ABSTRACT
Resumo Fundamento As doenças cardiovasculares constituem um grupo importante de causas de morte no Brasil. As doenças isquêmicas do coração são as principais causas de parada cardiorrespiratória, levando a um impacto na mortalidade devido às doenças cardiovasculares no sistema de saúde. Objetivo Avaliar o número de óbitos domiciliares por parada cardiorrespiratória notificados pelo Serviço de Atendimento Móvel de Urgência (SAMU) em março de 2018, 2019 e 2020. Métodos Trata-se de um estudo observacional realizado a partir da análise de dados de mortalidade por parada cardiorrespiratória de cidadãos atendidos pelo SAMU em Belo Horizonte, Minas Gerais, Brasil. Foram analisadas as características sociais e clínicas e as informações de ocorrência. Foi avaliada a taxa de mortalidade por parada cardiorrespiratória em relação ao número total de atendimentos. Foi considerado um nível de significância de 95%. Resultados Houve um aumento nos óbitos domiciliares por parada cardiorrespiratória em março de 2020, em comparação com março de 2018 (p < 0,001) e março de 2019 (p = 0,050). Dos óbitos relatados em 2020, 63,8% dos pacientes tinham 60 anos ou mais; 63,7% das ocorrências foram à tarde e aproximadamente 87% dos casos de parada cardiorrespiratória notificados apresentavam comorbidades clínicas, com hipertensão arterial sistêmicas e parada cardíaca correspondendo a 22,87% e 13,03% dos casos relatados, respectivamente. A maioria da amostra avaliada deste estudo não teve acompanhamento médico (88,7%). Conclusão Considerando o aumento do número de óbitos, sugerimos reflexões e reajustes quanto ao monitoramento das doenças crônicas não transmissíveis durante a pandemia, bem como melhorias na vigilância dos óbitos. (Arq Bras Cardiol. 2021; 116(2):266-271)
Abstract Background Cardiovascular diseases constitute an important group of causes of death in the country. Ischemic heart diseases that are the main causes of cardiopulmonary arrest, leading to an impact on the mortality of the cardiovascular diseases in the health system. Objective Assess the number of home deaths by cardiopulmonary arrest notified by the Mobile Emergency Medical Service (SAMU) in March 2018, 2019 and 2020. Methods Observational study carried out from the analysis of cardiopulmonary arrest mortality data of citizens assisted by SAMU in Belo Horizonte, Minas Gerais, Brazil. Social and clinical characteristics and occurrence information of the patients were analyzed. The mortality rate due to cardiopulmonary arrest in relation to the total number of attendances was assessed. A significance level of 95% was considered. Results There was increase of home deaths due to cardiopulmonary arrest in March 2020 compared to March 2018 (p<0.001) and March 2019 (p=0.050). Of the deaths reported in 2020, 63.8% of the patients were aged 60 years or older, 63.7% of the occurrences were performed in the afternoon and approximately 87% of the cardiopulmonary arrest notified had associated clinical comorbidities, with systemic arterial hypertension and heart failure represented by 22.87% and 13.03% of the reported cases, respectively. The majority of the evaluated sample of this study did not have any medical care follow-up (88.7%). Conclusion Considering the increase in the number of the deaths, we suggest reflections and readjustments regarding the monitoring of chronic non-transmissible diseases during a pandemic, as well as improvements in death surveillance. (Arq Bras Cardiol. 2021; 116(2):266-271)
Subject(s)
Humans , Cardiopulmonary Resuscitation , COVID-19 , Heart Arrest/epidemiology , Brazil/epidemiology , Pandemics , SARS-CoV-2 , Middle AgedABSTRACT
A terapia antirretroviral (TARV) promoveu reduções drásticas na morbidade e mortalidade de pessoas vivendo com HIV (PVH). A utilização adequada da TARV requer monitoramento contínuo para avaliar a resposta terapêutica e identificar eventos adversos relacionados à administração a longo prazo. Trata-se de um estudo de coorte, realizado em centro de referência em doenças infecciosas, Belo Horizonte, Minas Gerais, com o objetivo de avaliar a efetividade da TARV entre 2012 e 2018. A população do estudo foi composta por 82 PVH que tiveram indicação para início da TARV entre janeiro a dezembro de 2012. A efetividade da TARV, definida como carga viral < 50 cópias/mL, foi de 75,6% e 80,5% após 12 e 66 meses de seu início, respectivamente. Os casos de falha terapêutica continham em prontuário informações sobre má-adesão e/ou abandono. Apesar da introdução tardia da TARV, a resposta terapêutica foi melhor às estimadas pelo Ministério da Saúde e semelhante a estudos de eficácia, demonstrando efetividade da TARV nos períodos analisados. Estes dados ratificam que a política brasileira de enfrentamento da epidemia de HIV/ Aids, de distribuição universal, é exitosa e deve ser mantida e aprimorada para evitar eventuais falhas terapêuticas.
The antiretroviral therapy (ART) has caused a significant reduction in morbidity and mortality in people living with HIV (PLH). The appropriate use of the ART demands continuous monitoring in order to assess the therapeutic response and identify adverse events related to medium and long-term ART exposure. The aim of this study is to evaluate the effectiveness of ART between 2012 and 2018. It is a prospective cohort study carried out at a reference centre of infectious diseases in Belo Horizonte, Minas Gerais - Brazil. The population of this study was composed of 82 PLH who had indication for the beginning of ART between January and December 2012. The effectiveness of ART, defined as viral load < 50 copies/mL, was of 75.6% and 80.5% after 12 and 66 months, respectively. The cases of treatment failure registered in medical records had information of poor adhesion and abandonment of treatment. In spite of the late introduction of ART in this population, the therapeutic response was better than the values described by Ministry of Health and similar to efficacy studies. These data ratify that the Brazilian public policies of combating HIV/AIDS epidemic, of universal distribution, have been successful and must be kept and improved to avoid possible treatment failures.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Effectiveness , Antiretroviral Therapy, Highly Active , Anti-Retroviral Agents/therapeutic use , Communicable Diseases , HIV , Viral LoadABSTRACT
Abstract INTRODUCTION: Metabolic disorders in people living with HIV/AIDS (PLH) have been described even before the introduction of antiretroviral (ARV) drugs in the treatment of HIV infection and are risk factors for cardiovascular diseases. Based on this, the purpose of this study was to assess metabolic disorders and cardiovascular risk in PLH before the initiation of antiretroviral treatment (ART). METHODS: This was a cross-sectional descriptive study of 87 PLH without the use of ART, which was carried out between January and September 2012 at a specialized infectious diseases center in Minas Gerais, Brazil. RESULTS: The main metabolic disorders in the population were low serum levels of HDL-cholesterol, hypertriglyceridemia and abdominal obesity. Dyslipidemia was prevalent in 62.6% of the study population, whereas metabolic syndrome (MS) was prevalent in 11.5% of patients assessed by the International Diabetes Federation (IDF) criteria and 10.8% assessed by the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATPIII) criteria. Regarding cardiovascular risk, 89.7% of the population presented a low coronary risk according to the Framingham Risk Score. A greater proportion of patients diagnosed with MS presented low cardiovascular risk (80% assessed by IDF criteria and 77.8% assessed by NCEP-ATPIII criteria). CONCLUSIONS: Metabolic disorders in this population may be due to HIV infection or lifestyle (smoking, sedentary lifestyle and inadequate diet). The introduction of ART can enhance dyslipidemia, increasing cardiovascular risk, especially among those who have classic risks of cardiovascular disease.