Impact of a structured educational intervention on attitudes and practice of heart failure in Latin America

Lucrecia M. Burgos, Heart Failure, Pulmonary Hypertension, and Transplant Service, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
María P. Duczynski, Cardiology Department, Fundación Favaloro, Buenos Aires, Argentina
María L. Coronel, Cardiology Service, Instituto de Cardiología de Corrientes Juana F. Cabral, Corrientes, Argentina
Jorge Thierer, Heart Failure Unit, CEMIC, Buenos Aires, Argentina

Objective: The implementation of heart failure (HF) guidelines in actual practice is rarely adequate and most patients do not receive optimal treatments. Our aim was to assess changes in attitudes, knowledge, confidence, and care pathways of HF patients among physicians in Argentina after a structured educational intervention. Methods: Cross-sectional survey in 22 public and private health centers of physicians who participated in a comprehensive multi-module educational program (patient identification, classification/therapeutic options in advanced HF, structure/organization of the HF Day Hospital, education of patients in different stages/scenarios, and education of nursing staff in the management of patients at different stages/scenarios). Simple evidence-based roadmaps were created to address knowledge gaps. Results: The intervention improved physicians’ confidence in the diagnosis of HF with preserved ejection fraction (p < 0.001), and prioritization of quadruple therapy for outpatients (p = 0.01) and patients with acute HF (p < 0.001). The proportion of “confident”/”very confident” physicians in identifying HF patients with reduced ejection fraction who could benefit from an implantable cardioverter-defibrillator increased significantly (p = 0.01), as did the relevance of hypertonic saline administration and intravenous iron infusions. The use of discharge checklists increased significantly after the intervention. Conclusions: This multifaceted, structured intervention was effective in improving physicians’ confidence and attitudes, as well as their knowledge and care pathways of HF patients in Argentina.

Keywords: Heart failure. Educational intervention. Attitudes. Argentina.