Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
1.
Medicina (B Aires) ; 79(6): 461-467, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829948

RESUMO

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.

2.
Rev. Hosp. El Cruce ; (25): 35-43, Dic 2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1047124

RESUMO

OBJETIVO: Compartir la estrategia de gestión del conocimiento en el marco del acceso abierto implementada en el Hospital. METODOLOGÍA: Frente a la necesidad de gestionar el conocimiento, los dos métodos para implementar el acceso abierto en el hospital son: la vía verde, el autoarchivo de contenidos en el Repositorio Digital del Hospital, y en segundo lugar la vía dorada, la publicación en acceso abierto de la Revista del Hospital El Cruce. Se documenta la evolución por medio del análisis de los indicadores disponibles en Google Analytics. RESULTADOS: Al analizar los indicadores de usuarios, usuarios nuevos y sesiones, se identifica un incremento superior al 80% en cantidad de usuarios y sesiones en los últimos 12 meses. Hay una importante distribución mundial en la difusión del conocimiento generado en el hospital. Esto se debe a la indización de la Revista del Hospital en la iniciativa regional LILACS y a la infraestructura tecnológica disponible. CONCLUSIONES: la gestión de conocimiento en el marco del acceso abierto forma parte de las actividades estratégicas que se orientan a promover el desarrollo de actividades de asistencia, de investigación, de docencia y la consolidación como hospital universitario. Los repositorios y las revistas de acceso abierto mejoran la difusión de los recursos que contienen, incrementando su visibilidad y el acceso a la producción institucional.


OBJECTIVE: To share the knowledge management strategy within the framework of openaccess implemented in the Hospital. METHODS: The two methods to implement open access in the hospital are: The greenway, the self-archiving of contents in the Hospital's Digital Repository and the golden route the open access publication of the El Cruce Hospital Journal. The evolution is documented through the analysis of the indicators available in Google Analytics. RESULTS: In the indicators of users, new users and sessions, there is an increase of more than 80% in the number of users and sessions in the last 12 months. There is an important worldwide distribution in the dissemination of knowledge generated in the hospital. This is due to the indexing of the Hospital Journal in the LILACS regional initiative and the available technological infrastructure. CONCLUSIONS: Knowledge management within the framework of open access is part of the strategic activities aimed at promoting the development of assistance, research, teaching and consolidation activities as a university hospital. Repositories and open access journals improve the dissemination of the resources they contain, increasing their visibility and access to institutional production.


Assuntos
Argentina , Acesso à Informação , Ciência, Tecnologia e Sociedade , Gestão do Conhecimento , Hospitais Públicos
3.
Rev. Hosp. El Cruce ; (25): 44-48, Dic 2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1047126

RESUMO

El score de riesgo KAsH fue diseñado como alternativa para predecir mortalidad intrahospitalaria en pacientes con IAMCEST en una población europea, y cuenta con variables sencillas que se pueden obtener en la cabecera de los pacientes. OBJETIVO:Validar el score KAsH en nuestro medio y compararlo con otros scores. METODOLOGÍA: La validación se realizó en una base de datos hospitalaria del conurbano bonaerense que cuenta con un registro consecutivo y en forma prospectiva de pacientes con IAMCEST desde mayo de 2009 a julio de 2018 (n=977). Se descartaron los casos con información incompleta. Para cada paciente se calculó un puntaje según la fórmula KAsH y se agruparon en 4 categorías. La discriminación del modelo se evaluó con curva ROC y se calculó el área bajo la curva (AUC) con su respectivo intervalo de confianza. El score KAsH se comparó con los modelos GRACE, TIMI y ProACS mediante el test de DeLong. RESULTADOS: Se incluyeron 884 casos con información completa. La mortalidad intrahospitalaria fue 5.2% y por subgrupos fue la siguiente: 1=0.91%, 2=5.1%, 3=18.8%, 4=53.3%. El AUC fue de 0.86 (IC 95% 0,80-0.93). El análisis de comparaciones múltiples de AUC evaluado con el test de DeLong no evidenció diferencias estadísticamente significativas (p=0.18). CONCLUSIONES: El score KAsH presentó buena discriminación y calibración para pronóstico de mortalidad intrahospitalaria en nuestro medio. Dado que requiere pocas variables de sencilla adquisición, la aplicación del score KAsH puede constituir una alternativa atractiva a los scores tradicionales.


The KAsH risk score was designed as an alternative to predict in-hospital mortality in patients with IAMCEST in a European population, and has variables that can be obtained at the bedside. OBJECTIVE: To validate the KAsH score in our environment and compare it with other scores. METHODS: The validation was carried out in a hospital database of the Buenos Aires suburbs that has a consecutive and prospective registry of patients with IAMCEST from May 2009 to July 2018 (n = 977). Cases with incomplete information were ruled out. For each patient, a score was calculated according to the KAsH formula and grouped into 4 categories. The discrimination of the model was evaluated with the ROC curve and the area under the curve (AUC) was calculated with its respective confidence interval. The KAsH score was compared with the GRACE, TIMI and ProACS models using the DeLong test. RESULTS: 884 cases with complete information were included. In-hospital mortality was 5.2% and by subgroups it was as follows: 1 = 0.91%, 2 = 5.1%, 3 = 18.8%, 4 = 53.3%. The AUC was 0.86 (95% CI 0.80-0.93). The analysis of multiple comparisons of AUC evaluated with the DeLong test showed no statistically significant differences (p = 0.18). CONCLUSIONS: The KAsH score presented good discrimination and calibration for in-hospital mortality prognosis in our environment. Since it requires few variables of simple acquisition, the application of the KAsH score can be an attractive alternative to traditional scores.


Assuntos
Prognóstico , Mortalidade , Estudos de Validação , Infarto do Miocárdio
4.
Expert Rev Cardiovasc Ther ; 16(10): 765-770, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30122073

RESUMO

BACKGROUND: Fractional flow reserve (FFR) has become a useful tool in the assessment of physiological significance of coronary artery stenosis (CAS), and Adenosine (ADE) is associated with a high incidence of transient side effects. Sodium nitroprusside (NPS) has been proposed as an alternative vasodilator agent. A meta-analysis of studies comparing ADE and NPS for FFR assessment in the same coronary lesions was performed. METHODS: Authors searched for articles comparing NPS and ADE for FFR assessment in intermediate coronary lesions published through January 2018. The following keywords were used: 'fractional flow reserve' AND 'nitroprusside'. Data were summarized using weighted mean differences for paired data. RESULTS: Seven studies were identified comprising 342 patients and 401 lesions. Four studies evaluated intravenous ADE and 3 studies intracoronary ADE administration. Weighted means FFR values obtained with ADE and NPS were 0.8411 and 0.8445, respectively (weighted mean difference: 0.00, 95% confidence interval (CI) -0.01 to 0.01, p = 0,548). Adverse events were significantly reduced with IC NPS (RR = 0.08, 95%CI 0.02-0.30, P < 0.0001). CONCLUSIONS: NPS produces similar FFR measurements compared to ADE with a significant reduction in adverse effects. These results may support its use as a suitable alternative to ADE for FFR assessment.


Assuntos
Adenosina/uso terapêutico , Estenose Coronária/tratamento farmacológico , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Nitroprussiato/uso terapêutico , Vasodilatadores/uso terapêutico , Humanos
5.
Cochrane Database Syst Rev ; 4: CD011851, 2017 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-28455948

