1
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Passaglia LG, Cerqueira MLR, Pires MM, Chagas LV, Cunha CT, Rodrigues ENDO, Diniz FMM, Ferreira DF, Nogueira MR, Braga GT, Taniguchi FP, Ribeiro ALP. Cardiovascular Statistics from the Good Practices in Cardiology Program - Data from a Brazilian Tertiary Public Hospital. Arq Bras Cardiol 2023; 120:e20220247. [PMID: 36856240 PMCID: PMC10263458 DOI: 10.36660/abc.20220247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/25/2022] [Accepted: 11/16/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The Good Practices in Cardiology Program is an initiative created by the Brazilian Society of Cardiology (SBC) to improve the quality of care of cardiovascular disease patients in Brazilian public hospitals. OBJECTIVES To characterize patients admitted to a tertiary public hospital with diagnosis of acute coronary syndrome (ACS) or heart failure (HF) and to evaluate performance indicators in both ACS and HF arms, with a pre-established target of 85% adherence to the SBC recommendations. METHODS This was a descriptive cross-sectional study through data collection of patients hospitalized between May 2016 and September 2019. RESULTS A total of 1,036 patients were included, 273 in the HF arm and 763 in the ACS arm. Mean age was 59.8 ± 12.0 years in the ACS and 57.0 ± 14.1 years in the HF, with a predominance of male patients in both groups. More than half of patients had some primary education and more than 90% reported a monthly income of less than five minimum wages. In ACS, the diagnosis of ACS with ST segment elevation was predominant (66.3%), and 2.9% of patients died. In HF, the most common etiology was Chagas disease (25.8%), and 17.9% died. Analysis of the performance indicators revealed an adherence rate higher than 85% to nine of the 12 indicators. CONCLUSION Quality programs are essential for improvement of quality of care. Performance indicators pointed to a good adherence to the SBC guidelines, mainly in the ACS arm.
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Affiliation(s)
- Luiz Guilherme Passaglia
- Universidade Federal de Minas GeraisServiço de Cardiologia e Cirurgia CardíacaHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Serviço de Cardiologia e Cirurgia Cardíaca do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Marina Lírio Resende Cerqueira
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina, Belo Horizonte, MG – Brasil
| | - Mariana Martins Pires
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina, Belo Horizonte, MG – Brasil
| | - Lucas Vieira Chagas
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina, Belo Horizonte, MG – Brasil
| | - Carolina Teixeira Cunha
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Erika Nunes de Oliveira Rodrigues
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Flávia Mariana Mendes Diniz
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Darkiane Fernandes Ferreira
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Monique Rocha Nogueira
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Gisia Teodoro Braga
- Universidade Federal de Minas GeraisEquipe de EnfermagemHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Equipe de Enfermagem do Hospital das Clínicas, Belo Horizonte, MG – Brasil
| | - Fábio P. Taniguchi
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (Hcor), São Paulo, SP – Brasil
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas GeraisDepartamento de Clínica MédicaHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Departamento de Clínica Médica da UFMG e Centro de Telessáude do Hospital das Clínicas,Belo Horizonte, MG – Brasil
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2
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Alves L, Ziegelmann PK, Ribeiro V, Polanczyk C. Hospital Mortality from Myocardial Infarction in Latin America and the Caribbean: Systematic Review and Meta-Analysis. Arq Bras Cardiol 2022; 119:970-978. [PMID: 36541993 PMCID: PMC9814809 DOI: 10.36660/abc.20220194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most cardiovascular deaths occur in low- and middle-income countries and myocardial infarction is one of the main life-threatening conditions. OBJECTIVE We assessed all-cause in-hospital mortality in patients admitted for myocardial infarction (STEMI and NSTEMI) in Latin America and the Caribbean from 2000 onward. METHODS We systematically searched in electronic bibliographic databases for cohort studies which reported in-hospital mortality due to STEMI and NSTEMI. A meta-analysis was performed and a p-value < 0.05 was considered significant. RESULTS We identified 38 studies (29 STEMI, 3 NSTEMI and 6 both). Pooled STEMI in-hospital mortality was 9.9% (95% CI: 9.1 - 10.7). Heterogeneity was not trivial (I2 = 74% and prediction interval = 6.6 - 14.5). The percentage of reperfusion therapy and decade explain part of the heterogeneity (I2 = 54%). The higher the rate of reperfusion therapy, the lower the in-hospital mortality (coefficient = -0.009, 95% CI: -0.013 to -0.006, p<0.001). This mortality was higher in the first decade as compared with the second (coefficient = -0.14, 95% CI: -0.27 to -0.02, p=0.047). Pooled NSTEMI in-hospital mortality was 6.3% (95% CI: 5.4 - 7.4) and heterogeneity was null. CONCLUSION Pooled STEMI in-hospital mortality in low- and middle-income countries was high in comparison with rates reported in high income countries. To improve these estimates, higher use of reperfusion therapy must be pursued. Pooled NSTEMI in-hospital mortality was similar to the ones found in high-income countries; however, it was based on few studies and most of them were carried out in two countries.
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Affiliation(s)
- Leonardo Alves
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil,Universidade Federal do Rio GrandeFaculdade de MedicinaRio GrandeRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS – Brasil,Correspondência: Leonardo Alves •, Universidade Federal do Rio Grande – Departamento de Medicina - Gen Osório. CEP 96201-900, Porto Alegre, RS – Brasil. E-mail:
| | - Patrícia K. Ziegelmann
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Victor Ribeiro
- Universidade Federal do Rio GrandeFaculdade de MedicinaRio GrandeRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS – Brasil
| | - Carisi Polanczyk
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil,Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
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3
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Vieira RCP, Marcolino MS, Silva LGSE, Pereira DN, Nascimento BR, Jorge ADO, Ribeiro ALP. Assessment of the Impact of the Implementation of a Pre-Hospital Ambulance System on Acute Myocardial Infarction Mortality in a Developing Country. Arq Bras Cardiol 2022; 119:S0066-782X2022005016204. [PMID: 36169452 PMCID: PMC9750209 DOI: 10.36660/abc.20210953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/05/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effective management of patients with acute myocardial infarction (AMI) is time-dependent. OBJECTIVES To assess the impacts of the implementation of prehospital care on admission rates and mortality associated with AMI. METHODS Retrospective, ecological study, which assessed data from the Brazilian Universal Health System, from all 853 municipalities of Minas Gerais, from 2008 to 2016. Excessive skewness of general and in-hospital mortality rates was smoothed using the empirical Bayes method. This study assessed the relationship between Mobile Emergency Care Service (SAMU) in each municipality and the following 3 outcomes: mortality rate due to AMI, AMI in-hospital mortality, and AMI hospitalization rate, using the Poisson hierarchical model. Rates were corrected by age structure and detrended by seasonality and temporal influences. A confidence interval of 95% was adopted. RESULTS AMI mortality rates decreased throughout the study, on average 2% per year, with seasonal variation. AMI in-hospital mortality also showed a decreasing trend, from 13.81% in 2008 to 11.43% in 2016. SAMU implementation was associated with decreased AMI mortality (odds ratio [OR] = 0.967, 95% confidence interval [CI] 0.936 to 0.998) and AMI in-hospital mortality (OR = 0.914, 95% CI 0.845 to 0.986), with no relation with hospitalizations (OR = 1.003, 95% CI 0.927 to 1.083). CONCLUSION SAMU implementation was associated with a modest but significant decrease in AMI in-hospital mortality. This finding reinforces the key role of prehospital care in AMI care and the need for investments on this service to improve clinical outcomes in low- and middle-income countries.
