Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia Hebert et al: Feasibility of Heart Failure Management

Background Little is known about the importation of a heart failure disease management program (HFMDP) into low and middle income countries (LMIC). Here we examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses. Methods and 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 (ED) 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. Beta-blocker prescriptions increased from 7.4% to 80.7% (P<0.001), angiotensin-converting enzyme inhibitor prescriptions increased from 18.4% to 92.6% (P<0.001) and mean systolic blood pressure declined from 145 mmHg to 114 mmHg (P<0.001). Patients visiting the ED 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 due to war-related events. Conclusions Importation of a Western HFDMP was demonstrated to be feasible with a 5fold increase in the use of recommended therapies, reduction of blood pressure, decrease of ED 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 LMIC requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions.