Hospitalization – ABC CARDIOL

IJCS

Original Article

Overview of Heart Failure in Brazil over 15 Years of Analysis: Impacts and Perspectives for the Health System

Gabriel Dalves Lauretti Betez et al. Eduarda Braga Rossi Sofia Liz Gutierrez Natalia Puschnick Gimenez Giovanna Brian de Moura

Abstract

Background:

Heart failure (HF) remains one of the leading causes of hospital admissions and in-hospital mortality in Brazil. As the population ages, understanding how these hospitalizations have evolved over time is crucial for improving healthcare planning and reducing the burden on the public health system.

Objectives:

To evaluate temporal trends in HF hospitalizations in Brazil from 2010 to 2024, considering factors such as time, region, patient profile, and hospital-related costs.

Methods:

This observational study used data from the Brazilian Unified Health System’s Hospital Information System (SIH/SUS). Hospitalization rates per 100,000 inhabitants were adjusted using population estimates from the Brazilian Institute of Geography and Statistics. Temporal trends were assessed using annual percent change (APC) and average annual percent change (AAPC), with statistical significance set at p < 0.05.

Results:

Over 3 million HF hospitalizations were recorded during the study period. Annual admissions declined from 264,000 in 2010 to 205,000 in 2024, representing an average annual decrease of 1.8%. Adjusted rates fell from 135.3 to 94.3 per 100,000 inhabitants (AAPC: −2.55%; p < 0.001). In-hospital mortality peaked in 2021, reaching 13.5%. The average cost per hospitalization more than doubled, rising from BRL 1,151.42 to BRL 2,459.57.

Conclusion:

Despite a significant reduction in hospitalization rates, HF continues to pose a major challenge to Brazil’s healthcare system due to its high case volume and the steadily rising economic burden.

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Editorial

The Burden of Cardiovascular Disease in Brazil: Insights From a Decade of Emergency Hospital Admissions

Fernando Yue Cesena

Cardiovascular disease (CVD) remains the leading cause of death both globally and in Brazil.^, Although cancer has surpassed CVD as the top cause in some countries, projections indicate that CVD will continue to be the primary cause of mortality in Brazil for the decades to come.^,

Epidemiological analyses are essential for evaluating current public health strategies and informing future policy decisions. In this issue of the International Journal of Cardiovascular Sciences, an epidemiological study of recent emergency hospital admissions for CVD in Brazil is presented. Using data from the Department of Informatics of the Brazilian Unified Health System (DATASUS), the authors report data from over eight million hospital admissions from 2013 to 2023.

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Original Article

Feasibility and Safety of One-Minute Step Test in Patients with Heart Failure Hospitalized in the Cardio-Intensive Care Unit: A Pilot Study.

Andresa Narcizo Volotão et al. Clara Pinto Diniz Ana Carolina Cossio Rodriguez Vivian de Freitas Martins da Silva … Juliana Rega de Oliveira Ana Paula Nunes Carneiro Mariana Barcellos de Avila Carolina Nigro Di Leone

Abstract

Background:

The One-Minute Step Test (1MST) seems to be a useful tool for exploring the component of energy metabolism used in Activities of Daily Living (ADL), but it is still little explored in patients with Heart Failure (HF) in the hospital environment.

Objective:

To evaluate the feasibility and safety of performing 1MST in hospitalized patients with HF.

Methods:

Data were collected using electronic medical records and evaluative tests from patients with HF. The safety of the 1MST was assessed through vital signs records, perceived exertion, adverse events, and feasibility based on the ability to complete the test. The paired Student’s T-test and Wilcoxon test were employed to compare the data before and after the test, depending on the distribution of the data, while the relationship between the variables was examined using Pearson’s correlation test. The significance level set was p < 0.05.

Results:

Twenty patients were evaluated between May and December 2022. All patients completed the test, and no adverse events were recorded. Heart rate (HR) (p < 0.001), systolic blood pressure (SBP) (p = 0.01), mean arterial pressure (MBP) (p = 0.03), and respiratory rate (p < 0.001), and peripheral oxygen saturation showed a reduction (p = 0.04). A negative correlation was observed between 1MST and age (r = −0.46; p = 0.03) and a positive correlation between 1MST and length of stay in the CICU (r = 0.44; p = 0.04).

