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1.
Arq. bras. cardiol ; 115(1): 92-99, jul. 2020. tab, graf
Artigo em Português | LILACS-Express | LILACS, Sec. Est. Saúde SP | ID: biblio-1131254

RESUMO

Resumo Fundamento Existem grandes oportunidades de melhoria da qualidade do cuidado cardiovascular em países em desenvolvimento por meio da implementação de um programa de qualidade. Objetivo Avaliar o efeito de um programa de Boas Práticas em Cardiologia (BPC) nos indicadores de desempenho e desfechos clínicos dos pacientes relacionados à insuficiência cardíaca, fibrilação atrial e síndromes coronarianas agudas em um subconjunto de hospitais públicos brasileiros. Métodos O programa Boas Práticas em Cardiologia (BPC) foi adaptado do programa Get With The Guidelines (GWTG) da American Heart Association (AHA) para ser utilizado no Brasil. O programa está sendo iniciado em três domínios de cuidado simultaneamente (síndrome coronariana aguda, fibrilação atrial e insuficiência cardíaca), o que consiste em uma abordagem nunca testada no GWTG. Existem seis eixos de intervenções utilizadas pela literatura sobre tradução do conhecimento que abordará barreiras locais identificadas por meio de entrevistas estruturadas e reuniões regulares para auditoria e feedback. Planeja-se incluir no mínimo 10 hospitais e 1500 pacientes por doença cardíaca. O desfecho primário inclui as taxas de adesão às medidas de cuidado recomendadas pelas diretrizes. Desfechos secundários incluem o efeito do programa sobre o tempo de internação, mortalidade global e específica, taxas de readmissão, qualidade de vida, percepção do paciente sobre saúde e adesão dos pacientes às intervenções prescritas. Resultados Espera-se, nos hospitais participantes, uma melhoria e a manutenção das taxas de adesão as recomendações baseadas em evidência e dos desfechos dos pacientes. Este é o primeiro programa em melhoria da qualidade a ser realizado na América do Sul, que fornecerá informações importantes de como programas de sucesso originados em países desenvolvidos como os Estados Unidos podem ser adaptados às necessidades de países com economias em desenvolvimento como o Brasil. Um programa bem sucedido dará informações valiosas para o desenvolvimento de programas de melhoria da qualidade em outros países em desenvolvimento. Conclusões Este estudo de mundo real proverá informações para a avaliação e aumento da adesão às diretrizes de cardiologia no Brasil, bem como a melhora dos processos assistenciais. (Arq Bras Cardiol. 2020; 115(1):92-99)


Abstract Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

2.
ESC Heart Fail ; 7(4): 1744-1752, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32383349

RESUMO

AIMS: Exhaled breath acetone (EBA) has been described as a new biomarker of heart failure (HF) diagnosis. EBA concentration increases according to severity of HF and is associated with poor prognosis, especially in acute decompensated HF. However, there are no data on chronic HF patients. The aim is to evaluate the role of EBA for predicting cardiac and overall mortality in chronic HF patients. METHODS AND RESULTS: In GENIUS-HF cohort, chronic patients were enrolled between August 2012 and December 2014. All patients had left ventricular ejection fraction ≤ 50%, and the diagnosis was established according to Framingham criteria. After consent, patients were submitted to clinical evaluation and exhaled breath collection. EBA identification and quantitative determination were done by spectrophotometry. The clinical characteristics associated with acetone were identified. All participants were followed for 18 months to assess cardiac and overall mortality. Around 700 participants were enrolled in the current analysis. Patients were 55.4 ± 12.2 years old, 67.6% male patients, and 81% New York Heart Association I/II with left ventricular ejection fraction of 32 ± 8.6%. EBA median concentration was 0.6 (0.3-1.2) ug/L. Acetone levels increased with the number of symptoms of HF and were associated with right HF signs/symptoms and liver biochemical changes. EBA at highest quartile (EBA > 1.2ug/L) was associated with a significantly worse prognosis (log rank test, P < 0.001). Cox proportional multivariable regression model revealed that EBA > 1.20ug/L was an independent predictor of cardiac (P = 0.011) and overall (P = 0.010) mortality in our population. CONCLUSIONS: This study shows that EBA levels reflect clinical HF features, especially right HF signs/symptoms. EBA is an independent predictor of cardiac and overall mortality in chronic HF patients.

3.
Arq Bras Cardiol ; 115(1): 92-99, 2020 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32187286

RESUMO

Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).


