ABSTRACT
Background: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data. Methods: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237). Findings: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (ß = -0.05, P < 0.001) form, and directly associated with CCM (ß = 0.06, P < 0.001) and digestive (ß = 0.02, P < 0.001) forms. Heterogeneity was overall high. Interpretation: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form. Funding: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.
ABSTRACT
BACKGROUND: Catheter ablation (CA) is a well-established therapy for patients with atrial fibrillation (AF); however, there is paucity of data for elderly patients. We aimed to assess long-term efficacy and safety of CA for elderly patients with AF. METHODS: Medline, BVS, Cochrane, and Embase were searched through April 2023 to investigate comparative outcomes between elderly patients > 75 or 80 years, as per-study cutoff, and individuals ≤ 75/80 years, undergoing CA. Primary efficacy and safety endpoints (AF recurrence and procedure-related major complications) were pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup analyses were performed by age groups and type of procedure (radiofrequency vs. cryoballoon). RESULTS: Four thousand eight hundred twenty-nine titles were screened, and 27 studies were included, being 26 observational and 1 randomized trial, comprising 117,869 patients, being 8714 (7.4%) elderly > 75/80 years, with follow-up from 11.7 to 72.3 months. In comparative studies (N = 17 studies), elderly > 75/80 years had a higher risk of AF recurrence compared to those ≤ 75/80: relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot indicated publication bias, and after imputation of 5 studies, the groups were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major complications (N = 14 studies) were higher in elderly > 75/80 years (RR 1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24, I2 = 0.0). Results were similar when individual study arms (N = 27 studies) were pooled. CONCLUSION: AF ablation is feasible in elderly patients > 75/80 years, with success rates compared to younger individuals. Complication rates, however, were higher.
ABSTRACT
BACKGROUND: The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known. OBJECTIVES: We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study. METHODS: We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant. RESULTS: Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 - -61.2) and in Brazil (-49.8%, 95%CI -52.5 - -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023). CONCLUSIONS: In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.
FUNDAMENTO: O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido. OBJETIVO: Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019. MÉTODOS: Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo. RESULTADOS: A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023). CONCLUSÕES: Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.
Subject(s)
Cardiovascular Diseases , Global Burden of Disease , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Humans , Portugal/epidemiology , Quality-Adjusted Life Years , Risk FactorsABSTRACT
Resumo Fundamento: O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido. Objetivo: Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019. Métodos: Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo. Resultados: A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023). Conclusões: Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.
Abstract Background: The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known. Objectives: We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study. Methods: We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant. Results: Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 - -61.2) and in Brazil (-49.8%, 95%CI -52.5 - -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023). Conclusions: In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.