Conclusion:

It is concluded that the 1MST is a safe and viable tool for assessing the anaerobic metabolism of patients with HF.

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Original Article

Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023

Yago Souza Luiz et al. Vitor Moreira Alvarenga Mikaela de Miranda Lopes Lara Gomes Silva

Abstract

Introduction:

Cardiovascular diseases (CVDs) remain among the leading causes of morbidity and mortality worldwide, posing a significant public health challenge. Thus, analyzing their prevalence over time is crucial.

Objective:

To perform an epidemiological analysis of emergency hospital admissions due to CVD in Brazil between 2013 and 2023.

Methods:

This is an ecological, descriptive study based on data from the DATASUS database. Cardiovascular morbidities classified by ICD-10, along with variables such as sex and age group, were selected for analysis. Data was collected in October 2024 and organized into graphs and tables.

Results:

From January 2013 to December 2023, 8,208,282 patients were admitted for emergency cardiovascular conditions, 53.7% of whom were male, with 26% aged between 60 and 69 years. A significant reduction in hospital admissions was observed in 2020 and 2021. Ischemic heart diseases were the most frequent cause of hospitalization, accounting for 29.72% of cases. A notable increase in mortality was recorded in 2021 and 2022, with higher mortality rates among male patients and those admitted for cerebrovascular diseases.

Conclusion:

The observed increase in hospitalizations is attributed to the demographic transition occurring in the country, while the sharp decline in 2020 and 2021 appears to be a consequence of COVID-19-related measures, which is a trend also observed in other countries. These findings underscore the importance of studying the epidemiology of CVD in Brazil and reinforce the need for public investment aimed at reducing their prevalence.

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Editorial

The Complex Relationship Between Emotions and the Heart: Should We Care?

Sarah Fagundes Grobe et al. Lídia Zytynski Moura

Knowing how to live with negative emotions is not easy, and developing mechanisms to overcome them can be even more challenging. The attempt to determine the physical effects of emotions and establish their profound influence on the heart has challenged physicians for centuries. Mood disorders, such as depression and anxiety, significantly impact quality of life and increase morbidity and mortality.

At least 30% of patients diagnosed with heart failure (HF) have depressive symptoms, and these numbers have progressively increased since the 1990s. A meta-analysis found that the rates of mortality and cardiovascular events were twice as high in patients with HF and associated depression, and this was often independent of functional class.^, Some behavioral patterns contribute to these results, since patients with depression or anxiety often do not adhere to pharmacological treatment, are less active, have poor eating habits, and use tobacco.^,

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Original Article

Effectiveness of Telemedicine in Reducing Hospitalizations in Patients Discharged from the Hospital Due to Heart Failure: A Randomized Clinical Trial Protocol

Edmar Geraldo Ribeiro et al. Luisa Brant Lilian Cristina Rezende Renato Azeredo Teixeira … Laura Carvalho Parreiras Tulio Batista Franco Antônio Ribeiro Deborah Malta

Abstract

Fundament:

Telemedicine for follow-up in heart failure (HF) patients is effective in reducing hospitalizations, total and cardiovascular mortality. However, few studies were conducted in low and middle income, where lower access to technology and illiteracy could impact the results.

Objective:

To assess the effectiveness of associating telemedicine strategies, when compared to usual care, in reducing hospitalizations related to HF in patients discharged from the hospital due to HF.

Methods:

Controlled, randomized, multicenter, parallel-arm clinical trial, with an allocation ratio of 1:1, blinded to outcome evaluation, in which 340 patients who were discharged from public hospitals in Belo Horizonte due to HF will be randomized. Patients will be followed for 6 months and the intervention group will receive, in addition to the usual care, Structured Telephone Support (STS) from a nurse, a doctor, and an educational program. Counseling will be according to a clinical decision tree. The level of significance in the statistical analysis will be 5%.

Expected results:

Reduction in the number of hospital readmissions and/or in hospitalization time, in addition to developing a software with a clinical decision tree for remote follow-up and patient education about HF adapted to local culture.

Conclusions:

The intention of this study is to develop a telemedicine strategy and assess whether or not, in addition to the usual care, it is effective in reducing hospitalizations and mortality from HF. If effective, the aforementioned strategy could reduce costs and hospital needs in the Unified Health System (SUS, in Portuguese) for patients with HF. These results will be even more relevant considering the pandemic of COVID-19.

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Original Article

The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil

Dirceu Rodrigues de Almeida et al. Antonio Carlos Pereira-Barretto Francisco Jose Forestiero Juliana S. Nakamuta André Bichels

Abstract

Background:

Due to its poor prognosis and mortality rates, heart failure (HF) has been recognized as a malignant condition, comparable to some cancers in developed countries.

Objectives:

To compare mortality from HF and prevalent cancers using data from a nationwide database in Brazil.

Methods:

This was a descriptive, cross-sectional study using secondary data obtained from Brazilian administrative databases of death records and hospitalization claims maintained by the Ministry of Health. Data were analyzed according to main diagnosis, year of occurrence (2005-2015), sex and age group. Descriptive analyses of absolute number of events, hospitalization rate, mortality rate, and in-hospital mortality rate were performed.

Results:

The selected cancers accounted for higher mortality, lower hospitalization and higher in-hospital mortality rates than HF. In a group analysis, HF showed mortality rates of 100-150 per 100,000 inhabitants over the period, lower than the selected cancers. However, HF had a higher mortality rate than each type of cancer, even when compared to the most prevalent and deadly ones. Regarding hospitalization rates, HF was associated with a higher risk of hospitalization when compared to cancer-related conditions as a group.

Conclusions:

Our findings indicate that HF has an important impact on mortality, hospitalization and in-hospital mortality, comparable to or even worse than some types of cancer, representing a potential burden to the healthcare system.

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Editorial

Cause or Consequence? What is the Relationship between Cardiac Injury and COVID-19 Severity?

Claudio Tinoco Mesquita

In most patients, coronavirus disease-2019 (COVID-19) causes minor respiratory symptoms or even no symptoms. SARS-CoV-2 infection can also cause extrapulmonary manifestations and complications. COVID-19 is more severe and fatal among patients with pre-existing cardiovascular risk factors or diseases. Increases in cardiac troponin (cTn) are indicative of myocardial injury and frequently found in patients with COVID-19. The Chinese Center for Disease Control and Prevention published a survey demonstrating that among patients diagnosed with COVID-19, 13% had hypertension, 5% had diabetes mellitus, and 4% had a history of cardiovascular disease. However, in this same cohort, among patients who had not survived, 40% had hypertension, 20% had diabetes, and 22% had pre-existing cardiovascular disease. Patients with cardiovascular disease had the highest case fatality rate (10.5%).

In this issue of the International Journal of Cardiovascular Sciences, Rocha et al. , studied 192 patients admitted with COVID-19 in a quaternary care cardiac hospital in Rio de Janeiro, Brazil. Mortality rate was 28%. Multivariate analysis demonstrated that elevated cTnI levels (OR=9.504; 95% CI=1.281–70.528; P=0.028) upon admission and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360–923.706; P=0.012) were independent predictors of death during hospitalization. The main limitations of the study are a sample from a single Brazilian metropolitan region and a short follow-up period. However, these limitations do not invalidate the main message of the study: the measurement of cardiac troponin at hospital admission may be useful for identification of high-risk patients infected by SARS-CoV-2.

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Original Article

Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Renato Lott Bezerra et al. Lucas Sousa Salgado Yago Machado da Silva Gustavo Guimarães Rocha Figueiredo … Raimundo Matos Bezerra Filho Eduardo Luís Guimarães Machado Isabel Cristina Gomes Ângelo Geraldo José Cunha

Abstract

Background

Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time.

Objectives

We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil.

Methods

In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher’s exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant.

Results

The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years.

Conclusion

No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

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Editorial

Public Health Programs and Cardiovascular Diseases

Paolo Blanco Villela et al. Larissa Franco de Andrade

For decades, cardiovascular diseases, mainly coronary artery disease and stroke, have been the main cause of death in Brazil. In 2017, they accounted for 27.3% of all deaths in the country, with an age-standardized mortality rate of 178 per 100,000 inhabitants. In the same year, cerebrovascular diseases had an age-standardized mortality rate of 80 per 100,000 inhabitants. With respect to the burden of cardiovascular diseases, the number are even more concerning, with 1,602.4 disability-adjusted life years (DALYs) per 100,000 inhabitants for coronary disease and 1,145.3 DALYs per 100,000 inhabitants for stroke.