Assuntos
Cardiologia , Qualidade de Vida , Brasil , Fidelidade a Diretrizes , Hospitais Públicos , Humanos , Estados Unidos
4.
JACC Heart Fail ; 8(3): 212-222, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31838032

RESUMO

Whereas multiple national, international, and trial registries for heart failure have been created, international standards for clinical assessment and outcome measurement do not currently exist. The working group's objective was to facilitate international comparison in heart failure care, using standardized parameters and meaningful patient-centered outcomes for research and quality of care assessments. The International Consortium for Health Outcomes Measurement recruited an international working group of clinical heart failure experts, researchers, and patient representatives to define a standard set of outcomes and risk-adjustment variables. This was designed to document, compare, and ultimately improve patient care outcomes in the heart failure population, with a focus on global feasibility and relevance. The working group employed a Delphi process, patient focus groups, online patient surveys, and multiple systematic publications searches. The process occurred over 10 months, employing 7 international teleconferences. A 17-item set has been established, addressing selected functional, psychosocial, burden of care, and survival outcome domains. These measures were designed to include all patients with heart failure, whether entered at first presentation or subsequent decompensation, excluding cardiogenic shock. Sources include clinician report, administrative data, and validated patient-reported outcome measurement tools: the Kansas City Cardiomyopathy Questionnaire; the Patient Health Questionnaire-2; and the Patient-Reported Outcomes Measurement Information System. Recommended data included those to support risk adjustment and benchmarking across providers and regions. The International Consortium for Health Outcomes Measurement developed a dataset designed to capture, compare, and improve care for heart failure, with feasibility and relevance for patients and clinicians worldwide.

6.
BMC Cardiovasc Disord ; 19(1): 251, 2019 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706288

RESUMO

BACKGROUND: Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge. We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort. METHODS: We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use. RESULTS: We screened 2314 consecutive patients for eligibility and enrolled 700 participants. The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008-1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347-2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969-0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies. CONCLUSIONS: High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample. TRIAL REGISTRATION: Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.


Assuntos
Insuficiência Cardíaca Sistólica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Pressão Sanguínea , Nitrogênio da Ureia Sanguínea , Brasil/epidemiologia , Doença Crônica , Progressão da Doença , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Cardíaca Sistólica/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda , Adulto Jovem
7.
Heart ; 104(18): 1522-1528, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523589

RESUMO

BACKGROUND: Chagas cardiomyopathy (ChC) prevalence is decreasing in Brazil and medical therapies for heart failure (HF) have improved in the last decade. Whether these changes modified the prognosis of ChC relative to non-Chagas cardiomyopathies (NChC) remains unknown. This study evaluated the temporal trends in population attributable risk (PAR) of ChC for 2-year mortality among patients with HF enrolled at years 2002-2004 (era 1) and 2012-2014 (era 2) in a Brazilian university hospital. METHODS: We prospectively studied 362 (15% with ChC) and 582 (18% with ChC) HF patients with ejection fraction ≤50% in eras 1 and 2, respectively and estimated the PAR of ChC for 2-year mortality. RESULTS: There were 145 deaths (29 in ChC) in era 1 and 85 deaths (26 in ChC) in era 2. In multivariable Cox-regression analysis adjusted for age, sex, ejection fraction, heart rate, body mass index, hypertension, diabetes mellitus, systolic blood pressure and ischaemic/valvar aetiology, ChC was associated with higher risk of death in era 1 (HR (95% CI)=1.92 (1.00 to 3.71), p=0.05) and era 2 (HR (95% CI)=3.51 (1.94 to 6.36), p<0.001). In fully adjusted analysis, the PAR of ChC for mortality increased twofold from era 1 (PAR (95% CI)=11.0 (2.8 to 18.5)%) to era 2 (PAR (95% CI)=21.9 (16.5 to 26.9)%; p=0.023 versus era 1). CONCLUSION: Although the absolute death rates decreased over time in the ChC and NChC groups, the PAR of ChC for mortality increased among patients with HF, driven by increases in the HR associated with ChC. Our results highlight the need for additional efforts aiming to prevent and treat ChC.