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Affiliation(s)
- Rodrigo Costa Pereira Vieira
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Milena Soriano Marcolino
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Luis Gustavo Silva e Silva
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Daniella Nunes Pereira
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Bruno Ramos Nascimento
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Alzira de Oliveira Jorge
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Antonio Luiz P Ribeiro
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
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4
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes AADP, Schaan BD, Castilho FMD, Cesena FHY, Soares GP, Xavier GF, Barreto JAS, Passaglia LG, Pinto MM, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Villela PB, Teixeira RA, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Estatística Cardiovascular – Brasil 2021. Arq Bras Cardiol 2022; 118:115-373. [PMID: 35195219 PMCID: PMC8959063 DOI: 10.36660/abc.20211012] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
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5
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Alves L, Polanczyk CA. Hospitalization for Acute Myocardial Infarction: A Population-Based Registry. Arq Bras Cardiol 2020; 115:916-924. [PMID: 32965396 PMCID: PMC8452198 DOI: 10.36660/abc.20190573] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/27/2019] [Indexed: 12/03/2022] Open
Abstract
Fundamento: O infarto agudo do miocárdio com supradesnivelamento do segmento ST (STEMI) é uma das principais apresentações clínicas da cardiopatia isquêmica. Dados de base populacional são relevantes para entendimento contemporâneo da epidemiologia da doença. Objetivo: Descrever incidência, manejo terapêutico, desfechos clínicos hospitalares e eventos cardiovasculares do primeiro ano de seguimento dos indivíduos hospitalizados por STEMI. Métodos: Estudo de coorte prospectiva de base populacional com registro consecutivo das hospitalizações por STEMI em uma cidade do Sul do Brasil entre 2011 e 2014. Foram incluídos indivíduos com STEMI que apresentaram sintomas de isquemia miocárdica aguda nas últimas 72 horas. Os valores de p < 0,05 foram considerados significativos. Resultados: A incidência anual de hospitalizações por STEMI foi de 108 casos por 100.000 habitantes. A incidência ajustada foi maior entre os mais velhos (risco relativo 64,9; IC95% 26,9 – 156,9; p para tendência linear < 0,001) e entre os homens (risco relativo 2,8; IC95% 2,3 – 3,3; p < 0,001). Ocorreram 530 hospitalizações durante o período avaliado e a taxa de reperfusão foi de 80,9%. A mortalidade hospitalar e a taxa de eventos cardiovasculares em 1 ano foram, respectivamente, 8,9% e 6,1%. Os mais velhos apresentaram maior mortalidade hospitalar (risco relativo 3,72; IC95% 1,57 – 8,82; p para tendência linear = 0,002) e mais eventos cardiovasculares em 1 ano (hazard ratio 2,35; IC95% 1,12 – 4,95; p = 0,03). Conclusão: Este registro demonstra abordagem terapêutica e mortalidade hospitalar semelhante às observadas em países desenvolvidos. Entretanto, a taxa de hospitalizações foi maior comparada com esses países.
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Affiliation(s)
- Leonardo Alves
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande, Rio Grande, RS - Brasil.,Hospital Santa Casa do Rio Grande - Hospital de Cardiologia, Rio Grande, RS - Brasil
| | - Carisi Anne Polanczyk
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
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6
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de Oliveira GMM, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, de Souza MDFM, Soares GP, Xavier GF, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115:308-439. [PMID: 33027364 PMCID: PMC9363085 DOI: 10.36660/abc.20200812] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson SaadUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Instituto do Coração Edson Saad
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Disciplina de Cardiologia,
Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
| | - Luisa Campos Caldeira Brant
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Carisi Anne Polanczyk
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Faculdade de Medicina
da
Universidade Federal do Rio Grande do Sul
(UFRS),
Porto Alegre
,
RS
–
Brasil
- Serviço de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Cardiologia
do
Hospital Moinhos de Vento
,
Porto Alegre
,
RS
–
Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre
(HCPA),
Porto Alegre
,
RS
–
Brasil
| | - Andreia Biolo
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Faculdade de Medicina
da
Universidade Federal do Rio Grande do Sul
(UFRS),
Porto Alegre
,
RS
–
Brasil
- Serviço de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Cardiologia
do
Hospital Moinhos de Vento
,
Porto Alegre
,
RS
–
Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre
(HCPA),
Porto Alegre
,
RS
–
Brasil
| | - Bruno Ramos Nascimento
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Maria de Fatima Marinho de Souza
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Organização Vital StrategiesNova YorkEUA Organização Vital Strategies
,
Nova York
–
EUA
| | - Gabriel Porto Soares
- Instituto do Coração Edson SaadUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Instituto do Coração Edson Saad
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
- Universidade de VassourasVassourasRJBrasil Curso de Medicina da
Universidade de Vassouras
,
Vassouras
,
RJ
–
Brasil
| | - Gesner Francisco Xavier
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Biblioteca da
Faculdade de Medicina
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - M. Julia Machline-Carrion
- ePHealth Primary Care SolutionsSanto Antônio SCBrasil ePHealth Primary Care Solutions
,
Santo Antônio
,
SC
–
Brasil
| | - Marcio Sommer Bittencourt
- Divisão de Clínica MédicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Divisão de Clínica Médica
do
Hospital Universitário
da
Universidade de São Paulo
,
São Paulo
,
SP
–
Brasil
- Faculdade Israelita de Ciências da Saúde Albert Einstein São PauloSPBrasil Faculdade Israelita de Ciências da Saúde Albert Einstein
,
São Paulo
,
SP
–
Brasil
| | - Octavio M. Pontes
- Departamento de Neurociências e Ciências do Comportamento Faculdade de Medicina de Ribeirão PretoUniversidade de São PauloSão PauloSPBrasil Serviço de Neurologia Vascular e Emergências Neurológicas, Divisão de Neurologia,
Departamento de Neurociências e Ciências do Comportamento
,
Faculdade de Medicina de Ribeirão Preto
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
| | - Odilson Marcos Silvestre
- Universidade Federal do AcreRio BrancoACBrasil Universidade Federal do Acre
(UFAC),
Rio Branco
,
AC
–
Brasil
| | - Renato Azeredo Teixeira
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Roney Orismar Sampaio
- Departamento de CardiopneumologiaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Cardiopneumologia
da
Faculdade de Medicina
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
- Programa de Pós-GraduaçãoFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Programa de Pós-Graduação
da
Faculdade de Medicina
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade Clínica de Cardiopatias Valvares do Instituto do Coração (Incor) do
Hospital das Clínicas
da
Faculdade de Medicina
da
Universidade de São Paulo
(HCFMUSP),
São Paulo
,
SP
–
Brasil
| | - Thomaz A. Gaziano
- Brigham and Women’s HospitalBostonEUA Brigham and Women’s Hospital
,
Boston
–
EUA
- Department of MedicineHarvard Medical SchoolBostonEUA Department of Medicine
, Cardiovascular,
Harvard Medical School
,
Boston
–
EUA
| | - Gregory A. Roth
- Global Health and Health Metrics SciencesInstitute for Health Metrics and EvaluationWashingtonEUA Global Health and Health Metrics Sciences
at the
Institute for Health Metrics and Evaluation
(IHME),
Washington
–
EUA
- Division of CardiologyUniversity of WashingtonSchool of MedicineWashingtonEUA Division of Cardiology
at the
University of Washington
School of Medicine
,
Washington
–
EUA
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
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7
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Aimoli US, Miranda CH. Clinical Competence in ST-segment Elevation Myocardial Infarction Management by Recently Graduated Physicians Applying for a Medical Residency Program. Arq Bras Cardiol 2020; 114:35-44. [PMID: 32049168 PMCID: PMC7025295 DOI: 10.36660/abc.20180309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/20/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A significant reduction in the morbidity and mortality related to ST-segment elevation myocardial infarction (STEMI) has been achieved with the development of reperfusion therapies. Early diagnosis and correct initial management are important to ensure this benefit. In Brazil, recent graduates in medicine are responsible for a large part of the initial care provided for these patients. OBJECTIVE To assess the clinical competence in the diagnosis and initial treatment of STEMI by newly graduated physicians applying for a medical residency program. METHODS We assessed the performance of 771 applicants for the direct entry selection process of the FMRP-USP Clinical Hospital Medicine Residency Program, performed in a simulated setting of STEMI, with professional actors and medical evaluators, using a standardized checklist following the recommendations of the Brazilian Guidelines for the management of this disease. RESULTS The general performance score presented a median of 7 and an interquartile range of 5.5-8.0. In relation to the items assessed: 83% required ECG monitoring, 57% requested the insertion of a peripheral venous access catheter, 95% administered acetylsalicylic acid, 80% administered a second antiplatelet agent (p2y12 inhibitor), 66% administered nitrate, 71% administered morphine, 69% recognized the diagnosis of STEMI, 71% assessed the pain duration, 63% recognized the need for immediate transfer, 34% showed adequate communication skills and only 25% insisted on the transfer even in case of non-availability of beds. CONCLUSIONS The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS).
