The Challenges of Heart Failure Yesterday, Today and Tomorrow and the 20 Years of DEIC

Evandro Tinoco Mesquita Ana Paula Mendes Lidia Moura José Albuquerque de Figueiredo Neto Fabiana G. Marcondes-Braga Fernando Bacal Maria da Consolação Vieira Moreira Nadine Oliveira Clausell About the authors

Heart Failure/trends; Demographic Aging; Translational Medical Research; Guidelines; Scientific Production

The Department of Heart Failure of the Brazilian Society of Cardiology (DEIC) completes 20 years in 2020 and represents a robust legacy of scientific activities and associations of Brazilian cardiology.

Its foundation represented an important milestone in the fight against heart failure (HF), a complex progressive and often fatal clinical syndrome. HF should be addressed in a multidisciplinary way, supported by translational science and good practices (clinical guidelines and protocols), involving patients, families, caregivers, managers and the whole society, in view of its social impacts in Brazil and in the world.

With population aging and increased survival of patients with cardiovascular diseases, the prevalence of HF is increasing globally, with about 26 million people affected worldwide, in addition to thousands of undiagnosed cases.11. Ferreira JP, Krausy S, Mitchellz S, Perel P, Pineiro D, Chioncel O, et al. et al. World Heart Federation Roadmap for Heart Failure. Global Heart. 2019; 14(3):197-214.HF is the leading cause of hospitalization in the world and this results in an overload at all levels of care. It is estimated that HF affects approximately 2.5 million people in Brazil and a recent study has revealed its financial impact in Brazil, with an estimated expenditure of BRL 22.1 million/US$ 6.8 million in 2015.22. Stevens B, Pezzullo L, Verdian L, Tomlinson J, George A, Bacal F. Os custos das doenças cardíacas no Brasil. Arq. Bras. Cardiol. 2018; 111(1):29-36.Besides, the study revealed a substantial loss of well-being. Of the 521,941 years of life lost adjusted for disability, adjusted for comorbidities, there are 270,806 years of healthy life lost due to disability and 251,941 years of life lost as a result premature death.

DEIC was created under the leadership of Professor Maria da Consolação Vieira Moreira and had the support of Professor Gilson Soares Feitosa, then president of the Brazilian Society of Cardiology (1999–2001), mobilizing leaders from all over Brazil, particularly the professor Edimar Alcides Bocchi, leading the Heart Failure Study Group (GEIC) in 2000. On July 6, 2001, chaired by Professor Maria da Consolação, the 1stBrazilian Symposium on Heart Failure was held in Belo Horizonte during the 12thCongress of Society of Cardiology of Minas Gerais ( Chart 1 ).

Chart 1
– GEIC/DEIC Presidents.

With a successful history, built by HF leaders in Brazil, due to the growing number of members and relevance in scientific productivity, GEIC gradually became the Department of Heart Failure (DEIC), finally created in 2011, in the administration of Professor Fernando Bacal. This important fact occurred during the 10thBrazilian Congress of Heart Failure, celebrating 11 years since the foundation of GEIC, in the city of Belo Horizonte ( Chart 1 ).

Since its foundation, congresses of high scientific quality and international exchange have been held annually, providing the Brazilian medical community with the improvement of the state of the art of multidisciplinary care and treatment of HF. In the last congresses, we have had more than 1,000 registrants and about 200 papers have been presented, allowing exchanges of experiences with renowned specialists from various locations, from Brazil and the world. In 2020, due to the impacts of the pandemic of the new coronavirus, DEIC, in a revolutionary way, held a virtual congress — Heart Failure Summit Brazil 2020 — to present and discuss the main advances that, in the last 12 months, transformed the HF and will be reasons for changes to our HF Guideline due to be released in the first half of 2021 ( Chart 2 ).

Chart 2
– GEIC/DEIC Symposia and Congresses.

Fulfilling its scientific role, DEIC has an important project of Guidelines and Updates, intended to demonstrate strategies and propose evidence-based recommendations. The first HF Guideline, in the form of a consensus, was published in 1992, before the DEIC was created. It was published in São Paulo and was coordinated by the esteemed master Dr. Michel Batlouni ( Chart 3 ).

Chart 3
– Consensuses and Guidelines

In 2014, the 1stBrazilian Registry of Heart Failure — Clinical Aspects, Quality of Care and Hospital Outcomes — BREATHE was published. It was organized by Professor Denilson Campos de Albuquerque and outlined a picture of HF in hospitalized patients around the country, identifying the incorporation of diagnostic methods and therapeutic interventions. The Brazilian Registry of Takotsubo Syndrome, led by Professor Marcelo Westerlund Montera, is currently underway.

DEIC has taken a contemporary stance and expanded its technical and scientific scope, working on chronic HF, acute HF (emergency room/cardiovascular intensive care unit), advanced HF (heart transplantation/mechanical circulatory support), HF in children and adolescents and cardiomyopathies. In Cardiomyopathy, we had the pioneering spirit of teachers Marco Aurélio Dias, Francisco Manes Albanesi, Raul Carlos Pareto Junior, Antonio Carlos Pereira Barreto, Charles Mady, who helped train leaders in HF.

Over the last five years, the following study groups were created in important thematic areas: GETAC (Heart Transplant and Mechanical Circulatory Assistance Study Group), GEICPED (Study Group on HF in Children and Adults with Congenital Heart Diseases) and GEMIC (Cardiomyopathy Study Group). From a modern perspective, we are organizing ourselves to build an ecosystem for inter and multidisciplinary collaboration and cooperation in different sub-areas, which has been a trend in the following international HF societies: HFA-ESC (https://www.escardio.org/Sub-specialty-communities/Heart-Failure-Association-of-the-ESC-(HFA) and HFSA (https://hfsa.org/) ( Chart 4 ).

Chart 4
– Medical Residency Programs and Specialization Courses in Advanced HF and Heart Transplantation

In 2004, the GEIC for the Youth was created to encourage the scientific and associative development of young cardiologists interested in HF. The first meeting held at the Brazilian Congress of Heart Failure in Salvador (2004), since then, has been changing each year and adding new leaders and now bringing innovation and entrepreneurship to our attendees.

Reaffirming its social role, with community actions and health policies, in the 73rdBrazilian Congress of Cardiology (2018), DEIC president Salvador Rassi and scientific director Evandro Tinoco Mesquita made official the National Day of Alert against Heart Failure,33. Mesquita ET, Grippa de Souza ALAA, Rassi S. Dia de alerta da insuficiência cardíaca: um tributo ao gênio Carlos Chagas. Arq Bras Cardiol. 2019; 113(1):5-8.celebrated on the 9thof July. The date was chosen because it was the day of birth of Carlos Chagas, our patron. This first “modern cardiologist” confirms the quote from the late Professor Nelson Botelho, as he used a translational view bringing the bench closer to the bed and connecting a look at population health in Chagas disease. Besides, we created the Carlos Chagas commendation from DEIC for colleagues outstanding in teaching/education, assistance, innovation, science and associations. In collaboration with REBRIC (Brazilian Network of Heart Failure) we work not only with alerts against HF, but also with the application of literacy, building tools for self-care and improvement of clinical outcomes (https://www.rebric.com.br/).

The next decade brings us new challenges: firstly, cementing the paths to a new area of expertise in cardiology — the HF specialist. In the present decade, in line with a contemporary view well established in other countries, several initiatives were introduced to promote and train HF specialists, ensuring education with technical and scientific quality.

In addition, a broader look at prevention in HF involves understanding the model of chronic cardiometabolic disease,44. Mechanick JI, Farkouh ME, Newman JD, Garvey T. Cardiometabolic-based chronic disease adiposity and dysglycemia drivers. J Am Coll Cardiol. 2019; 75(5):525-38.making it essential to combine systemic arterial hypertension, obesity, dyslipidemia and diabetes mellitus in the genesis, progression and treatment of HF. Lastly, the need for comprehensive care of HF, involving general practitioners, geriatricians, internists, intensivists and palliative care specialists. Besides, advances in artificial intelligence,55. Souza Filho EM, Fernandes FA, Soares CLA, Seixas FL, Santos AA, Gismondi RA, Inteligência artificial em cardiologia: conceitos, ferramentas e desafios – “quem corre é o cavalo, você precisa ser o jóquei”. Arq Bras Cardiol. 2020; 114(4):718-25.digital medicine and genomics are building personalized cardiovascular medicine in HF that will transform the concepts of prevention, diagnosis and treatment, as it has been developed in cardiac amyloidosis and hereditary cardiomyopathies. The COVID-19 pandemic further establishes the concept of cardiovascular surveillance,66. Figueiredo Neto JA, Marcondes-Braga FG, Moura LZ, Figueiredo AM, Figueiredo V, Rocha RM, et al. Doença de coronavírus-19 e o miocárdio. Arq Bras Cardiol. 2020; 114(6):1051-7. , 77. Fernandes F, Ramires FJA, Fernandes FD, Simões MV, Mesquita ET. Afecções pericárdicas em pacientes com COVID-19: uma possível causa de deterioração hemodinâmica. Arq Bras Cardiol. 2020; 115(3):569-573. as studies that used cardiac resonance imaging found that, even in people without symptoms, there is a degree of aggression to the heart that should be studied regarding the future risk of developing dilated cardiomyopathy and symptomatic heart failure.

To celebrate the 20 years of DEIC, we gathered the achievements of our brilliant story and applauded the cardiologists, whose work and dedication were responsible for the excellence and success of the department. It is a great honor to revive and revere the past, envisioning a future with the challenge of producing new ideas and renewing ourselves ( Figure 1 ).

Figure 1
– Challenges of DEIC 2020–30

References

  • 1
    Ferreira JP, Krausy S, Mitchellz S, Perel P, Pineiro D, Chioncel O, et al. et al. World Heart Federation Roadmap for Heart Failure. Global Heart. 2019; 14(3):197-214.
  • 2
    Stevens B, Pezzullo L, Verdian L, Tomlinson J, George A, Bacal F. Os custos das doenças cardíacas no Brasil. Arq. Bras. Cardiol. 2018; 111(1):29-36.
  • 3
    Mesquita ET, Grippa de Souza ALAA, Rassi S. Dia de alerta da insuficiência cardíaca: um tributo ao gênio Carlos Chagas. Arq Bras Cardiol. 2019; 113(1):5-8.
  • 4
    Mechanick JI, Farkouh ME, Newman JD, Garvey T. Cardiometabolic-based chronic disease adiposity and dysglycemia drivers. J Am Coll Cardiol. 2019; 75(5):525-38.
  • 5
    Souza Filho EM, Fernandes FA, Soares CLA, Seixas FL, Santos AA, Gismondi RA, Inteligência artificial em cardiologia: conceitos, ferramentas e desafios – “quem corre é o cavalo, você precisa ser o jóquei”. Arq Bras Cardiol. 2020; 114(4):718-25.
  • 6
    Figueiredo Neto JA, Marcondes-Braga FG, Moura LZ, Figueiredo AM, Figueiredo V, Rocha RM, et al. Doença de coronavírus-19 e o miocárdio. Arq Bras Cardiol. 2020; 114(6):1051-7.
  • 7
    Fernandes F, Ramires FJA, Fernandes FD, Simões MV, Mesquita ET. Afecções pericárdicas em pacientes com COVID-19: uma possível causa de deterioração hemodinâmica. Arq Bras Cardiol. 2020; 115(3):569-573.

  • Study Association
    This study is not associated with any thesis or dissertation work.

  • Sources of Funding .There were no external funding sources for this study.

Publication Dates

  • Publication in this collection
    01 Mar 2021
  • Date of issue
    Feb 2021

History

  • Received
    10 Nov 2020
  • Reviewed
    19 Nov 2020
  • Accepted
    02 Dec 2020
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