Assuntos
Cardiomiopatia Chagásica/complicações , Insuficiência Cardíaca/mortalidade , Medição de Risco/métodos , Volume Sistólico/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
8.
Cardiol Rev ; 26(4): 196-200, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29369824

RESUMO

Heart failure (HF) is a common clinical syndrome associated with significant morbidity and mortality, and there remains a clear need for innovative therapies that can modify disease progression. Sacubitril/valsartan (LCZ696) is a novel complex that combines simultaneous neprilysin inhibition and angiotensin II receptor blockade, that has demonstrated significant cardiovascular death or HF hospitalization reduction in the Prospective Comparison of Angiotensin Receptor/Neprilysin Inhibitor (ARNI) With Angiotensin-Converting Enzyme (ACE) Inhibitors to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial when compared with evidence-based doses of the gold standard ACE inhibitor enalapril. In this comprehensive review, the authors discuss historical trials that have investigated clinical outcomes utilizing variable dosing levels of ACE inhibitors or angiotensin receptor blockers in patients with HF with reduced ejection fraction. A critical analysis of the highlighted studies is proposed in the context of current HF management guidelines and HF clinical practice. In conclusion, based on current evidence, it is unclear whether a maximum recommended enalapril dose would promote improved patient outcomes compared with an intermediate dose. However, no prospective study to date comparing ACE inhibitor doses has documented that higher doses result in significant mortality reduction, although the data suggest that there may be a decrease in HF hospitalizations when compared with lower doses.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Ensaios Clínicos como Assunto , Humanos , Resultado do Tratamento
9.
Diabetes Res Clin Pract ; 127: 275-284, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28412543

RESUMO

AIMS: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/etiologia , Brasil , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/patologia , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Classe Social
10.
Diabetes Res Clin Pract ; 127: 275-284, 2017. tab, ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1062383

RESUMO

AIMS:The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country.METHODS:REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke).


Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Diabetes Mellitus/etiologia , Diabetes Mellitus/mortalidade , Diabetes Mellitus/patologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/patologia
11.
Open Heart ; 3(2): e000434, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27547430

RESUMO

OBJECTIVE: The aim of this study is to assess the association between genetic ancestry, self-declared race and haemodynamic parameters in patients with chronic heart failure (HF). METHODS: Observational, cross-sectional study. Eligible participants were aged between 18 and 80 years; ejection fraction was ≤50%. Patients underwent genetic analysis of ancestry informative markers, echocardiography and impedance cardiography (ICG). Race was determined by self-classification into two groups: white and non-white. Genomic ancestry was estimated using a panel of 101 348 polymorphic markers and three continental reference populations (European, African and Native American). RESULTS: Our study included 362 patients with HF between August 2012 and August 2014. 123 patients with HF declared themselves as white and 234 patients declared themselves as non-white. No statistically significant differences were found regarding the ICG parameters according to self-declared race. The Amerindian ancestry was positively correlated with systolic time ratio (r=0.109, p<0.05). The thoracic fluid content index (r=0.124. p<0.05), E wave peak (r=0.127. p<0.05) and E/e' ratio (r=0.197. p<0.01) were correlated positively with African ancestry. In multiple linear regression, African ancestry remained associated with the E/e' ratio, even after adjustment to risk factors. CONCLUSIONS: The African genetic ancestry was associated with worse parameters of diastolic function; the Amerindian ancestry correlated with a worse pattern of ventricular contractility, while self-declared colour was not helpful to infer haemodynamic profiles in HF. TRIALS REGISTRATION NUMBER: NTC02043431.

12.
Am Heart J ; 176: 10-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27264215

RESUMO

BACKGROUND: Atrial fibrillation (AF) is an important and growing public health problem worldwide, but data about its actual prevalence, therapeutic management, and clinical outcomes in middle- to low-income countries are scarce. DESIGN: The First Brazilian Cardiovascular Registry of Atrial Fibrillation (the RECALL study) will assess demographic characteristics and evidence-based practice of a representative sample of patients with AF in Brazil. The prospective, multicenter registry has a planned sample size of around 5,000 patients at approximately 80 sites. Eligibility criteria include age >18 years and permanent, paroxysmal, or persistent AF documented by electrocardiogram, 24-hour Holter monitoring, or device interrogation. Patients will be followed up through 1 year after enrollment. Information on laboratory tests, echocardiographic data, medication use, and clinical outcomes will be obtained. Various aspects of the population will be described, including demographic characteristics; antithrombotic therapies; antiarrhythmic agents; level of control of international normalized ratio (by average time within the therapeutic range) among patients using vitamin K antagonists; rates of warfarin discontinuation; outcomes such as death, stroke, systemic embolism, and major bleeding within 1 year after enrollment in the study; and rates of electrical cardioversion, percutaneous ablation of AF, ablation of the atrioventricular junction, and pacemaker/cardioverter-defibrillator implantation. SUMMARY: RECALL is the first prospective, multicenter registry of AF in Brazil. This study will provide important information about demographics, practice patterns, treatments, and associated outcomes in patients with AF. The results of this registry will also allow Brazilian data to be put in perspective with other AF registries across the world and provide opportunities to improve care of patients with AF in Brazil.


Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes , Fibrilação Atrial , Cardioversão Elétrica , Administração dos Cuidados ao Paciente , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Brasil/epidemiologia , Cardioversão Elétrica/métodos , Cardioversão Elétrica/estatística & dados numéricos , Eletrocardiografia/métodos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Coeficiente Internacional Normatizado , Masculino , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Estudos Prospectivos , Sistema de Registros , Projetos de Pesquisa
13.
Arq Bras Cardiol ; 104(6): 433-42, 2015 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26131698

RESUMO

BACKGROUND: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. OBJECTIVE: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. METHODS: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. RESULTS: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. CONCLUSION: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.


Assuntos
Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização , Registros Médicos , Qualidade da Assistência à Saúde , Sistema de Registros/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Comorbidade , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Resultado do Tratamento
14.
Arq. bras. cardiol ; 104(6): 433-442, 06/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-750702

RESUMO

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .


Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtorno Bipolar , Esquizofrenia , Antipsicóticos/economia , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/economia , Transtorno Bipolar/epidemiologia , Análise Custo-Benefício , Prescrições de Medicamentos/estatística & dados numéricos , Custos de Cuidados de Saúde , Seguro Saúde/economia , Medicaid/economia , Prevalência , Esquizofrenia/tratamento farmacológico , Esquizofrenia/economia , Esquizofrenia/epidemiologia , Estados Unidos/epidemiologia
15.
BMC Cardiovasc Disord ; 14: 90, 2014 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-25059829

RESUMO

BACKGROUND: Previous studies have shown the occurrence of actinin-3 deficiency in the presence of the R577X polymorphism in the ACTN3 gene. Our hypothesis is that this deficiency, by interfering with the function of skeletal muscle fiber, can result in a worse prognosis in patients with chronic heart failure. METHODS: A prospective cohort study was conducted from 2002 to 2004. The eligibility criteria included diagnosis of chronic heart failure stage C from different etiologies. We excluded all patients with concomitant disease that could be related to poor prognosis. ACTN3 rs1815739 (R577X) polymorphism was detected by high resolution melting analysis. Survival curves were calculated with the Kaplan-Meier method and evaluated with the log-rank statistic. The relationship between the baseline variables and the composite end-point of all-cause death was assessed using a Cox proportional hazards survival model. RESULTS: A total of 463 patients were included in this study. The frequency of the ACTN3 577X variant allele was 39.0%. The LVEF mean was 45.6 ± 18.7% and the most common etiology of this study was hypertensive. After a follow-up of five years, 239 (51.6%) patients met the pre-defined endpoint. Survival curves showed higher mortality in patients carrying RX or XX genotypes compared with patients carrying RR genotype (p = 0.01). CONCLUSION: R577X polymorphism in the ACTN3 gene was independently associated with worse survival in patients with chronic heart failure. Further studies are necessary to ensure its use as a marker of prognosis for this syndrome.


Assuntos
Actinina/genética , Insuficiência Cardíaca/genética , Polimorfismo Genético , Sobreviventes , Adulto , Idoso , Feminino , Frequência do Gene , Predisposição Genética para Doença , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Volume Sistólico/genética , Fatores de Tempo , Função Ventricular Esquerda/genética
16.
Am Heart J ; 168(2): 213-9.e1, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25066561

RESUMO

BACKGROUND: Early termination of clinical trials due to low recruitment represents an understudied challenge for clinical research. We aimed to describe characteristics of cardiovascular trials terminated because of low recruitment and identify the major predictors of such early termination. METHODS: We reviewed all cardiovascular clinical trials (7,042 studies) registered in ClinicalTrials.gov from February 29, 2000, to January 17, 2013, and assessed information about trials that were completed and those that were terminated early. Logistic regression models were developed to identify independent predictors of early termination due to low recruitment. RESULTS: Our search strategy identified 6,279 cardiovascular clinical trials, of which 684 (10.9%) were terminated prematurely. Of these halted trials, the main reason for termination was lower than expected recruitment (278 trials; 53.6%). When comparing trials that terminated early because of low recruitment with those that were completed, we found that studies funded by the National Institutes of Health or other US federal agencies (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.14-0.89), studies of behavior/diet intervention (OR 0.35, 95% CI 0.19-0.65), and single-arm design studies (OR 0.57, 95% CI 0.42-0.78) were associated with a lower risk of early termination. University/hospital-funded (OR 1.52, 95% CI 1.10-2.10) and mixed-source-funded studies (OR 2.14, 95% CI 1.52-3.01) were associated with a higher likelihood of early termination due to lower than expected recruitment rates. CONCLUSIONS: Low recruitment represents the main cause of early termination of cardiovascular clinical trials. Funding source, type of intervention, and study design are factors associated with early termination due to low recruitment and might be good targets for improving enrollment into cardiovascular clinical trials.


Assuntos
Doenças Cardiovasculares , Ensaios Clínicos como Assunto , Término Precoce de Ensaios Clínicos/estatística & dados numéricos , Seleção de Pacientes , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , National Library of Medicine (U.S.) , Prevalência , Sistema de Registros/estatística & dados numéricos , Viés de Seleção , Estados Unidos
17.
BMC Cardiovasc Disord ; 14: 32, 2014 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-24592820

RESUMO

BACKGROUND: Studies adopting electronic medical records and genomic information are becoming widespread. Through this new modality in research, it is possible to study how genetic variants influence susceptibility towards chronic conditions and can improve patient care.Our aim is to develop a biobank with 2,000 heart failure patients treated in a tertiary cardiology hospital containing electronic medical records data and biologic samples for performing genome-wide association studies for validation and development of medical decision routines aimed at helping the clinical management of patients. METHODS/DESIGN: Patients between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤ 50% in the past 2 years will be eligible for enrollment on the cohort. After consent, patients will be submitted to clinical baseline, echocardiography, cardiograph impedance and biochemical evaluation. Study data will be collected and managed using Research Electronic Data Capture tools. The follow up will take place every 6 months to assess cardiovascular outcomes (all-cause mortality, cardiovascular mortality, hospitalization for worsening heart failure and current medication use). Initial analytical strategy will focus on the establishment of the accuracy of electronic medical records extraction protocols for main predictor factors of morbidity and mortality in heart failure. DISCUSSION: Building a biobank with biologic samples and clinical data of 2,000 heart failure patients we will perform genome-wide association studies. By this way, we pretend to study how genetic variants influence susceptibility towards chronic conditions. Besides, it will be created a working group focused on the development and implementation of algorithms for validation and application of medical routines using the electronic medical records of the Heart Institute (InCor - HCFMUSP). TRIAL REGISTRATION: Current Controlled Trials NTC02043431.


Assuntos
Registros Eletrônicos de Saúde , Insuficiência Cardíaca/genética , Projetos de Pesquisa , Bancos de Tecidos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Brasil , Procedimentos Clínicos , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Volume Sistólico , Centros de Atenção Terciária , Fatores de Tempo , Função Ventricular Esquerda , Adulto Jovem
18.
Insuf. card ; 6(3): 117-123, jul.-set. 2011. ilus, tab
Artigo em Português | LILACS-Express | LILACS | ID: lil-633403

RESUMO

Objetivo. Demonstrar que escore baseado em marcadores laboratoriais de baixo custo pode determinar prognóstico de pacientes ambulatoriais portadores de insuficiência cardíaca (IC). Introdução: A IC é uma doença que reconhecidamente evolui com alta morbimortalidade. Os biomarcadores estão emergindo como importante auxiliar na avaliação clínica padrão de uma variedade de desordens cardiovasculares, incluindo a IC. Métodos. Consiste em coorte prospectiva de pacientes ambulatoriais portadores de IC, foram selecionados os marcadores: sódio, high density lipoprotein (HDL), creatinina, clearance de creatinina, ácido úrico e hemoglobina. Foi conferido um ponto para alterações em cada marcador e definido como baixo risco: 0 a 2 pontos, moderado risco: 3 a 4 pontos e alto risco: 5 a 6 pontos. O desfecho primário foi óbitos de origem cardiovascular, e o secundário foi óbitos de causa cardiovascular associado a internações de causas cardiovasculares. Os métodos estatísticos utilizados foram qui-quadrado, teste t de Student, regressão de Cox e utilizado método de Kaplan Meier para análise de curva de eventos. Resultados. Foram estudados 146 pacientes com média etária de 58±13.04, 44 pacientes (30,2%) do sexo masculino e 102 (69,8%) do sexo feminino. Os desfechos foram o primário: 15 (10,2%) óbitos e secundário: 54 (37%) eventos compostos. O número de indivíduos segundo o estágio de risco: baixo: 68, intermediário: 63 e alto: 15. A taxa de eventos no baixo, intermediário e alto risco foram 8 (11,7%), 34 (54%) e 12 (80%), respectivamente. Segundo a estratificação de risco, o hazard ratio para baixo risco (HR=0,14; p=0,0001), moderado (HR=1,69; p=0,01) e alto (HR=2,46;p=0,001). Conclusão. O escore multimarcadores baseado em marcadores de baixo custo permite a estratificação prognóstica dos pacientes, permitindo prever óbitos e internações hospitalares e também criar uma estratégia terapêutica de seguimento dos pacientes de acordo a estratificação de risco.