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Affiliation(s)
- Ugo Stocco Aimoli
- Universidade de São Paulo - Campus de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brazil
| | - Carlos Henrique Miranda
- Universidade de São Paulo - Campus de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brazil
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Ranasinghe WG, Beane A, Vithanage TDP, Priyadarshani GDD, Colombage DDE, Ponnamperuma CJ, Karunarathne S, Schultsz C, Dondorp AM, Haniffa R. Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka. Heart 2019; 106:603-608. [PMID: 31843877 PMCID: PMC7146937 DOI: 10.1136/heartjnl-2019-315396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
Aim This study evaluates the quality of care for patients admitted with acute myocardial infarction (AMI) in a tertiary hospital in Colombo using the European Society of Cardiology Quality of Care Working Group’s guidelines (2017). Methods A recently implemented electronic AMI registry m-Health tool was used for prospective data collection. Each patient was assessed for eligibility for each of the six domains of quality. Global Registry of Acute Coronary Events Risk Model for predicted probability of mortality, and scores for risk of bleeding complications (CRUSADE) and severity of heart failure (Killip classification) were calculated as per published guidelines. A composite measure of quality was derived from compliance with the six domains. Patients were followed up via telephone at 30 days following discharge to evaluate outcome and satisfaction. Organisational information was assessed by administrative review and interview. Results Between March 2017 and April 2018, 934 patients with AMI presented to the cardiology department. The majority of patients (90.4%) presented with features of ST-elevation myocardial infarction (STEMI). Mean (SD) overall compliance with the composite quality indicator (CQI) was 44% (0.07). Compliance of ≥50% to the CQI was achieved in 9.8% of STEMI patients. The highest compliance was observed for antithrombotics during hospitalisation (79.1%) and continuous measure of patient satisfaction (76.1%). The lowest compliance was for organisational structure and care processes (22.4%). Conclusion This study reports a registry-based continuous evaluation of the quality of AMI care from a low and middle-income country. Priorities for improvement include improved referral, and networking of primary and secondary health facilities with the percutaneous coronary intervention centre.
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Affiliation(s)
| | - Abi Beane
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand .,Network for Improving Critical Care System and Training, Colombo, Sri Lanka.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gamage Dona Dilanthi Priyadarshani
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Network for Improving Critical Care System and Training, Colombo, Sri Lanka
| | | | | | | | - Constance Schultsz
- Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjen M Dondorp
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rashan Haniffa
- Department of Critical care and Malaria, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Network for Improving Critical Care System and Training, Colombo, Sri Lanka.,Internal Medicine, University College London, London, United Kingdom
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Stein AT, Lang E, Migowski A. Implementing clinical guidelines: a need to follow recommendations based on the best evidence available. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180021. [DOI: 10.1590/1980-549720180021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Airton Tetelbom Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Grupo Hospitalar Conceição, Brazil
| | - Eddy Lang
- University of Calgary, Canada; Zone Clinical Department Head for Emergency Medicine in Calgary, Canada
| | - Arn Migowski
- Instituto Nacional de Cardiologia, Brazil; Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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Nascimento BR, Brant LCC, Marino BCA, Passaglia LG, Ribeiro ALP. Implementing myocardial infarction systems of care in low/middle-income countries. Heart 2018; 105:20-26. [DOI: 10.1136/heartjnl-2018-313398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023] Open
Abstract
Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.
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