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Gómez-Mesa JE, Gutiérrez-Posso JM, Escalante-Forero M, Eraso-Bolaños DE, Drazner MH, Quesada-Chaves D, Romero-Guerra A, Perna ER, Álvarez-Sangabriel A, Rossel V, Alarco W, Speranza M. American registry of ambulatory and acute decompensated heart failure (AMERICCAASS registry): Rationale and design. ESC Heart Fail 2024. [PMID: 39014556 DOI: 10.1002/ehf2.14965] [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: 06/23/2023] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Heart failure (HF) is a highly prevalent and progressive condition associated with significant morbidity and mortality rates. Acute decompensated HF precipitates millions of hospitalizations each year. Despite therapeutic advances, the overall prognosis of HF is poor. The varying clinical courses and outcomes of patients with this disease may be due to region-specific gaps and since most HF studies are conducted in developed countries, the participation of Latin American and Caribbean countries is low. Considering this, the American Registry of Ambulatory and Acute Decompensated Heart Failure (AMERICCAASS) aims to characterize the population with ambulatory and acute decompensated HF in the American continent and to determine rehospitalization and survival outcomes during the 12 months of follow-up. METHODS AND RESULTS AMERICCAASS Registry is an observational, prospective, and hospital-based registry recruiting patients with ambulatory or acute decompensated HF. The registry plans to include between two and four institutions per country from at least 20 countries in the Americas, and at least 60 patients recruited from each participant institution regardless of their ambulatory or acutely decompensated condition. Ambulatory patients with confirmed HF diagnosis or inpatients presenting with acute decompensated HF will be included. Follow-up will be performed at 12 months in ambulatory patients or 1, 6, and 12 months after hospital discharge in acutely decompensated HF patients. This ongoing study began on 1 April 2022, with recruitment scheduled to end on 30 November 2023, and follow-up on 31 January 2025. Ethics approval was obtained from the Biomedical Research Ethics Committee of Fundación Valle del Lili. Data collected in the AMERICCAASS registry is being stored on the electronic platform REDCap (Research Electronic Data Capture), which allows different forms for patient groups to enable unbiased analyses. For quantitative variables comparison, we will use the Student's t-test or non-parametric tests accordingly. Categorical variables will be presented as proportions, and groups will be compared with Fisher's exact test. The significance level will be <0.05 for comparisons. Readmissions and post-discharge mortality will be calculated as proportions at 1, 6, and 12 months, with a survival analysis by conditional probability and the Kaplan-Meier method. CONCLUSIONS AMERICCAASS Registry is intended to be the most important registry of the continent for obtaining important information about demographics, aetiology, co-morbidities, and treatment received, either ambulatory or hospitalized. This registry may contribute to the optimization of national and regional evidence and public policies for the diagnosis and treatment of HF disease.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
- Department of Investigation and Innovation, Fundación Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
| | | | | | | | - Mark H Drazner
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Quesada-Chaves
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital San Vicente de Paul, Heredia, Costa Rica
| | - Alexander Romero-Guerra
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital Santo Tomas, Panama City, Panama
| | - Eduardo R Perna
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Heart Failure and Pulmonary Hypertension, Instituto De Cardiología J. F. Cabral, Corrientes, Argentina
| | - Amada Álvarez-Sangabriel
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Emergency Department and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Víctor Rossel
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Instituto Nacional del Tórax, Santiago, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Walter Alarco
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Instituto Nacional Cardiovascular INCOR, Lima, Peru
| | - Mario Speranza
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital Clínica Bíblica, San José, Costa Rica
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Rodrigues AS, de Castilho FM, Ribeiro AJF, Passaglia LG, Taniguchi FP, Ribeiro AL. Association between Hemodynamic Profile at Hospital Admission and Mortality in Acute Heart Failure Patients Included in the Best Practice in Cardiology Program in Brazil. Arq Bras Cardiol 2024; 121:e20230699. [PMID: 38922272 PMCID: PMC11216337 DOI: 10.36660/abc.20230699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 02/15/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Heart failure (HF) contributes to a high burden of hospitalization, and its form of presentation is associated with disease prognosis. OBJECTIVES To describe the association of hemodynamic profile of acute HF patients at hospital admission, based on congestion (wet/dry) and perfusion (cold/warm), with mortality, hospital length of stay and risk of readmission. METHODS Cohort study, with patients participating in the "Best Practice in Cardiology" program, admitted for acute HF in Brazilian public hospitals between March 2016 and December 2019, with a six-month follow-up. Characteristics of the population and hemodynamic profile at admission were analyzed, in addition to survival analysis using Cox proportional hazard model for associations between hemodynamic profile at admission and mortality, and logistic regression for the risk of rehospitalization, using a statistical significance level of 5%. RESULTS A total of 1,978 patients were assessed, with mean age of 60.2 (±14.8) years and mean left ventricular ejection fraction of 39.8% (±17.3%). A high six-month mortality rate (22%) was observed, with an association of cold hemodynamic profiles with in-hospital mortality (HR=1.72, 95%CI 1.27-2.31; p < 0.001) and six-month mortality (HR= 1.61, 95%CI 1.29-2.02). Six-month rehospitalization rate was 22%, and higher among patients with wet profiles (OR 2.30; 95%CI 1.45-3.65; p < 0.001). CONCLUSIONS Acute HF is associated with high mortality and rehospitalization rates. Patient hemodynamic profile at admission is a good prognostic marker of this condition.
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Affiliation(s)
- André Silva Rodrigues
- Universidade Federal de Minas GeraisServiço de Cardiologia HCBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Serviço de Cardiologia HC- UFMG, Belo Horizonte, MG – Brasil
| | - Fábio Morato de Castilho
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de Clínica MédicaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Departamento de Clínica Médica - Faculdade de Medicina – UFMG, Belo Horizonte, MG – Brasil
| | - Aloisio Joaquim Freitas Ribeiro
- Universidade Federal de Minas GeraisDepartamento de EstatísticaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Departamento de Estatística, Belo Horizonte, MG – Brasil
| | - Luiz Guilherme Passaglia
- Universidade Federal de Minas GeraisServiço de Cardiologia HCBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Serviço de Cardiologia HC- UFMG, Belo Horizonte, MG – Brasil
| | | | - Antonio L. Ribeiro
- Universidade Federal de Minas GeraisCentro de TelessaúdeHospital das ClínicasBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais - Centro de Telessaúde - Hospital das Clínicas – UFMG, Belo Horizonte, MG – Brasil
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3
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Goulart CDL, Agostoni P, Salvioni E, Silva RN, Bassi-Dibai D, Roscani MG, Arena R, Myers J, Borghi-Silva A. Phenotyping cardiopulmonary exercise testing measures in heart failure with reduced ejection fraction: A comparison between Italy and Brazil. Heart Lung 2024; 65:54-58. [PMID: 38402757 DOI: 10.1016/j.hrtlng.2024.02.002] [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: 04/23/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND While patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) constitutes a global health crisis the incidence, prevalence and prognosis of the disease may differ depending on the continent and country. OBJECTIVE To profile, analyze and compare cardiopulmonary exercise testing (CPET) data of patients with HFrEF between Italian and Brazilian cohorts. METHODS In this observational study, a total of 630 patients with clinical and functional diagnosis of HFrEF (315 patients from Brazil and 315 patients from Italy) performed CPET. RESULTS Although Brazilian patients were slightly younger (Brazil 60±10 vs Italy 64±11 p<0.001) with a better peak oxygen consumption (V̇O2), circulatory power and left ventricular ejection fraction (LVEF) (p<0.01), ventilatory inefficiency and oscillation ventilation was higher when compared to the Italian cohort. When stratifying patients with LVEF≤30 % and age≥60 years, Brazilian patients presented worse ventilatory efficiency, and lower peak V̇O2 compared to the Italian cohort. CONCLUSION Patients with HFrEF from Brazil exhibited higher ventilatory inefficiency and a greater prevalence of oscillatory ventilation during CPET compared to patients with the same diagnosis from Italy.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | | | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management in Health Programs and Services, Universidade CEUMA, São Luís, MA, Brazil
| | - Meliza Goi Roscani
- Cardiology and Exercise Research Center Laboratory, Department of Medicine, Federal University of São Carlos, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto CA, United States
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil.
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes Júnior AADP, Schaan BD, Silva CGDSE, Castilho FMD, Cesena FHY, Soares GP, Xavier Junior GF, Barreto Filho JAS, Passaglia LG, Pinto Filho MM, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Villela PB, Teixeira RA, Stein R, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2023. Arq Bras Cardiol 2024; 121:e20240079. [PMID: 38896747 PMCID: PMC11185831 DOI: 10.36660/abc.20240079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Luisa Campos Caldeira Brant
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | - Carisi Anne Polanczyk
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Bruno Ramos Nascimento
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital Madre Teresa, Belo Horizonte, MG - Brasil
| | | | - Andrea Rocha De Lorenzo
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | | | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Christina Grüne de Souza E Silva
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Fábio Morato de Castilho
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | | | - Gabriel Porto Soares
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Curso de Medicina da Universidade de Vassouras, Vassouras, RJ - Brasil
| | | | | | - Luiz Guilherme Passaglia
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | - Marcelo Martins Pinto Filho
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | | | | | - Octavio M Pontes Neto
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Paolo Blanco Villela
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Roney Orismar Sampaio
- Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brasil
- 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
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston - EUA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston - EUA
| | - Pablo Perel
- World Heart Federation, Geneva - Suíça
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, Londres - Inglaterra
| | - Gregory A Roth
- Division of Cardiology, Department of Medicine, University of Washington, Washington - EUA
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
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5
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Kaddour M, Burri H. Conduction System Pacing: Have We Finally Found the Holy Grail of Physiological Pacing? Heart Int 2023; 17:2-5. [PMID: 38419718 PMCID: PMC10919353 DOI: 10.17925/hi.2023.17.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 03/02/2024] Open
Abstract
The late fifties are considered a high point in the history of cardiac pacing, since this era is marked by the first pacemaker implantation, which has since evolved into life-saving therapy. Right ventricular apical and biventricular pacing are the classic techniques that are recommended as first-l ine approaches for most indications in current guidelines. However, conduction system pacing has emerged as being able to deliver a more physiological form of pacing and is becoming mainstream practice in a growing number of centres. In this review, we aim to compare traditional pacing methods with conduction system pacing.
