Abstract P133: Impact of a Systolic Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia

Introduction The prevalence and potential for disease management of heart failure is unknown in most low and middle income countries (LMIC) such as Georgia, located in the Caucuses. We examined the feasibility of importing a heart failure disease management program (HFDMP) into this population, which has a particularly high incidence of hypertension. Methods This is a prospective, nonrandomized, observational study in which patients with an ejection fraction ≤ 40% were enrolled into a new HFDMP staffed by local cardiologists after they received training in evidence-based HFDM. Medications, ER use, hospital admissions, and mortality during 16 months follow-up were assessed by patient interviews or by phone interviews with family members. Results The follow-up period for 400 enrolled patients ranged from 5-16 months. Beta blocker use increased from 7.5% at baseline to 82.4% and ACEI inhibitor use from 19.3% to 90.8%. Mean systolic blood pressure declined from 146 mmHg to 115 mmHg. ER use and hospitalizations were reduced by 42.5% and 54.6% respectively, but were also influenced by the outbreak of war, during which 17.5% (N=70) of patients received follow-up in refugee tents rather than clinic buildings. All cause mortality was 75.9 % during the 16 month follow-up of the study, with 12/23 deaths from war related events. Conclusion Importation of a Western HFDMP was demonstrated to be feasible. Use of evidence-based medication increased more than 4-fold, and was associated with blood pressure reduction and apparent reduction in ER visits and hospitalizations. These measures could result in substantial cost savings in resource-limited settings, but assessment of the impact is complicated in unstable areas. Translating effective interventions to LMIC requires sensitivity to local cultures and events of war and a willingness to adapt both clinical goals and strategies to unexpected conditions.