Although these numbers represent a decrease when compared with numbers in the year of 1990, the control of cardiovascular risk factors is clearly important. In this regard, in addition to the traditional risk factors, socioeconomical factors are known to play an important role in the development of these diseases. Investigators of the Prospective Urban Rural Epidemiologic (PURE) study evaluated socioeconomic status and educational attainment in adults aged between 35 and 70 years from 367 urban and 302 rural communities in 20 countries (five low-income countries, 11 middle-income and five low-income countries), with a total of 164,169 participants. The authors concluded that people with a lower level of education had higher mortality rates from cardiovascular events in all the countries. However, the authors discuss that these findings may be explained not only by the higher prevalence of risk factors, but also by the lower access to secondary prevention and medical management of chronic diseases such as hypertension and diabetes mellitus compared with people with higher level of education. This is in line with the study by Schultz et al., who demonstrated that even in high-income countries, factors like employment status, educational attainment, income level, and neighborhood socioeconomic factors are related to cardiovascular diseases. Thus, the authors consider the access to health services as part of a high-quality health care of low socioeconomic status populations. Therefore, it is possible to infer that, compared with absolute income, inequality levels are more stronger determinants of cardiovascular outcomes.

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Original Article

Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate?

Gabriel Silvestre Minucci et al. Samuel Marques dos Reis

Abstract

Background:

ST-segment elevation acute myocardial infarction (STEMI) is a pathological process that involves cardiac muscle tissue death. Intravenous thrombolysis with fibrinolytics or primary percutaneous coronary intervention (PCI), an invasive technique, can be performed for tissue revascularization. PCI has been preferred as compared to non-invasive methods, although few studies have described its use in Brazil.

Objectives:

The aim of the present study was to analyze data on the use of primary PCI and investigate the relevance of hospitalizations for the treatment of STEMI in the country.

Methods:

A descriptive, cross-sectional analysis of data from the Brazilian Unified Health system (SUS) Department of Informatics (DATASUS) from 2010 to 2019 was conducted.

Results:

Hospitalizations for STEMI represented 0.6% of all hospital admissions in Brazil in the analyzed period, 0.9% of hospital costs, and 2.1% of deaths. The number of hospitalizations due to STEMI was 659,811, and 82,793 for PCIs. Length of hospital stay was 36.0% shorter and mortality rate was 53.3% lower in PCI. The mean cost of PCI was 3.5-fold higher than for treatment of STEMI.

Conclusions:

Data on hospitalizations for STEMI treatment in Brazil revealed high hospitalization and mortality rates, elevated costs, and long hospital stay. Although primary PCI is a more expensive and less used technique than other methods, it can reduce the length of hospital stay and mortality in the treatment of STEMI.

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Original Article

Cardioprotective Effects of Sodium-glucose Cotransporter 2 Inhibitors Regardless of Type 2 Diabetes Mellitus: A Meta-analysis

Lucas Silva Sousa et al. Felipe de Araújo Nascimento Juliano Rocha Michelle Rocha-Parise

Abstract

Background:

Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular impairment, increasing the rates of atherosclerotic and non-atherosclerotic events. Additionally, adverse kidney events are directly linked with T2DM and cardiovascular diseases. In this context, the sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated both cardioprotective and renoprotective effects in patients with or without T2DM. Therefore, the present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or other add-on antidiabetic agents (ADA) in patients with or without T2DM.

Objetive:

The present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or add-on other ADA in patients with or without T2DM.

Methods:

The entrance criteria to SGLT2i studies were: describing any data regarding cardiovascular effects; enrolling more than 1,000 participants; being approved by either the FDA or the EU, and having available access to the supplementary data. The trial had to exhibit at least one of the following results: major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure, cardiovascular death, hospitalization for heart failure, renal or cardiovascular adverse events, or non-cardiovascular death. The significance level of 0.05 was adopted in the statistical analysis.

Results:

Nine trials with a total of 76,285 participants were included in the meta-analysis. SGLT2i reduced MACE (RR 0.75, 95% CI [0.55-1.01]), cardiovascular death or hospitalization for heart failure (RR 0.72, 95% CI [0.55-0.93]), cardiovascular death (RR 0.66, 95% CI [0.48-0.91]), hospitalization for heart failure (RR 0.58, 95% CI [0.46-0.73]), renal or cardiovascular adverse events (RR 0.55, 95% CI [0.39-0.78]), and non-cardiovascular death (RR 0.88, 95% CI [0.60-1.00]).