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Affiliation(s)
- Myriam Kaddour
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
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Moreira GR, Villacorta H. A Personalized Approach to the Management of Congestion in Acute Heart Failure. Heart Int 2023; 17:35-42. [PMID: 38455673 PMCID: PMC10919353 DOI: 10.17925/hi.2023.17.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 03/09/2024] Open
Abstract
Heart failure (HF) is the common final pathway of several conditions and is characterized by hyperactivation of numerous neurohumoral pathways. Cardiorenal interaction plays an essential role in the progression of the disease, and the use of diuretics is a cornerstone in the treatment of hypervolemic patients, especially in acute decompensated HF (ADHF). The management of congestion is complex and, to avoid misinterpretations and errors, one must understand the interface between the heart and the kidneys in ADHF. Congestion itself may impair renal function and must be treated aggressively. Transitory elevations in serum creatinine during decongestion is not associated with worse outcomes and diuretics should be maintained in patients with clear hypervolemia. Monitoring urinary sodium after diuretic administration seems to improve the response to diuretics as it allows for adjustments in doses and a personalized approach. Adequate assessment of volemia and the introduction and titration of guideline-directed medical therapy are mandatory before discharge. An early visit after discharge is highly recommended, to assess for residual congestion and thus avoid readmissions.
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Affiliation(s)
- Gustavo R Moreira
- Cardiology Division, Fluminense Federal University, Niterói, Rio de Janeiro State, Brazil
| | - Humberto Villacorta
- Cardiology Division, Fluminense Federal University, Niterói, Rio de Janeiro State, Brazil
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Gonzalez VL, Santos ABS, Rohde LEP, Foppa M. Left ventricular structural abnormalities in the assessment of diastolic function in the elderly: source of discrepancies between the 2009 and 2016 criteria. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2127-2137. [PMID: 37530969 DOI: 10.1007/s10554-023-02919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
Diastolic dysfunction (DD) is routinely evaluated in echocardiography to support diagnosis, prognostication, and management of heart failure, a condition highly prevalent in elderly patients. Clinical guidelines were published in 2009, and updated in 2016, pursuing to standardize and improve DD categorization. We aimed to assess the concordance of DD between these two documents in an elderly population and to investigate how left ventricular structural abnormalities (LVSA) impact the reclassification. To evaluate this we analyzed the 308 consecutive transthoracic echocardiograms in patients older than 60 years (70.4 ± 7.7 years-old, 59% women) that fulfilled the inclusion criteria out of the 1438 echocardiograms performed in a tertiary hospital. We found that the prevalence of DD was lower according to the 2016 criteria (64% vs. 91%; p < 0.001), with 207 (67.2%) patients changing category, indicating poor agreement between the guidelines (kappa = 0.21). There were 188 (61%) patients with LVSA, which drove most of the reclassifications in 2016 Grade I DD cases. The prevalence of elevated filling pressures by Doppler halved in this elderly population using the updated recommendations (20.9% vs. 39.2%; p < 0.001). In conclusion the prevalence of DD was lower applying the 2016 guidelines, with a poor agreement with 2009 guidelines in all DD grades. The role of LVSA in reclassifications was particularly evident in Grade I DD, while Doppler parameters drove reclassifications among the more severe grades. If not properly addressed, these discrepancies may undermine the reliance on DD as a diagnostic and prognostic tool, particularly in an elderly population at a higher risk of heart failure.
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Affiliation(s)
- Vinícius Leite Gonzalez
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Angela Barreto Santiago Santos
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Luis Eduardo Paim Rohde
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Murilo Foppa
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil.
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil.
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Coy-Canguçu A, Antunes-Correa LM, Mazzali M, Abrão P, Ronco F, Teixeira CM, Viana KP, Cordeiro G, Longato M, Coelho OR, Matos-Souza JR, Nadruz W, Sposito AC, Petersen SE, Jerosch-Herold M, Coelho-Filho OR. Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system. Front Cardiovasc Med 2023; 10:1226481. [PMID: 37680567 PMCID: PMC10482263 DOI: 10.3389/fcvm.2023.1226481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Data on patients hospitalized with acute heart failure in Brazil scarce. Methods We performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome. Results In total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88). Discussion The in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil.
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Affiliation(s)
- Andréa Coy-Canguçu
- Catholic Pontifical University of Campinas Medical School, Campinas, Brazil
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Lígia M. Antunes-Correa
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Marilda Mazzali
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | | | | | | | | | | | | | - Otávio Rizzi Coelho
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - José Roberto Matos-Souza
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Wilson Nadruz
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Andrei C. Sposito
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Steffen E. Petersen
- William Harvey Research Institute NIHR Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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10
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Lima PC, Rios DM, de Oliveira FP, Passos LR, Ribeiro LB, Serpa RG, Calil OA, de Barros LC, Barbosa LFM, Barbosa RR. Inflammation as a Prognostic Marker in Heart Failure. Cureus 2022; 14:e28605. [PMID: 36185864 PMCID: PMC9522525 DOI: 10.7759/cureus.28605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Heart failure (HF) is a chronic cardiac disease of great importance worldwide and responsible for one-fifth of hospitalizations for cardiovascular disease in Brazil. Pro-inflammatory mediators are involved in the pathophysiology of HF. However, the impact of inflammatory markers on the prognosis of the disease remains uncertain. Objective: We aimed to evaluate inflammation as a prognostic marker in chronic HF. Methods: In this prospective, single-center, observational cohort study conducted from June 2018 through December 2019, we included outpatients with HF from a specialized service of a teaching hospital. Patients with decompensated HF requiring hospitalization in the last 30 days were excluded. At the time of inclusion, serum C-reactive protein (CRP) and albumin were collected and the presence of inflammation was defined as CRP/albumin ≥1.2. Patients with CRP/albumin ratio <1.2 (group A) and CRP/albumin ratio ≥1.2 (group B) were compared. The primary outcome was all-cause mortality. The secondary outcomes were hospitalization for decompensated HF, number of hospitalizations, and number of days of hospitalization in the 12-month follow-up. Results: We included 77 patients, 49 (63.3%) in group A and 28 (3.4%) in group B. Six patients in group A (12.2%) and 10 patients in group B (35.7%) required at least one hospitalization during follow-up (p=0.01). The rate of hospitalizations for decompensated HF for every 100 patients was 16.3 in group A vs 50.0 in group B (p=0.0001) and the average in-hospital length of stay was 12.2 vs 14.2 days per hospitalized patient (p=0.36) in groups A and B, respectively. The mortality rate was 6.1% in group A vs 7.1% in group B (p=0.86). Conclusion: In HF outpatients with inflammation evidentiated by the CRP/albumin ratio ≥1.2, the risk of death was similar to patients without inflammation criteria. However, the presence of inflammation led to a three-fold higher risk of hospitalization for HF decompensation.
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11
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da Silva CG, de Araújo SS, da Silva JI, Lira ALBDC, Lopes MVDO, Lopes CT, Frazão CMFDQ. Analysis of the content of the nursing diagnosis deficient knowledge in individuals with heart failure. Int J Nurs Knowl 2022; 34:116-125. [PMID: 35794806 DOI: 10.1111/2047-3095.12386] [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: 05/06/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the content of the nursing diagnosis deficient knowledge in individuals with heart failure. METHODS Methodological study to validate the content of a nursing diagnosis based on the predictive model of diversity, carried out through the organization of the phenomenon of interest and analysis by judges using the collective wisdom model. The NANDA-I Knowledge Deficient diagnosis was evaluated by 48 judges and considered valid when it presented a median content validity index ≥ 0.8 in the confidence intervals. RESULTS Note that 66.6% of the judges indicated that the new definition proposed was more adequate than the definition adopted by NANDA-I. After the experts' analysis, the following defining characteristics were considered valid: inaccurate statements about the disease and/or therapy, inadequate performance in the management of intercurrences, increase in hospital readmissions, worsened quality of life, deficit in self-care performance, and follow-up of inadequate instruction; related factors are as follows: inadequate guidance offered by health professionals, nonparticipation of the patient in the planning of their health care, weakened relationship between professional and individual; populations at risk-elderly and low level of education of the individual and/or caregiver and the associated condition, mild cognitive impairment. Anxiety, depression, and impaired social interaction were elements considered not relevant to the content domain. CONCLUSION The validation of the content of the aforementioned diagnosis in patients with heart failure, through the analysis of judges with different degrees of expertise, made it possible to improve the definition and expansion of new diagnostic indicators. IMPLICATIONS FOR NURSING PRACTICE Updated diagnostic elements for the nursing diagnosis deficient knowledge in individuals with heart failure will facilitate accurate clinical judgment and the establishment of a therapeutic plan aimed at etiological factors modifiable by nurses.
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Affiliation(s)
| | | | | | - Ana Luísa Brandão de Carvalho Lira
- Nurse, Permanent Professor of the Graduate Program in Nursing, Federal University of Rio Grande do Norte, Doctor in Nursing, Natal, Brazil
| | | | - Camila Takáo Lopes
- Nurse, Adjunct Professor at Escola Paulista de Enfermagem (EPE), Federal University of São Paulo. Doctor in Nursing, São Paulo, Brazil
| | - Cecília Maria Farias de Queiroz Frazão
- Nurse, Adjunct Professor of the undergraduate and graduate courses of the Department of Nursing, Federal University of Pernambuco, Doctor in Nursing, Recife, Brazil
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12
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Costa JO, Barbosa JS, Alves LVS, de Almeida RR, Oliveira VB, Pereira LMC, de Oliveira LMSM, Rocha RMS, dos Santos Vieira DA, Barbosa KBF, de Carvalho Costa IMNB, Aidar FJ, de Souza MFC, Oliveira JLM, Baumworcel L, Neves EB, Díaz-de-Durana AL, Almeida-Santos MA, Sousa ACS. Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil. Nutrients 2022; 14:987. [PMID: 35267962 PMCID: PMC8912487 DOI: 10.3390/nu14050987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)” of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System—SUS (67.5%). Three dietary patterns were identified, labeled “traditional” (typical foods of the Brazilian northeastern population added to ultra-processed foods), “Mediterranean” (foods recommended by the Mediterranean diet) and “dual” (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the “traditional” pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The “Mediterranean” was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The “dual” diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the “traditional” pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the “dual” pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.
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Affiliation(s)
- Jamille Oliveira Costa
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Juliana Santos Barbosa
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Luciana Vieira Sousa Alves
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Rebeca Rocha de Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Victor Batista Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Larissa Monteiro Costa Pereira
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Larissa Marina Santana Mendonça de Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Raysa Manuelle Santos Rocha
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, Brazil;
| | | | | | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil;
- Postgraduate Program in Physical Education, Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil
| | - Márcia Ferreira Cândido de Souza
- Postgraduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe (UFS), Aracaju 49100-000, Brazil;
| | - Joselina Luzia Menezes Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil; (L.B.); (M.A.A.-S.)
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil; (L.B.); (M.A.A.-S.)
| | - Eduardo Borba Neves
- Postgraduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, Brazil;
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil; (L.B.); (M.A.A.-S.)
- Postgraduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49010-390, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil; (J.S.B.); (L.V.S.A.); (R.R.d.A.); (V.B.O.); (L.M.C.P.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), Sao Cristovao 49100-000, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil; (L.B.); (M.A.A.-S.)
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13
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Lenarduzzi Júnior RM, de Almeida Neto OP, Pedrosa LAK, Silva PC, Coelho VM, Resende ES, Mendes DS. Electrocardiographic and echocardiographic profile of patients with heart failure. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:695-703. [PMID: 35116181 PMCID: PMC8784673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
Describing and analyzing the electrocardiographic and echocardiographic profile of patients with heart failure (HF). METHODS Documentary, retrospective, quantitative and descriptive research; data collected at the Hospital das Clinicas of Uberlandia with patients diagnosed with HF. RESULTS 81 patients participated in this study, with the average age of 66.75 years, 4 to 6 years of formal education and family income of approximately two minimum wages. A diagnosis time of 5 to 6 years and Left Ventricular Ejection Fraction (LVEF) of 40.88±11.97% were observed. In the clinical profile, the presence of comorbidities was evident, such as systemic arterial hypertension, arterial disease and cardiac arrhythmias (82.72%, 30.86% and 35.80% respectively). CONCLUSION Cardio Vascular Diseases (CVD) directly impacts the lives of thousands of people, presenting an important public expenditure, not to mention the scarcity of diagnostic research, which can contribute to future research and guideline development.
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Affiliation(s)
| | | | | | | | | | | | - David S Mendes
- Federal University of Health Science of Porto AlegreBrazil
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14
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Noya-Rabelo MM, de Azevedo DFC, de Souza OF. Predictive Models to Enhance our Knowledge: Is It Necessary? Arq Bras Cardiol 2021; 117:624-625. [PMID: 34709289 PMCID: PMC8528350 DOI: 10.36660/abc.20210733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Marcia M. Noya-Rabelo
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
- Hospital AliançaSalvadorBABrazilHospital Aliança, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | - Diogo Freitas Cardoso de Azevedo
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
- Hospital AliançaSalvadorBABrazilHospital Aliança, Salvador, BA - Brazil
| | - Olga Ferreira de Souza
- Instituto D’Or de Pesquisa e EnsinoSalvadorBABrazilInstituto D’Or de Pesquisa e Ensino (IDOR), Salvador, BA - Brazil
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15
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Kochi AN, Pimentel M, Andrades M, Zimerman T, Zimerman LI, Rohde LE. Predictors of Total Mortality and Serious Arrhythmic Events in Non-Ischemic Heart Failure Patients: The Role of Galectin-3. Arq Bras Cardiol 2021; 117:531-541. [PMID: 34550239 PMCID: PMC8462942 DOI: 10.36660/abc.20200353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/05/2020] [Indexed: 12/30/2022] Open
Abstract
Fundamento: A estratificação de risco continua sendo clinicamente desafiadora em pacientes com insuficiência cardíaca (IC) de etiologia não isquêmica. A galectina-3 é um marcador sérico de fibrose que pode ajudar no prognóstico. Objetivo: Determinar o papel da galectina-3 como preditora de eventos arrítmicos graves e mortalidade total. Métodos: Este é um estudo de coorte prospectivo que incluiu 148 pacientes com IC não isquêmica. Todos os pacientes foram submetidos a uma avaliação clínica e laboratorial abrangente para coleta de dados de referência, incluindo níveis de galectina-3 sérica. O desfecho primário foi a ocorrência de síncope arrítmica, intervenções apropriadas do cardioversor desfibrilador implantável, taquicardia ventricular sustentada ou morte súbita cardíaca. O desfecho secundário foi a morte por todas as causas. Para todos os testes estatísticos, considerou-se significativo o valor p<0,05 (bicaudal). Resultados: Em seguimento mediano de 941 dias, os desfechos primário e secundário ocorreram em 26 (17,5%) e 30 (20%) pacientes, respectivamente. A galectina-3 sérica>22,5 ng/mL (quartil mais alto) não foi preditora de eventos arrítmicos graves (HR: 1,98; p=0,152). Os preditores independentes do desfecho primário foram diâmetro diastólico final do ventrículo esquerdo (DDFVE)>73 mm (HR: 3,70; p=0,001), ventilação periódica durante o exercício (VPE) no teste de esforço cardiopulmonar (HR: 2,67; p=0,01) e taquicardia ventricular não sustentada (TVNS)>8 batimentos na monitorização por Holter (HR: 3,47; p=0,027). Os preditores de morte por todas as causas foram: galectina-3>22,5 ng/mL (HR: 3,69; p=0,001), DDFVE>73 mm (HR: 3,35; p=0,003), VPE (HR: 3,06; p=0,006) e TVNS>8 batimentos (HR: 3,95; p=0,007). A ausência de todos os preditores de risco foi associada a um valor preditivo negativo de 91,1% para o desfecho primário e 96,6% para a mortalidade total. Conclusões: Em pacientes com IC não isquêmica, níveis elevados de galectina-3 não foram preditores de eventos arrítmicos graves, mas foram associados à mortalidade total. A ausência de preditores de risco revelou um subgrupo prevalente de pacientes com IC com excelente prognóstico.
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Affiliation(s)
- Adriano Nunes Kochi
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.,Programa de Pós-Graduação em Ciências Cardiovasculares e Cardiologia da Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Mauricio Pimentel
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.,Programa de Pós-Graduação em Ciências Cardiovasculares e Cardiologia da Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Michael Andrades
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.,Programa de Pós-Graduação em Ciências Cardiovasculares e Cardiologia da Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Tiago Zimerman
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil
| | | | - Luis Eduardo Rohde
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brasil.,Programa de Pós-Graduação em Ciências Cardiovasculares e Cardiologia da Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
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16
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Blume GG, Machado-Junior PAB, Simeoni RB, Bertinato GP, Tonial MS, Nagashima S, Pinho RA, de Noronha L, Olandoski M, de Carvalho KAT, Francisco JC, Guarita-Souza LC. Bone-Marrow Stem Cells and Acellular Human Amniotic Membrane in a Rat Model of Heart Failure. Life (Basel) 2021; 11:958. [PMID: 34575107 PMCID: PMC8471644 DOI: 10.3390/life11090958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Myocardial infarction (MI) remains the leading cause of cardiovascular death worldwide and a major cause of heart failure. Recent studies have suggested that cell-based therapies with bone marrow stem cells (BMSC) and human amniotic membrane (hAM) would recover the ventricular function after MI; however, the mechanisms underlying these effects are still controversial. Herein, we aimed to compare the effects of BMSC and hAM in a rat model of heart failure. MI was induced through coronary occlusion, and animals with an ejection fraction (EF) < 50% were included and randomized into three groups: control, BMSC, and hAM. The BMSC and hAM groups were implanted on the anterior ventricular wall seven days after MI, and a new echocardiographic analysis was performed on the 30th day, followed by euthanasia. The echocardiographic results after 30 days showed significant improvements on EF and left-ventricular end-sistolic and end-diastolic volumes in both BMSC and hAM groups, without significant benefits in the control group. New blood vessels, desmine-positive cells and connexin-43 expression were also elevated in both BMSC and hAM groups. These results suggest a recovery of global cardiac function with the therapeutic use of both BMSC and hAM, associated with angiogenesis and cardiomyocyte regeneration after 30 days.
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Affiliation(s)
- Gustavo Gavazzoni Blume
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Paulo André Bispo Machado-Junior
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Rossana Baggio Simeoni
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Giovana Paludo Bertinato
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Murilo Sgarbossa Tonial
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Seigo Nagashima
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Ricardo Aurino Pinho
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Brazil;
| | - Lucia de Noronha
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Marcia Olandoski
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
| | - Katherine Athayde Teixeira de Carvalho
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, The Pelé Pequeno Príncipe Institute, Child and Adolescent Health Research & Pequeno Príncipe Faculties, Curitiba 80215-901, Brazil; (K.A.T.d.C.); (J.C.F.)
| | - Julio Cesar Francisco
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, The Pelé Pequeno Príncipe Institute, Child and Adolescent Health Research & Pequeno Príncipe Faculties, Curitiba 80215-901, Brazil; (K.A.T.d.C.); (J.C.F.)
| | - Luiz Cesar Guarita-Souza
- Experimental Laboratory of Institute of Biological and Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil; (P.A.B.M.-J.); (R.B.S.); (G.P.B.); (M.S.T.); (S.N.); (L.d.N.); (M.O.); (L.C.G.-S.)
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17
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Soni S, Panwar Y, Bharani A. Do we need a simplified model to predict outcomes in patients hospitalized with Acute Decompensated Heart Failure? Results from The Role of Sodium in Heart Failure Outcomes Prediction ('SHOUT-PREDICTION') study. Indian Heart J 2021; 73:458-463. [PMID: 34474758 PMCID: PMC8424268 DOI: 10.1016/j.ihj.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
Context Hyponatremia is associated with high in-hospital mortality in patients with acute decompensated Heart Failure (ADHF) and is one of the components in various risk scores in heart failure (HF). However, some risk scores predict outcomes in these patients without using hyponatremia as its component. Aim The study was aimed to evaluate the relationship between serum sodium levels at admission and clinical outcomes during the in-hospital course and three months’ follow-up, in patients admitted in the intensive cardiac care unit (ICCU) with ADHF. Methods and material This was a single-center prospective, observational study in which 130 consecutive patients admitted with ADHF were observed for clinical characteristics and blood investigation at admission and their clinical outcomes during the in-hospital course and follow-up of 3 months. Results Hyponatremia and systolic blood pressure (SBP) both were found to be the independent predictor of in-hospital mortality. The SXS score (calculated as a product of SBP and serum sodium, divided by 1000) as a new prediction variable was significantly associated with in-hospital mortality and was compared with the Get with the guideline HF (GWTG-HF) score and ADHF national registry (ADHERE) score. The SXS score showed the best overall accuracy in predicting in-hospital mortality [area under the curve (AUC) = 0.899] as compared to the ADHERE (AUC = 0.780) and the GWTG (AUC = 0.815). Conclusions A score derived from the product of serum sodium and SBP (SXS score) had a significant association with in-hospital mortality, and better predictive value as compared to GWTG and ADHERE risk score in these patients.
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Affiliation(s)
- Shishir Soni
- Department of Medicine, M.G.M. Medical College & M.Y. Hospital, Indore, MP, India.
| | - Yashwant Panwar
- Department of Medicine, M.G.M. Medical College & M.Y. Hospital, Indore, MP, India
| | - Anil Bharani
- Department of Medicine, M.G.M. Medical College & M.Y. Hospital, Indore, MP, India
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18
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Piardi DS, Butzke M, Mazzuca ACM, Gomes BS, Alves SG, Kotzian BJ, Ghisleni EC, Giaretta V, Bellaver P, Varaschin GA, Garbin AP, Beck-da-Silva L. Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial. Sci Rep 2021; 11:16474. [PMID: 34389780 PMCID: PMC8363660 DOI: 10.1038/s41598-021-96002-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022] Open
Abstract
Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized-26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: - 1.78 ± 1.08 kg/day vs placebo: - 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: - 0.74 ± 0.47 kg/40 mg vs placebo: - 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .
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Affiliation(s)
| | - Maurício Butzke
- Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Ana Carolina Martins Mazzuca
- Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | | | | | | | | | - Vanessa Giaretta
- Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | - Priscila Bellaver
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil
| | | | | | - Luís Beck-da-Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, 90035-003, Brazil.
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19
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Silva PC, de Almeida Neto OP, Resende ES. Epidemiological profile, cardiopulmonary fitness and health-related quality of life of patients with heart failure: a longitudinal study. Health Qual Life Outcomes 2021; 19:129. [PMID: 33892726 PMCID: PMC8063347 DOI: 10.1186/s12955-020-01634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a severe and self-limiting syndrome. Its signs and symptoms are believed to predict poorer health-related quality of life scores, which are mainly influenced by deterioration in physical capacity. In the present study we try to analyze the influence of clinical and socioeconomic characteristics and physical capacity on the quality of life of people with HF diagnosis. METHODS A longitudinal study was conducted over 2 years with patients diagnosed with HF. To evaluate the patients the method of face-to-face visit and telephone monitoring was used. In the evaluations were applied: the Clinical and Socioeconomic Characterization Questionnaire, the Minnesota Living With Heart Failure Questionnaire (MLHFQ) for quality of life evaluation and the Veterans Specific Activity Questionnaire (VSAQ) for cardiopulmonary fitness analysis. Measures of central tendency, proportion, normality test, confidence intervals, comparison of data through paired Student t test and Wilcoxon or Mann Whitney test were performed and correlations were verified through Spearman coefficient. RESULTS The study included 108 patients, most of them female (50.90%) and mean age of 66.62 ± 11.33 years. The median time of HF diagnosis was 5 ± 6 years, being Chagas' disease the main etiologic cause for the disease (57.40%). As for the clinical condition, functional classes II (44.40%) and III (48.10%) of the New York Heart Association (NYHA) were the most frequent. There was a low cardiopulmonary fitness, with loss of capacity to perform daily activities (3 ± 1 to 3 ± 3) over the time of clinical follow-up. There was an increase in the MLHFQ instrument scores, from 50.98 ± 15.52 to 61.76 ± 19.95, over the analysis time. The analysis of correlations demonstrated that variables such as schooling, NYHA class, echocardiographic alterations and the drug profile have a significant relationship with the constructs of quality of life and physical fitness. CONCLUSION Individuals in HF have significant impairment of cardiorespiratory capacity and tend to present worsening of QL along the evolution of the disease.
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Affiliation(s)
- Paula Cristina Silva
- Health Sciences, Federal University of Uberlândia. CV, Rua Adamastor Leocádio, 624/ Bairro Pampulha, Uberlândia, Minas Gerais 38408-678 Brazil
| | | | - Elmiro Santos Resende
- Cardiology, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
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20
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Issa VS, Ayub-Ferreira SM, Schroyens M, Chizzola PR, Soares PR, Lage SHG, Bocchi EA. The course of patients with Chagas heart disease during episodes of decompensated heart failure. ESC Heart Fail 2021; 8:1460-1471. [PMID: 33595916 PMCID: PMC8006612 DOI: 10.1002/ehf2.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/04/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS This study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies. METHODS AND RESULTS A prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2-66.7 years]. Main aetiologies were non-Chagas/non-ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22-35%). Patients with Chagas differed from both patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission (17.8%, 11.6%, and 11%, respectively, P < 0.001) and had lower blood pressure at admission (systolic blood pressure 90 [80-102.5], 100 [85-110], and 100 [88.2-120] mmHg, P < 0.001) and lower heart rate (heart rate 71 [60-80], 87 [70-102], and 79 [64-96.5] b.p.m., P < 0.001). Further, patients with Chagas had higher serum BNP level (1544 [734-3148], 1061 [465-239], and 927 [369-1455] pg/mL, P < 0.001), higher serum bilirubin (1.4 [0.922.44], 1.2 [0.77-2.19], and 0.84 [0.49-1.45] mg/dL, P < 0.001), larger left ventricular diameter (68 [63-73], 67 [58-74], and 62 [56.8-68.3] mm, respectively, P < 0.001), lower left ventricular ejection fraction (25 [21-30]%, 26 [22-35]%, and 30 [25-38]%, P < 0.001), and a higher proportion of patients with right ventricular function (48.8%, 40.7%, and 25.9%, P < 0.001). Patients with Chagas disease were more likely to receive inotropes than patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies (77.5%, 67.5%, and 62.5%, respectively, P = 0.007) and also to receive intra-aortic balloon pumping (30.8%, 16.2%, and 10.5%, P < 0.001). Overall, the rates of death or urgent transplant were higher among patients with Chagas than in other aetiologies, a difference that was driven mostly due to increased rate of heart transplant during hospital admission (20.2%, 10.3%, and 8.1%). The prognosis of patients at 180 days after hospital admission was worse for patients with Chagas disease as compared with other aetiologies. In patients with Chagas, age [odds ratio (OR) = 0.934, confidence interval (CI)95% 0.901-0.982, P = 0.005], right ventricular dysfunction by echocardiography (OR = 2.68, CI95% 1.055-6.81, P = 0.016), and urea (OR = 1.009, CI95% 1.001-1.018, P = 0.038) were significantly associated with prognosis. CONCLUSIONS Patients with Chagas cardiomyopathy and decompensated HF have a distinct clinical presentation and worse prognosis compared with other aetiologies.
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Affiliation(s)
- Victor Sarli Issa
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Silvia Moreira Ayub-Ferreira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthew Schroyens
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Paulo Roberto Chizzola
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Rogerio Soares
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Helena Gelas Lage
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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21
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Petersen LC, Danzmann LC, Bartholomay E, Bodanese LC, Donay BG, Magedanz EH, Azevedo AV, Porciuncula GF, Miglioranza MH. Survival of Patients with Acute Heart Failure and Mid-range Ejection Fraction in a Developing Country - A Cohort Study in South Brazil. Arq Bras Cardiol 2021; 116:14-23. [PMID: 33566960 PMCID: PMC8159506 DOI: 10.36660/abc.20190427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heart Failure with mid-range Ejection Fraction (HFmEF) was recently described by European and Brazilian guidelines on Heart Failure (HF). The ejection fraction (EF) is an important parameter to guide therapy and prognosis. Studies have shown conflicting results without representative data from developing countries. OBJECTIVE To analyze and compare survival rate in patients with HFmEF, HF patients with reduced EF (HFrEF), and HF patients with preserved EF (HFpEF), and to evaluate the clinical characteristics of these patients. METHODS A cohort study that included adult patients with acute HF admitted through the emergency department to a tertiary hospital, reference in cardiology, in south Brazil from 2009 to 2011. The sample was divided into three groups according to EF: reduced, mid-range and preserved. A Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was done. Statistical significance was established as p < 0.05. RESULTS A total of 380 patients were analyzed. Most patients had HFpEF (51%), followed by patients with HFrEF (32%) and HFmEF (17%). Patients with HFmEF showed intermediate characteristics related to age, blood pressure and ventricular diameters, and most patients were of ischemic etiology. Median follow-up time was 4.0 years. There was no statistical difference in overall survival or cardiovascular mortality (p=.0031) between the EF groups (reduced EF: 40.5% mortality; mid-range EF 39.7% and preserved EF 26%). Hospital mortality was 7.6%. CONCLUSION There was no difference in overall survival rate between the EF groups. Patients with HFmEF showed higher mortality from cardiovascular diseases in comparison with HFpEF patients. (Arq Bras Cardiol. 2021; 116(1):14-23).
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Affiliation(s)
- Lucas Celia Petersen
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Luiz Claudio Danzmann
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil
| | - Eduardo Bartholomay
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil
| | | | | | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil.,Prevencor - Hospital Mãe de Deus, Porto Alegre, RS - Brasil
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22
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Castro RRT, Lechnewski L, Homero A, Albuquerque DCD, Rohde LE, Almeida D, David J, Rassi S, Bacal F, Bocchi E, Moura L. Acute Hemodynamic Index Predicts In-Hospital Mortality in Acute Decompensated Heart Failure. Arq Bras Cardiol 2021; 116:77-86. [PMID: 33566969 PMCID: PMC8159496 DOI: 10.36660/abc.20190439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/16/2020] [Indexed: 01/13/2023] Open
Abstract
Fundamento O exame físico permite a avaliação prognóstica de pacientes com insuficiência cardíaca (IC) descompensada, porém não é suficientemente confiável e depende da experiência clínica do profissional. Considerando as respostas hemodinâmicas a situações do tipo “luta ou fuga” tais como a admissão no serviço de emergência, foi proposto o índice hemodinâmico agudo (IHA), calculado a partir da frequência cardíaca e pressão de pulso. Objetivo avaliar a capacidade prognóstica intra-hospitalar do IHA na IC descompensada. Métodos estudo prospectivo, multicêntrico e observacional baseado no registro BREATHE, incluindo dados de hospitais públicos e privados no Brasil. Foram utilizadas análises ROC (
Receiver Operating Characteristic
), de estatística c e de regressão multivariada, assim como o critério de informação de Akaike, para testar a capacidade prognóstica do IHA. O valor-p < 0,05 foi considerado estatisticamente significativo. Resultados Foram analisados dados de 463 pacientes com IC com fração de ejeção reduzida a partir do registro BREATHE. A mortalidade intra-hospitalar foi de 9%. A mediana do IHA foi considerada o valor de corte (4 mmHg⋅bpm). Um baixo IHA (≤ 4 mmHg⋅bpm) foi encontrado em 80% dos pacientes falecidos. O risco de mortalidade intra-hospitalar em pacientes com baixo IHA foi 2,5 vezes maior que aquele para pacientes com IHA > 4 mmHg⋅bpm. O IHA foi capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada [sensibilidade: 0,786; especificidade: 0,429; AUC (área sob a curva): 0,607 (0,540-0,674), p = 0,010] mesmo depois dos ajustes para comorbidades e uso de medicamentos [razão de chances (RC): 0,061 (0,007-0,114), p = 0,025]. Conclusões O IHA é capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada. Esse índice simples e realizado à beira do leito pode se mostrar útil em serviços de emergência. (Arq Bras Cardiol. 2021; 116(1):77-86)
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Affiliation(s)
- Renata R T Castro
- Brigham and Womens Hospital - Medicine, Boston - EUA.,Hospital Naval Marcilio Dias, Rio de Janeiro, RJ - Brasil.,Faculdade de Medicina, Universidade Iguaçu, Nova Iguaçu, RJ - Brasil
| | - Luka Lechnewski
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Alan Homero
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | | | - Dirceu Almeida
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - João David
- Hospital de Messejana, Fortaleza, CE - Brasil
| | | | - Fernando Bacal
- Universidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Edimar Bocchi
- Universidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Lidia Moura
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
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23
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Almeida Junior GLGD, Mansur Filho J, Albuquerque DCD, Xavier SS, Pontes Á, Gouvêa EP, Martins ABB, Nunes NSV, Carestiato LV, Petriz JLF, Santos AMG, Bandeira BS, Abufaiad BEDJ, Pacheco LDC, Oliveira MSD, Ribeiro Filho PEC, Sampaio PPN, Duque GS, Camillis LF, Marques AC, Lourenço FC, Palazzo JR, Costa CRD, Silva BAD, Zukowski CN, Garcia RR, Zonis FDC, Paula SAMD, Ferrari CGF, Rangel BSDS, Ferreira RM, Mendes BFDS, Castro IRCD, Souza LGGD, Araújo LHDS, Giani A. Takotsubo Multicenter Registry (REMUTA) - Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality. Arq Bras Cardiol 2020; 115:207-216. [PMID: 32876186 PMCID: PMC8384277 DOI: 10.36660/abc.20190166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/14/2019] [Indexed: 12/31/2022] Open
Abstract
Fundamento A síndrome de takotsubo (takotsubo) é uma forma de cardiomiopatia adquirida. Dados nacionais sobre essa condição são escassos. O Registro REMUTA é o primeiro a incluir dados multicêntricos dessa condição no nosso país. Objetivo Descrever as características clínicas, prognóstico, tratamento intra-hospitalar e mortalidade hospitalar e em 1 ano de seguimento. Métodos Estudo observacional, retrospectivo, tipo registro. Incluídos pacientes internados com diagnóstico de takotsubo ou que desenvolveram esta condição durante internação por outra causa. Os desfechos avaliados incluíram fator desencadeador, análise dos exames, uso de medicações, complicações e óbito intra-hospitalar e em 1 ano de seguimento. O nível de significância adotado foi de 5%. Resultados Foram incluídos 169 pacientes, em 12 centros no Estado do Rio de Janeiro. A idade média foi de 70,9 ± 14,1 anos e 90,5% eram do sexo feminino; 63% dos casos foram de takotsubo primário e 37% secundário. Troponina I foi positiva em 92,5% dos pacientes e a mediana de BNP foi de 395 (176,5; 1725). Supradesnivelamento do segmento ST esteve presente em 28% dos pacientes. A fração de ejeção do ventrículo esquerdo teve mediana de 40 (35; 48)%. Observamos taxa de 25,7% de ventilação mecânica invasiva e 17,4% de choque. Suporte circulatório mecânico foi utilizado em 7,7%. A mortalidade intra-hospitalar foi de 10,6% e a mortalidade ao final de 1 ano foi de 16,5%. Takotsubo secundário e choque cardiogênico foram preditores independentes de mortalidade. Conclusão Os resultados do REMUTA mostram que takotsubo não se trata de patologia benigna como se pensava, especialmente no grupo de takotsubo secundário que acarreta elevada taxa de complicações e de mortalidade. (Arq Bras Cardiol. 2020; 115(2):207-216)
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Affiliation(s)
| | | | - Denilson Campos de Albuquerque
- Universidade do Estado do Rio de Janeiro,Rio de Janeiro, RJ - Brasil.,Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
| | - Sergio Salles Xavier
- Instituto Nacional de Infectologia Evandro Chagas - FIOCRUZ,Rio de Janeiro, RJ - Brasil
| | - Álvaro Pontes
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
| | - Elias Pimentel Gouvêa
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
| | | | - Nágela S V Nunes
- Complexo Hospitalar de Niterói,Niterói, RJ - Brasil.,Hospital Universitário Antonio Pedro,Niterói, RJ - Brasil
| | - Lilian Vieira Carestiato
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil.,Clínica São Vicente,Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Gustavo Salgado Duque
- Universidade do Estado do Rio de Janeiro,Rio de Janeiro, RJ - Brasil.,Americas Medical City,Rio de Janeiro, RJ - Brasil
| | | | - André Casarsa Marques
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
| | | | - José Ricardo Palazzo
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Roberto Muniz Ferreira
- Hospital Samaritano,Rio de Janeiro, RJ - Brasil.,Universidade Federal do Rio de Janeiro,Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Alexandre Giani
- Instituto D'or de pesquisa e ensino: ID'or/Cardiologia D'or,Rio de Janeiro, RJ - Brasil
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Cardoso J, de Espíndola MD, Cunha M, Netto E, Cardoso C, Novaes M, Del Carlo CH, Brancalhão E, Name AL, Barretto ACP. Is Current Drug Therapy for Heart Failure Sufficient to Control Heart Rate of Patients? Arq Bras Cardiol 2020; 115:1063-1069. [PMID: 33470302 PMCID: PMC8133726 DOI: 10.36660/abc.20190090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/12/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR. OBJECTIVE To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic. METHODS We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups - HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student's t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses. RESULTS A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients. CONCLUSION The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069).
