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IJCS
Original Article

Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review

Liza Yurie Teruya Uchimura et al. Cintia de Freitas Oliveira Mabel Fernandes Figueiró Camila Pereira Pinto Toth … Camila Roncon de Lima Patricia Vendramim

Abstract

Introduction

Cardiovascular diseases (CVD) are a major cause of mortality in Brazil, requiring the improvement of healthcare mechanisms that can promote rapid and effective care for patients.

Objectives

To identify and characterize Brazilian policies and programs (PP) regarding urgency and emergency care in the context of CVD.

Method

The scoping review followed recommendations from the Joanna Briggs Institute (JBI). The search for studies was conducted across seven databases. The screening and eligibility steps were performed by reviewers independently, with conflicts resolved by consensus or consultation with a third reviewer. The data extraction was done in a spreadsheet and the information was analyzed and grouped by content similarity.

Results

Through the analysis of 14 studies, a systematic and contextualized understanding was gained regarding 10 PPs implemented in the urgency and emergency network (RUE) for individuals with CVDs. SAMU emerged as the most extensively studied PP, predominantly in the state of Minas Gerais. The diseases most commonly addressed in these studies included acute myocardial infarction (featured in 80% of publications), stroke, acute coronary syndrome, heart failure, and atrial fibrillation. These PP have demonstrated significant improvements in clinical outcomes, particularly in reducing morbidity and mortality rates. The studies also revealed important insights into barriers and drivers related to infrastructure, health education, and system management and coordination.

Conclusion

The evidence gathered provides significant contributions to guide future policy development and improve decision-making in clinical management for cardiologists.

  • Cardiology
  • cardiovascular diseases
  • Emergencies
  • Health Policy
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Creative Commons Attribution (CC BY) Creative Commons license
19/08/2024 DOI: 10.36660/ijcs.20240056 Visualizações 7
IJCS
Original Article

Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department

Alan Fabiani Chiaparini et al. Paola Stefania Bohrer Rabaioli João Vitor Slaviero Cinthia Scatolin Tem-Pass … Hugo Antonio Fontana Filho Iran Castro Eduardo Dytz Almeida Tiago Luiz Luz Leiria

Abstract

Background

Vitamin K antagonists (VKA) are indicated for the prevention of thromboembolic events and reduction of mortality in patients with atrial fibrillation and patients with valvular prostheses. However, their use is associated with bleeding complications and hospitalizations. Predictors of hospital admission for bleeding in these patients are poorly known.

Objectives

To define the predictors for hospitalization of VKA users who seek emergency care due to bleeding.

Methods

Single-center, cross-sectional study, with retrospective analysis of electronic medical records from 03/01/2012 to 02/27/2017. Clinical and laboratory variables were compared between patients who were hospitalized and those who were not. A logistic regression model as used, in which the variables were included using the Backward stepwise method, with a p value of 0.05 as the input criterion, a removal value of 0.20 and a confidence interval of 95%. The p-value was considered statistically significant when <0.05.

Results

A total of 510 patients with bleeding were included, of whom 158 were hospitalized. Predictors of hospitalization were: INR at supratherapeutic levels (OR 3.45; P <0.01; 95% CI 1.58 – 7.51), gastrointestinal bleeding (OR 2.36; P <0.01; CI 95% 1.24 – 4.50), drop in hemoglobin (OR 6.93; P <0.01; 95% CI 3.67 – 13.07), heart failure (OR 1.96; P 0.01; 95% CI 1.16 – 3.30) and need for blood transfusion (OR 8.03; P <0.01; 95% CI 2.98 – 21.64).

Conclusion

Drop in hemoglobin, heart failure, INR at supratherapeutic levels, gastrointestinal bleeding and need for blood transfusion were associated with hospitalization. Identification of these factors in the initial evaluation would help to define which patients will demand more intensive care.

  • Emergencies
  • Hemorrhage
  • Platelet Aggregation
  • Warfarin
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Creative Commons Attribution (CC BY) Creative Commons license
03/09/2021 DOI: 10.36660/ijcs.20200320 Visualizações 9
ABC
Original Article

The bussola study. Final results, conclusions and proposals

Antonio Luiz da Silva Brasileiro

OBJECTIVE: To evaluate the use of thrombolytic and acetylsalicylic acid therapies in acute myocardial infarct patients as well as the availability of technical and human resources for the care of these patients in the emergency units of the city of Rio de Janeiro. Additional objectives were the evaluation of the use of primary angioplasty and the level of acceptance of SBC /RJ as an entity responsible for programs of continued medical education. METHODS: Interviews with physicians at 46 emergency units in the city of Rio de Janeiro. RESULTS: Of the 46 emergency units inspected, a policy of encouragement to use thrombolytic therapy was only prescribed in 6.5%. In 1/3 of the public wards no thrombolytic agents were available, and in none of them was access to primary angioplasty regularly available; 45.9% did not offer the minimal conditions required for the handling of cases of acute myocardial infarction; 60% of the physicians on-call (at both public and private emergency units), appeared not to know the importance of the use of acetylsalicylic acid in acute myocardial infarct patients; all physicians interviewed would participate in programs of continued medical education organized by the SBC/RJ. CONCLUSION: The study suggests there was: 1) the low probability of the use of thrombolytic therapy in the majority of the emergency units in of the city of Rio de Janeiro due to the inadequate policy of waiting for the transfer of the patient to coronary or intensive care unit; 2) a low awareness to the importance of early use of acetylsalic acid in acute myocardial infarct; 3) half of the emergency units of the public net do not have the minimal conditions required for the handling of cases of acute myocardial infarction; 4) a high level of credibility exists that would enable the SBC/RJ to set up programs for continued medical education to change the mentality regarding the use of thrombolytic therapy and of acetylsalicylic acid.

  • Emergencies
  • myocardial infarct
  • thrombolysis
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Creative Commons Attribution (CC BY) Creative Commons license
08/01/2002 DOI: 10.1590/S0066-782X2000000900004 Visualizações 7

Como citar este artigo

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Uchimura LYT, Oliveira CF, Figueiró MF, Toth CPP, Lima CR, Vendramim P. Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review. International Journal of Cardiovascular Sciences 2024;37:e20240056.

Formato de Documento Eletrônico (ABNT)

Uchimura, Liza Yurie Teruya; Oliveira, Cintia de Freitas; Figueiró, Mabel Fernandes; Toth, Camila Pereira Pinto; Lima, Camila Roncon de; Vendramim, Patricia. Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review. International Journal of Cardiovascular Sciences, v. 37, e20240056, ago. 2024.

Formato de Documento Eletrônico (APA)

Uchimura, L. Y. T., Oliveira, C. F., Figueiró, M. F., Toth, C. P. P., Lima, C. R. , & Vendramim, P. (2024). Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review. International Journal of Cardiovascular Sciences, 37, e20240056.

Formato de Documento Eletrônico (ISO)

Uchimura, Liza Yurie Teruya and Oliveira, Cintia de Freitas and Figueiró, Mabel Fernandes and Toth, Camila Pereira Pinto and Lima, Camila Roncon de and Vendramim, Patricia. Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review. International Journal of Cardiovascular Sciences [online]. 2024, vol. 37, [citado 2026-11-15], e20240056. Disponível em: <https://journals.cardiol.br/article/brazilian-policies-and-programs-in-urgent-and-emergency-care-services-in-the-context-of-cardiovascular-diseases-a-scoping-review-2/>. ISSN 2359-4802

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Chiaparini AF, Rabaioli PSB, Slaviero JV, Tem-Pass CS, Fontana Filho HA, Castro I, Almeida ED, et al. Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department. International Journal of Cardiovascular Sciences 2021;35(1):88-94.

Formato de Documento Eletrônico (ABNT)

Chiaparini, Alan Fabiani; Rabaioli, Paola Stefania Bohrer; Slaviero, João Vitor; Tem-Pass, Cinthia Scatolin; Fontana Filho, Hugo Antonio; Castro, Iran; Almeida, Eduardo Dytz; Leiria, Tiago Luiz Luz. Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department. International Journal of Cardiovascular Sciences, v. 35, n. 1, p. 88-94, set. 2021.

Formato de Documento Eletrônico (APA)

Chiaparini, A. F., Rabaioli, P. S. B., Slaviero, J. V., Tem-Pass, C. S., Fontana Filho, H. A., Castro, I., Almeida, E. D., & Leiria, T. L. L. (2021). Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department. International Journal of Cardiovascular Sciences, 35(1), 88-94.

Formato de Documento Eletrônico (ISO)

Chiaparini, Alan Fabiani and Rabaioli, Paola Stefania Bohrer and Slaviero, João Vitor and Tem-Pass, Cinthia Scatolin and Fontana Filho, Hugo Antonio and Castro, Iran and Almeida, Eduardo Dytz and Leiria, Tiago Luiz Luz. Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department. International Journal of Cardiovascular Sciences [online]. 2021, vol. 35, n. 1, [citado 2026-11-15], pp. 88-94. Disponível em: <https://journals.cardiol.br/article/predictors-of-hospitalization-in-vitamin-k-antagonist-users-presenting-with-bleeding-at-the-emergency-department-2/>. ISSN 2359-4802

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Brasileiro ALS. The bussola study. Final results, conclusions and proposals. Arquivos Brasileiros de Cardiologia 2002;75(3):230-4.

Formato de Documento Eletrônico (ABNT)

Brasileiro, Antonio Luiz da Silva. The bussola study. Final results, conclusions and proposals. Arquivos Brasileiros de Cardiologia, v. 75, n. 3, p. 230-234, jan. 2002.

Formato de Documento Eletrônico (APA)

Brasileiro, A. L. S. (2002). The bussola study. Final results, conclusions and proposals. Arquivos Brasileiros de Cardiologia, 75(3), 230-234.

Formato de Documento Eletrônico (ISO)

Brasileiro, Antonio Luiz da Silva. The bussola study. Final results, conclusions and proposals. Arquivos Brasileiros de Cardiologia [online]. 2002, vol. 75, n. 3, [citado 2026-11-15], pp. 230-234. Disponível em: <https://journals.cardiol.br/article/the-bussola-study-final-results-conclusions-and-proposals-2/>. ISSN 0066-782X

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