Conclusions:

Conjunction overall data suggests that these drugs can minimize the risk of cardiovascular events, thus decreasing mortality in patients, regardless of the presence of T2DM.

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Original Article

Emergency Department Visits and Deaths from Cardiovascular Diseases at a Referral Center for Cardiology During the COVID-19 Pandemic

Luis Sérgio Carvalho Luciano et al. Luiz Eduardo Koenig São Thiago Isabela de Carlos Back Leandro Waldrich … Luiza Di Bernardi de São Thiago Amabile Rodrigues Alves Beatriz Campos Comelli Mariane Janning Santos Luiz Carlos Giuliano

Abstract

Background

The COVID-19 pandemic has imposed measures of social distancing and, during this time, there has been an elevation in cardiovascular mortality rates and a decrease in the number of emergency visits.

Objectives

To assess and compare in-hospital mortality for cardiovascular diseases and emergency department visits during the COVID-19 pandemic and the same period in 2019.

Methods

Retrospective, single-center study that evaluated emergency visits and in-hospital deaths between March 16, 2020 and June 16, 2020, when the steepest fall in the number of emergency admissions for COVID-19 was registered. These data were compared with the emergency visits and in-hospital deaths between March 16 and June 16, 2019. We analyzed the total number of deaths, and cardiovascular deaths. The level of significance was set at p < 0.05.

Results

There was a 35% decrease in the number of emergency visits and an increase in the ratio of the number of deaths to the number of emergency visits in 2020. The increase in the ratio of the number of all-cause deaths to the number of emergency visits was 45.6% and the increase in the ratio of the number of cardiovascular deaths to the number of emergency visits was 62.1%. None of the patients who died in the study period in 2020 tested positive for COVID-19.

Conclusion

In-hospital mortality for cardiovascular diseases increased proportionally to the number of emergency visits during the COVID-19-imposed social distancing compared with the same period in 2019. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Editorial

AVC – Optimizing Pre-Hospital Care For A Time-Sensitive Disease

André Volschan

The care of patients with acute illnesses, in which the time to start treatment can have an important influence on the prognosis, requires a strategy based on well-defined structure and processes. Acute stroke is a disease whose prognosis is causally related to the length of care, and the possibility of implementing cerebral reperfusion therapies and neuroprotective measures. The recommendations suggest that the time should be optimized in the different phases of care, in the recognition of signs and symptoms, medical evaluation, computed tomography and thrombolysis, for patients who meet the criteria for their performance. The instruction of the population to identify the clinical manifestations of stroke, prioritizing the search for assistance, is an important step in this chain of treatment, which can modify the outcomes of this disease.

As a result, access to treatment is another major challenge. Interventions that effectively demonstrated an impact on outcomes in acute ischemic stroke, need a structure that can be supported, in large part, by telemedicine, significantly increasing patient access. National experiences have shown important results in improving the rate of pharmacological thrombolysis and thrombectomy, when designing a service network strategy with the support of neurologists, neuroradiologists and neurointerventionists.

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Letter to the Editor

The Big Mistake of not Considering Physical Activity an Essential Element of Care During the Covid-19 Pandemic

Francisco José Gondim Pitanga et al. Carmem Cristina Beck Cristiano Penas Seara Pitanga

Dear Editor,

In response to the letter to the editor entitled “Declaring physical activity as ‘essential’ during the Covid-19 pandemic may not be a good measure” that presented contributions to our point of view entitled “Should physical activity be considered essential activity during the Covid-19 pandemic?” we thank you for the suggestions and we present a reply letter with our arguments:

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Original Article

Athletes Health during Pandemic Times: Hospitalization Rates and Variables Related to COVID-19 Prevalence among Endurance Athletes

Fabricio Braga da Silva et al. Beatriz Fonseca Fernanda Domecg Marcelo Riccio Facio … Christiane Prado Leandro Toledo Walter Tuche

Abstract

Background

The SARS-COV2 pandemic has deeply affected the availability for training and competing for recreational and professional athletes. However, to date, the disease’s course among the athletic population has not been *studied .

Objectives

To compare the observed and expected rates of hospitalization for COVID-19 and to establish relationships between demographics and sportive characteristics of an athletic sample, and the COVID-19 infection rate.

