Coronary artery bypass surgery in Brazil: analysis of the national reality through the bypass registry

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry.

INTRODUCTION: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. OBJECTIVE: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. METHODS: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. RESULTS: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. CONCLUSION: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

Avaliação das limitações físicas, aspectos psicossociais e qualidade de vida de pessoas atingidas pela hanseníase / Evaluation of the physical limitations, psychosocial aspects and quality of life of people affected by leprosy / Evaluación de las limitaciones físicas, aspectos psicosoconales y calidad de vida de personas atencidas por la hanseniasis

Objetivo: Avaliar os aspectos referentes as limitações físicas, psicossociais e qualidade de vida das pessoas atingidas pela hanseníase. Método: Estudo quantitativo, transversal. Foram aplicadas as escalas Screening Activity Limitation and Safety Awareness (SALSA), Participação Social e World Health Organization Quality of Life (WHOQOL-bref) com 31 sujeitos. Resultado: Evidenciou-se que a maioria dos participantes apresentava algum grau de restrição física e social. Correlacionando com o grau de incapacidade, destaca-se que os pacientes que apresentaram restrições também possuíam grau II de incapacidade. Quanto à qualidade de vida, o domínio psicológico e o de relações sociais apresentaram as médias mais altas, enquanto o físico e o ambiental tiveram as mais baixas. Conclusão: Afirma-se a necessidade de priorização e intensificação das ações de prevenção de incapacidades da hanseníase

Objective: Analyze the aspects related to the physical, psychosocial and quality of life of people affected by leprosy. Method: Quantitative, crosssectional study. The Screening Activity Limitation and Safety Awareness (SALSA), Social Participation and e World Health Organization Quality of Life (WHOQOL-bref) scales were applied with 31 subjects. Result: The majority of the participants presented some degree of physical and social restriction. The correlation with the degree of disability highlighted that the patients who presented restrictions also had degree of disability II. About the quality of life, the psychological domain and the social relations showed the highest averages, while the physical and the environmental had the lowest ones. Conclusion: It is necessary to prioritize and intensify actions to prevent disability in leprosy

Objetivo: Evaluar los aspectos referentes a las limitaciones físicas, psicosociales y calidad de vida de las personas afectadas por la lepra. Método: Estudio cuantitativo, transversal. Se aplicaron las escalas Screening Activity Limitation and Safety Awareness (SALSA), Participación Social y World Health Organization Quality of Life (WHOQOL-bref) con 31 sujetos. Resultado: Se evidenció que la mayoría de los participantes presentaba algún grado de restricción física y social. Correlacionando con el grado de incapacidad, se destaca que los pacientes que presentaron restricciones, también poseían grado II de incapacidad. En cuanto a la calidad de vida, el dominio psicológico y el de relaciones sociales presentaron las medias más altas, mientras que el físico y el ambiental tuvieron las más bajas. Conclusión: Se afirma la necesidad de priorización e intensificación de las acciones de prevención de incapacidades de la lepra

Qualidade de vida de pessoas afetadas pela hanseníase inseridas em grupos de apoio ao autocuidado / Calidad de vida de personas con lepra que acuden a grupos de apoyo para el autocuidado / Quality of life of people affected by leprosy in self-care support groups

RESUMO Objetivo: analisar a qualidade de vida de pessoas afetadas pela hanseníase inseridas em grupos de apoio ao autocuidado. Método: estudo quantitativo, descritivo, com 43 participantes em unidades de referência que possuíam grupos de apoio ao autocuidado em hanseníase, em Recife e Região Metropolitana. A coleta de dados ocorreu entre janeiro e julho de 2018 com a aplicação do instrumento de avaliação de qualidade de vida WHOQOL-bref. A distribuição das variáveis numéricas contínuas foi analisada pelo teste de Kolmogorov-Smirnov, as categóricas foram apresentadas por frequência absoluta e relativa (%). Resultados: o escore global de qualidade de vida foi 56,4 e os escores dos domínios revelaram-se medianos, com faixas de 50-60. Verificou-se que os domínios com menores pontuações foram os domínios físicos e relações ambientais. Conclusão: pessoas afetadas pela hanseníase apresentam diminuição da qualidade de vida. Apesar de ter cura, é problema de saúde pública, necessitando de atenção para controle e eliminação.

RESUMEN: Objetivo: analizar la calidad de vida de personas con lepra que acuden a grupos de apoyo para el autocuidado. Método: estudio cuantitativo y descriptivo realizado con 43 participantes en unidades de referencia que poseían grupos de apoyo para el autocuidado de la lepra, en Recife y en su Región Metropolitana. Los datos se recolectaron entre enero y julio de 2018 con la aplicación del instrumento de evaluación de la calidad de vida llamado WHOQOL-bref. La distribución de las variables numéricas continuas se analizó con la prueba de Kolmogorov-Smirnov; las categóricas se presentaron por medio de frecuencias absolutas y relativas (%). Resultados: el puntaje global de la calidad de vida fue 56,4 y los de los dominios resultaron medianos, con un margen de50 a 60. Se verificó que los dominios con los puntajes más bajos fueron los dominios físico y de relaciones ambientales. Conclusión: las personas con lepra presentan una reducción en su calidad de vida. Pese a tener cura, es un problema de salud pública, que requiere atención para su control y eliminación.

