Treatment Patterns of Chronic Heart Failure (CHF) In Brazil

VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3

to assess the impact of CHF. Patient record forms (PRF) were completed by 50 cardiologists for 8 consecutive patients with CHF. The same patients were invited to complete a patient self-completion questionnaire.  Results: The PRF (n= 394) data revealed that a typical CHF patient was male (62%) with a mean age of 64.8 years. Physicians reported a shorter duration of time that patients experienced symptoms before visiting a doctor; reporting 36 weeks, versus the patient-reported 39.8 weeks. Patients on average had been diagnosed for two years and the majority (66%) were considered to be stable/compensated. Cause: Hypertension was the leading cause of CHF (58%), followed by CHD/Myocardial infarction (33%). Physical signs/examinations were used to diagnose and monitor CHF; the key tests were blood pressure and heart rate. For 54% (n= 211) of patients, the primary reason for consultation was diagnosis and/or testing of CHF symptoms. The lower a patient’s ejection fraction, and the more severe the NYHA functional classification, the more unstable/decompensated the patient was considered to be. Hospitalization: In the last year, 42% of patients were hospitalized for CHF, 7% of which were readmitted to hospital within 30 days (n= 8). Physicians believed that half of patients were at a moderate or greater risk of being hospitalised and/or dying in the next year. Treatment: 75% of doctors and patients were in agreement about how the last treatment decision was made. Nearly 70% of patients received a Beta Blocker; 55% received Loop Diuretics, 52% received Statins, and 51% were prescribed ACE (angiotensin-converting-enzyme) inhibitors. Physicians reported that only 5% of patients took OTC (over-the-counter) CHF treatment.  Conclusions: These data are important for better understanding treatment patterns and characteristics of CHF in Mexico.

PCV28 Treatment Patterns of Chronic Heart Failure (CHF) In Brazil Lopes N1, Jackson J2, Cotton S2, Proenca C3, Calado F3, MacPherson A4, Barbeau M5 1Novartis Biociências SA, Sao Paulo, Brazil, 2Adelphi Real World, Bollington, Macclesfield, UK, 3Novartis Pharma AG, Basel, Switzerland, 4Dalhousie University, Halifax, NS, Canada, 5Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada

Objectives: To understand the disease and treatment patterns of Chronic Heart Failure (CHF) in Brazil.  Methods: A Disease Specific Program was conducted to assess the impact of CHF. Patient record forms (PRF) were completed by 45 cardiologists for 443 patients with CHF. The same patients were invited to complete a patient self-completion questionnaire.  Results: PRF data (n= 443) revealed that a typical CHF patient was male (55%) with a mean age of 65.7 years. Physicians underestimated the length of time patients experienced symptoms before visiting a doctor; reporting 25.3 weeks, versus the patient-reported 47.1 weeks. Patients on average had been diagnosed for two and a half years and the majority (54%) were considered to be stable/compensated. Cause: Hypertension was the leading cause of CHF (60%), followed by CHD/Myocardial infarction (23%). Physical signs/ examinations were used to both diagnose and monitor CHF; the key tests were blood pressure and heart rate. For 33% (n= 141) of patients, the primary reason for consultation was diagnosis and/or testing of CHF symptoms. The lower a patient’s ejection fraction, and the more severe the NYHA functional classification, the more unstable/decompensated the patient was considered to be. Hospitalization: In the last year, 24% of patients were hospitalized for CHF, 16% of which were readmitted to hospital within 30 days (n= 11). Physicians believed two fifths of patients were at a moderate or greater risk of being hospitalised and/or dying within the next year. Treatment: 71% of doctors and patients were in agreement about how the last treatment decision was made. Approximately 70% of patients received Beta Blockers; 58% received Ace Inhibitors, 58% received Statins, and 55% were prescribed Loop Diuretics. Physicians reported that 92% of patients did not take OTC (overthe-counter) CHF treatments.  Conclusions: These data are important for better understanding treatment patterns and characteristics of CHF in Brazil.

DIABETES/ENDOCRINE DISORDERS – Clinical Outcomes Studies PDB1 GLYCEMIC CONTROL IN PATIENTS WITH T2DM TREATED WITH SULFONYLUREAS ALONE OR IN COMBINATION WITH METFORMIN, ARGENTINA Monti CI MSD Argentina, Munro, Buenos Aires, Argentina

Objectives: Glycemic control in patients with T2DM treated with sulfonylureas alone or in combination with Metformin, Argentina  Methods: Multicenter observational study based on retrospective analysis of clinical histories and cross-sectional analysis of surveys of patients and physicians. 397 patients who satisfied inclusion and exclusion criteria were collected between June and November 2015 and their medical records were reviewed by leading researchers from 16 centers in Argentina.  Results: Patient´s mean age was 62.5 years (range: 33 to 89 years), 54.2% male. Mean disease duration was 9.9 years (range: 1 to 44 years). A 45.5% (95% CI: 40.4 – 50.5%) of patients self-reported at least one episode of hypoglycemia in the last 6-months compared to 21.4% (95% CI: 17.2 - 25.6%) documented in medical chart reviews. The agreement between self-reported and medical chart registered hypoglycemia was measured by the kappa concordance coefficient and it showed a moderate agreement (kappa= 0.47). Patients who Self-reported hypoglycemia had more mobility problems: 37.8% vs. 23%, p=  0.004; and more pain/discomfort: 61.5% vs. 43.4%, p= 0.001 than those who didn´t had hypoglycemia. In chart registered hypoglycemia, patients had more mobility problems: 42.9% vs. 26.3% p= 0.002, and more pain/discomfort: 62.2% vs. 48.7% p= 0.05 than those without hypoglycemia episodes. Patients who self-reported hypoglycemic events had lower satisfaction scores for the side effects dimension on the TSQM than those patients who did not selfreport hypoglycemia (mean scores 87 vs. 98, respectively; p< 0.001)  Conclusions: Hypoglycemic events are frequent in patients receiving SUs and are associated with deterioration in certain dimensions of QoL and a lower satisfaction score for some dimensions of the TSQM.

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PDB2 GROWTH FACTORS FOR THE MANAGEMENT OF DIABETIC FOOT ULCERS: MIXED TREATMENT COMPARISONS OF RANDOMIZED CONTROLLED TRIALS Sridharan K1, Sivaramakrishnan G2 1Fiji National University, Suva, Fiji, 2Fiji National University, Suva, Fiji, Fiji

Objectives: Topical growth factors accelerate wound healing in patients with diabetic foot ulcers (DFU). In the absence of head to head comparisons, we carried out a network meta-analysis comparing the efficacy and safety of growth factors.  Methods: Using an appropriate search strategy, randomized controlled trials on topical growth factors compared with standard of care in patients with DFU, were included. Odds ratio [95% confidence interval] was used as the effect estimate and random effects model was used for both direct and indirect comparisons. Markov Chain Monte Carlo simulation was used to obtain pooled estimates. Rankogram was generated based on surface under the cumulative ranking curve (SUCRA).  Results: A total of 26 studies with 2088 participants and 1018 events were included. No inconsistency was observed. The pooled estimates for recombinant epidermal growth factor (rhEGF), autologous platelet rich plasma (PRP), recombinant human plateletderived growth factor (rhPDGF) were 5.72 [3.34, 10.37], 2.65 [1.60, 4.54] and 1.97 [1.54, 2.55] respectively. SUCRA for rhEGF was 0.95. Sensitivity analyses did not have a significant effect on the pooled estimates and rankogram. No differences were observed in the overall risk of adverse events between the growth factors.  Conclusions: To conclude, rhEGF, rhPDGF and autologous PRP were found to significantly improve the healing rate when used as adjuvant to standard of care. Recombinant human epidermal growth factor may perform better than other growth factors. PDB3 DATABASE ANALYSIS OF A SUPPORT PROGRAM FOR PEDIATRIC PATIENTS USING SOMATROPIN DUE TO GROWTH HORMONE DEFICIENCY (GHD) Biglia LV, Seiler P, Souza PV Merck, São Paulo, Brazil

