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OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

ABSTRACT The objective of this study was to evaluate the standardized ileal digestible (SID) valine and SID leucine levels on performance, backfat thickness, longissimus dorsi depth, and biochemical blood parameters of starting gilts. A total of 72 gilts, with initial weight of 15.16±1.15 kg, were distributed in a randomized block design in a 2 × 4 factorial scheme, comprised of two SID leucine levels (1.20 and 1.77%) and four SID valine levels (0.58, 0.73, 0.88, and 1.03%), with nine replicates and one animal per experimental unit. No interactions were observed for growth performance parameters. Final weight and average daily gain presented linear and quadratic effects. Setting data to the quadratic model associated with the Linear Response Plateau model, the optimal level of SID valine for average daily gain was achieved at 0.703%. A quadratic effect was also observed for average daily feed intake (ADFI), estimating the highest ADFI at 0.822% of SID valine. No branched chain amino acid (BCAA) effects were observed for backfat thickness, longissimus dorsi depth, and lean meat percentage. The interaction between levels of BCAA showed that the highest SID leucine levels (1.77%) provided a high plasma urea concentration only at low SID valine levels (0.58 and 0.73%). The SID valine requirement of starting gilts for a maximum average daily gain is achieved at 0.703%, corresponding to 9.72 g day−1, and is not affected by SID leucine levels currently used in conventional diets.

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ta	título abreviado da revista (ex. Cad. Saúde Pública)
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type	tipo do documento
pid	identificador da publicação
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