RESUMO

BACKGROUND: Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions. OBJECTIVES: To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non-fatal cardiovascular events, and adverse effects. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the Conference Proceedings Citation Index - Science on Web of Science on 7 November 2016, and two clinical trial registers on 12 November 2016. We contacted authors of included studies for missing information and searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA: We included randomised trials with at least 50% of the participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim to improve adherence to medication for the secondary prevention of cardiovascular events. Eligible comparators were no intervention or other modes of communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. In addition, we attempted to contact all authors on how the SMS were developed. MAIN RESULTS: We included seven trials (reported in 13 reports) with 1310 participants randomised. Follow-up ranged from one month to 12 months. Due to heterogeneity in the methods, population and outcome measures, we were unable to conduct meta-analysis on these studies. All seven studies reported on adherence, but using different methods and scales. Six out of seven trials showed a beneficial effect of mobile phone text messaging for medication adherence. Dale 2015a, reported significantly greater medication adherence score in the intervention group (Mean Difference (MD) 0.58, 95% confidence interval (CI) 0.19 to 0.97; 123 participants randomised) at six months. Khonsari 2015 reported less adherence in the control group (Relative Risk (RR) 4.09, 95% CI 1.82 to 9.18; 62 participants randomised) at eight weeks. Pandey 2014 (34 participants randomised) assessed medication adherence through self-reported logs with 90% adherence in the intervention group compared to 70% in the control group at 12 months. Park 2014a (90 participants randomised) reported a greater increase of the medication adherence score in the control group, but also measured adherence with an event monitoring system for a number of medications with adherence levels ranging from 84.1% adherence to 86.2% in the intervention group and 79.7% to 85.7% in the control group at 30 days. Quilici 2013, reported reduced odds of non-adherence in the intervention group (Odds Ratio (OR) 0.43, 95% CI 0.22 to 0.86, 521 participants randomised) at 30 days. Fang 2016, reported that participants given SMS alone had reduced odds of being non-adherent compared to telephone reminders (OR 0.40 95% CI 0.18 to 0.63; 280 patients randomised). Kamal 2015 reported higher levels of adherence in the intervention arm (adjusted MD 0.54, 95% CI 0.22 to 0.85; 200 participants randomised). Khonsari 2015 was the only study to report fatal cardiovascular events and only reported two events, both in the control arm. No study reported on the other primary outcomes. No study reported repetitive thumb injury or road traffic crashes or other adverse events that were related to the intervention.Four authors replied to our questionnaire on SMS development. No study reported examining causes of non-adherence or provided SMS tailored to individual patient characteristics.The included studies were small, heterogeneous and included participants recruited directly after acute events. All studies were assessed as having high risk of bias across at least one domain. Most of the studies came from high-income countries, with two studies conducted in an upper middle-income country (China, Malaysia), and one study from a lower middle-income country (Pakistan). The quality of the evidence was found to be very low. There was no obvious conflicts of interest from authors, although only two declared their funding. AUTHORS' CONCLUSIONS: While the results of this systematic review are promising, there is insufficient evidence to draw conclusions on the effectiveness of text message-based interventions for adherence to medications for secondary prevention of CVD. Sufficiently powered, high-quality randomised trials are needed, particularly in low- and middle-income countries.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Adesão à Medicação/estatística & dados numéricos , Sistemas de Alerta , Prevenção Secundária/métodos , Mensagem de Texto , Telefone Celular , Humanos , Multimídia , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Rev. argent. cardiol ; 85(1): 1-10, feb. 2017. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957749

RESUMO

Introducción: Los traslados interhospitalarios de pacientes críticos son frecuentes en nuestro medio; sin embargo, a pesar de la existencia de servicios de traslados médicos de emergencia tanto en el ámbito público como privado, no se han generado publicaciones científicas relacionadas con traslado de pacientes críticos que permitan conocer su funcionamiento, planificación y resultados. Objetivo: Describir las condiciones de traslado interhospitalario de pacientes con patología cardiovascular. Material y métodos: Estudio de diseño observacional, prospectivo, multicéntrico. Se relevaron los traslados interhospitalarios por vía terrestre de pacientes ingresados a una unidad coronaria de tercer nivel entre abril de 2014 y abril de 2015. Se encuestó al médico de traslado. Se relevaron además las complicaciones relacionadas con el traslado y la mortalidad hospitalaria. Resultados: Se analizaron 214 traslados. Mediana de tiempo de traslado: 30 minutos (IIC 18,5-50). El 16,1% de los traslados se consideraron de riesgo alto, el 71,2% de riesgo moderado y el 12,7% de riesgo bajo, según un puntaje validado. Los principales diagnósticos fueron síndrome coronario agudo (66,8%), insuficiencia cardíaca (8,9%) y bradiarritmia o bloqueo (3,7%). El 73,5% de los traslados de riesgo alto se realizaron con móviles de alta complejidad y entre los de riesgo bajo y moderado, el 30,8% y el 28,9%, respectivamente, se efectuaron con móviles de baja complejidad. El 50% de los traslados fueron realizados por médicos residentes. El 10,8% presentaron alguna complicación durante el traslado y/o durante la primera hora. Las complicaciones fueron más frecuentes en traslados de riesgo alto y se asociaron con mortalidad hospitalaria. No existió asociación entre mayor riesgo de traslado estimado y mayor complejidad del móvil (p = 0,6). Conclusión: La programación de traslados no fue adecuada. El riesgo calculado de los traslados fue predominantemente bajo, con una elevada proporción de complicaciones graves, que impactaron en la mortalidad hospitalaria.

