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1.
Rev. Hosp. Ital. B. Aires (2004) ; 42(1): 12-20, mar. 2022. graf, ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1368801

ABSTRACT

Introducción: determinar la causa de muerte de los pacientes internados con enfermedad cardiovascular es de suma importancia para poder tomar medidas y así mejorar la calidad su atención y prevenir muertes evitables. Objetivos: determinar las principales causas de muerte durante la internación por enfermedades cardiovasculares. Desarrollar y validar un algoritmo para clasificar automáticamente a los pacientes fallecidos durante la internación con enfermedades cardiovasculares Diseño del estudio: estudio exploratorio retrospectivo. Desarrollo de un algoritmo de clasificación. Resultados: del total de 6161 pacientes, el 21,3% (1316) se internaron por causas cardiovasculares; las enfermedades cerebrovasculares representan el 30,7%, la insuficiencia cardíaca el 24,9% y las enfermedades cardíacas isquémicas el 14%. El algoritmo de clasificación según motivo de internación cardiovascular vs. no cardiovascular alcanzó una precisión de 0,9546 (IC 95%: 0,9351-0,9696). El algoritmo de clasificación de causa específica de internación cardiovascular alcanzó una precisión global de 0,9407 (IC 95%: 0,8866-0,9741). Conclusiones: la enfermedad cardiovascular representa el 21,3% de los motivos de internación de pacientes que fallecen durante su desarrollo. Los algoritmos presentaron en general buena performance, particularmente el de clasificación del motivo de internación cardiovascular y no cardiovascular y el clasificador según causa específica de internación cardiovascular. (AU)


Introduction: determining the cause of death of hospitalized patients with cardiovascular disease is of the utmost importance in order to take measures and thus improve the quality of care of these patients and prevent preventable deaths. Objectives: to determine the main causes of death during hospitalization due to cardiovascular diseases.To development and validate a natural language processing algorithm to automatically classify deceased patients according to their cause for hospitalization. Design: retrospective exploratory study. Development of a natural language processing classification algorithm. Results: of the total 6161 patients in our sample who died during hospitalization, 21.3% (1316) were hospitalized due to cardiovascular causes. The stroke represent 30.7%, heart failure 24.9%, and ischemic cardiac disease 14%. The classification algorithm for detecting cardiovascular vs. Non-cardiovascular admission diagnoses yielded an accuracy of 0.9546 (95% CI 0.9351, 0.9696), the algorithm for detecting specific cardiovascular cause of admission resulted in an overall accuracy of 0.9407 (95% CI 0.8866, 0.9741). Conclusions: cardiovascular disease represents 21.3% of the reasons for hospitalization of patients who die during hospital stays. The classification algorithms generally showed good performance, particularly the classification of cardiovascular vs non-cardiovascular cause for admission and the specific cardiovascular admission cause classifier. (AU)


Subject(s)
Humans , Artificial Intelligence/statistics & numerical data , Cerebrovascular Disorders/mortality , Myocardial Ischemia/mortality , Heart Failure/mortality , Hospitalization , Quality of Health Care , Algorithms , Reproducibility of Results , Factor Analysis, Statistical , Mortality , Cause of Death , Electronic Health Records
3.
Rev. cuba. med ; 60(3): e2059, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347514

ABSTRACT

Introducción: La insuficiencia cardíaca constituye un problema a nivel mundial y aumentará en los próximos años a consecuencia del envejecimiento poblacional. Se asocia a múltiples comorbilidades que pueden estar implicadas en su desarrollo, contribuir a la progresión de la enfermedad o empeorar el pronóstico. Objetivo: Evaluar la influencia de comorbilidades en la mortalidad de pacientes con insuficiencia cardíaca crónica. Métodos: Se realizó un estudio de cohorte retrospectivo en 242 pacientes, con diagnóstico de insuficiencia cardíaca crónica y una media de seguimiento de 5 años en la consulta de protocolo de insuficiencia cardíaca del Hospital Clínico Quirúrgico Hermanos Ameijeiras. Se determinó la magnitud de la asociación de la presencia de comorbilidades y la mortalidad a través del empleo de regresión logística. Resultados: El promedio de la edad fue mayor en los pacientes fallecidos 72,12 ± 12,088 años (p = 0,003). La presencia aislada de comorbilidades no mostró asociación con la mortalidad pero sí cuando coexistían más de dos comorbilidades. (OR: 2,91. IC: .991-8,61). Se encontró asociación lineal entre el número de comorbilidades y la mortalidad (p = 0,044). Conclusión: Las comorbilidades estudiadas no presentaron una asociación independiente con la mortalidad, pero la suma de ellas sí aumentó el riesgo de muerte en los pacientes con insuficiencia cardiaca(AU)


Introduction: Heart failure is a worldwide problem and will increase in the coming years as a result of population aging. It is associated with multiple comorbidities that may be involved in its development, contribute to the progression of the disease, or worsen the prognosis. Objective: To assess the influence of comorbidities on the mortality of patients with chronic heart failure. Methods: A retrospective cohort study was carried out in 242 patients with a diagnosis of chronic heart failure and a mean follow-up of 5 years in the heart failure protocol consultation at Hermanos Ameijeiras Surgical Clinical Hospital. The magnitude of the association between the presence of comorbidities and mortality was determined through the use of logistic regression. Results: The mean age was higher in deceased patients 72.12 ± 12.088 years (p = 0.003). The isolated presence of comorbidities did not show an association with mortality, but it did when more than two comorbidities coexisted. (OR: 2.91. CI: .991-8.61). A linear association was found between the number of comorbidities and mortality (p = 0.044). Conclusion: The studied comorbidities did not show an independent association with mortality, but the sum of them did increase the risk of death in patients with heart failure(AU)


Subject(s)
Humans , Comorbidity , Heart Failure/mortality , Retrospective Studies
4.
ABC., imagem cardiovasc ; 34(4): eabc215, 2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1358883

ABSTRACT

Fundamento: A quimioterapia para o câncer de mama está associada a complicações cardiovasculares graves, como a insuficiência cardíaca. A fração de ejeção do ventrículo esquerdo é o principal parâmetro para avaliar a função sistólica nessas pacientes. Todavia, a ocorrência de disfunção diastólica pode preceder à disfunção sistólica. Objetivos: Avaliar as funções diastólica e sistólica do ventrículo esquerdo de portadoras de câncer de mama em tratamento quimioterápico com antraciclinas. Métodos: Trata-se de estudo observacional, longitudinal, analítico e prospectivo. Estudaram-se 62 mulheres com câncer de mama, com idades de 21 a 75 anos, que realizaram ecocardiogramas basais e após 3 meses de tratamento. Avaliaram-se parâmetros de função diastólica, e as pacientes foram classificadas em disfunção diastólica tipos:1, 2 ou 3. Definiu-se a disfunção sistólica como fração de ejeção do ventrículo esquerdo ≤ 53%. Resultados: Decorridos 3 meses de tratamento, 35 pacientes (56,4%) apresentavam disfunção diastólica tipo 1, e apenas uma (1,6%) do tipo 2. A disfunção diastólica ocorreu em 26 pacientes já na etapa basal e surgiu em dez indivíduos no decurso do tratamento. Os parâmetros de função diastólica velocidade de onda E e relação E/A diminuíram significativamente (p < 0,05) com a quimioterapia, todavia, os demais não tiveram variação significativa. Apenas três pacientes apresentaram disfunção sistólica, porém verificou-se maior redução da fração de ejeção do ventrículo esquerdo no grupo que desenvolveu disfunção diastólica durante o tratamento comparativamente ao grupo que apresentava já disfunção diastólica no período basal (p = 0,04). Conclusão: A disfunção diastólica ocorre precocemente em portadoras de câncer de mama submetidas à quimioterapia. O surgimento de disfunção diastólica no decurso do tratamento se associa à redução significativa da fração de ejeção do ventrículo esquerdo. (AU)


Background: Chemotherapy for breast cancer is associated with serious cardiovascular complications such as heart failure. The left ventricular ejection fraction is the main parameter used to assess systolic function in these patients. However, the occurrence of diastolic dysfunction may precede that of systolic dysfunction. Objectives: To evaluate left ventricle diastolic and systolic functions in women with breast cancer undergoing chemotherapy using anthracyclines. Methods: This observational, longitudinal, analytical, and prospective study included 62 women with breast cancer aged 21­75 years old who underwent echocardiography at baseline and after three months of treatment. Diastolic function parameters were evaluated, and the patients were classified as diastolic dysfunction type 1, 2, or 3. Systolic dysfunction was defined as a left ventricular ejection fraction ≤ 53%. Results: After three months of treatment, 35 patients (56.4%) had type 1 diastolic dysfunction, while one (1.6%) had type 2. Diastolic dysfunction was identified in 26 patients at baseline and developed in 10 patients during treatment. Diastolic function parameters, E wave velocity, and E/A ratio decreased significantly (p < 0.05) with chemotherapy; however, the others showed no significant variations. Only three patients had systolic dysfunction, but there was a greater reduction in left ventricular ejection fraction in the group that developed diastolic dysfunction during treatment versus the group with diastolic dysfunction at baseline (p = 0.04). Conclusion: Diastolic dysfunction occurs early in women with breast cancer undergoing chemotherapy. Its onset during the course of treatment is associated with a significantly reduced left ventricular ejection fraction. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Young Adult , Breast Neoplasms/drug therapy , Ventricular Dysfunction, Left/etiology , Cardiotoxicity/complications , Heart Failure/physiopathology , Heart Failure/mortality , Time Factors , Echocardiography/methods , Anthracyclines/administration & dosage , Anthracyclines/toxicity , Anthracyclines/therapeutic use
5.
Chinese Medical Journal ; (24): 1803-1811, 2021.
Article in English | WPRIM | ID: wpr-887602

ABSTRACT

BACKGROUND@#Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.@*METHODS@#This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.@*RESULTS@#The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023-1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958-0.983), fatigue (HR: 1.127, 95% CI: 1.009-1.258), ascites (HR: 1.190, 95% CI: 1.057-1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291-1.769), heart rate (HR: 1.003, 95% CI: 1.001-1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993-0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220-1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223-1.690), serum sodium (HR: 0.980, 95% CI: 0.972-0.988), serum albumin (HR: 0.981, 95% CI: 0.971-0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073-1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183-1.614), diabetes (HR: 1.118, 95% CI: 1.010-1.237), stroke (HR: 1.252, 95% CI: 1.121-1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626-0.814), β-blockers (HR: 0.673, 95% CI: 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646-0.965), spironolactone (HR: 0.814, 95% CI: 0.663-0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531-0.733), nitrates (HR: 0.715, 95% CI: 0.631-0.811), and digoxin (HR: 0.579, 95% CI: 0.465-0.721).@*CONCLUSIONS@#The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.


Subject(s)
Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , Beijing/epidemiology , Biomarkers , Cohort Studies , Emergency Service, Hospital , Follow-Up Studies , Heart Failure/mortality , Humans , Natriuretic Peptide, Brain , Peptide Fragments , Prognosis , Prospective Studies
6.
Rev. chil. cardiol ; 39(1): 24-33, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115446

ABSTRACT

INTRODUCCIÓN: Los ratones SR-B1 KO/ApoER6 1h/h que son alimentados con una dieta rica en grasas saturadas, desarrollan enfermedad coronaria aterosclerótica severa, complicaciones isquémicas e insuficiencia cardíaca, con alta mortalidad. Los estudios con este modelo se han enfocado fundamentalmente en la enfermedad coronaria y menos en el remodelado cardíaco. El OBJETIVO del trabajo ha sido caracterizar el remodelado miocárdico, evaluar la evolución temporal de la función ventricular izquierda y la sobrevida asociada a enfermedad cardíaca por ateromatosis. MÉTODO: Ratones homocigotos SR-B1 KO/ApoER6 1h/h fueron alimentados por 8 semanas con dieta aterogénica o dieta normal y se comparó la sobrevida en ambos grupos. A las 4 semanas se realizó un ecocardiograma bidimensional. En los ratones eutanasiados se evaluó en la pared cardíaca fibrosis miocárdica y tamaño de los cardiomiocitos por morfometría, apoptosis con técnica de TUNEL e infiltración por células inflamatorias mononucleares (ED1) por inmunohistoquímica. RESULTADOS: En el grupo que recibió dieta aterogénica la sobrevida se redujo en 46,7% (p < 0.001), debido a muerte súbita y a falla cardíaca progresiva. En este grupo, a las 4 semanas se observó dilatación de cavidades izquierdas y disminución de la fracción de eyección del ventrículo izquierdo en comparación con el grupo control (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01). También se observó aumento de la masa cardíaca relativa de 2.1 veces (p<0,001) y del peso pulmonar relativo en 80% (p<0,001), sin cambios en las dimensiones de los cardiomiocitos. En el miocardio de los ratones que recibieron dieta aterogénica hubo un aumento de la fibrosis cardíaca de 7.9 veces (p < 0.01) y del número de cardiomiocitos apoptóticos en 55.9 veces (p < 0.01), junto a un aumento del número de células inflamatorias mononucleares ED1. CONCLUSIONES: En el modelo de falla cardíaca severa de etiología isquémica con alta mortalidad en el ratón homocigoto SR-B1 KO/ApoER6 1h/h sometido a una dieta aterogénica, con falla cardíaca izquierda por disfunción sistólica, el remodelado patológico del miocardio está dado fundamentalmente por apoptosis y fibrosis. También se observa un aumento discreto de macrófagos en la pared cardíaca. Es posible que el edema parietal también pueda ser un mecanismo de remodelado relevante en este modelo.


Abstract: SR-B1 KO/ApoER6 1h/h mice fed a high saturated fat diet develop severe coronary atheromatosis, and cardiac failure with a high mortality rate. Cardiac remodeling under these conditions has not been well studied. AIM: To evaluate the time course of left ventricular function, cardiac remodeling and survival associated to the administration of an atherogenic diet. METHOD: Homozygote SR-B1 KO/ApoER6 1h/h mice received an atherogenic diet for 8 weeks. Mice receiving a normal diet served as controls. Survival rate, myocardial fibrosis, cardiomyocyte size, apoptosis and infiltration by inflammatory or mononuclear cells were compared between groups. A TUNEL technique was used to evaluate apoptosis. RESULTS: A 46.7% survival reduction compared to controls was observed in the experimental group (p<0.01), due to left ventricular and atrial dilatation associated to a decrease in ejection fraction (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01, respectively). Also, an increased cardiac weight, 2.6 times greater was observed in the experimental group, compared to controls. Mice receiving the atherogenic diet showed an 80% increased lung weight. There was no evident change in cardiomyocytes, but there was more (7.9 times) cardiac fibrosis (p<0.01) and 55.9 times more apoptotic cells. (p<0.01), along with a greater number of inflammatory cells and ED1 mononuclear cells. CONCLUSION: Mice receiving an atherogenic diet develop heart failure and reduced survival rate. This is associated with cardiac remodeling with underlying apoptosis an ventricular wall fibrosis. It is posible that wall edema might contribute to the observed cardiac remodeling.


Subject(s)
Animals , Mice , Ventricular Remodeling , Diet, Atherogenic , Heart Failure/etiology , Hyperlipidemias/pathology , Ischemia/etiology , Fibrosis , Survival Analysis , Ventricular Function, Left , Apoptosis , Mice, Knockout , Ventricular Dysfunction , Disease Models, Animal , Heart Failure/physiopathology , Heart Failure/mortality , Heart Failure/pathology , Ischemia/physiopathology , Ischemia/mortality , Ischemia/pathology
7.
Arq. bras. cardiol ; 114(2): 209-218, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088870

ABSTRACT

Abstract Background: Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. Objective: To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. Methods: Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. Results: There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. Conclusion: Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.


Resumo Fundamento: A fibrilação atrial (FA) está associada ao aumento da mortalidade em pacientes com insuficiência cardíaca (IC). Objetivo: Avaliar se o risco de pacientes com FA pode ser estratificado com precisão em relação aos pontos de corte do teste de esforço cardiopulmonar (TECP) para seleção do transplante cardíaco (TC). Métodos: Avaliação prospectiva de 274 pacientes consecutivos com IC com fração de ejeção do ventrículo esquerdo ≤ 40%. O endpoint primário foi um composto de morte cardíaca ou TC urgente no seguimento de 1 ano. O endpoint primário foi analisado através de vários parâmetros do TECP para a maior área sob a curva e para o valor preditivo positivo (VPP) e negativo (VPN) em pacientes com FA e ritmo sinusal (RS) para detectar se os atuais pontos de corte para a seleção de TC podem estratificar com precisão o grupo com FA. Diferenças estatísticas com valor de p < 0,05 foram consideradas significativas. Resultados: Havia 51 pacientes no grupo de FA e 223 no grupo RS. O endpoint primário foi maior no grupo FA (17,6% vs. 8,1%, p = 0,038). O valor de corte de pVO2 para a seleção do TC mostrou um VPP de 100% e um VPN de 95,5% para o endpoint primário no grupo FA, com um VPP de 38,5% e um VPN de 94,3% no grupo RS. O valor de corte da inclinação VE/VCO2 apresentou valores mais baixos de VPP (33,3%) e valor semelhante de VPN (92,3%) aos resultados de pVO2 no grupo FA. Conclusões: Apesar do fato de a FA apresentar um pior prognóstico para os pacientes com IC, o atual ponto de corte de pVO2 para a seleção de TC pode estratificar com precisão esse grupo de alto risco.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Atrial Fibrillation/physiopathology , Atrial Fibrillation/mortality , Risk Assessment/standards , Exercise Test/standards , Heart Failure/physiopathology , Oxygen/metabolism , Oxygen Consumption/physiology , Prognosis , Reference Standards , Stroke Volume/physiology , Time Factors , Proportional Hazards Models , Multivariate Analysis , Prospective Studies , Risk Factors , Follow-Up Studies , Statistics, Nonparametric , Exercise Test/methods , Heart Failure/mortality
8.
Arq. bras. cardiol ; 114(2): 222-231, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088862

ABSTRACT

Abstract Background: Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce. Objective: Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends. Methods: A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%. Results: From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in-hospital mortality rate increased in Paraiba and Brazil [65.1% (p = 0.006) and 30.1% (p = 0.003), respectively], but the absolute in-hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil. Conclusions: Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase.


Resumo Fundamento: Dados sobre a epidemiologia da insuficiência cardíaca (IC) em áreas pouco desenvolvidas são escassos. Objetivos: Nosso objetivo foi determinar a morbidade e a mortalidade por IC na Paraíba e no Brasil, e sua tendência em dez anos. Métodos: Realizou-se uma busca retrospectiva de 2008 a 2017 utilizando-se o banco de dados do DATASUS incluindo pacientes com idade ≥ 15 anos, com diagnóstico primário de IC. Os dados da morbimortalidade por IC foram coletados e estratificados por ano, sexo e idade. Foram realizados correlação de Pearson e teste para tendências de Mantel-Haenzsel. Um nível de 5% foi definido como estatisticamente significativo. Resultados: De 2008 a 2017, as internações por IC diminuíram 62% (p = 0,004) na Paraíba, e 34% (p = 0,004) no Brasil. A taxa de mortalidade hospitalar aumentou na Paraíba e no Brasil [65,1% (p = 0,006) e 30,1% (p = 0,003), respectivamente], mas a mortalidade hospitalar em números absolutos apresentou uma diminuição significativa somente na Paraíba [37,5% (p = 0,013)], o que foi mantido após a estratificação por idade, exceto para os grupos 15-19, 60-69 e > 80 anos. Observou-se um aumento no período de internação [44% (p = 0,004) na Paraíba e 12,3% (p = 0,004) no Brasil]. De 2008 a 2015, a taxa de mortalidade por IC na população diminuiu 10,7% na Paraíba (p = 0,047) e 7,7% (p = 0,017) no Brasil. Conclusões: Apesar de a taxa de mortalidade por IC estar diminuindo na Paraíba e no Brasil, observou-se um aumento na taxa de mortalidade hospitalar e na duração da internação por IC. Devem ser realizados estudos clínicos em hospitais para serem identificadas as causas dessa tendência de aumento.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Hospital Mortality/trends , Heart Failure/mortality , Hospitalization/trends , Time Factors , Brazil/epidemiology , Retrospective Studies , Morbidity , Sex Distribution , Age Distribution , Statistics, Nonparametric , Hospitalization/statistics & numerical data
9.
Rev. Assoc. Med. Bras. (1992) ; 65(11): 1391-1396, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057081

ABSTRACT

SUMMARY BACKGROUND: Cardiac resynchronization therapy (CRT) is a therapeutic modality for patients with heart failure (HF). The effectiveness of this treatment for event reduction is based on clinical trials where the population of patients with Chagas' disease (DC) is underrepresented. OBJECTIVE: To evaluate the prognosis after CRT of a population in which CD is an endemic cause of HF. METHODS: A retrospective cohort conducted between January 2015 and December 2016 that included patients with HF and left ventricular ejection fraction (LVEF) of less than 35% and undergoing CRT. Clinical and demographic data were collected to search for predictors for the combined outcome of death or hospitalization for HF at one year after CRT implantation. RESULTS: Fifty-four patients were evaluated, and 13 (24.1%) presented CD as the etiology of HF. The mean LVEF was 26.2± 6.1%, and 36 (66.7%) patients presented functional class III or IV HF. After the mean follow-up of 15 (±6,9) months, 17 (32.1%) patients presented the combined outcome. In the univariate analysis, CD was associated with the combined event when compared to other etiologies of HF, 8 (47%) vs. 9 (13,5%), RR: 3,91 CI: 1,46-10,45, p=0,007, as well as lower values of LVEF. In the multivariate analysis, CD and LVEF remained independent risk factors for the combined outcome. CONCLUSION: In a population of HF patients undergoing CRT, CD was independently associated with mortality and hospitalization for HF.


RESUMO INTRODUÇÃO: A terapia de ressincronização cardíaca (TRC) é uma modalidade terapêutica para pacientes com insuficiência cardíaca (IC). A eficácia desse tratamento para redução de eventos baseia-se em ensaios clínicos em que a população de pacientes com doença de Chagas (DC) é sub-representada. OBJETIVO: Avaliar o prognóstico após TRC em uma população em que a DC é uma causa frequente de IC. MÉTODOS: Coorte retrospectiva realizada entre janeiro de 2015 e dezembro de 2016, sendo incluídos pacientes portadores de IC com fração de ejeção do ventrículo esquerdo (Feve) menor que 35% e submetidos à TRC. Os dados clínicos e demográficos foram coletados para pesquisa de preditores para o desfecho combinado de morte ou internação por IC após implante da TRC. RESULTADOS: Foram avaliados 54 pacientes, dos quais 13 (24,1%) apresentavam a DC como etiologia da IC. A Feve média foi de 26,2% (±6,1) e 36 (66,7%) pacientes apresentavam classe funcional de IC III ou IV. Após o seguimento médio de 15 meses, 17 (32,1%) pacientes apresentaram o desfecho combinado. Na análise univariada, a DC esteve associada ao evento combinado quando comparada a outras etiologias de IC, 8 (47%) vs 9 (13,5%), RR: 3,91 IC: 1,46-10,45, p=0,007, assim como valores mais baixos da Feve. Na análise multivariada, a DC e a Feve permaneceram como fatores de risco independentes para o desfecho combinado. CONCLUSÃO: Em uma população de pacientes com IC submetidos à TRC, a doença de Chagas esteve independentemente associada à mortalidade e internação por insuficiência cardíaca no seguimento de 15 meses.


Subject(s)
Humans , Male , Female , Aged , Chagas Cardiomyopathy/therapy , Cardiac Resynchronization Therapy , Heart Failure/therapy , Prognosis , Chagas Cardiomyopathy/complications , Chagas Cardiomyopathy/mortality , Retrospective Studies , Follow-Up Studies , Treatment Failure , Statistics, Nonparametric , Heart Failure/mortality , Heart Failure/parasitology , Middle Aged
10.
Rev. medica electron ; 41(4): 899-913, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094097

ABSTRACT

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en los carbohidratos, grasas y proteínas. Las tasas de morbimortalidad han aumentado al igual que la obesidad, constituye un problema de salud en el mundo, Cuba y la provincia de Matanzas. Objetivo: realizar una caracterización clínica epidemiológica de la diabetes mellitus tipo 2 en dos áreas de salud, conocer las variables e identificar las barreras para una posterior intervención. Materiales y métodos: se realizó un estudio epidemiológico descriptivo- transversal a 750 diabéticos tipo 2 mayores de 18 años en dos áreas de salud. Se realizaron encuestas, procesándose en el programa Epi-Info, obteniéndose la frecuencia de las variables, y las diferencias estadísticas significativas entre variables de las dos aéreas de salud, utilizándose el valor de p < 0,05 % y el Chi2. Resultados: el promedio de edad fue de 62,2 años, predominio del sexo femenino y color de la piel blanca. La hipertensión arterial y la obesidad fueron las enfermedades más asociadas, y el tabaquismo, la ingestión de bebidas alcohólicas y azucaradas, y la no realización de ejercicios físicos fueron los factores asociados más relevantes. Los medicamentos más utilizados fueron la glibenclamida y la metformina. Conclusiones: la diabetes mellitus es la primera causa de fracaso renal en el mundo occidental, siendo la insuficiencia renal una de las complicaciones crónicas más graves de esta enfermedad. Entre las principales causas de muerte de esta enfermedad son las complicaciones macrovasculares, manifestadas clínicamente como cardiopatía isquémica, insuficiencia cardíaca, la enfermedad vascular cerebral y la insuficiencia arterial periférica.


ABSTRACT Introduction: diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Morbi-mortality rates have increased as have done obesity, being a health problem in the world, Cuba and the province of Matanzas. Objective: to carry out clinical-epidemiological characterization of type 2 diabetes mellitus in two health areas, knowing the variables and identifying the barriers for a subsequent intervention. Materials and methods: a cross-sectional descriptive study was carried out in 750 type-2 diabetic patients over 18 years in two health areas. Surveys were made and processed in Epi-Info program, showing significant statistic differences among variables of both health areas; p < 0,05 % value and Chi2 were used. Results: the average age was 62.2 years, predominating female sex and white skin color. The most commonly associated diseases were arterial hypertension and obesity; smoking and drinking alcoholic and sugar-sweetened beverages and sedentary life were the most relevant associated factors. The most commonly used medications were glibenclamide and metformin. Conclusions: diabetes is the first cause of renal failure in the Western world, being renal insufficiency one of the most serious chronic complications of this disease. The main causes of death of this disease are macro vascular complications clinically manifested as ischemic heart disease, heart failure, cerebra-vascular disease and peripheral arterial insufficiency.


Subject(s)
Humans , Adult , Risk Factors , Glyburide/therapeutic use , Diabetes Mellitus/diagnosis , Diabetes Mellitus/etiology , Diabetes Mellitus/mortality , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Metformin/therapeutic use , Tobacco Use Disorder/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Myocardial Ischemia/mortality , Stroke/mortality , Alcoholism/diagnosis , Renal Insufficiency/complications , Sedentary Behavior , Peripheral Arterial Disease/mortality , Heart Failure/mortality , Hypertension/diagnosis , Obesity/diagnosis
11.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 269-273, May-June 2019. tab
Article in English | LILACS | ID: biblio-1002229

ABSTRACT

Ischemic heart failure is a chronic and degenerative disease with high morbidity and mortality in the world. Coronary artery bypass grafting is indicated as elective treatment and may cause a catabolic state that depletes energy reserves. Data on body composition evaluation in the postoperative period of major cardiac surgery are limited. Objective: To evaluate the influence of elective coronary artery bypass grafting on body composition on the seventh postoperative day of patients with ischemic heart failure. Methods: A cross-sectional study was carried out in which eighteen volunteers with New York Heart Association Class II and III heart failure underwent coronary artery bypass grafting. The energy and protein reserves of the participants were evaluated by anthropometry in the preoperative and on the seventh postoperative day. Paired t-Test or Mann-Whitney test was used if applicable. A significance level was considered at p value < 0.05. Results: A significant loss of muscle mass was observed through the reduction of arm muscle circumference after surgery (4.2%, p 0.007). Major surgery causes hypermetabolic state and systemic inflammatory stimulus, due to the release of hormones and cytokines that may justify the observed loss of muscle mass. Conclusion: Coronary artery bypass grafting had an impact on muscle mass reduction seven days after surgery in patients with ischemic heart failure


Subject(s)
Humans , Male , Aged , Postoperative Period , Body Composition , Coronary Artery Bypass , Myocardial Revascularization/methods , Body Mass Index , Anthropometry/methods , Chronic Disease , Cross-Sectional Studies , Statistical Analysis , Risk Factors , Abdominal Circumference , Heart Failure/physiopathology , Heart Failure/mortality , Obesity
12.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 524-529, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003061

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Cardiomyopathy, Dilated/drug therapy , Cardiotonic Agents/therapeutic use , Simendan/therapeutic use , Heart Failure/drug therapy , Brazil , Cardiomyopathy, Dilated/mortality , Reproducibility of Results , Risk Factors , Treatment Outcome , Clinical Decision-Making , Heart Failure/mortality
13.
Arq. bras. cardiol ; 112(2): 130-135, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-983830

ABSTRACT

Abstract Background: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. Objective: To evaluate the results of conversion from FK to TCPC. Methods: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. Results: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. Conclusions: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.


Resumo Fundamento: O procedimento de Fontan-Kreutzer (FK) foi amplamente realizado no passado, mas a longo prazo gerou muitas complicações, resultando em falha na circulação univentricular. A conversão para conexão cavopulmonar total (CCPT) é uma das opções de tratamento. Objetivo: Avaliar os resultados da conversão de FK para CCPT. Métodos: Revisão retrospectiva de prontuários de pacientes submetidos à conversão de FK para CCPT no período de 1985 a 2016. Significância p < 0,05. Resultados: Operações do tipo Fontan foram realizadas em 420 pacientes durante este período: CCPT foi realizada em 320, técnica de túnel lateral em 82 e FK em 18. Dez casos do grupo FK foram eleitos para conversão em CCPT. Todos os pacientes submetidos à conversão de Fontan foram incluídos neste estudo. Em nove pacientes, a indicação deveu-se a arritmia não controlada e em um devido à enteropatia perdedora de proteínas. A morte foi observada nos dois primeiros casos. O tempo médio de internação na unidade de terapia intensiva (UTI) foi de 13 dias e o tempo médio de internação hospitalar foi de 37 dias. Uma classe funcional pela melhora da New York Heart Association (NYHA) foi observada em 80% dos pacientes em NYHA I ou II. Cinquenta e sete por cento das conversões devido a arritmias tiveram melhora das arritmias; quatro casos foram curados. Conclusões: A conversão é um procedimento complexo e requer que um hospital terciário experiente seja realizado. A conversão melhorou a classe funcional da NYHA, apesar de uma resolução insatisfatória da arritmia.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Heart Bypass, Right/methods , Fontan Procedure/methods , Univentricular Heart/surgery , Heart Failure/surgery , Arrhythmias, Cardiac/surgery , Arrhythmias, Cardiac/mortality , Time Factors , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Heart Bypass, Right/mortality , Fontan Procedure/adverse effects , Fontan Procedure/mortality , Coronary Circulation , Kaplan-Meier Estimate , Univentricular Heart/mortality , Heart Failure/mortality , Length of Stay
14.
Braz. j. med. biol. res ; 52(7): e8416, 2019. graf
Article in English | LILACS | ID: biblio-1011587

ABSTRACT

Studies regarding the prognostic value of circulating adiponectin level in patients with heart failure are conflicting. The aim of this meta-analysis was to evaluate the association between elevated circulating adiponectin level and adverse outcomes in patients with heart failure. We searched PubMed and Embase databases from their inception to June 2018. Original observational studies that investigated the prognostic value of adiponectin in heart failure patients and reported all-cause mortality or combined endpoints of death/readmission as outcome measure were included. Pooled risk ratio (RR) with 95% confidence intervals (CI) were estimated by higher versus lower circulating adiponectin level. A total of 7 studies involving 862 heart failure patients were identified. Meta-analysis showed that heart failure patients with higher adiponectin level had significantly increased risk of all-cause mortality (RR 2.05; 95%CI 1.22-3.43) after adjustment for potential confounders. In addition, higher adiponectin level was associated with an increased risk of the combined endpoints of death/readmission (RR 2.22; 95%CI 1.38-3.57). Elevated baseline circulating adiponectin level is possibly associated with an increased risk of all-cause mortality and the combined endpoints of death/readmission in patients with heart failure. Determination of circulating adiponectin level has potential to improve risk stratification in heart failure patients.


Subject(s)
Humans , Adiponectin/blood , Heart Failure/mortality , Heart Failure/blood , Prognosis , Biomarkers/blood , Risk Factors
15.
Cad. Saúde Pública (Online) ; 35(5): e00135617, 2019. tab
Article in English | LILACS | ID: biblio-1001672

ABSTRACT

Heart failure is considered a garbage code when assigned as the underlying cause of death. Reassigning garbage codes to plausible causes reduces bias and increases comparability of mortality data. Two redistribution methods were applied to Brazilian data, from 2008 to 2012, for decedents aged 55 years and older. In the multiple causes of death method, heart failure deaths were redistributed based on the proportion of underlying causes found in matched deaths that had heart failure listed as an intermediate cause. In the hospitalization data method, heart failure deaths were redistributed based on data from the decedents' corresponding hospitalization record. There were 123,269 (3.7%) heart failure deaths. The method with multiple causes of death redistributed 25.3% to hypertensive heart and kidney diseases, 22.6% to coronary heart diseases and 9.6% to diabetes. The total of 41,324 heart failure deaths were linked to hospitalization records. Heart failure was listed as the principal diagnosis in 45.8% of the corresponding hospitalization records. For those, no redistribution occurred. For the remaining ones, the hospitalization data method redistributed 21.2% to a group with other (non-cardiac) diseases, 6.5% to lower respiratory infections and 9.3% to other garbage codes. Heart failure is a frequently used garbage code in Brazil. We used two redistribution methods, which were straightforwardly applied but led to different results. These methods need to be validated, which can be done in the wake of a recent national study that will investigate a big sample of hospital deaths with garbage codes listed as underlying causes.


A insuficiência cardíaca, quando atribuída como a causa básica de morte, é considerada um código lixo. A reatribuição de códigos lixo a causas plausíveis tem por objetivo reduzir viés e aumentar a comparabilidade de dados sobre mortalidade. Dois modelos de redistribuição foram aplicados a dados brasileiros de 2008 a 2012, para pacientes falecidos de 55 anos de idade ou mais. No modelo de causas múltiplas de morte, óbitos por insuficiência cardíaca foram redistribuídos com base na proporção de causas básicas identificadas em óbitos pareados que tinham insuficiência cardíaca listada como causa intermediária. No método de dados hospitalares, óbitos por insuficiência cardíaca foram redistribuídos com base nos dados dos registros de hospitalização dos pacientes falecidos. Houve 123.269 (3,7%) óbitos por insuficiência cardíaca. O método de causas múltiplas de morte redistribuiu 25,3% para doenças cardíacas hipertensivas e doenças renais, 22,6% para doenças cardíacas coronarianas e 9,6% para diabetes. Houve 41.324 óbitos por insuficiência cardíaca relacionados com registros de hospitalização. A insuficiência cardíaca foi listada como o diagnóstico principal em 45,8% dos registros de hospitalização correspondentes. Para estes, não foi feita redistribuição. Para os óbitos remanescentes, o método de dados hospitalares redistribuiu 21,2% para outras doenças (não cardíacas), 6,5% para infecções das vias aéreas inferiores e 9,3% para outros códigos lixo. A insuficiência cardíaca é um código lixo frequentemente usado no Brasil. Nós usamos dois métodos de redistribuição, aplicados de forma simples, mas que levaram a resultados distintos. É importante que esses métodos sejam validados, o que pode ser feito a partir de um estudo nacional recente que investigará uma grande amostra de óbitos hospitalares com códigos lixo listados como causas básicas.


El fallo cardíaco, cuando es asignado como causa subyacente de la muerte está considerado como código basura. El objetivo de este estudio es reasignar códigos basura de fallecimiento, con el fin de reducir sesgos e incrementar la comparabilidad de los datos de mortalidad. Se aplicaron dos métodos de redistribución en los datos brasileños de 2008 a 2012, para fallecidos de 55 años y mayores. En el método de causas múltiples de muerte, las muertes por fallo cardiaco fueron redistribuidas basándose en la proporción de causas subyacentes encontradas en las muertes compatibles que contaban con un fallo cardiaco descrito como causa intermedia. En el método de datos de hospitalización, las muertes por fallo cardiaco fueron redistribuidas basándose en datos del historial de hospitalización de los fallecimientos. Hubo 123.269 (3,7%) muertes por fallo cardíaco. El método de múltiples causas de fallecimiento redistribuyó un 25,3% a problemas de hipertensión cardiaca y enfermedades de riñón, un 22,6% a enfermedades coronarias de corazón y un 9,6% a diabetes. Hubo 41.324 muertes por fallos cardiacos vinculadas a los registros de hospitalización. El fallo cardíaco fue listado como diagnóstico principal en un 45,8% de los registros de hospitalización correspondientes. Para estos últimos, no se produjo redistribución. En el caso de los restantes, el método de datos de hospitalización redistribuyó un 21,2% a un grupo con otras enfermedades (no-cardíacas), un 6,5% a infecciones en las vías respiratorias bajas y un 9,3% a otros códigos basura. El fallo cardíaco es frecuentemente usado en Brasil como código basura. Usamos dos métodos de redistribución, que fueron directamente aplicados, pero que condujeron a resultados diferentes. Es importante validar estos métodos, que como consecuencia de un estudio nacional recientemente iniciado es posible que se pueda hacer, además de investigar una gran muestra de muertes hospitalarias registradas con códigos basura procedentes de causas subyacentes.


Subject(s)
Humans , Information Systems , Death Certificates , Medical Record Linkage/methods , Mortality , Heart Failure/mortality , Hospital Records , International Classification of Diseases , Cause of Death , Data Accuracy
16.
Rev. gaúch. enferm ; 40: e20190201, 2019. tab
Article in English | LILACS, BDENF | ID: biblio-1043027

ABSTRACT

Abstract OBJECTIVE To analyze the ranking and percentage variation of the main causes of hospital admissions and death of Brazilian elders between 2005 and 2015, according to gender and age groups. METHOD Retrospective and temporal analysis study. The six main causes of hospitalization and death of elders were collected in DATASUS according to sex and age groups (60 ~ 79, ≥80) in 2017. RESULTS Heart Failure (2005) and pneumonia (2015) were the two main causes of hospital admissions in both sexes and age groups, except for the younger group. Acute Myocardial Infarction was the main cause of death in 2005 and 2015. The second cause in the overall ranking was the Stroke in 2005 and Pneumonia in 2015. CONCLUSION Circulatory and respiratory diseases were the main causes of hospital admissions and death among the elderly, highlighting the impotant increase in pneumonia as a cause of morbimortality.


Resumen OBJETIVO Analizar el ranking y la variación porcentual de las principales causas de internación y muerte de adultos mayores brasileños entre 2005 y 2015, de acuerdo con sexo y grupos de edad. MÉTODO Estudio retrospectivo, de análisis temporal. Las seis principales causas de internación y muerte de adultos mayores fueron recogidas en el DATASUS, según el sexo y grupos de edad (60 ~ 79; ≥80), en 2017. RESULTADOS La Insuficiencia Cardiaca (2005) y la neumonía (2015) fueron las dos las principales causas de hospitalizaciones en ambos sexos y grupos de edad, excepto en ancianos más jóvenes. El infarto agudo de miocardio fue la principal causa de muerte en 2005 y 2015. La segunda causa en el ranking general fue el accidente vascular cerebral en 2005 y la neumonía en 2015. CONCLUSIÓN Las enfermedades del aparato circulatorio y respiratorio fueron las principales causas de hospitalización y muerte entre los ancianos, destacándose el significativo aumento de la neumonía como causa de morbimortalidad.


Resumo OBJETIVO Analisar o ranking e a variação percentual das principais causas de internação e óbito de idosos brasileiros entre 2005 e 2015, de acordo com sexo e grupos etários. MÉTODO Estudo retrospectivo, de análise temporal. As seis principais causas de internação e óbito de idosos foram coletados no DATASUS, segundo o sexo e grupos etários (60~79; ≥80), em 2017. RESULTADOS A Insuficiência Cardíaca (2005) e a pneumonia (2015) foram as duas principais causas de hospitalizações em ambos os sexos e grupos etários, exceto em idosos mais jovens. O Infarto Agudo do Miocárdio foi a principal causa de óbito em 2005 e 2015. Já a segunda causa no ranking geral foi o Acidente Vascular Cerebral em 2005, e a Pneumonia em 2015. CONCLUSÃO As doenças do aparelho circulatório e respiratório foram as principais causas de hospitalização e óbito entre os idosos, destacando-se o significativo aumento da pneumonia como causa de morbimortalidade.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Cause of Death , Hospital Mortality , Patient Admission/statistics & numerical data , Pneumonia/mortality , Time Factors , Brazil , Retrospective Studies , Life Expectancy , Stroke/mortality , Heart Failure/mortality , Middle Aged , Myocardial Infarction/mortality
18.
Revista Digital de Postgrado ; 8(3): e181, 2019. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1094886

ABSTRACT

La Insuficiencia Cardíaca (IC) es una entidad clínica de gran importancia, por su elevada incidencia y mortalidad, por ende la inquietud de realizar constantes y actualizadas revisiones para optimizar su tratamiento y así impactar la morbimortalidad de los pacientes. Objetivo: analizar críticamente la literatura médica, en el tratamiento farmacológico de la insuficiencia cardíaca para ofrecer una mejor calidad de vida al paciente. Métodos: investigación documental a través de la revisión sistemática de artículos primarios en revistas científicas en bases de datos bibliográficas en ciencias de la salud: Pub Med, Google Académico, Elsevier, ScienceDirect, Biblioteca Virtual en Salud (BVS) OPS y Scielo, entre los años de 2014 y 2018, para ello se determinaron los siguientes descriptores: insuficiencia cardiaca, tratamiento, desafíos, calidad de vida. Se revisaron 28 artículos digitales actualizados y cotejados. Resultados: En el tratamiento actual de la insuficiencia cardiaca, prevalece la combinación Sacubitril/Valsartán, ya que disminuye el riesgo de muerte cardiovascular en un 20% y de hospitalización en 21%; además, disminuye los efectos adversos en relación al tratamiento convencional con (IECA). Conclusión: Las nuevas terapias farmacológicas en insuficiencia cardíaca, permiten sustituir las terapias convencionales y optimizar calidad de vida(AU)


Heart Failure (HF) is a clinical entity of great importance, due to its high incidence and mortality, therefore the concern of conducting constant and updated reviews to optimize their treatment and thus impact the morbidity and mortality of patients. Objective: to critically analyze the medical literature, in the pharmacological treatment of heart failure to offer a better quality of life to the patient. Methods: documentary research through the systematic review of primary articles in scientific journals in bibliographic databases in health sciences: Pub Med, Google Scholar, Elsevier, ScienceDirect, Virtual Health Library (VHL) PAHO and Scielo, among the years of 2014 and 2018, for this the following descriptors were determined: heart failure, treatment, challenges, quality of life. 28 updated and collated digital articles were reviewed. Results: In the current treatment of heart failure, the Sacubitril / Valsartan combination prevails, since it reduces the risk of cardiovascular death by 20% and hospitalization by 21%; In addition, it reduces adverse effects in relation to conventional treatment with (ACEI). Conclusion: the new pharmacological therapies in heart failure, allow to replace conventional therapies and optimizing quality of life(AU)


Subject(s)
Humans , Cardiovascular Diseases/mortality , Cardiovascular Diseases/drug therapy , Heart Failure/mortality , Heart Failure/drug therapy , Quality of Life/psychology , Echocardiography/methods , Risk Factors
19.
Ethiop. j. health sci ; 29(1): 811-818, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1261880

ABSTRACT

BACKGROUND: HeartFailure (HF) is a progressive clinical and pathophysiological syndrome caused by cardiovascular and noncardiovascular abnormalities. Childhood HF has not been well studied in Sub-Sharan Africa, particularly in Ethiopia. Hence, this study aimed at describing the pattern and outcome of pediatrics HF at a referral-teaching hospital. METHODS: Medical records of 216 HFchildren aged 2months to 14 years, and admitted between January 2014 and January 2016 were reviewed. Clinical information was collected, analyzed and presented in tables and pie charts. RESULTS: A total of 2000 children were admitted to Hawassa University Hospital during the study period. HF accounted for 10.8% (216) of pediatrics admissions, 51.9% males. The median age of the study subjects was 6years. Functionally, NYHA/Ross class III and IV consisted 65(30.1%) and 139(64.4%) of HF. Structural heart diseasewas the commonest cause of HF, 144(66.7%): Rheumatic heart disease (RHD),75(52%), and congenital heart disease (CHD),64(44.5%). Anemia and renal cases contributed to 50(23.1) and 12(5.6%) of HF.CHD was predominantly documented in <5years. Pneumonia 66(42.9%), and infective endocarditis 29(18.8%) were the common precipitating/comorbid conditions with HF.Thecase fatality rate of HF was 13.9 %( 30). CONCLUSION: In this study, HF accounted for a tenth of pediatrics admissions. Structural heart disease was the commonest cause of heart failure. CHD and RHD affected predominantly children of <5years of age and >5 years of age. Echocardiographic screening of HF cases for structural heart disease and optimal care for patients with underlying structural heart disease are recommended


Subject(s)
Child , Ethiopia , Heart Diseases , Heart Failure , Heart Failure/mortality
20.
Rev. latinoam. enferm. (Online) ; 27: e3159, 2019. tab, graf
Article in Portuguese | SES-SP, LILACS, BDENF, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1020699

ABSTRACT

Objetivo avaliar a efetividade da intervenção comportamental de orientação de alta e contato telefônico na adesão terapêutica, re-hospitalizações e mortalidade em pacientes com insuficiência cardíaca. Método ensaio clínico randomizado, sem cegamento, incluídos 201 pacientes, internados em pronto socorro, com diagnóstico de insuficiência cardíaca. Randomizados em Grupo Controle e Grupo Intervenção, realizada intervenção de orientação de alta específica no Grupo Intervenção, contatados para reorientação via telefonemas em 07 e 30 dias e após 90 dias avaliado a adesão ao tratamento através dos testes de Morisky, Brief Medical Questionnaire e teste para adesão não medicamentosa em ambos grupos. Utilizou-se o Modelo de Equações de Estimação Generalizadas (p<0,05%). Resultados foram alocados aleatoriamente 101 pacientes no Grupo Controle e 100 no Grupo Intervenção, com média de idade de 62,6±15,2. O Grupo Intervenção apresentou maior adesão terapêutica medicamentosa e não medicamentosa em relação ao Grupo Controle (p<0,001) e houve menor índice de re-hospitalização e morte no Grupo Intervenção após 90 dias. Conclusão a orientação de alta com acompanhamento telefônico foi efetiva e resultou em maior adesão terapêutica, diminuição de re-hospitalizações e óbitos em pacientes com insuficiência cardíaca. Registro de Ensaio Clínico (REBEC): RBR- 37n859


Objective to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure. Method randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%). Results One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days. Conclusion discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859


Objetivo evaluar la efectividad de la intervención conductual de orientación del alta y seguimiento telefónico en la adhesión terapéutica, las rehospitalizaciones y la mortalidad en pacientes con insuficiencia cardíaca. Método ensayo clínico aleatorizado, no ciego, en el cual participaron 201 pacientes internados en la sala de urgencias, con el diagnóstico de insuficiencia cardíaca. Divididos al azar en Grupo Control y Grupo Intervención, se realizó una intervención de orientación de alta específica en el Grupo Intervención, siendo contactado por teléfono para la reorientación en 07 y 30 días después del alta; y después de 90 días se evaluó la adhesión al tratamiento por medio de las pruebas de Morisky, Brief Medical Questionnaire y la prueba para la adhesión no medicamentosa en ambos grupos. Se utilizó el Modelo de Ecuaciones de Estimación Generalizadas (p<0,05%). Resultados fueron asignados aleatoriamente 101 pacientes en el Grupo Control y 100 en el Grupo Intervención, con un promedio de edad de 62,6±15,2. El Grupo Intervención tuvo una mayor adhesión terapéutica medicamentosa y no medicamentosa en comparación al Grupo Control (p<0,001), y hubo menores tasas de rehospitalizaciones y de fallecimientos en el Grupo Intervención después de 90 días del alta. Conclusión la orientación del alta y el seguimiento telefónico se mostraron eficaces, promoviendo una mayor adhesión terapéutica, una disminución de las rehospitalizaciones y de fallecimientos en pacientes con insuficiencia cardíaca. Registro de Ensayo Clínico (REBEC): RBR- 37n859


Subject(s)
Humans , Animals , Male , Adult , Middle Aged , Heart Failure/mortality , Heart Failure/therapy , Patient Discharge/statistics & numerical data , Patient Education as Topic/statistics & numerical data , Follow-Up Studies
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