Objectives: Endocare is a pediatric patient support program for children treatment with somatropin for growth hormone deficiency (GHD) among other indications. Since its launching in 2009, a database was developed to gather epidemiological information and to identify treatment profile of these pediatric patients. Our goal is to analyze this information.  Methods: Information such as age, gender, state, city, treatment duration and dropout rates and causes were included. Age of start and end of treatment are also part of the data. All patients in the program use / used an electronic device for application and various presentations of somatropin.  Results: In eight years of Endocare, there were 5,037 patients, among those, 52% are currently on treatment. On those 48% who discontinued treatment, 68% were due to medical guidance, clinical reassessment or end of treatment. Among all causes of drop outs, only 3.5% were caused by difficulty of application and fear of needle. Only 1 patient (0.04%) claimed to drop out due to lack of information.  Conclusions: The analysis of the database allows us to observe that the majority of dropouts are due to the end of treatment, which demonstrates a significant satisfaction to the program, device and medication. The use of an electronic device contributes so that patients who have difficulty in applying and fear of needle do not dropout treatment and possibility to evaluate adherence rate. For these reasons and by the program provide all the necessary information about the disease and follow up, there is a greater stimulus for non-discontinuation of the medication and better clinical outcomes. PDB4 EVALUATION OF SMOKING PREVALENCE AND ITS ASSOCIATED FACTORS AMONG THE DIABETICS IN PAKISTAN Gillani AH1, Aziz MM1, Bashir S2, Mustafa A3, Fang Y1 1Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China, Xi’an, China, 2Quaid E Azam medical college Bahawalpur Pakistan, Bahawalpur, Pakistan, 3Islamia University of Bahawalpur, Bahawalpr, Pakistan

Objectives: Smoking among diabetics is the foremost cause of cardiovascular disease (CVD). Thus the major prospect of this study is to determine the prevalence and associated factors of smoking among diabetes mellitus patient in southern Punjab Pakistan.  Methods: A quantitative, cross-sectional survey was conducted in between December 2015 and March 2016 using a semi-structured questionnaire. We targeted three government hospitals and three private clinics in southern Punjab and patients were approached using systemic sampling method. If a patient reported smoking any sort of cigarette in any quantity in the previous 12 months, he/she was considered as current smoker. Data summarization was accomplished by descriptive statistics. Both T test and Chi-square test were used to estimate the significance between variables. Complete analysis was done by SPSS Version 18.0 (SPSS, Chicago, IL, USA).  Results: A total of 299 patients consisting of 169 (56.5%) males and 130 (43.5%) females participated in study. Mean age± SD of the respondent’s was 48.8±14.6 years and mean duration± SD of diabetes was 9.36±6.9 years. Smoking prevalence was found to be 15.4% (46/299). Out of 169 males, 41 (24.2%) were smokers while among 130 females, 5 (3.8%) were smokers. Age (p, 0.828), duration of diabetes (p, 0.649), locality (p, 0.337), education (p 0.52), marital status (p, 0.77) monthly income (p, 0.682), family history of diabetes (p, 0.296), presence of hypertension (p, 0.254), at least one episode of CVD (p, 0.698) and number of cigarettes smoked per day (p, 0.695) were insignificantly associated with smoking. Gender was the only variable significantly associated with smoking (p, 0.00).  Conclusions: Study demonstrated high prevalence of smoking among diabetic males than females which needs to be controlled. Appropriate guidance and edification from health care provider is needed to eradicate this practice.

DIABETES/ENDOCRINE DISORDERS – Cost Studies PDB5 Cost-Minimization of Somatropin for GH Deficiency and Turner Syndrome Treatment from SUS Perspective