7.
Rev. Hosp. El Cruce ; (19): 16-26, 20161220.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-946505

RESUMO

Las complicaciones mecánicas del infarto agudo de miocardio han disminuido actualmente, principalmente por un mayor acceso a las técnicas de reperfusión. Pese a ello, los pacientes que no acceden a las mismas continúan siendo vulnerables a la ocurrencia de estas afecciones con elevada morbimortalidad. Presentamos el caso de una paciente diabética que consultó por disnea, lo cual fue interpretado inicialmente como insuficiencia cardíaca, diagnosticándose luego un pseudoaneurisma ventricular izquierdo por infarto silente, asociado a oclusión de arteria circunfleja; posteriormente fue operada con éxito. Finalmente se revisa el tema y se discuten las opciones terapéuticas de esta entidad.


Assuntos
Diabetes Mellitus , Dispneia , Infarto do Miocárdio
8.
Dig Liver Dis ; 48(11): 1372-1377, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27260329

RESUMO

BACKGROUND: The non-surgical management in a selected group of rectal cancer patients has shown promising results with adequate follow up. AIMS: describing the results of the non-surgical management in patients with complete clinical response, with a close follow up. METHODS: Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines. RESULTS: 68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3cm. Chemoradiation included radiotherapy at 50.4cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5-19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%. CONCLUSIONS: conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/terapia , Neoplasias Retais/terapia , Adulto , Idoso , Argentina , Intervalo Livre de Doença , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Estudos Retrospectivos
9.
Rev. argent. cardiol ; 84(2): 1-10, abr. 2016. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957710

RESUMO

Introducción: Aunque recientemente se reportó la relación entre la muerte prematura y la condición socioeconómica en la Argentina, no existen análisis sobre el impacto que dicha condición tiene en distintas regiones del país. Objetivo: Describir el impacto que la condición socioeconómica presentó sobre la incidencia de muerte prematura en las distintas provincias de la Argentina durante el período 2000-2010. Material y métodos: Se utilizó un modelo ecológico, que evaluó las tasas estandarizadas de muerte prematura (≤ 74 años) durante el período 2000-2010. Asimismo, se examinó la relación entre la condición socioeconómica medida en deciles de necesidades básicas insatisfechas por departamento geográfico y la muerte prematura. La unidad de análisis fueron los 512 departamentos de la Argentina y las 15 comunas de la ciudad de Buenos Aires. Resultados: La condición socioeconómica estuvo significativamente asociada con la muerte prematura en la Argentina durante el período analizado. En todas las provincias y regiones se observó un gradiente lineal entre la muerte precoz y la condición socioeconómica. Sin embargo, la pendiente de desigualdad entre los componentes de la condición socioeconómica varió significativamente entre los distintos departamentos. Mientras que en toda la Argentina la diferencia absoluta en la tasa estandarizada de muerte prematura entre los componentes extremos de condición socioeconómica fue de 10 muertes (rango: 7,81-12,36) por cada 10.000 personas por año, en la ciudad de Buenos Aires esa diferencia fue de 61 muertes (rango: 53-69). Las comunas del sur de la ciudad de Buenos Aires fueron las zonas con mayor desigualdad social y sanitaria de la Argentina. Conclusiones: Aunque la inequidad social tuvo un impacto significativo en la muerte prematura en todo el período en toda la Argentina, la ciudad de Buenos Aires se mostró como la región más desigual.


Background: Although the relationship between premature death and socioeconomic status has been recently reported in Argentina, there are no analyses on the impact of this condition in different regions of the country. Objective: The aim of this study was to describe the influence of socioeconomic status on the incidence of premature death rate in different provinces of Argentina, from 2000 to 2010. Methods: An ecological model was used to evaluate standardized premature death rates (≤74 years) during the period between 2000 and 2010. In addition, the relationship between socioeconomic status, measured in deciles of unmet basic needs at geo-graphic departmental level and premature death was examined. The units of analysis were the 512 Argentine departments and the 15 communes of the city of Buenos Aires. Results: Socioeconomic status was significantly associated with premature death rate in Argentina during the study period. A linear gradient was observed between premature death and socioeconomic status in all provinces and regions. However, the slope index of inequality varied significantly between departments. While the absolute difference in standardized premature death rate between the extreme components of socioeconomic status was 10 deaths (range: 7.81-12.36) per 10,000 persons pers year in all Argentina, in the city of Buenos Aires this difference was 61 deaths (range: 53-69). The Southern communes of Buenos Aires were the areas with the highest social and health inequalities of Argentina. Conclusions: Although social inequity had a significant impact on premature death rate throughout Argentina during the study period, the city of Buenos Aires was the most unequal region.