Purpose. To demonstrate that score based on low cost laboratory markers can determine prognosis of ambulatory patients with heart failure (HF). Introduction. HF is a disease known for her evolving with high mortality. Biomarkers are emerging as an important aid in the standard clinical evaluation of a variety of cardiovascular disorders, including HF. Methods. This study consists on a prospective cohort of outpatients with HF, the markers selected were: sodium, high density lipoprotein (HDL), creatinine, creatinine clearance, uric acid and hemoglobin. One point for changes in each marker was given and defined as low risk: 0-2 points, moderate risk: 3-4 points, and high risk: 5-6 points. The primary outcome was death from cardiovascular causes and secondary deaths from cardiovascular causes associated with hospitalizations for cardiovascular causes. The statistical methods used were chi-square, Student t test, Cox regression and it was used the Kaplan Meier curve analysis of events. Results. We studied 146 patients with mean age 58±13.04, 44 male patients (30.2%) and 102 female ones (69.8%). The primary outcomes were: 15 (10.2%) deaths and secondary: 54 (37%) compound events. The number of individuals according to the stage of risk: low: 68, intermediate: 63 and higher: 15. The rate of events in low, intermediate and high risk were eight (11.7%), 34 (54%) and 12 (80%), respectively. According to the risk stratification, the hazard ratio for low risk (HR=0.14, p=0.0001), moderate (HR=1.69, p=0.01) and high (HR=2.46, p=0.001). Conclusion. The multi-markers score based on markers of low cost admits prognostic stratification of patients, allowing predicting deaths and hospital admissions, and also creating a therapeutic strategy for follow-up of patients according to risk stratification.


Objetivo. Demostrar que un score basado en marcadores de laboratorio de bajo costo puede determinar el pronóstico de pacientes ambulatorios con insuficiencia cardíaca (IC). Introducción. La IC es una enfermedad que reconocidamente evoluciona con alta mortalidad. Los biomarcadores están emergiendo como una ayuda importante en la evaluación clínica estándar de una variedad de enfermedades cardiovasculares, incluyendo la IC. Métodos. Consiste en una cohorte prospectiva de pacientes ambulatorios portadores de IC. Los marcadores seleccionados fueron sodio, lipoproteína de alta densidad (HDL), creatinina, clearance de creatinina, ácido úrico y hemoglobina. Se otorgó un punto por alteración en cada marcador, y se definió como riesgo bajo: 0-2 puntos, riesgo moderado: 3-4 puntos y riesgo alto: 5-6 puntos. El resultado primario fue muerte por causas cardiovasculares, y el secundario: muerte por causas cardiovasculares asociada a internaciones por causas cardiovasculares. Los métodos estadísticos utilizados fueron Chi-cuadrado, test T de Student, regresión de Cox y el método de Kaplan-Meier para el análisis de curvas de eventos. Resultados. Fueron estudiados 146 pacientes con una edad media de 58±13,04; 44 pacientes eran hombres (30,2%) y 102 eran mujeres (69,8%). Los resultados primarios fueron 15 (10,2%) muertes, y los secundarios, 54 (37%) eventos compuestos. El número de individuos de acuerdo al estadio de riesgo fue: bajo 68, moderado 63 y alto 15. La tasa de eventos en los estadios bajo, moderado y alto fue de 8 (11,7%), 34 (54%) y 12 (80%), respectivamente. De acuerdo a la estratificación de riesgo, hubo un hazard ratio para riesgo bajo (HR=0,14; p=0,0001), moderado (HR=1,69; p=0,01) y alto (HR=2,46; p=0,001). Conclusión. El score de multimarcadores basado en marcadores de bajo costo, permite la estratificación pronóstica de los pacientes, posibilitando la predicción de muertes y hospitalizaciones. También crea una estrategia terapéutica para el seguimiento de los pacientes, de acuerdo a la estratificación de riesgo.

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