Material and Methods

This study uses cross-sectional data sampling through an online questionnaire to collect data from recreational and professional athletes. Based on self-reports, athletes were grouped in COVID-19 and Non-COVID-19 cases. To decrease detection bias for each four patients who reported being hospitalized, one additional virtual patient was added to the sample. The observed rate of hospitalization (ORH) was compared with age expected rate of hospitalization (ERH) from the literature data. A multivariate model (MM) was developed to establish independent relationships between the prevalence of COVID-19 cases and the variables mentioned above. The statistical significance level was defined for a p-value<0.05.

Results

Answers from 1,701 individuals were analyzed. The COVID-19 group was comprised of 99 (5.8%) individuals, four of whom reported having been hospitalized. ORH and ERH were respectively of 5.0% and 18.1% (p=0.001). In the MM female gender (OR=2.02, 95% CI 1.28 to 3.19), cycling (OR=2.91, 95% CI 1.58 to 5.39), swimming (OR=2.97, 95% CI 1.14 to 7.74), and triathlon (OR=2.10, 95% CI 1.13 to 3.91) were independently associated with a COVID-19 prevalence.

Conclusion

Self-reported rates of hospitalization for COVID-19 among athletes were much lower than expected. The prevalence of positive cases of COVID-19 was independently higher for cyclists, triathletes, and swimmers than for runners.

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Editorial

Hospital Malnutrition, Inflammation, and Cardiovascular Diseases

Camila Weschenfelder et al. Aline Marcadenti

Malnutrition in hospitalized patients, whose prevalence ranges between 40% and 60% in Latin America, is related to longer hospital stays, worse clinical outcomes, and increased hospitalization costs. The consequences related to hospital malnutrition have also been reported among patients diagnosed with cardiovascular disease (CVD). In these individuals, an exacerbated inflammatory state is associated with malnutrition, loss of muscle mass, and cardiac cachexia, especially in the more advanced stages of the disease.

Globally, there is a policy that aims to recognize the importance of hospital malnutrition and its consequences. In Brazil, in 2018, the campaign “Say no to malnutrition” was published, composed of 11 steps to combat hospital malnutrition. In this campaign, the first step involves risk stratification and nutritional assessment for subsequent implementation and monitoring of appropriate nutritional therapy.

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Original Article

Does Tight Glucose Control During the First 24 hours of Hospitalization Reduce Scintigraphic Infarct Size in STEMI Patients?

Kamil Gulsen et al. Burak Ayca Murat Baskurt Baris Okcun Murat Kazim Ersanli

Abstract

Background

Hyperglycemia at the time of admission is related to increased mortality and poor prognosis in patients diagnosed with ST-segment elevation myocardial infarction (STEMI).

Objective

We aimed to investigate whether tight glucose control during the first 24 hours of STEMI decreases the scintigraphic infarct size.

Methods

The study population consisted of 56 out of 134 consecutive patients hospitalized with STEMI in a coronary care unit. Twenty-eight patients were treated with continuous insulin infusion during the first 24 hours of hospitalization, while the other 28 patients were treated with subcutaneous insulin on an as-needed basis. The final infarct size was evaluated with single-photon emission computed tomography (SPECT) in all patients on days 4 to 10 of hospitalization. The groups were compared and then predictors of final infarct size were analyzed with univariate and multivariate linear regression analysis. A p-value < 0.05 was considered statistically significant.

Results

The mean glucose level in the first 24 hours was 130 ± 20 mg/dL in the infusion group and 152 ± 31 mg/dL in the standard care group (p = 0.002), while the mean final infarct size was 20 ± 12% and 27 ± 15% (p = 0.06), respectively. The multivariate linear regression analysis demonstrated that the mean 24-hour glucose level was an independent predictor of the final infarct size (beta 0.29, p = 0.026).

Conclusion

Tight glucose control with continuous insulin infusion was not associated with smaller infarct size when compared to standard care in STEMI patients. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Original Article

Prevalence of Malnutrition and Its Association with Clinical Complications in Hospitalized Cardiac Patients: Retrospective Cohort Study

Natally Gonçalves de Ávila et al. Juliana Umbelino Carneiro Fernanda Donner Alves Izabele Vian da Silveira Corrêa Juliana Paludo Vallandro

Abstract

Background

Malnutrition can affect the clinical course of hospitalized patients, increasing hospital stay, infections, mortality, and hospital costs. Among heart disease patients, the malnutrition prevalence ranges from 25 to 51.9%.

Objective

To assess the prevalence of malnutrition and its association with clinical complications in cardiac patients admitted to a cardiology hospital.

Method

Retrospective cohort study with patients evaluated within 48 hours of admission to the ward of a referral center for cardiology in Porto Alegre, Brazil. Patients were aged 18 years or older. Malnutrition was assessed by Subjective Global Assessment. Length of hospital stay, transfer to the intensive care unit (ICU), hospital discharge and in-hospital death were collected from medical records. Statistical analysis was performed using the SPSS 22.0 program. Comparisons between groups with and without malnutrition were made by unpaired Student’s t-test and chi-square test with adjusted residuals, and multivariate Poisson regression used for analysis of outcomes. The significance level considered was 5%.

Results

We evaluated 130 patients aged 63 ± 13 years, 63% were male, and the most frequent cause of hospitalization was angina (25%). The prevalence of malnutrition was 27% and, after statistical adjustment for age, malnutrition was positively associated with ICU transfer and length of hospital stay longer than seven days.

Conclusion

The prevalence of malnutrition found in this sample was 27% and this nutritional diagnosis was positively associated with ICU transfer and length of hospital stay longer than seven days. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Editorial

Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

Cristiane Martins et al. Bruna M. N. Gama

Congenital heart defect commonly requires care in pediatric intensive care unit (PICU). They are a heterogeneous group of disorders with an annual incidence of 25,757 new cases in Brazil, 12 cases per 1,000 inhabitants . In this paper, Guimarães et al., published a cross-sectional study to describe the epidemiology of patients admitted to PICU from a tertiary hospital in Brazil. In this editorial, we review recent progress in understanding the risk factors for mortality in PICU. The editorial was produced by searching Pubmed and Scielo, using the terms “PICU”, “RACHS”, “CHD”, and “mortality”.

Congenital heart defects (CHD) are serious and common conditions that have a significant impact on morbidity, mortality and healthcare costs in both children and adults. It is estimated that at least 32,000 infants in the United States will be affected each year by CHD. Of these, approximately 25%, or 2.4 per 1,000 live births require invasive treatment in the first year of life. While advances in treatment in the last decades have decreased infant mortality, they have also led to an increase in the number of children and adults with CHD. Despite these advances and developments in interventional and surgical techniques, heart disease in children remains an important cause of morbidity and mortality.

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Editorial

Hepatic Elastography in the Assessment of Heart Failure: Where We Came from and Where We Are Going

Edison Migowski

Conclusion

There seems to be a consensus that the greater the liver stiffness, the greater the risk of mortality (“Stone liver, heart in danger”, according to Pernot and Villemain) However, innumerous studies are necessary to determine which therapeutic interventions would be capable of decreasing that stiffness and whether such decrease would have a consistent impact on prognosis. Another relevant data is that we do not know exactly the amount of information that HE can add to clinical practice, in addition to the information already provided by echocardiography and BNP.

It is believed that a long way must be taken until this technique becomes a useful tool for cardiologists, with favorable impact on the management of a disease with high morbidity, mortality and cost for the healthcare system. Nevertheless, we can state that the interpretation of results by the clinician involved in the patient’s treatment will be undoubtedly crucial for its success.

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Original Article

Predictors of Post-Discharge 30-Day Hospital Readmission in Decompensated Heart Failure Patients

Camila Sarteschi et al. Wayner Vieira de Souza Carolina Medeiros Paulo Sergio Rodrigues Oliveira … Silvia Marinho Martins Eduarda Ângela Pessoa Cesse

Abstract

Background

Heart failure (HF) is worldwide known as a public health issue with high morbimortality. One of the issues related to the evolution of HF is the high rate of hospital readmission caused by decompensation of the clinical condition, with high costs and worsening of ventricular function.

Objective

To quantify the readmission rate and identify the predictors of rehospitalization in patients with acute decompensated heart failure.

Methods

Hospital-based historic cohort of patients admitted with acute decompensated HF in a private hospital from Recife/PE, from January 2008 to February 2016, followed-up for at least 30 days after discharge. Demographic and clinical data of admission, hospitalization, and clinical and late outcomes were analyzed. Logistic regression was used as a strategy to identify the predictors of independent risks.

