors: LM
authors: Arcement
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019468:Disease Management; D005061:Europe, Eastern / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006297:Health Services Accessibility; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D012923:Social Class; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors