Abstract Background: Brazil is a country with different biomes and social disparities. There are limited data available on regional differences and prognosis of heart failure (HF) in the country. Objective: The Rosa dos Ventos study aims to investigate regional differences and the current prognosis of HF outpatients with reduced or mildly reduced ejection fraction in Brazil. Methods: This is a prospective, multicenter, observational cohort study that will include outpatients older than 18 years with HF and an ejection fraction < 50% in 30 public and private centers distributed in all Brazilian regions. A total of 2,500 patients will be enrolled from June 2021 and October 2023, with a 12-month follow-up period. We will collect data on socioeconomic and clinical status, medical prescription and results of cardiology tests. Follow-up phone calls will be made at 6 and 12 months after inclusion to collect information regarding emergency room visits, hospitalization and mortality. Conclusion: The Rosa dos Ventos study will allow a more accurate characterization of chronic HF in Brazil. This initiative will provide relevant information for the development of effective management strategies to mitigate the impact of this condition on patients and the healthcare system. Background disparities (HF Objective Methods prospective multicenter 1 50 3 regions 2500 2 500 2,50 202 2023 12month month followup follow up period status tests Followup Follow visits mortality Conclusion system 5 250 2,5 20 25 2,

Resumo Fundamento: O Brasil é um país com diferentes biomas e desigualdades sociais. Existem poucos dados disponíveis sobre as diferenças regionais e o prognóstico da insuficiência cardíaca (IC) no país. Objetivo: O estudo Rosa dos Ventos tem como objetivo investigar as diferenças regionais e o prognóstico atual de pacientes com IC com fração de ejeção reduzida ou moderadamente reduzida no Brasil. Métodos: Este é um estudo prospectivo, multicêntrico, observacional, do tipo coorte que incluirá pacientes ambulatoriais com idade superior a 18 anos com IC e fração de ejeção < 50% em 30 centros privados distribuídos nas regiões brasileiras. Um total de 2500 pacientes serão incluídos entre junho de 2021 e outubro de 2023, com um período de 12 meses de seguimento. Coletaremos dados sobre status clínico e socioeconômico, prescrição médica e resultados de exames cardiológicos. Serão realizados telefonemas para o seguimento dos pacientes seis e 12 meses após a inclusão para coleta de informações sobre visitas ao departamento de emergência, internações e mortalidade. Conclusão: O estudo Rosa dos Ventos permitirá uma caracterização mais precisa da IC crônica no Brasil. Essa iniciativa proverá informações relevantes para o desenvolvimento de estratégias de manejo efetivas para mitigar o impacto dessa condição sobre os pacientes e o sistema de saúde. Fundamento sociais (IC Objetivo Métodos prospectivo multicêntrico observacional 1 50 3 brasileiras 250 202 2023 socioeconômico cardiológicos emergência mortalidade Conclusão saúde 5 25 20 2

Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value. Objectives (QoL (HF ValueBased Value Based VBHC (VBHC concept methods Crosssectional Cross sectional study 50 <50% 36Item Item 36 SF36 SF [SF-36 [MLHFQ] anxietydepression applied SF-3 domains TimeDriven Time Driven ActivityBased Activity TDABC (TDABC method sex 201 2021 19 49.5 495 49 5 (49. IQR 210 21 0 21.0 69.0 690 69 69.0] classes moderatesevere moderate severe symptoms followup follow up US 23 29 39 66 101 IIIIV III IV Labexam Lab exam 30 74 6326 63 26 63.2 vs 491.05. 49105 491.05 . 491 05 491.05) Conclusion increases labexams lab exams lab/exams value <50 3 SF3 [SF-3 [MLHFQ SF- 20 202 1 49. 4 (49 2 21. 69. 6 10 7 632 63. 4910 491.0 <5 [SF- (4 491. < [SF (