Results

312 followed-up patients, average age 73 (± 14), 61% males, 51% NYHA Class III, and 58% ischemic etiology. Thirty-day readmission rate was 23%. Multivariate analysis identified the independent predictors ejection fraction < 40% (OR = 2.1; p = 0.009), hyponatremia (OR = 2.9; p = 0.022) and acute coronary syndrome (ACS) as the cause of decompensation (OR = 1.1; p = 0,026). The final model using those three variables presented reasonable discriminatory power (C-Statistics = 0.655 – HF 95%: 0.582 – 0.728) and good calibration (Hosmer-Lemeshow p = 0.925).

Conclusions

Among hospitalized patients with acute decompensated heart failure, the rate of readmission was high. Hyponatremia, reduced ejection fraction and ACS as causes of decompensation were robust markers for the prediction of hospital readmission within 30 days of discharge. (Int J Cardiovasc Sci. 2020; 33(2):175-184)

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Original Article

Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul

Carolina Zenilda Nicolao et al. Juliana Bischoff Ferreira Adriana Aparecida Paz Graciele Fernanda da Costa Linch … Marciane Rover Emiliane Nogueira de Souza

Abstract

Background:

Heart failure (HF) is the final pathway of most cardiac diseases. Although the prevalence of HF has increased, due to the ageing of the population, more comprehensive data have shown a reduction in the percentage of HF hospital admissions over the last years.

Objective:

Assess the morbidity and mortality of HF patients in Brazil, Rio Grande do Sul and Porto Alegre.

Method:

The study is a retrospective analysis of data from the Brazilian Unified Health System’s (Sistema Único de Saúde [SUS]) Department of Informatics (DataSUS). We evaluated the incidence of HF hospital admissions, the average length of stay, hospital costs and sex ratio, during a ten-year period (2007 to 2016). Due to availability of the system, mortality rate and age range, the total duration of the study was nine years.

Results:

Within this period, the percentage of hospitalizations for HF decreased. On the other hand, the length of stay increased in all regions studied. Mortality rates were in decline in all regions. Hospital costs showed an increase of 110.8%. HF was more prevalent in patients between the seventh and eighth decades of life, with men being more affected than women, except in Rio Grande do Sul.

Conclusion:

We conclude that, in spite of the high costs of HF to healthcare providers, hospitalizations and mortality rates have shown a significant decline over the last years, which results from the advances in the treatment of this disease, through initiatives to improve patient education, engagement and planning in health care and self-care.

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Original Article

Impact of Complications of Myocardial Revascularization Surgery on Expenses During Hospital Stay

João Luís Barbosa et al. Clarissa Antunes Thiers Anderson Ferreira Rolim da Silva Marcos Maia Vianna … Paulo Otávio de Paula Ravaglia Gedeon Lauro Martins Neto Marina Brunner Uchôa Dantas Moreira Luiz Felipe Faria Bernardo Rangel Tura

Abstract

Background:

Coronary artery bypass grafting (CABG) is an important treatment option for obstructive coronary artery disease, but it represents a high expense for paying sources. The complications of CABG impose an additional expense to the procedure that is not yet clearly established.

Objective:

To determine the economic impact of postoperative complications of CABG during hospitalization in a hospital of the unified health system (SUS).

Methods:

This is an observational study involving 240 patients undergoing isolated CABG in a reference hospital in cardiology in 2013. Patients aged over 30 years with proven coronary artery disease and indication to perform CRVM were included. Patients who performed CRVM associated with other procedures were excluded.

Results:

The average cost of hospitalization was R$ 22,647.24 (SD = R$ 28,105.66). In 97 patients who presented some complication the average cost was R$ 35,400.28 (SD = R$ 40,509.47), and in the 143 patients without complications the average cost was R$ 13,996.57 (SD = R$ 5,800.61) (p < 0.001). Expenditures ranged from R$ 17,344.37 in patients with one complication up to R$ 104,596.52 in patients with five complications (p < 0.001).

Conclusions:

The occurrence of complications during hospitalization for CABG significantly increases the costs of the procedure, but the magnitude of this increase depends on the type of complication developed, and higher expenses related to cardiovascular complications, infections and bleeding. With this information, managers can improve the allocation of resources to health.

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