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Affiliation(s)
- Juliano Cardoso
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | | | - Mauricio Cunha
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Enock Netto
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Cristina Cardoso
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Milena Novaes
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Carlos Henrique Del Carlo
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Euler Brancalhão
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
| | - Alessandro Lyra Name
- Hospital Santa MarcelinaSão PauloSPBrazilHospital Santa Marcelina – Cardiologia, São Paulo, SP – Brazil
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Lima MA, Duque AP, Rodrigues Junior LF, Lima VCS, Trotte LAC, Guimaraes TCF. Health literacy and quality of life in hospitalized heart failure patients: a cross-sectional study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:490-498. [PMID: 33224600 PMCID: PMC7675168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Heart Failure (HF) treatment may be improved by good knowledge of the disease (Health Literacy) that, despite the well-established role on improving self-care, preventing complications and avoiding worse outcomes, has little evidence on affecting QoL of HF patients. Therefore, the objective of the present study was to evaluate the impact of Health Literacy on QoL in hospitalized HF patients. METHODOLOGY A cross-sectional exploratory study was conducted with HF patients hospitalized at a public cardiological hospital. Health Literacy was assessed using the "Questionnaire about Heart Failure Patients' Knowledge of Disease" and QoL using the "Minnesota Living with Heart Failure Questionnaire" (MLHFQ). The association between Health Literacy and QoL was assessed by linear regression (P<0.05). RESULTS 50 patients were included in the study; the mean Health Literacy score was 34.2 ± 15.1 (the majority presenting acceptable or better knowledge). The mean MLHFQ score was 73.5 ± 19.8. The one-year hospital readmission rate (β=+3.8; P=0.009) and the patients' Health Literacy score (β=-0.4; P=0.024) or good knowledge category (β=-20.2; P=0.016) were independently associated with QoL. CONCLUSION While the readmission rate was inversely associated with QoL, the better the HF knowledge the better QoL in hospitalized HF patients.
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Affiliation(s)
- Marcone A Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Alice P Duque
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Luiz F Rodrigues Junior
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
- Department of Physiological Sciences, Federal University of The State of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Viviani CS Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Liana AC Trotte
- Department of Nursing Methodology, Federal University of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Tereza CF Guimaraes
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
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Affiliation(s)
- Felix J A Ramires
- Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brasil
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Borovac JA, Glavas D, Susilovic Grabovac Z, Supe Domic D, Stanisic L, D'Amario D, Kwok CS, Bozic J. Circulating sST2 and catestatin levels in patients with acute worsening of heart failure: a report from the CATSTAT-HF study. ESC Heart Fail 2020; 7:2818-2828. [PMID: 32681700 PMCID: PMC7524138 DOI: 10.1002/ehf2.12882] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/07/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Soluble suppression of tumourigenicity 2 (sST2) and catestatin (CST) reflect myocardial fibrosis and sympathetic overactivity during the acute worsening of heart failure (AWHF). We aimed to determine serum levels and associations of sST2 and CST with in-hospital death as well as the association between sST2 and CST among AWHF patients. METHODS AND RESULTS A total of 96 AWHF patients were consecutively enrolled, while levels of sST2 and CST were determined and compared between non-survivors and survivors. Predictive values of sST2 and CST for in-hospital death were determined by the penalized multivariable Firth logistic regression. The diagnostic ability of sST2 and CST for in-hospital death was assessed by the receiver operating characteristic analysis and examined with respect to the N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin I, and C-reactive protein. The in-hospital death rate was 6.25%. Serum sST2 and CST levels were significantly higher among non-survivors than survivors [146.6 (inter-quartile range, IQR 65.9-156.2) vs. 35.3 (IQR 20.6-64.4) ng/mL, P < 0.001, and 19.8 (IQR 9.9-28.0) vs. 5.6 (IQR 3.4-9.8) ng/mL, P < 0.001, respectively]. Both sST2 and CST were independent predictors of in-hospital death [Firth coefficient (FC) 6.00, 95% confidence interval (CI), 1.48-15.20, P = 0.005, and FC 6.58, 95% CI 1.66-21.78, P = 0.003, respectively], while NT-proBNP was not a significant predictor (FC 1.57, 95% CI 0.51-3.99, P = 0.142). In classifying non-survivors from survivors, sST2 provided area under the curve (AUC) of 0.917 (95% CI 0.819-1.000, P < 0.001) followed by CST (AUC 0.905, 95% CI 0.792-1.000, P < 0.001), while NT-proBNP yielded AUC of 0.735 (95% CI 0.516-0.954, P = 0.036). High-sensitivity cardiac troponin I and C-reactive protein were not found as significant classifiers of in-hospital death (AUC 0.719, 95% CI 0.509-0.930, P = 0.075, and AUC 0.682, 95% CI 0.541-0.822, P = 0.164, respectively). Among survivors, those with sST2 serum levels ≥35 ng/mL had significantly higher CST levels, compared with those with sST2 < 35 ng/mL (9.05 ± 5.17 vs. 5.06 ± 2.76 ng/mL, P < 0.001). Serum sST2 levels positively and independently correlated with CST levels in the whole patient cohort (β = 0.437, P < 0.001). CONCLUSIONS Elevated sST2 and CST levels, reflecting two distinct pathophysiological pathways in heart failure, might indicate impending clinical deterioration among AWHF patients during hospitalization and facilitate prognosis beyond traditional biomarkers regarding the risk of in-hospital death (CATSTAT-HF ClinicalTrials.gov Number NCT03389386).
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Affiliation(s)
- Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, 21000, Croatia.,Institute of Emergency Medicine of Split-Dalmatia County, Split, Croatia.,Clinic for Cardiovascular Diseases, University Hospital of Split, Split, Croatia
| | - Duska Glavas
- Clinic for Cardiovascular Diseases, University Hospital of Split, Split, Croatia.,Department of Internal Medicine, University of Split School of Medicine, Split, Croatia
| | | | - Daniela Supe Domic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Split, Croatia.,Department of Health Studies, University of Split, Split, Croatia
| | - Lada Stanisic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Split, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chun S Kwok
- University Hospitals of North Midlands Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, 21000, Croatia
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Fernandes ADF, Fernandes GC, Mazza MR, Knijnik LM, Fernandes GS, Vilela ATD, Badiye A, Chaparro SV. A 10-Year Trend Analysis of Heart Failure in the Less Developed Brazil. Arq Bras Cardiol 2020; 114:222-231. [PMID: 32215488 PMCID: PMC7077585 DOI: 10.36660/abc.20180321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce. OBJECTIVE Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends. METHODS A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%. RESULTS From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in-hospital mortality rate increased in Paraiba and Brazil [65.1% (p = 0.006) and 30.1% (p = 0.003), respectively], but the absolute in-hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil. CONCLUSIONS Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase.
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Affiliation(s)
- Amanda D F Fernandes
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Gilson C Fernandes
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Manuel Rivera Mazza
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Leonardo M Knijnik
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | | | | | - Amit Badiye
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Sandra V Chaparro
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
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Athayde CCD, Nishijuka FA, Queiroz MCDC, Luna MM, Figueiredo JL, Albuquerque NMD, Castilho SCRD, Castro RRT. Acute Decompensated Heart Failure due to Chikungunya Fever. Arq Bras Cardiol 2020; 114:19-22. [PMID: 32428107 PMCID: PMC8149109 DOI: 10.36660/abc.20180316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/10/2019] [Indexed: 01/09/2023] Open
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Marcondes-Braga FG, Gioli-Pereira L, Bernardez-Pereira S, Batista GL, Mangini S, Issa VS, Fernandes F, Bocchi EA, Ayub-Ferreira SM, Mansur AJ, Gutz IGR, Krieger JE, Pereira AC, Bacal F. Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients. ESC Heart Fail 2020; 7:1744-1752. [PMID: 32383349 PMCID: PMC7373929 DOI: 10.1002/ehf2.12736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Fabiana G Marcondes-Braga
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Luciana Gioli-Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Sabrina Bernardez-Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | | | - Sandrigo Mangini
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Victor S Issa
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Fabio Fernandes
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Edimar A Bocchi
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Silvia M Ayub-Ferreira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Alfredo J Mansur
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Ivano G R Gutz
- Institute of Chemistry (IQ-USP), University of Sao Paulo, Sao Paulo, Brazil
| | - Jose E Krieger
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Alexandre C Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
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Vaz J, Abelin AP, Schmidt MM, de Oliveira PP, Gottschall CAM, Rodrigues CG, de Quadros AS. Creation and Implementation of a Prospective and Multicentric Database of Patients with Acute Myocardial Infarction: RIAM. Arq Bras Cardiol 2020; 114:446-455. [PMID: 32267314 PMCID: PMC7792739 DOI: 10.36660/abc.20190036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multicenter registries representing the real world can be a significant source of information, but few studies exist describing the methodology to implement these tools. OBJECTIVE To describe the process of implementing a database of ST-segment elevation acute myocardial infarction (STEMI) at a reference hospital, and the application of this process to other centers by means of an online platform. METHODS In 2009, our institution implemented an Registry of Acute Myocardial Infarction (RIAM), with the prospective and consecutive inclusion of every patient admitted to the institution who received a diagnosis of STEMI. From March 2014 to April 2016, the registries were uploaded to a web-based system using the REDCap software and the registry was expanded to other centers. Upon subscription, the REDCap platform is a noncommercial software made available by Vanderbilt University to institutions interested in research. RESULTS The following steps were taken to improve and expand the registry: 1. Standardization of variables; 2. Implementation of institutional REDCap (Research Electronic Data Capture); 3. Development of data collection forms (Case Report Form - CRF); 4. Expansion of registry to other reference centers using the REDCap software; 5. Training of teams and participating centers following an SOP (Standard Operating Procedure). CONCLUSION The description of the methodology used to implement and expand the RIAM may help other centers and researchers to conduct similar studies, share information between institutions, develop new health technologies, and assist public policies regarding cardiovascular diseases. (Arq Bras Cardiol. 2020; 114(3):446-455).