10.
Rev. argent. cardiol ; 84(2): 1-10, abr. 2016. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957711

RESUMO

Introducción: La asociación entre mortalidad por accidente cerebrovascular y el nivel socioeconómico está escasamente descripta en la Argentina. La evaluación de las tendencias temporales de muerte precoz por accidente cerebrovascular y su relación con el nivel socioeconómico podría ser útil desde el punto de vista de la salud pública para la identificación de grupos de mayor vulnerabilidad. Objetivos: Describir la evolución temporal de la mortalidad por accidente cerebrovascular y su asociación con el nivel socioeconómico en la Argentina entre 2000 y 2011. Material y métodos: Se realizó un estudio ecológico longitudinal. La mortalidad se cuantificó mediante tasas estandarizadas por edad y sexo y el nivel socioeconómico, mediante quintiles de necesidades básicas insatisfechas. Las unidades de observación fueron los departamentos de la Argentina. La asociación entre mortalidad y nivel socioeconómico se evaluó utilizando un modelo de regresión de Poisson para datos de panel. Resultados: La mortalidad por accidente cerebrovascular aumentó progresivamente entre los quintiles de nivel socioeconómico (26,2, 28,4, 30,5, 34,5 y 36,9 por 100.000 personas para los quintiles 1 a 5, respectivamente, en el año 2000). La mortalidad en todos los grupos de nivel socioeconómico disminuyó, aunque persistieron diferencias entre ellos (17,2, 18,5, 20,1, 22,1 y 25,3 por 100.000 personas para los quintiles 1 a 5, respectivamente, en el año 2011). Las razones de tasas de incidencias fueron de 1,15 (IC 95% 1,09 a 1,22; p < 0,001), 1,27 (IC 95% 1,21 a 1,34; p < 0,001), 1,32 (IC 95% 1,26 a 1,39; p < 0,001) y de 1,48 (IC 95% 1,41 a 1,56; p < 0,001) para los quintiles 2 a 5, respectivamente. Conclusiones: Los resultados sugieren una asociación inversa entre el nivel socioeconómico y la mortalidad por accidente cerebrovascular. Además, persistió una diferencia de mortalidad entre los niveles socioeconómicos durante el período de estudio.

11.
Rev. argent. cardiol ; 84(2): 1-10, abr. 2016. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957712

RESUMO

Introducción: Desde 2003, el programa Remediar (+Redes) distribuye gratuitamente medicación antihipertensiva. Durante este período, la mortalidad por accidente cerebrovascular disminuyó, aunque con inequidades entre grupos socioeconómicos. Objetivos: Evaluar la asociación entre la mortalidad por accidente cerebrovascular y la provisión de fármacos antihiperten-sivos. Estudiar la posible interacción entre los efectos de los antihipertensivos sobre la mortalidad y el nivel socioeconómico. Material y métodos: Se realizó un estudio ecológico para datos de panel. La mortalidad se expresa como tasas estandarizadas. Los fármacos antihipertensivos están ajustados a la población entre la que se distribuyeron y se expresan en cuartiles de dispensación. El nivel socioeconómico se midió por las necesidades básicas insatisfechas. Resultados: Desde el inicio del programa en 2003, la distribución de antihipertensivos aumentó significativamente, sobre todo en los grupos menos afluentes (p < 0,001). No hubo una asociación estadísticamente significativa entre la tasa de dispensación de antihipertensivos y la mortalidad por accidente cerebrovascular globalmente. Sin embargo, en los análisis de interacción se observó que en los quintiles 3 a 5 de necesidades básicas insatisfechas (menos afluentes), los cuartiles en los que se distribuyeron más antihipertensivos tuvieron significativamente menor mortalidad por accidente cerebrovascular (p = 0,004, p = 0,015 y p = 0,017, para los quintiles 3 a 5 de nivel socioeconómico). Conclusiones: Los resultados del presente análisis sugieren la ausencia de efectos globales de la provisión de antihipertensivos sobre la mortalidad por accidente cerebrovascular. Sin embargo, los datos muestran que, entre los grupos más desfavorecidos, la distribución de antihipertensivos estuvo asociada con una reducción de la mortalidad por esta causa.

12.
Rev. Hosp. El Cruce ; (18): 18-23, 20160330.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-946756

RESUMO

Las condiciones en que se realizan los traslados interhospitalarios por vía terrestre de pacientes críticos impactan directamente en el pronóstico de los pacientes. El objetivo del estudio es conocer las condiciones generales de traslado de los pacientes con patología cardiovascular que ingresan a la unidad coronaria de nuestro hospital, en lo referido a programación del mismo, complejidad de los móviles, instrucción de los médicos encargados del traslado, complicaciones clínicas durante el traslado y estado clínico del paciente al ingreso.


