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3.
Arq. bras. cardiol ; 102(4): 319-326, abr. 2014. tab, graf
Artigo em Português | LILACS | ID: lil-709321

RESUMO

Fundamento: As diretrizes baseiam-se em evidências para pautar suas recomendações; apesar disso, há uma lacuna entre o recomendado e a prática clínica. Objetivo: Descrever a prática de prescrição de tratamentos com indicação baseada em diretrizes para pacientes com síndrome coronariana aguda no Brasil. Métodos: Foi realizada uma subanálise do registro ACCEPT, na qual foram avaliados os dados epidemiológicos e a taxa de prescrição de ácido acetilsalicílico, inibidores P2Y12, antitrombóticos, betabloqueadores, inibidores da enzima conversora de angiotensina/bloqueadores AT1 e estatinas. Além disso, avaliou-se a qualidade da reperfusão coronariana no infarto com supradesnivelamento do segmento ST. Resultados: Foram avaliados 2.453 pacientes. As taxas de prescrição de ácido acetilsalicílico, inibidores de P2Y12, antitrombóticos, betabloqueadores, inibidores da enzima conversora de angiotensina/bloqueadores AT1 e estatinas foram, respectivamente, de 97,6%, 89,5%, 89,1, 80,2%, 67,9%, 90,6%, em 24 horas, e, respectivamente, de 89,3%, 53,6, 0%, 74,4%, 57,6%, 85,4%, em 6 meses. Com relação ao infarto com supradesnivelamento do segmento ST, somente 35,9% e 25,3% dos pacientes foram submetidos a angioplastia primária e trombólise, respectivamente, nos tempos recomendados. Conclusão: Este registro mostrou altas taxas de prescrição inicial de antiplaquetários, antitrombóticos e estatina, bem como taxas mais baixas de betabloqueadores e de inibidores da enzima conversora de angiotensina/bloqueadores AT1. Independentemente da classe, todos apresentaram queda do uso aos 6 meses. A maioria dos pacientes com infarto com supradesnivelamento do segmento ST não foi submetida a reperfusão coronariana no tempo recomendado. .


Background: The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice. Objective: To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil. Methods: This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated. Results: This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times. Conclusion: This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended. .


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Análise de Variância , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/uso terapêutico , Brasil , Fibrinolíticos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Reperfusão Miocárdica , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , /uso terapêutico , Fatores de Tempo , Resultado do Tratamento
4.
Arq Bras Cardiol ; 102(4): 319-26, 2014 Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24652052

RESUMO

BACKGROUND: The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice. OBJECTIVE: To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil. METHODS: This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated. RESULTS: This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times. CONCLUSION: This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Análise de Variância , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/uso terapêutico , Brasil , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Reperfusão Miocárdica , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
5.
Arq. bras. cardiol ; 102(04): 319-326, 2014. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-29310

RESUMO

Background: The recommendations in guidelines are based on evidence; however, there is a gap between recommendationsand clinical practice.Objective: To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndromein Brazil.Methods: This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescriptionrate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevationmyocardial infarction was evaluated.Results: This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithromboticdrugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours – 97.6%,89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months – 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively.Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplastyand thrombolysis, respectively, within the recommended times.Conclusion: This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins,and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of theclass, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did notundergo myocardial reperfusion within the time recommended.(AU)


Assuntos
Prática Clínica Baseada em Evidências , Síndrome Coronariana Aguda , Registros de Doenças , Epidemiologia
7.
Arq Bras Cardiol ; 100(3): 212-20, 2013 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23598574

RESUMO

BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.


Assuntos
Assistência Ambulatorial/normas , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/terapia , Medicina Baseada em Evidências/normas , Estilo de Vida , Guias de Prática Clínica como Assunto/normas , Idoso , Brasil , Fármacos Cardiovasculares/classificação , Métodos Epidemiológicos , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Masculino , Fatores de Risco
9.
Arq. bras. cardiol ; 100(3): 212-220, mar. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-670878

RESUMO

FUNDAMENTO: Dados de atendimento ambulatorial ao paciente de alto risco cardiovascular no Brasil são insuficientes. OBJETIVO: Descrever o perfil e documentar a prática clínica do atendimento ambulatorial de pacientes de alto risco cardiovascular no Brasil, no que diz respeito à prescrição de terapias baseadas em evidências. MÉTODOS: Registro prospectivo que documentou a prática clínica ambulatorial de indivíduos de alto risco cardiovascular, que foi definido como a presença de um dos seguintes fatores: doença arterial coronariana, cerebrovascular e vascular periférica; diabetes; ou aqueles com pelo menos três dos seguintes fatores: hipertensão arterial, tabagismo, dislipidemia, maiores 70 anos, histórico familiar de doença arterial coronariana, nefropatia crônica ou doença carotídea assintomática. Foram avaliadas características basais e a taxa de prescrição das intervenções medicamentosas e não medicamentosas. RESULTADOS: Foram incluídos 2.364 pacientes consecutivos, sendo 52,2% do gênero masculino, idade média de 66,0 anos (± 10,1). Dentre os pacientes incluídos, 78,3% utilizavam antiplaquetários, 77,0% estatinas e, dos pacientes com história de infarto do miocárdio, 58,0% receberam betabloqueadores. O uso concomitante destas três classes foi de 34%. Não atingiram as metas preconizadas pelas diretrizes 50,9% dos hipertensos, 67% dos diabéticos e 25,7% dos dislipidêmicos. Os principais preditores de prescrição de terapias com benefício comprovado foram centro com cardiologista e histórico de doença arterial coronariana. CONCLUSÃO: Este registro nacional e representativo identificou hiatos importantes na incorporação de terapias com benefício comprovado, oferecendo um panorama real dos pacientes de alto risco cardiovascular.


BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.


Assuntos
Idoso , Feminino , Humanos , Masculino , Assistência Ambulatorial/normas , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/terapia , Medicina Baseada em Evidências/normas , Estilo de Vida , Guias de Prática Clínica como Assunto/normas , Brasil , Fármacos Cardiovasculares/classificação , Métodos Epidemiológicos , Medicina Baseada em Evidências/métodos , Fatores de Risco
10.
Arq Bras Cardiol ; 100(1): 6-13, 2013 Jan.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23370816

RESUMO

BACKGROUND: There are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome. OBJECTIVES: Demography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome. METHODS: The ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up. RESULTS: Between August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively. CONCLUSIONS: The prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Registros Médicos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Síndrome Coronariana Aguda/terapia , Distribuição por Idade , Idoso , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Resultado do Tratamento
11.
Arq. bras. cardiol ; 100(1): 6-13, jan. 2013. tab
Artigo em Português | LILACS | ID: lil-662395

RESUMO

FUNDAMENTO: São escassos os registros documentando a prática clínica brasileira na vigência de uma síndrome coronária aguda. OBJETIVOS: Descrição da demografia, ocorrência de desfechos graves e análise comparativa dentre aqueles que efetivaram ou não uma estratégia invasiva (cinecoronariografia e revascularização miocárdica) em um registro brasileiro multicêntrico de portadores de uma síndrome coronária aguda. MÉTODOS: O registro ACCEPT/SBC coletou prospectivamente, em 47 centros hospitalares brasileiros, pacientes na vigência de uma síndrome coronária aguda. Apresentamos a ocorrência de desfechos clínicos graves, de modo integral, e de acordo com a submissão ou não a um procedimento de revascularização do miocárdio ao final dos primeiros 30 dias de seguimento. RESULTADOS: De agosto de 2010 até dezembro de 2011, 2.485 pacientes foram incluídos neste registro. Destes, 31,6% eram portadores de angina instável e 34,9% e 33,4%, com síndrome sem e com supradesnível do segmento ST. Aos 30 dias, a submissão a procedimento de revascularização do miocárdio foi progressivamente maior de acordo com a gravidade da apresentação clínica (38,7% versus 53,6% versus 77,7%; p < 0,001). A ocorrência de mortalidade cardíaca, dentre aqueles submetidos ou não à revascularização miocárdica, foi de 1,0% versus 2,3% (p = 0,268), 1,9% versus 4,2% (p = 0,070) e 2,0% versus 8,1% (p < 0,001), angina instável, síndrome sem e com supradesnível do segmento ST, respectivamente. CONCLUSÕES: A prescrição de revascularização do miocárdio foi progressivamente mais frequente de acordo com a gravidade da apresentação clínica; naqueles atendidos na vigência de síndrome coronária sem e com supradesnível do segmento ST, promoveu tendência e redução significativa da mortalidade, aos 30 dias, respectivamente.


BACKGROUND: There are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome. OBJECTIVES: Demography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome. METHODS: The ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up. RESULTS: Between August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively. CONCLUSIONS: The prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/epidemiologia , Registros Médicos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Distribuição por Idade , Síndrome Coronariana Aguda/terapia , Brasil/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Resultado do Tratamento
12.
Arq. bras. cardiol ; 100(03): 203-211, 2013. ilus
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-29284

RESUMO

Das 57 milhões de mortes que ocorreram no mundo, em 2008, 63% ou 36 milhões foram causadas por doenças crônicasnão transmissíveis (DCNT), sendo que, destas, 48% (ou 30% detodas as mortes) foram provocadas por doenças cardiovasculares.Aproximadamente, 80% das mortes por DCNT foram registradasem países de baixa e média renda. Um terço dessas mortesocorreu em pessoas com idade inferior a 60 anos...(AU)


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/mortalidade , Educação Médica/tendências
14.
Arq Bras Cardiol ; 96(6): 434-42, 2011 Jun.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-21789345

RESUMO

Much has been achieved in one century after Carlos Chagas' discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. It's also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas' disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.


Assuntos
Cardiomiopatia Chagásica , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/terapia , Humanos
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