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Affiliation(s)
- Jacqueline Vaz
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
| | - Anibal Pereira Abelin
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
- Universidade Federal de Santa MariaSanta MariaRSBrasilUniversidade Federal de Santa Maria (UFSM), Santa Maria, RS – Brasil
- Universidade FranciscanaSanta MariaRSBrasilUniversidade Franciscana (UNIFRA), Santa Maria, RS – Brasil
| | - Marcia Moura Schmidt
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
| | | | - Carlos A. M. Gottschall
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
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Taniguchi FP, Bernardez-Pereira S, Silva SA, Ribeiro ALP, Morgan L, Curtis AB, Taubert K, Albuquerque DCD, Weber B, Chrispim PPM, Toth CPP, Morosov EDM, Fonarow GC, Smith SC, Paola AAVD. Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines®in Brazilian Public Hospitals: Study Design and Rationale. Arq Bras Cardiol 2020; 115:92-99. [PMID: 32187286 PMCID: PMC8384317 DOI: 10.36660/abc.20190393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023] Open
Abstract
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)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gregg C Fonarow
- University of California Los Angeles, Los Angeles, Califórnia, EUA
| | - Sidney C Smith
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, EUA
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Jesus ICD, Menezes Junior FJD, Bento PCB, Wiens A, Mota J, Leite N. Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:8-19. [PMID: 31047776 PMCID: PMC6994317 DOI: 10.1016/j.bjpt.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/07/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols. OBJECTIVE To evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure. METHODS We search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model. RESULTS Ten articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO2peak in favor to combined training group compared to interval training group (SMD=0.25; CI=0.04-0.46) and without intervention group (SMD=0.46; CI=0.29-0.64), respectively. CONCLUSION The combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.
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Affiliation(s)
- Incare Correa De Jesus
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil.
| | | | - Paulo Cesar Barauce Bento
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Astrid Wiens
- Farmacy Department, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Jorge Mota
- Ciafel, Porto University, Porto, Portugal
| | - Neiva Leite
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil; Ciafel, Porto University, Porto, Portugal
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Santos VB, Lopes CT, dos Anjos LD, Begot I, Cassiolatto F, Guizilinni S, Moreira RSL. Accuracy of the Defining Characteristics of Fatigue in Patients with Heart Failure as Identified by the 6‐Minute Walking Test. Int J Nurs Knowl 2019; 31:188-193. [DOI: 10.1111/2047-3095.12270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/07/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Isis Begot
- Nursing Paulista SchoolFederal University of São Paulo São Paulo Brazil
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Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy. PLoS One 2019; 14:e0225612. [PMID: 31790460 PMCID: PMC6886771 DOI: 10.1371/journal.pone.0225612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022] Open
Abstract
Aim Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure. Methods and results A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I—< 65 years—88/ 249 (35%); Group II– 65 to 75 years (old)– 72/ 249 (29%); Group III—≥ 75 years (very old)– 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns). Conclusion The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.
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Gioli-Pereira L, Marcondes-Braga FG, Bernardez-Pereira S, Bacal F, Fernandes F, Mansur AJ, Pereira AC, Krieger JE. Predictors of one-year outcomes in chronic heart failure: the portrait of a middle income country. BMC Cardiovasc Disord 2019; 19:251. [PMID: 31706288 PMCID: PMC6842241 DOI: 10.1186/s12872-019-1226-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Luciana Gioli-Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Fabiana G Marcondes-Braga
- Heart Transplant Department, Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Sabrina Bernardez-Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fernando Bacal
- Heart Transplant Department, Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Fábio Fernandes
- Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Alfredo J Mansur
- Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - José E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
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Ferrari F, Menegazzo WR. Global Longitudinal Strain or Measurement of Ejection Fraction: Which Method is Better in Stratifying Patients with Heart Failure? Arq Bras Cardiol 2019; 113:195-196. [PMID: 31483015 PMCID: PMC6777883 DOI: 10.5935/abc.20190151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Willian Roberto Menegazzo
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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Mesquita ET, de Souza ALADAG, Rassi S. Heart Failure Awareness Day: A Tribute to the Genius Carlos Chagas. Arq Bras Cardiol 2019; 113:5-8. [PMID: 31411287 PMCID: PMC6684175 DOI: 10.5935/abc.20190137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Evandro Tinoco Mesquita
- Universidade Federal Fluminense, Niterói, RJ - Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ -
Brazil
- Departamento de Insuficiência Cardíaca da Sociedade
Brasileira de Cardiologia (DEIC/SBC) - Diretoria Científica, Rio de Janeiro,
RJ - Brazil
| | | | - Salvador Rassi
- Universidade Federal de Goiás, Goiânia, GO -
Brazil
- Departamento de Insuficiência Cardíaca da Sociedade
Brasileira de Cardiologia (DEIC/SBC) - Presidência, Rio de Janeiro, RJ -
Brazil
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Cross SH, Kamal AH, Taylor DH, Warraich HJ. Hospice Use Among Patients with Heart Failure. Card Fail Rev 2019; 5:93-98. [PMID: 31179019 PMCID: PMC6545999 DOI: 10.15420/cfr.2019.2.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022] Open
Abstract
Despite its many benefits, hospice care is underused for patients with heart failure. This paper discusses the factors contributing to this underuse and offers recommendations to optimise use for patients with heart failure and proposes metrics to optimise quality of hospice care for this patient group.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University Durham, NC, US
| | - Arif H Kamal
- Duke Cancer Institute Durham, NC, US.,Duke Fuqua School of Business, Duke University Durham, NC, US
| | - Donald H Taylor
- Sanford School of Public Policy, Duke University Durham, NC, US.,Margolis Center for Health Policy, Duke University Durham, NC, US.,Duke Clinical Research Institute Durham, NC, US
| | - Haider J Warraich
- Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, NC, US
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40
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Muniz RT, Mesquita ET, Souza Junior CV, Martins WDA. Pulmonary Ultrasound in Patients with Heart Failure - Systematic Review. Arq Bras Cardiol 2019; 110:577-584. [PMID: 30226917 PMCID: PMC6023636 DOI: 10.5935/abc.20180097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Pulmonary congestion is an important clinical finding in patients with heart failure (HF). Physical examination and chest X-ray have limited accuracy in detecting congestion. Pulmonary ultrasound (PU) has been incorporated into clinical practice in the evaluation of pulmonary congestion. This paper aimed to perform a systematic review of the use of PU in patients with HF, in different scenarios. A search was performed in the MEDLINE and LILACS databases in February 2017 involving articles published between 2006 and 2016. We found 26 articles in the present review, 11 of which in the emergency setting and 7 in the outpatient setting, with diagnostic and prognosis defined value and poorly studied therapeutic value. PU increased accuracy by 90% as compared to physical examination and chest X-ray for the diagnosis of congestion, being more sensitive and precocious. The skill of the PU performer did not interfere with diagnostic accuracy. The presence of B-lines ≥ 15 correlated with high BNP values (≥ 500) and E/e' ratio ≥ 15, with prognostic impact in IC patients at hospital discharge and those followed up on an outpatient basis. In conclusion, when assessing pulmonary congestion in HF, PU has an incremental value in the diagnostic and prognostic approach in all scenarios studied.