Assuntos
Continuidade da Assistência ao Paciente , Unidades de Cuidados Coronarianos , Transferência de Pacientes
13.
Rev. Hosp. El Cruce ; (18): 1-7, 20160330.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-946764

RESUMO

El presente meta-análisis se propone como objetivo analizar los efectos sobre la morbi-mortalidad de los anti-depresivos en pacientes con depresión tras un infarto. Entre un 17-27% de los pacientes con un evento coronario reciente tienen asociado un trastorno depresivo mayor, encontrándose síntomas depresivos en hasta un 65%. Nueve estudios incluyeron los criterios de inclusión. Se incluyeron 3330 pacientes, 1236 a un grupo de intervención (GI) que recibió tratamiento con antidepresivos y 2094 pacientes a un grupo control (GC). Los resultados del meta-análisis sugieren que el tratamiento anti-depresivo podría ser beneficioso entre pacientes con diagnóstico de depresión después de un infarto, a expensas de la disminución de la mortalidad y del re-infarto de miocardio.


Assuntos
Antidepressivos , Metanálise , Infarto do Miocárdio
14.
PLoS One ; 11(2): e0148756, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26886918

RESUMO

BACKGROUND: Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed. METHODS: A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model. RESULTS: Twelve studies were included (n = 117,685). Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%), with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%), revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9%) or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%). All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger's test p = 0.097). CONCLUSION: Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/terapia , Angioplastia , Vasos Sanguíneos/patologia , Eletrocardiografia , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Diabetes Mellitus/epidemiologia , Stents Farmacológicos , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Intervenção Coronária Percutânea , Prevalência , Viés de Publicação , Resultado do Tratamento , Ultrassonografia
15.
Rev. argent. cardiol ; 83(6): 1-8, Dec. 2015. graf
Artigo em Inglês | LILACS-Express | ID: biblio-957672

RESUMO

Background: Premature death is a challenge from the social, medical, sanitary and economic point of view. Many of these deaths are avoidable with the implementation of State policies. Scientific societies may and should participate in the guidance of public policies. However, precise data and an inclusive approach are necessary to accomplish this end. Objective: The aim of this study was to describe the temporal trend of premature all-cause and cardiovascular deaths in Argentina during the period 2000-2010. Methods: An ecological model, evaluating the evolution of specific and standardized rates of premature death (≤74 years) was used. Additionally, the relationship between socioeconomic status (SES) and premature death was examined. The 513 departments of Argentina were the analysis unit. Results: Premature all-cause mortality (median per 10,000 persons/year; p value) declined from 42.65 in 2000 to 38.67 in 2011 (p<0.001). A similar result was obtained for cardiovascular death (from 12.75 in 2000 to 10.09 in 2011; p<0.001). A significant, linear relationship between SES and premature death was verified without threshold in all years. The velocity and relative reduction were significantly different across different SES strata. Conclusions: Although the mortality rate was reduced, the gap between SES and premature deaths widened in Argentina, indicating the need to think on whom and how we should pay closer attention.


Introducción: La muerte prematura constituye un desafío desde el punto de vista social, médico, sanitario y económico. Muchas son evitables con la implementación de políticas de Estado. Las sociedades científicas pueden y deben participar en el asesoramiento de políticas públicas. Sin embargo, para esto son necesarios datos precisos y una mirada inclusiva. Objetivo: Describir la tendencia temporal de muertes prematuras por todas las causas y cardiovasculares en la Argentina en el período 2000-2011. Material y métodos: Se utilizó un modelo ecológico, que evaluó la evolución de las tasas específicas y estandarizadas de muerte prematura (≤74 años). Asimismo, se examinó la relación entre la condición socioeconómica (CSE) y la muerte prematura. La unidad de análisis fueron los 513 departamentos de la Argentina. Resultados: La muerte prematura (mediana cada 10.000 personas/año; valor de p) por todas las causas se redujo significativamente desde el año 2000 (42,65) hasta el 2011 (38,7) (p < 0,001). Lo propio sucedió con la muerte cardiovascular (de 12,75 en el año 2000 a 10,09 en el año 2011; p < 0,001). La muerte prematura tuvo una asociación significativa con la CSE, existiendo un gradiente lineal, sin umbrales en todos los años entre CSE y muerte prematura. La velocidad y la reducción relativa fueron significativamente distintas entre los diversos estratos de CSE. Conclusiones: Aunque la tasa de mortalidad se redujo, la brecha entre la CSE y la muerte prematura se incrementó, lo que obliga a reflexionar sobre en quiénes y cómo debemos depositar la mirada.

