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1.
Clinics (Sao Paulo) ; 69(10): 666-71, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25518017

RESUMO

OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.


Assuntos
Cardiologia/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Idoso , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
2.
Clinics ; 69(10): 666-671, 10/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-730466

RESUMO

OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations. .


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cardiologia/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Hospitais Universitários/estatística & dados numéricos , Unidades de Terapia Intensiva , Modelos Logísticos , Razão de Chances , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
3.
Rev Assoc Med Bras (1992) ; 58(4): 505-12, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22930033

RESUMO

When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.


Assuntos
Doenças Cardiovasculares/diagnóstico , Assistência Perioperatória/normas , Complicações Pós-Operatórias/prevenção & controle , Algoritmos , Índice Tornozelo-Braço , Biomarcadores/análise , Humanos , Peptídeo Natriurético Encefálico/análise , Medição de Risco
4.
Rev. Assoc. Med. Bras. (1992) ; 58(4): 505-512, July-Aug. 2012. tab
Artigo em Inglês | LILACS | ID: lil-646896

RESUMO

When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.


Assuntos
Humanos , Doenças Cardiovasculares/diagnóstico , Assistência Perioperatória/normas , Complicações Pós-Operatórias/prevenção & controle , Algoritmos , Índice Tornozelo-Braço , Biomarcadores/análise , Peptídeo Natriurético Encefálico/análise , Medição de Risco
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