Heart diseases – ABC CARDIOL

IJCS

Original Article

Factors Associated with Variation in Time in Therapeutic Range in Two Anticoagulation Clinics in Brazil

Josiane Moreira da Costa et al. Milena S. Marcolino Carla Jorge Machado Leandro Pinheiro Cintra … Izabella Fernanda Bastos Siqueira Daniel Dias Ribeiro Maria Auxiliadora Parreiras Martins

Abstract

Background

Time in therapeutic range (TTR) plays an important role in the effectiveness of anticoagulant therapy with vitamin K antagonists.

Objective

To identify factors associated with variation in TTR.

Methods

The study sites were anticoagulation clinics at two university hospitals in Minas Gerais, with a total of 1357 patients studied. TTR was calculated using the Rosendaal method. Binary logistic regressions were carried out with the study variables, followed by multiple regression with those that were significant for the model, adopting a significance level of 5%.

Results

The outpatient clinics presented different values in mean TTR; one corresponded to the expected percentage, while the other did not. Multiple regression identified the variable male sex as a protective factor in relation to TTR < 60% (odds ratio [OR]: 0.42; p = 0).

Conclusion

The identification of variables associated with inadequate TTR contributes to identifying weaknesses in the care process and implementing improvement actions in the hospitals studied.

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Viewpoint

Value-based Health Care Impact on Cardiovascular and Metabolic Diseases

Ana Paula Beck da Silva Etges et al. Gabriela Boff Comiran Anna Luiza Reinehr Ferreira Carisi Anne Polanczyk

Final considerations

The development of a value-based health system that is centered around individual needs and scaled to deliver the best health outcomes within a budget constraint is possible and favored by structural changes to the system, such as payment methods and a technology base that enables real-life data-driven management. PHC centralization and the interconnection with data shared between the assisted population and specialized care systems seem to be a requirement for greater capacity for tracking, diagnosing, and managing cardiometabolic diseases in the health system. For Brazil’s current scenario, the challenges start with the precarious measurement culture and remuneration strategies that are centered on payment for the service delivery rather than the impact they have on population health.

As primary steps to establish a value-based health model for cardiometabolic diseases in Brazil, seeking inspiration from existing evidence, the following are recommended: start by disseminating mobile technologies that provide education and self-care and can be easily accessed by the population; advance towards implementing a measurement culture in PHC, sharing results with specialized care institutions and funding sources; and establish a better capacity for longitudinal monitoring of individuals in the care pathways, which can be driven by a change in the specific reimbursement strategy for each of care pathways.

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Original Article

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Bruna Fraga dos Santos et al. Bruna Eibel Ana Lúcia Grasel Antunes Cláudia Monster Martins … Renata Della Giustina Melina Borba Duarte Izabele Vian da Silveira Corrêa

Abstract

Background

Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition.

Objective

To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients.

Methods

A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet (cooked without salt; salt [2g per meal] added by the patient at the time of consumption) on one day and on the next day patients were given the intervention diet – a low sodium diet cooked with salt (2 grams of salt, divided between preparations). Dietary acceptance was evaluated by weighing leftover food and calculating intake. A questionnaire was used to verify reasons that influenced acceptance. For data analysis, parametric data are presented as mean and standard deviation, Student’s t test was used to compare means, with significance defined as p<0.05.

Results

Sixty-four patients were evaluated, with a mean age of 66 ± 11.3 years; 64% were male. There were no differences in percentage acceptance between the standard low-sodium diet and the low-sodium diet cooked with salt at lunch (p= 0.876) or at dinner (p= 0.255). Around 80% of what was offered at each meal was consumed by the patients, with no significant difference between groups.

Conclusions

The low-sodium diet cooked with salt was well accepted, but there was no difference when compared with the standard low-sodium diet, which also had adequate acceptance.

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Original Article

Abnormalities of Cardiac Situs and Heart Disease Diagnosed by Echocardiography in Patients with Biliary Atresia

Henrique de Assis Fonseca Tonelli et al. Zilda Maria Alves Meira Sandra Regina Tolentino Castilho Adriana Furletti Machado Guimarães … Tháis Costa Nascentes Queiroz Alexandre Rodrigues Ferreira

Abstract

Background:

Left isomerism (LI) is a common finding in patients with biliary atresia (BA), and it can be identified by echocardiography. Several comorbidities may be present in patients with LI, including heart disease.

Objective:

To investigate the prevalence of LI and heart disease in children (< 18 years of age) with BA followed-up at Hospital das Clínicas, UFMG.

Methods:

This is a cross-sectional study involving patients diagnosed with BA between February 2016 and April 2020 who underwent transthoracic echocardiography and, in case of situs abnormalities, also electrocardiography.

Results:

Our study recruited 58 patients (mean age: 3.08 years; female/male ratio: 1.5:1). The general prevalence of situs abnormalities was 8.6% (5/58) and the most common one was LI (4/5 or 80%). One patient had situs inversus. Among patients with situs abnormalities, the general prevalence of heart disease was 80% (4/5), apart from anomalies of the inferior vena cava), with pulmonary valve stenosis (PVS) as the only change seen (75% of mild forms and 25% of moderate forms). Among patients with situs abnormalities, the prevalence of rhythm changes was 80% (4/5), and low atrial rhythm was the most common finding (3/4 or 75%).

Conclusion:

The prevalence of situs abnormalities in our sample was similar to that described in the literature. We observed an exclusive prevalence of PVS and a high prevalence of rhythm changes among patients with LI. Although the diagnosis of isomerism does not initially add much cardiovascular risk to the sample, possible late deterioration should be considered.

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Editorial

Exercise-based Cardiovascular Rehabilitation in Chronic Heart Failure: does Exercise Intensity Matter?

Gabriel Dias Rodrigues

It is well recognized that chronic heart failure (CHF) is a multifactorial syndrome that reduces physical exercise tolerance. Exercise-based cardiac rehabilitation program is on the frontline of non-pharmacological therapies for CHF patients, counterbalancing the disease-induced issues of physical capacity.

Since a successful exercise rehabilitation program should be efficient and safe, the search for optimal combinations of exercise volume and intensity has sparked interest in the current literature. Although studies have shown feasible combinations of low volume and high intensity, and vice versa, the optimal dose-response of exercise in cardiovascular rehabilitation remains unknown. Classically, aerobic training with moderate intensity (i.e., between 60% and 80% VO_2peak or heart rate reserve – HRreserve) is a safe approach to improve physical capacity and provide a cardioprotective effect in CHF disease. As a promising method, short bouts of high-intensity exercise, called high-intensity interval training, seems to be superior than moderate continuous training to reverse left ventricle remodeling and improve aerobic capacity, endothelial function, and quality of life in post-infarction heart failure patients.

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Editorial

Women and Cardiac Disease: A Special Issue

Roxana Mehran et al. Birgit Vogel

Cardiovascular disease is the leading cause of death in women worldwide. Despite improvements in awareness on heart disease in women through various campaigns and initiatives, cardiovascular risk in women still tends to be underestimated by health care professionals and women themselves. With respect to the latter, a study from the United States has even shown a decline in awareness regarding the fact that heart disease is the leading cause of death among women over recent years. Especially young women are affected by low awareness about cardiovascular risk as confirmed by the data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, which also found that women are less likely than men to have a discussion about their cardiovascular risk and potential risk modification with their health care provider. Health care providers’ preparedness to assess women’s cardiovascular risk appears to be suboptimal, and according to survey data the majority of primary care physicians and cardiologists do not comprehensively implement cardiovascular disease prevention guidelines in women. Accurate and timely diagnosis of various cardiovascular diseases, especially ischemic heart disease, are less frequent in women compared with men. In addition, women with established cardiovascular disease have repeatedly been documented to be less likely to receive guideline-recommended therapies.^, Sex-related differences in disease presentation and comorbidities may contribute to these disparities, and uncertainties persist with respect to diagnosis and treatment of certain disease states that disproportionally affect women (e.g. ischemia with non-obstructive coronary arteries [INOCA], myocardial infarction in the absence of obstructive coronary artery disease [MINOCA], spontaneous coronary artery dissection [SCAD], and takotsubo syndrome).

One of the major issues is the lack of robust study data on cardiovascular disease in women. Women remain underrepresented in the majority of cardiovascular clinical trials, and sex-specific study data reporting is often absent, which results in uncertainty about the safety and efficacy of many cardiovascular therapies. In addition, it leads to knowledge gaps in the sex-specific pathophysiological mechanisms and the natural history of cardiovascular disease in women.

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Original Article

The REBECGA Brazilian Registry of Pregnancy and Heart Disease: Rationale and Design

Walkiria Samuel Avila et al. Maria Alayde Mendonça Rivera Celi Marques-Santos Ivan Romero Rivera … Maria Elizabeth Navegantes Caetano Costa Alexandre Jorge Gomes de Lucena Claudia Maria Vilas Freire Regina Coeli Marques de Carvalho Daniel Born Felipe Favorette Campanharo Fabio Bruno Silva

Abstract

Background:

Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes.

Objective:

To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country’s macro-regions.

Method:

This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees.

Results:

Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy.

Conclusion:

REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

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Editorial

REBECGA Registry: A Multicenter Study for the Reduction of Maternal Mortality Due to Heart Diseases Manifested During Pregnancy

Karyne Pollo de Souza et al. Christianne Brêtas Vieira Scaramello

According to the literature, although the prevalence of heart disease in pregnancy varies considerably among countries, cardiovascular disease is responsible for 1% to 4% of complicated pregnancies in industrialized countries. This pattern is related to cardiovascular risk factors, such as smoking, diabetes, obesity, and hypertension, especially in low- and middle-income countries, as well as late motherhood and the presence of congenital heart disease, mainly in high-income countries.^,

Improved diagnostic methods and therapeutic alternatives have encouraged maternity by promoting safer pregnancies. However, heart disease is still the leading non-obstetric cause of maternal mortality worldwide. Although the rate of maternal mortality has decreased in Brazil over the last three decades, it continues to be higher than estimated for this millennium.

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Original Article

Metabolic Syndrome and Risk of Cardiovascular Diseases in Female Breast Cancer Survivors

Leandro Marque da Silva et al. José Albuquerque de Figueiredo Neto

Abstract

Background

The implementation of intensive therapy protocols increases the probability of adverse events in patients with breast cancer (BC). Components of metabolic syndrome (MS) are among these events.

Objective

To verify the prevalence of MS and cardiovascular disease (CVD) risk in female BC survivors.

Materials and Methods

This is a descriptive, observational, cross-sectional study. Our sample comprised 60 women without BC (G1) and 60 women who had survived BC (G2). We collected sociodemographic, anthropometric, tumor, and clinical data. After variable analysis, the participants received positive or negative MS diagnoses and a 10-year CVD risk stratification. The significance level adopted for the analyses was 5% ( p < 0.05) and the confidence interval (CI) was 95%. For comparing categorical data, we used the chi-squared, Fisher’s exact, or G tests; for comparing continuous data, we used the parametric Student’s t-test and the non-parametric Mann-Whitney test.

Results

Both groups presented overweight and an increased waist-to-hip ratio. Weight, body mass index, abdominal circumference, hip circumference, and low-density cholesterol were variables that presented statistically significant differences between groups. MS was diagnosed in 32% of women in G1 and 45% of those in G2. Regarding the 10-year risk for CVD, most women were in the low-risk stratum: the mean total risk of CVD occurrences was 7.48% in G1 and 7.70% in G2.

Conclusion

We observed a higher prevalence of MS among women who survived BC, possibly due to overweight, as well as a low 10-year risk for CVD after cancer treatment. Although we did not observe a statistically significant difference, we suggest the adoption of a healthy lifestyle and rigorous control of cardiometabolic risk factors.

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