16.
Rev. argent. cardiol ; 83(6): 1-10, Dec. 2015. ilus, tab
Artigo em Inglês | LILACS-Express | ID: biblio-957679

RESUMO

Background: Acute coronary syndromes (ACS) seem to have a chronobiological distribution with seasonal, weekly and circadian variations. So far, there is no evidence in the published literature about the weekly distribution of ACS in Argentina; thus, it is unknown whether ACS have a specific pattern and which could be the associated variables. Objective: The aim of this study was to analyze the weekly distribution of ACS and the differences in treatment and clinical outcome. Methods: The distribution of non-ST-segment elevation (NSTE) (n=6,277) and ST-segment elevation (STE) ACS (n=4,237) was mretrospectively analyzed according to the day of the week using the 2006-2012 Epi-Cardio registry. Results: The frequency was higher during the first days of the week and descended during the weekend (overall ACS and NSTE-ACS p <0.001, and STE-ACS p <0.01), and was not related to either age or sex. In STE-ACS, the indication and the type of reperfusion therapy did not present differences according to the day of the week. Conclusions: The frequency of hospitalization due to ACS is higher within the first weekdays and decreases during the weekend, with no differences in the use of complex resources or in the initial outcome.


Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución impresiona tener aspectos cronobiológicos, ya que no se mantiene estable a lo largo del año y varía incluso según el día de la semana y la hora del día. No tenemos conocimiento de evidencia publicada acerca de la distribución de los casos de SCA acorde al día de la semana en nuestro país, por lo que se ignora si sigue un patrón determinado y cuáles podrían ser las variables asociadas. Objetivo: Analizar la distribución diaria de los casos de SCA y las eventuales diferencias en el tratamiento y la evolución clínica de los pacientes. Material y métodos: Se estudió el número y la evolución de SCA sin ST elevado (SCA no-STE, n = 6.277) y con ST elevado al ingreso (SCA-STE, n = 4.237) acorde al día de la semana mediante el análisis del registro Epi-Cardio 2006-2012. Resultados: La frecuencia fue mayor en los primeros días de la semana, descendiendo durante el fin de semana (global y SCA no-STE: p < 0,001; SCA-STE: p < 0,01), sin relación con la edad y el sexo. En los SCASTE, la indicación y el tipo de reperfusión no tuvieron diferencias según el día de la semana. Conclusiones: La frecuencia de internaciones por SCA es mayor en los primeros días laborables y menor los fines de semana, sin diferencias en el uso de recursos complejos ni en la evolución inicial.

17.
Rev. argent. cardiol ; 83(3): 1-10, June 2015. ilus
Artigo em Inglês | LILACS-Express | ID: biblio-957605

RESUMO

background: Early management of myocardial infarction in the area of public health requires the integration of specific programs for the coordination of healthcare services. Objective: The aim of this study was to evaluate the impact on delay times and reperfusion rate of a comprehensive program for the reperfusion of myocardial infarction in a hospital network of the Southern Greater Buenos Aires. Methods: The network consists of six low-mid-complexity hospitals and a third-level referral center with 24-hour cath-lab. Stage 1 of the program (2009-2010) evaluated the existing barriers to reperfusion; Stage 2 (2011-2013) implemented the progressive incorpora-tion of improvements and Stage 3 assessed the program (2013-2014) complemented with fellows in each hospital. Program impact was evaluated by the proportion of patients reperfused and time to its implementation. results: A total of 432 patients referred from the network were hospitalized with diagnosis of ST-segment elevation myocardial infarction. Mean age was 56±9 years and 83.3% were men. The proportion of reperfused patients progressively increased: S1 60.7%, S2 69% and S3 78%, p for trend=0.01. Time to reperfusion decreased significantly between S1 and S3, from 120 minutes (IQR 55-240) to 90 minutes (IQR 35-150), p=0.04, with a median reduction of 30 minutes in the door-to-balloon and door-to-needle times. Conclusions: The application of a program for myocardial reperfusion based on the diagnosis of barriers was associated with 28.5% increase in reperfusion, and a significant reduction in the implementation times. This public network model built on algorithms adapted to local barriers may contribute to improve the care of myocardial infarction in our country.