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Affiliation(s)
- Rafael Tostes Muniz
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil.,Complexo Hospitalar de Niterói, Niterói, RJ - Brazil
| | - Evandro Tinoco Mesquita
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | | | - Wolney de Andrade Martins
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil.,Complexo Hospitalar de Niterói, Niterói, RJ - Brazil
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Muñoz-Mejía OA, Sierra-Vargas EC, Zapata-Cárdenas A, Isaza-Montoya M, Muñoz-Cifuentes MA, Sánchez-Echavarría JD, Echeverri-García J. Caracterización sociodemográfica y clínica de una población con falla cardíaca aguda: cohorte MED-ICA. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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42
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Cardoso JN, Del Carlo CH, Oliveira Junior MTD, Ochiai ME, Kalil Filho R, Barretto ACP. Infection in Patients with Decompensated Heart Failure: In-Hospital Mortality and Outcome. Arq Bras Cardiol 2018. [PMID: 29538504 PMCID: PMC5941960 DOI: 10.5935/abc.20180037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Heart failure (HF) is a syndrome, whose advanced forms have a poor prognosis,
which is aggravated by the presence of comorbidities. Objective We assessed the impact of infection in patients with decompensated HF
admitted to a tertiary university-affiliated hospital in the city of
São Paulo. Methods This study assessed 260 patients consecutively admitted to our unit because
of decompensated HF. The presence of infection and other morbidities was
assessed, as were in-hospital mortality and outcome after discharge. The
chance of death was estimated by univariate logistic regression analysis of
the variables studied. The significance level adopted was P < 0.05. Results Of the patients studied, 54.2% were of the male sex, and the mean age
± SD was 66.1 ± 12.7 years. During hospitalization, 119
patients (45.8%) had infection: 88 (33.8%) being diagnosed with pulmonary
infection and 39 patients (15.0%), with urinary infection. During
hospitalization, 56 patients (21.5%) died, and, after discharge, 36 patients
(17.6%). During hospitalization, 26.9% of the patients with infection died
vs 17% of those without infection (p = 0.05). However, after discharge,
mortality was lower in the group that had infection: 11.5% vs 22.2% (p =
0.046). Conclusions Infection is a frequent morbidity among patients with HF admitted for
compensation of the condition, and those with infection show higher
in-hospital mortality. However, those patients who initially had infection
and survived had a better outcome after discharge.
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Affiliation(s)
- Juliano Novaes Cardoso
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Carlos Henrique Del Carlo
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Eidi Ochiai
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Terhoch CB, Moreira HF, Ayub-Ferreira SM, Conceição-Souza GE, Salemi VMC, Chizzola PR, Oliveira MT, Lage SHG, Bocchi EA, Issa VS. Clinical findings and prognosis of patients hospitalized for acute decompensated heart failure: Analysis of the influence of Chagas etiology and ventricular function. PLoS Negl Trop Dis 2018; 12:e0006207. [PMID: 29432453 PMCID: PMC5809014 DOI: 10.1371/journal.pntd.0006207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022] Open
Abstract
Aims Explore the association between clinical findings and prognosis in patients with acute decompensated heart failure (ADHF) and analyze the influence of etiology on clinical presentation and prognosis. Methods and results Prospective cohort of 500 patients admitted with ADHF from Aug/2013-Feb/2016; patients were predominantly male (61.8%), median age was 58 (IQ25-75% 47–66 years); etiology was dilated cardiomyopathy in 141 (28.2%), ischemic heart disease in 137 (27.4%), and Chagas heart disease in 113 (22.6%). Patients who died (154 [30.8%]) or underwent heart transplantation (53[10.6%]) were younger (56 years [IQ25-75% 45–64 vs 60 years, IQ25-75% 49–67], P = 0.032), more frequently admitted for cardiogenic shock (20.3% vs 6.8%, P<0.001), had longer duration of symptoms (14 days [IQ25-75% 4–32.8 vs 7.5 days, IQ25-75% 2–31], P = 0.004), had signs of congestion (90.8% vs 76.5%, P<0.001) and inadequate perfusion more frequently (45.9% vs 28%, P<0.001), and had lower blood pressure (90 [IQ25-75% 80–100 vs 100, IQ25-75% 90–120], P<0.001). In a logistic regression model analysis, systolic blood pressure (P<0.001, OR 0.97 [95%CI 0.96–0.98] per mmHg) and jugular distention (P = 0.004, OR 1.923 [95%CI 1.232–3.001]) were significant. Chagas patients were more frequently admitted for cardiogenic shock (15%) and syncope/arrhythmia (20.4%). Pulmonary congestion was rare among Chagas patients and blood pressure was lower. The rate of in-hospital death or heart transplant was higher among patients with Chagas (50.5%). Conclusions A physical exam may identify patients at higher risk in a contemporaneous population. Our findings support specific therapies targeted at Chagas patients in the setting of ADHF. It is recognized that the clinical evaluation of patients remains the basis for the characterization of diseases, data interpretation, and patient care. However, incorporation of technological methods into clinical practice has challenged the way cardiologists’ value of history and clinical examination. The present study sought to analyze the importance of clinical findings in a contemporaneous cohort of patients admitted with decompensated heart failure. Our results indicate that the physical exam may identify patients at higher risk in a contemporaneous patient population, and that clinical presentation varies according to etiology—especially Chagas disease—and ventricular function. Our findings support the need of development of specific therapeutic approaches targeted at Chagas patients in the setting of acute decompensated heart failure, as they represent a more vulnerable population.
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Affiliation(s)
- Caíque Bueno Terhoch
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Henry Fukuda Moreira
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Silvia Moreira Ayub-Ferreira
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Germano Emilio Conceição-Souza
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Vera Maria Cury Salemi
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Paulo Roberto Chizzola
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Mucio Tavares Oliveira
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Silvia Helena Gelas Lage
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Edimar Alcides Bocchi
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Victor Sarli Issa
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
- * E-mail:
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Levin RK, Katz M, Saldiva PHN, Caixeta A, Franken M, Pereira C, Coslovsky SV, Pesaro AE. Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America. PLoS One 2018; 13:e0190733. [PMID: 29300764 PMCID: PMC5754126 DOI: 10.1371/journal.pone.0190733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 12/15/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America. METHODS This was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates. FINDINGS The highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p<0.001; and AMI: 678 vs. 586 per month, p<0.001). Monthly average temperatures were moderately lower during winter than other seasons and they were not associated with hospitalizations for HF and AMI. INTERPRETATION The winter season was associated with a greater number of hospitalizations for both HF and AMI. This increase was not associated with seasonal oscillations in temperature, which were modest. Our study suggests that the prevention of cardiovascular disease decompensation should be emphasized during winter even in low to middle-income countries with tropical and subtropical climates.
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Affiliation(s)
| | - Marcelo Katz
- Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - Paulo H. N. Saldiva
- Instituto de Estudos Avançados da Universidade de São Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Adriano Caixeta
- Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Franken
- Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - Carolina Pereira
- Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - Salo V. Coslovsky
- Robert F. Wagner School of Public Service, New York University, New York, New York, United States of America
| | - Antonio E. Pesaro
- Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
- * E-mail:
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Muscular Atrophy in Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:369-391. [DOI: 10.1007/978-981-13-1435-3_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wajner A, Zuchinali P, Olsen V, Polanczyk CA, Rohde LE. Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil. Arq Bras Cardiol 2017; 109:321-330. [PMID: 28977049 PMCID: PMC5644212 DOI: 10.5935/abc.20170136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/03/2017] [Indexed: 12/04/2022] Open
Abstract
Background Although heart failure (HF) has high morbidity and mortality, studies in
Latin America on causes and predictors of in-hospital mortality are scarce.
We also do not know the evolution of patients with compensated HF
hospitalized for other reasons. Objective To identify causes and predictors of in-hospital mortality in patients
hospitalized for acute decompensated HF (ADHF), compared to those with HF
and admitted to the hospital for non-HF related causes (NDHF). Methods Historical cohort of patients hospitalized in a public tertiary hospital in
Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index
(CCI). Results A total of 2056 patients hospitalized between January 2009 and December 2010
(51% men, median age of 71 years, length of stay of 15 days) were evaluated.
There were 17.6% of deaths during hospitalization, of which 58.4% were
non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes
were responsible for most of the deaths and only 21.6% of the deaths were
attributed to HF. The independent predictors of in-hospital mortality were
similar between the groups and included: age, length of stay, elevated
potassium, clinical comorbidities, and CCI. Renal insufficiency was the most
relevant predictor in both groups. Conclusion Patients hospitalized with HF have high in-hospital mortality, regardless of
the primary reason for hospitalization. Few deaths are directly attributed
to HF; Age, renal function and levels of serum potassium, length of stay,
comorbid burden and CCI were independent predictors of in-hospital death in
a Brazilian tertiary hospital.
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Affiliation(s)
| | | | - Vírgilio Olsen
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Costa SDA, Rassi S, Freitas EMDM, Gutierrez NDS, Boaventura FM, Sampaio LPDC, Silva JBM. Prognostic Factors in Severe Chagasic Heart Failure. Arq Bras Cardiol 2017; 108:246-254. [PMID: 28443956 PMCID: PMC5389874 DOI: 10.5935/abc.20170027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prognostic factors are extensively studied in heart failure; however, their role in severe Chagasic heart failure have not been established. OBJECTIVES To identify the association of clinical and laboratory factors with the prognosis of severe Chagasic heart failure, as well as the association of these factors with mortality and survival in a 7.5-year follow-up. METHODS 60 patients with severe Chagasic heart failure were evaluated regarding the following variables: age, blood pressure, ejection fraction, serum sodium, creatinine, 6-minute walk test, non-sustained ventricular tachycardia, QRS width, indexed left atrial volume, and functional class. RESULTS 53 (88.3%) patients died during follow-up, and 7 (11.7%) remained alive. Cumulative overall survival probability was approximately 11%. Non-sustained ventricular tachycardia (HR = 2.11; 95% CI: 1.04 - 4.31; p<0.05) and indexed left atrial volume ≥ 72 mL/m2 (HR = 3.51; 95% CI: 1.63 - 7.52; p<0.05) were the only variables that remained as independent predictors of mortality. CONCLUSIONS The presence of non-sustained ventricular tachycardia on Holter and indexed left atrial volume > 72 mL/m2 are independent predictors of mortality in severe Chagasic heart failure, with cumulative survival probability of only 11% in 7.5 years.
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