ABSTRACT Objective: To analyze the quality of life of people affected by leprosy in self-care support groups. Method: A quantitative and descriptive study conducted with 43 participants in reference units with self-care support groups for people affected by leprosy in Recife and its Metropolitan Area. Data collection took place between January and July 2018 with the application of the WHOQOL-BREF instrument to assess quality of life. The distribution of the continuous numerical variables was analyzed by the Kolmogorov-Smirnov test; the categorical variables were presented by absolute and relative (%) frequency. Results: The overall quality of life score was 56.4 and the domain scores were average, ranging between 50 and 60. The domains with the lowest scores were found to be the physical and environmental relationship domains Conclusion: People affected by leprosy have a decreased quality of life. Although curable, it is a public health problem and requires attention for control and elimination.

Conhecimento dos enfermeiros sobre drogas vasoativas / Knowledge of nurses about vasoactive drugs

Objetivo: descrever o conhecimento dos enfermeiros de uma unidade de pós-operatório de cirurgia cardíaca sobre drogas vasoativas. Método: trata-se de um estudo quantitativo, descritivo, transversal, tendo como cenário a UTI de pós-operatório de cirurgia cardíaca de um hospital escola. Constituiu-se a amostra por enfermeiros. Utilizou-se um questionário para a coleta dos dados, e, para a análise as frequências absolutas e percentuais. Apresentaram-se os resultados em tabelas. Resultados: registrou-se que 75% dos pesquisados afirmaram que DVA's são denominadas de aminas vasoativas ou drogas simpatomiméticas. Verifica-se, quanto às classificações das DVA's como vasopressoras e vasodilatadoras, que 87,5% responderam que as drogas vasopressoras são a dopamina e a dobutamina; já em relação às drogas vasodilatadoras, todos os enfermeiros apontaram a nitroglicerina e o nitroprussiato de sódio. Conclusão: demonstram-se que as questões abordadas corroboram com outras pesquisas maiores, atuais e relevantes para o âmbito da assistência intensivista. Considera-se que o ensino de Enfermagem ainda deixa lacunas relativas ao assunto, representando um desafio para os educadores no sentido de aprimorar a didática sobre o tema.(AU)

Objective: to describe the knowledge of the nurses of a postoperative unit of cardiac surgery on vasoactive drugs. Method: this is a quantitative, descriptive, cross-sectional study based on the postoperative ICU of cardiac surgery at a school hospital. The sample was composed by nurses. A questionnaire was used to collect the data and, for the analysis, the absolute and percentage frequencies. Results were presented in tables. Results: it was recorded that 75% of respondents stated that VADs are denominated vasoactive amines or sympathomimetic drugs. As regards the classifications of VADs as vasopressors and vasodilators, 87.5% answered that the vasopressor drugs are dopamine and dobutamine; already in relation to vasodilator drugs, all nurses pointed to nitroglycerin and sodium nitroprusside. Conclusion: it is shown that the issues addressed corroborate with other larger, current and relevant research in the field of intensive care. It is considered that nursing education still leaves gaps related to the subject, representing a challenge for educators to improve didactics on the subject.(AU)

Objetivo: describir el conocimiento de los enfermeros de una unidad de postoperatorio de cirugía cardíaca sobre las drogas vasoactivas. Método: se trata de un estudio cuantitativo, descriptivo, transversal, teniendo como escenario la UTI de postoperatorio de cirugía cardíaca de un hospital escolar. Se constituyó la muestra por enfermeros. Se utilizó un cuestionario para la recolección de los datos, y para el análisis las frecuencias absolutas y porcentuales. Se presentaron los resultados en tablas. Resultados: se registró que el 75% de los encuestados afirmó que DVA's son denominadas aminas vasoactivas o drogas simpaticomiméticas. Se observa, en cuanto a las clasificaciones de las DVA como vasopresoras y vasodilatadoras, que el 87,5% respondió que las drogas vasopresoras son la dopamina y la dobutamina; ya en relación a las drogas vasodilatadoras, todos los enfermeros señalaron la nitroglicerina y el nitroprusiato de sodio. Conclusión: se demuestra que las cuestiones abordadas corroboran con otras investigaciones más grandes, actuales y relevantes para el ámbito de la asistencia intensiva. Se considera que la enseñanza de enfermería todavía deja huecos relativos al asunto, representando un desafío para los educadores en el sentido de mejorar la didáctica sobre el tema.(AU)

Practices for self-care in Hansen's disease: face, hands and feet. / Práticas de autocuidado em hanseníase: face, mãos e pés.

OBJECTIVE: To analyze the self-care practices on the face, hands and feet carried out by people affected by Hansen's disease. METHODOLOGY: A qualitative study, carried out in reference units for Hansen's disease in Pernambuco, between May 2014 and April 2015, with 24 people. Data was collected through the semi-structured interview and content analysis was carried out. RESULTS: Two categories emerged: Knowledge and execution of self-care practices in Leprosy and Singularities and challenges for self-care. The study found that respondents are familiar with information about face, hand and foot care, but report difficulties such as low income to acquire material for self-care, lack of time, and some lack of interest. Most of them already presented a degree of incapacity. CONCLUSIONS: The training of professionals who work on the empowerment of people facing the disease, guidelines on prevention of disabilities and access to inputs for carrying out self-care are necessary.

Percepção de pacientes com hanseníase acerca dos grupos de autocuidado / Perception of patients with lepra about the self-care groups

Objetivo: analisar a percepção dos pacientes com hanseníase acerca dos grupos de apoio ao autocuidado. Método: estudo qualitativo, descritivo, realizado em unidade de saúde de referência para tratamento da hanseníase com 11 pacientes. Os dados foram coletados por meio de entrevista semiestruturada, e realizada a Técnica de Análise de Conteúdo. Resultados: os achados foram classificados em duas categorias: << Importância do autocuidado para a prevenção de incapacidades físicas e psicossociais e << Contribuições dos grupos de apoio ao autocuidado no enfrentamento das dificuldades e limitações das pessoas atingidas pela hanseníase >>. Conclusão: os grupos de apoio ao autocuidado proporcionam a redução de incapacidades físicas, por meio de medidas de prevenção, educação em saúde, adesão ao autocuidado e tratamento. Além disso, esses grupos elevam a autoestima, proporcionam a superação de preconceito e possibilitam o vínculo terapêutico entre pacientes e profissionais. Este estudo auxilia no enfrentamento das dificuldades e limitações de pessoas atingidas pela hanseníase.(AU)

Práticas de autocuidado em hanseníase: face, mãos e pés / Prácticas de autocuidado en hanseniasis: cara, manos y pies / Practices for self-care in Hansen's disease: face, hands and feet

Resumo OBJETIVO Analisar as práticas de autocuidado em face, mãos e pés realizadas por pessoas atingidas pela hanseníase. METODOLOGIA Estudo qualitativo, realizado em unidades de referência para hanseníase em Pernambuco, entre maio de 2014 e abril de 2015, com 24 pessoas. Os dados foram coletados por meio da entrevista semiestruturada e realizada a análise de conteúdo. RESULTADOS Emergiram duas categorias: Conhecimento e realização de práticas de autocuidado em Hanseníase e Singularidades e desafios do autocuidado. O estudo apontou que os entrevistados conhecem as informações sobre os cuidados com a face, mãos e pés, mas relatam dificuldades como baixa renda para adquirir material para o autocuidado, falta de tempo, e alguns falta de interesse. A maior parte já apresentava grau de incapacidade. CONCLUSÕES É necessário a capacitação de profissionais que atuem no empoderamento das pessoas frente à doença e orientações sobre prevenção de incapacidades e acesso à insumos para realizar o autocuidado.

Resumen OBJETIVO Analizar las prácticas de autocuidado en cara, manos y pies realizadas por personas afectadas por la hanseniasis. METODOLOGÍA Estudio cualitativo, realizado en unidades de referencia para hanseniasis en Pernambuco, entre mayo de 2014 y abril de 2015, con 24 personas. Los datos fueron recolectados por medio de la entrevista semiestructurada y realizada el análisis de contenido. RESULTADOS emergieron dos categorías: Conocimiento y realización de prácticas de autocuidado en Hanseniasis y Singularidades y desafíos del autocuidado. El estudio apuntó que los entrevistados conocen las informaciones sobre los cuidados con la cara, manos y pies, pero relatan dificultades como bajas rentas para adquirir material para el autocuidado, falta de tiempo, y algunos falta de interés. La mayor parte ya presentaba grado de incapacidad. CONCLUSIONES Es necesario la capacitación de profesionales que actúen en el empoderamiento de las personas frente a la enfermedad y orientaciones sobre prevención de discapacidades y acceso a insumos para realizar el autocuidado.

ABSTRACT OBJECTIVE To analyze the self-care practices on the face, hands and feet carried out by people affected by Hansen's disease. METHODOLOGY A qualitative study, carried out in reference units for Hansen's disease in Pernambuco, between May 2014 and April 2015, with 24 people. Data was collected through the semi-structured interview and content analysis was carried out. RESULTS Two categories emerged: Knowledge and execution of self-care practices in Leprosy and Singularities and challenges for self-care. The study found that respondents are familiar with information about face, hand and foot care, but report difficulties such as low income to acquire material for self-care, lack of time, and some lack of interest. Most of them already presented a degree of incapacity. CONCLUSIONS The training of professionals who work on the empowerment of people facing the disease, guidelines on prevention of disabilities and access to inputs for carrying out self-care are necessary.

The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients.

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

The brazilian registry of adult patient undergoing cardiovascular surgery, the bypass project: results of the first 1,722 patients

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.