18.
Eur J Clin Pharmacol ; 71(4): 449-59, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25666028

RESUMO

PURPOSE: Recent guidelines expand indications for statins. However, research on practical economic feasibility and cost-effectiveness in low-risk people is lacking. We aimed to describe the incidence of cardiovascular events (CVE), their total direct costs and the hypothetical effects of wide provision of statins on those rates and expenditures. METHODS: We conducted a population-based cohort study using administrative data among low risk individuals. Estimators of effects of statins were taken from Cholesterol Treatment trialist metaanalysis and from Heart Protection Study trial. Two statin prices were used for analyses: National Italian Health System (€ 0.36) and the International Drug Price Indicator (€ 0.021). RESULTS: Overall, 920,067 persons at low risk were identified and 14,849 CVE were registered (incidence rate 27.3 per 10,000 person-years). Direct costs for hospitalizations for CVE were 143 M €. Universal provision of statins would result in a significant decrease in CVE rates, from 27.3 to 17.5 per 10,000 person-years (PY) (95% confidence interval (CI): 15.8-19.4). Universal prescription of simvastatin 20 mg would cost 802 M €. Otherwise, provision of simvastatin at International Drug Price Indicator's prices would be both clinically effective and cost saving in men older than age 44 (observed expenditures 120 M €, expected 97.4 M €) but not in women (observed expenditures 22.7 M €, expected 36.5 M €). CONCLUSIONS: Among a low-risk population, hypothetical universal provision of low-cost simvastatin to men over 44 years could be both clinically effective and a cost-saving strategy.


Assuntos
Prescrições de Medicamentos/economia , Uso de Medicamentos/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária/economia , Adulto , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevenção Primária/métodos , Sinvastatina/economia , Sinvastatina/uso terapêutico
19.
Eur J Clin Invest ; 45(2): 170-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25510286

RESUMO

BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients. METHODS: Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrollment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically. RESULTS: Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0.05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics. CONCLUSION: Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.


Assuntos
Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Troponina T/metabolismo , Fibrilação Atrial/sangue , Fibrilação Atrial/etiologia , Biomarcadores/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
20.
Arch. cardiol. Méx ; 84(4): 243-249, oct.-dic. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-744057

RESUMO

Resumen Objetivo: La asociación entre marcadores serológicos y fracción de expulsión en el infarto no ha sido completamente estudiada. Nuestro objetivo es estudiar la asociación existente entre marcadores bioquímicos y disfunción ventricular izquierda en el infarto agudo de miocardio con elevación del segmento ST. Métodos: Con un diseño observacional, prospectivo, incluimos a pacientes con infarto con elevación ST en las primeras 24 h. Se analizaron al ingreso: recuento de leucocitos, glucemia, péptido natriurético tipo B y troponina T, y creatinfosfocinasa total y fracción MB al ingreso y en forma seriada. Estos parámetros se correlacionaron con la fracción de expulsión estimada por ecocardiograma. Resultados: Se incluyeron 108 pacientes. Mediana de fracción de expulsión 48% (intervalo intercuartílico 41-57). En el análisis de regresión lineal simple, el péptido natriurético tipo B (p = 0.005), el pico de creatinfosfocinasa fracción MB (p = 0.01), el recuento leucocitario (p = 0.001) y la glucemia (p = 0.033) se asociaron inversa y significativamente con la fracción de expulsión. No mostraron asociación los otros parámetros. En el análisis de regresión lineal múltiple, solo el péptido natriurético tipo B (p = 0.01) y el pico de creatinfosfocinasa fracción MB (p = 0.02) presentaron correlación significativa con la fracción de expulsión. Ambos parámetros se asociaron significativamente con una fracción de expulsión < 50%, de manera independiente a otras variables clínicas. Conclusiones: En la etapa aguda del infarto con elevación ST, el péptido natriurético tipo B y la creatinfosfocinasa fracción MB se asociaron significativamente con la disfunción ventricular izquierda independientemente de la presencia de otros marcadores bioquímicos y variables clínicas determinantes de disfunción ventricular.


Objective: The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. Methods: With an observational and prospective design we included patients with less than 24 h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. Results: A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P = .005), peak creatine-phosphokinase-MB (P = .01), leukocyte count (P = .001) and glucose (P = .033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P = .01) and peak creatine-phosphokinase-MB (P = .02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. Conclusion: B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Disfunção Ventricular Esquerda/sangue , Biomarcadores/sangue , Eletrocardiografia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Estudos Prospectivos , Disfunção Ventricular Esquerda/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA