Mortality – ABC CARDIOL

IJCS

Original Article

Is Hypertension a Predictor of Mortality in People Living With HIV/AIDS?

Gustavo Eduardo Fante et al. Pedro Antonio Pagote Dall’Omo Karina Bobato do Valle Arcelio Benetoli … Jean Fernando Sandeski Zuber Camila Marineli Martins Erildo Vicente Muller

Abstract

Background:

Hypertension is a chronic non-communicable disease that increases cardiovascular risk and significantly contributes to mortality. It is one of the most prevalent conditions among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Objectives:

The objective of this study was to investigate hypertension as a predictor of mortality in people living with HIV/AIDS, analyzing the association of prior diagnosis of hypertension with morbidity and mortality in this population.

Methods:

This retrospective cohort study evaluated the medical records of 1207 patients receiving treatment at the Specialized Care Service (SAE) of a city in the state of Paraná over 264 months.

Results:

Among patients diagnosed with HIV/AIDS, 13.1% had hypertension. During the analyzed period, 52 deaths were recorded (4.31%), 30.77% of which occurred among patients with hypertension (p = 0.0002). Lower survival was observed among patients with hypertension (p < 0.0001), and mortality was significantly higher among women with hypertension (p < 0.0001). The hazard ratio (HR) for the general population was 3.1 (95% confidence interval [CI]: 1.7–5.6), with an HR of 1.7 for men (95% CI: 0.7–3.7) and 8.2 for women (95% CI: 3.1–21.6).

Conclusions:

Hypertension was a significant predictor of mortality in people living with HIV/AIDS, with a particularly strong impact among women.

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Letter to the Editor

Beyond the Numbers: A Critical Analysis of DATASUS on Cardiovascular Mortality

João Pedro Azevedo Lopes et al. João Emmanuel Coelho de Morais Pedro Pereira Tenório

Dear Editor,

We are writing to express our appreciation for the article “Epidemiological Analysis of Emergency Hospitalizations in Brazil Due to Cardiovascular Diseases From 2013 to 2023” by Luiz et al. This work is of great relevance, as it provides a robust and updated epidemiological overview (2013–2023) of Cardiovascular Diseases (CVD) in Brazil, which remain one of the country’s major public health challenges. The use of a decade of DATASUS data gives the study indispensable temporal breadth for long-term trend analysis, representing one of its greatest strengths.

[…]

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Original Article

Endocarditis – A 27-Year Epidemiological Analysis of Mortality in Brazil

Leticia da Costa Santana Silva et al. Luana Yasmim Fernández Avelaneda Castanheira Maria Dalila Santos Salim Ruy Felipe Melo Viegas … Gilson Fernandes Ruivo Sheila Cavalca Cortelli Davi Romeiro Aquino Taciana Mara Rezende Fortes Viégas

Abstract

Background:

Infective endocarditis (IE) is frequently caused by viridans streptococci. Short-term in-hospital mortality in high-income settings ranges from 11% to 25%. In Brazil, rheumatic heart disease remains a leading valvular substrate; however, its declining prevalence in developing nations has limited country-specific analyses.

Objective:

To describe the epidemiological profile of mortality from IE in Brazil, characterizing its magnitude and temporal trend.

Methods:

We conducted a retrospective, exploratory epidemiological study with descriptive and analytic components using data from the Mortality Information System of the Department of Informatics of Brazil’s Unified Health System. Chi-square tests of independence were applied (p < 0.05), and results were summarized in tables and figures. Variables included International Statistical Classification of Diseases and Related Health Problems, 10th Revision categories, year of death, region, and sex.

Results:

From 1996 to 2022, 40,157 deaths associated with IE were recorded in Brazil (chi-square = 1,701.43). The Southeast region accounted for the greatest burden, with 21,429 deaths (53.36%; chi-square = 15,236.00). By sex (chi-square = 999.32), men were more affected than women (55.57% [22,315] vs 44.41% [17,835]); in 0.02% of records, sex was unspecified.

Conclusions:

IE remains a condition of national and international concern, with substantial mortality in Brazil over the last 27 years. This overview of mortality patterns highlights regional disparities and sex differences and can inform public-health strategies and evidence-based interventions.

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Editorial

C-Reactive Protein as a Prognostic Tool in Acute Heart Failure: Evidence from Low-Resource Settings

Cristhian Espinoza Romero et al. Hernán Patricio García Mejía Fábio Fernandes

Acute heart failure (AHF) remains a leading cause of hospitalization and cardiovascular mortality worldwide, with an even greater burden in low- and middle-income countries. In Brazil, in-hospital mortality for AHF is approximately 12%, compared to 4% reported in high-income countries.^,

In this context, the prospective study by Ferigato et al., conducted at a public hospital in São Paulo, assessed the prognostic value of C-reactive protein (CRP) in patients with AHF. This investigation is particularly relevant given the structural limitations of the Brazilian public healthcare system, where conventional biomarkers such as natriuretic peptides are often unavailable. Therefore, CRP—a low-cost and widely accessible inflammatory marker—emerges as a promising alternative for risk stratification during hospitalization.

[…]

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Original Article

Mechanical Ventilation Time and Mortality After Coronary Artery Bypass Grafting: A Cohort Study

Tainá Lís de Araujo Dezidério et al. Vanessa Oliveira da Silva Vitória Novaes Macedo André Luiz Lisboa Cordeiro

Abstract

Introduction:

Cardiac surgery is a procedure that requires great assistance and care. In this way, patients are sent to the intensive care unit (ICU), where they are connected to mechanical ventilation (MV). Prolonged treatment of these patients worsens clinical outcomes and leads to mortality.

Objective:

To evaluate the impact of MV time on patients undergoing cardiac surgery.

Methods:

This is a retrospective cohort study. After surgery, patients were admitted to the ICU and connected to MV. The entire ventilation adjustment and weaning process was conducted according to the unit’s routine. They were divided into two groups, patients who continued on MV for more than eight hours and those who remained for less than eight hours. From this, univariate and multivariate analyses were carried out between predictor variables — MV time, age, sex, and cardiopulmonary bypass (CPB) time — and mortality. We considered p<0.05 as significant.

Results:

A total of 110 patients were evaluated, 25 stayed on MV for more than eight hours. In the univariate analysis, MV time was associated with mortality (HR 0.7 [0.3–0.9], p = 0.01), remaining in the multivariate analysis (HR 0.4 [0.2–0.6), p = 0.01). The other variables were not associated with death outcome.

Conclusion:

MV time of more than eight hours is a predictor of mortality after cardiac surgery, given the contribution of some risk factors.

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Original Article

Delay Times in Acute Myocardial Infarction Care: Comparison Between Periods Before and During the COVID-19 Pandemic

Layla Pasolini Lott et al. Roberto Ramos Barbosa Rhaaby Rodrigues Muzi Camila Marianelli … Isadora Cardozo Bragatto Valentin Trevizani Neto Glícia Chierici Baptista Eduardo Gomes Vieira Rodolfo Costa Sylvestre Osmar Araújo Calil Renato Giestas Serpa Lucas Crespo de Barros Larissa Novaes Paganini Lucas Martins Frizzera Borges Luiz Fernando Machado Barbosa

Abstract

Background

The success of acute myocardial infarction with ST-segment elevation (STEMI) treatment is time-dependent, requiring prompt access, diagnosis, and immediate medical intervention. The COVID-19 pandemic has significantly impacted the care of patients with STEMI.

Objective

To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) before and during the COVID-19 pandemic.

Methods

This retrospective observational study included patients with STEMI undergoing PPCI from June 2019 to July 2022. The COVID-19 pandemic period was divided into 3 time groups. Pandemic I referred to the interval from March to August 2020, pandemic II from September 2020 to July 2021, and pandemic III from August 2021 to July 2022. Delay times, clinical characteristics, and in-hospital mortality were analyzed. The chi-square, Fisher’s exact, Student’s t and one-way ANOVA tests were applied, with p values less than 0.05 being considered statistically significant.

Results

Comparing the periods, the total ischemic time to PPCI was 346.3 versus 448.4 versus 398.4 versus 348.4 minutes (p = 0.47); onset-to-door time 253.1 versus 421.1 versus 377.4 versus 370.6 minutes (p = 0.42); first medical contact (FMC)-to-balloon time 243.9 versus 313.0 versus 239.5 versus 279.4 minutes (p = 0.38); and door-to-balloon time 71.8 versus 76.8 versus 58.03 versus 88 minutes (p = 0.9). Mortality significantly increased in pandemic I compared to pre-pandemic (29.4% versus 5.0%, p = 0.01), with a marginal difference compared to pandemic II and III combined (12.2%, p = 0.05).

Conclusion

There was a trend toward increased onset-to-door time and FMC-to-balloon time in STEMI care during the pandemic compared to the pre-pandemic period, although not statistically significant. Higher mortality in STEMI was observed in the first months of the COVID-19 pandemic.

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Original Article

Epidemiological Profile and Comparison of Mortality Due to Stroke and Atrial Fibrillation in Brazil Over the Past 26 Years

Leticia Da Costa Santana Silva et al. Luana Yasmim Fernández Avelaneda Castanheira Maria Dalila Santos Salim Ohara Rumayane Paiva Santos Rebouças Ruy Felipe Melo Viegas

Abstract

Background:

Atrial fibrillation (AF) stands out as the most prevalent arrhythmia, and its incidence increases with age. Stroke ranks as the second leading cause of mortality in Brazil and represents the primary contributor to global disability.

Objective:

Considering the severity of these conditions, this study seeks to elucidate the epidemiological landscape of AF and stroke-related deaths in Brazil from 1996 to 2022.

Methods:

The following variable were analyzed in the study – geographic region, federative state, age demographics, gender distribution, year of mortality, race/ethnicity, educational attainment, and place of death. This research adopted a descriptive approach through a retrospective, exploratory, epidemiological analysis of data sourced from the Mortality Information System (SIM) accessible through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) website.

Results:

Over the 26-year period, 1,201,327 deaths from AF and stroke were registered in Brazil. These deaths were mostly caused by stroke (94.5%) and were more concentrated in the southeast region, where the highest number of doctors capable of identifying and notifying these deaths are also concentrated.

Conclusion:

This study claims for a paradigm shift in disease control strategies and underscores the imperative of bolstering the efficacy of public health policies to address the huge impact of stroke and AF-related mortality on population health.

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Original Article

Evolution of Patients With Atrial Fibrillation According to the EHRA Categorization

Rose Mary Ferreira Lisboa da Silva et al. Letícia Tanure Diniz Laura Selga da Silva Gomes Lucas Espíndola Borges

Abstract

Background

The lifetime risk of developing Atrial Fibrillation (AF) is one in three adults, with a prevalence ranging from 2% to 4%. In 2017, the Evaluated Heart valves, Rheumatic or Artificial (EHRA) classification was introduced to guide oral anticoagulation (OAC) for patients with AF and valvular heart disease.

Objective

To analyze the evolution of patients with AF according to the EHRA categorization type 1, type 2, and those without valvular heart disease (group 3).

Method

Prospective, observational, and longitudinal study with 421 patients with AF, divided into three groups. Baseline risk scores for embolism, bleeding, and OAC quality were calculated. Events were verified during the 12-month clinical follow-up. Chi-square, parametric, and non-parametric tests were used for statistical analysis, in addition to the Kaplan-Meier curve. P-value < 0.05 was the statistical significance criterion.

Results

The average age was 58.6 years; 227 patients were women and 269 had OAC. There were 113 OAC EHRA type 1 patients, 53 type 2, and 255 patients from group 3. Age was lower, the proportion of women and OAC usage was higher in group 1 and there was a lower ejection fraction in group 3. During follow-up, the OAC percentage was 87.6% in type 1; 62.2% in type 2; and 56.0% in group 3 (p < 0.0001), with no difference regarding OAC quality, bleeding rate, embolism, or combined events. A higher total mortality rate was observed in group 3 (p = 0.02).

Conclusion

Despite the higher use of OAC in EHRA type 1, there were no differences between the groups regarding bleeding, embolism, or combined events. Group 3, characterized by greater systolic dysfunction, exhibited higher total mortality rates.

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Original Article

Hemoglobin/Red Cell Distribution Width Ratio is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up

Oğuz Kılıç et al. Mehmet Mustu Hakan Suygun Enes Con … Ahmet Karakurt Sümeyye Fatma Özer

Abstract

Background

Acute coronary syndrome (ACS) is the most common subtype of coronary artery disease (CAD). It is one of the main reasons affecting the expected life expectancy and quality of life.

Objetives

In this study, we aimed to investigate the relationship between major adverse cardiac events (MACE) and Hemoglobin (Hb)/Red cell distribution width (RDW) in long-term follow-up after ACS.

Methods

A total of 1,146 ACS patients were included in the study, being classified according to the type of myocordial infarction (MI). MACE were recorded in long-term follow-up. The relationship between Hb/RDW and MACE was investigated. The statistical analyses of Mann-Whitney U test for comparison of two independent groups and chi-square test for categorical variables were used. In order to determine the diagnostic feature of the HB/RDW ratio, the diagnostic ratios were calculated by applying Receiver Operating Characteristic Curve (ROC) analysis. A p < 0.05 value was considered statistically significant in all analyses. Results: When the patients were analyzed according to MI types — ST segment elevation myocardial infarction (STEMI)/Non-ST segment elevation myocardial infarction (NSTEMI) —, it was observed that Hb/RDW (p = 0.038) was significantly higher in the STEMI group. The Hb/RDW ratio was statistically significant in predicting mortality. As a result of ROC analysis, Area Under the Curve (AUC) = 0.654 (p < 0.001) was found. The cut-off value for the Hb/RDW ratio was calculated as 0.947. The sensitivity and specificity of 76.9% and 48.4% for the diagnostic rates obtained were moderately acceptable.

Conclusion

The Hb/RDW-long-term mortality relationship was found to be significant in ROC analysis. It can be used in clinical practice as it is cheap, easy to apply, and reduces possible bias in post-ACS follow-up.

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Original Article

Characteristics of ST-Elevation Myocardial Infarction during the SARS-CoV-2 Outbreak

Guilherme Pinheiro Machado et al. Gustavo Neves de Araujo Rafael Beltrame André Luiz Theobald … Matheus de Souza Niches Julia Fagundes Fracasso Victoria Milan Julia Luchese Custodio Camila Porto Cardoso Pedro Henrique Torres Tietz Giulia Bonatto Reichert Marcia Moura Schmidt Alexandre Schaan de Quadros Marco Vugman Wainstein

Abstract

Background

The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction.

Objectives

The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year.

Methods

We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%.

Results

A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE).

Conclusions

We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.

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Editorial

The COVID-19 Collateral Damage in ST-Elevation Myocardial Infarctions in Low/Middle-Income American Regions

Karen Alexandra Dueñas-Criado et al. Oscar Maurício Perez-Fernandez

For this issue of the International Journal of Cardiovascular Sciences, we would like to discuss the post-coronavirus disease 2019 (COVID-19) pandemic effects on performance measures in patients with ST-segment elevation myocardial infarction (STEMI) in a low/middle-income country.

In the Americas, cardiovascular diseases, mainly ischemic heart disease and cerebrovascular disease (stroke), are the leading causes of long-term disability and mortality. Over three quarters of heart disease and stroke-related deaths occur in low- and middle-income countries. In the Americas region, during the last 3 years, more than 190.3 million people have been diagnosed with COVID-19, and more than 2.9 million people have died, according to Pan American Health Organization statistics from March 2023. As of 12 July 2023, more than 2 billion doses of vaccination against COVID-19 had been applied in the region to about 700 million people with a 3-dose regimen.

[…]

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Original Article

Risk Factors for In-Hospital Mortality from Cardiac Causes After Acute Myocardial Infarction

Gabriel Vasconcelos Oliveira et al. Maria Beatriz Guimarães Raponi Patricia Magnabosco Maria Angélica Melo e Oliveira … Suely Amorim de Araújo Vanderlei José Haas Valéria Nasser Figueiredo

Abstract

Background:

Risk stratification on admission of patients with acute ST-elevation myocardial infarction (STEMI) is considered a clear strategy for effective treatment, early intervention, and survival.

Objective:

The purpose of this study was to determine the risk factors for in-hospital mortality from cardiac causes after STEMI.

Methods:

Observational, retrospective, longitudinal study, with a quantitative approach, based on data from the medical records of individuals diagnosed with STEMI treated at the Emergency Room of a large hospital in the state of Minas Gerais, Brazil, from January 2011 to July 2016. The outcome of interest was 30-day in-hospital mortality from after STEMI. For statistical analysis, the Pearson’s chi-square test, Spearman’s correlation and multivariable Cox-regression analysis were used, with a significance level of α = 0.05.

Results:

Of the 459 patients, 55 (12%) died from cardiac causes within 30 days after STEMI. Mean admission SBP of these patients was 109.08mmHg. The incidence of death was higher in women (23.7%), patients with systemic arterial hypertension (SAH) (13.8%) and elderly patients (16.5%). The elderly — heart rate (HR) = 3.54 — and women — HR = 2.55 — had a statistically significant higher risk of progressing to death when compared to younger adults and men. The highest admission SBP had a protective effect (HR = 0.97), reducing the chance of death by 3%.

Conclusion:

SBP on admission, female gender and advanced age were significant risk factors for death within 30 days after STEMI.

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Original Article

Cardiovascular Diseases Mortality Rates in Nine Cities of Rio Grande do Sul from 2009 to 2019: Temporal Trends and Demographic Differences

Pâmela Sandri et al. Luiz Artur Rosa Filho Elias Sato de Almeida Shana Ginar da Silva

Abstract

Background

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality statistics in Brazil and worldwide. The evaluation of the temporal and spatial distribution of mortality due to CVD is essential to support actions aimed at monitoring the implementation of health policies.

Objectives

To analyze the temporal trend of mortality due to CVD from 2009 to 2019, as well as the main causes of death according to gender and age group in nine cities of Rio Grande do Sul (RS).

Methods

This is an ecological study based on data from the Mortality Information System. The rates were stratified according to gender, age group and cause, which were composed of ischemic heart diseases (IHD), cerebrovascular diseases and hypertensive diseases (HD). Prais-Winsten regression was used for time trend estimates.

Results

Three out of the nine cities analyzed showed a significant reduction in the overall mortality rates due to CVD in the timeframe evaluated (p<0.05). When the cause of death was analyzed, there was a decreasing trend in mortality due to IHD in Caxias do Sul, Ijuí and Porto Alegre. In these cities and also in Passo Fundo and Uruguaiana, there was a decrease in mortality due to cerebrovascular diseases. The cities of Ijuí, Porto Alegre and Santa Maria recorded an increase in hypertensive disease mortality rates. In most cities, there was an increase in rates related to greater age and male sex.

Conclusion

Heterogeneity was observed in the trend of mortality due to CVD throughout the historical series, which may be related to the execution of public policies and the control of cardiovascular risk factors in the evaluated territories.

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Original Article

Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot

Patrícia de Souza Pinheiro et al. Vitor Manuel Pereira Azevedo Gabrielle Rocha

Abstract

Background

In tetralogy of Fallot, correction surgery is a priority choice, seeing that it is desirable to minimize pulmonary hypoflow and severe hypoxemia, which result in hypoxemic crises, with sudden worsening of cyanosis, tachypnea, and, in some cases, loss of consciousness, seizures, and even death.

Objective

To evaluate the predicting factors of surgical mortality in children and adolescents undergoing correction of tetralogy of Fallot.

Methods

Retrospective cross-sectional study carried out by consulting all surgical records of the Child and Adolescent Cardiology Service of the Brazilian National Institute of Cardiology, during the period from 2007 to 2010. Results with p values < 0.05 were considered significant.

Results

The study evaluated 93 medical records. In relation to the characteristics of the population at the time of surgery, the median age was 3.69 (2.13 to 5.79) years, and 58.06% (n = 54) were male. White was the most common skin color, accounting for 55.43% (n = 51) of cases. In relation to assessment of nutritional status, median weight was 13.25 (10.10 to 17.60) kg, and body mass index was 14.49 (13.44 to 16.28) kg/m2. Down syndrome was present in 11.83% (n = 11) of the patients. All patients underwent correction surgery (n = 93, 100%). Prior cyanotic crisis was found in 53.85% (n = 49) with p = 0.013; surgical procedure duration was 218.83 ± 60.63 minutes, with p = 0.003, and lactate was 1.88 ± 1.33 mg/dL during the immediate postoperative period, with p = 0.009. Regarding the outcome of surgical death, it was found in 15.05% (n = 14) of patients. Mean follow-up lasted 5.68 ± 3.76 years.

Conclusions

According to the factors analyzed, the duration of the surgical procedure, prior cyanotic crisis, and blood lactate level may be relevant to surgical mortality.

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Editorial

Neuropeptides Y and Other Promising Biomarkers in Acute Coronary Syndrome

Fernanda A. Andrade et al. Leonardo Carvalho Pedro Gabriel Melo de Barros Silva

Neuropeptide Y (NPY) is a very common neurotransmitter with 36 amino acids that acts as a stimulator of angiogenesis, inflammation and adipogenesis through the NPY2 receptor. The description of high plasma concentrations of NPY in acute coronary syndrome (ACS) and left ventricular dysfunction and its close relationship with the sympathetic nervous system reinforces the possibility of a new prognostic biomarker for risk stratification.^,

In recent years, changes in the NPY signalling pathway have been related to ACS. For example, the NPYc.20T>C mutation is associated with increased serum lipid levels and consequent increase in the risk of ACS, stroke, hypertension, and obesity.^, The NPYc.-485T>C variant has been linked to the development of early atherosclerosis and stroke, and possibly to insulin resistance reduction and development of type 2 diabetes mellitus.^–

[…]

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Editorial

And We Doctors, What do We Die of?

Gabriel Porto Soares et al. Thais Rocha Salim

We hardly ask ourselves what we will die from. The certainty of this fact can even pass through our thoughts, but it always seems to us something far away and impossible to predict. We can know the causes of death of our fellow human beings to try to predict our death and perhaps use measures to postpone it, since it is impossible to avoid. Societies need to know their numbers, how many we are, how many are born, how many die, how we die, and how we live. These are questions that gain importance with reports of demographic and epidemiological surveys dating back to 400 BC in some ancient civilizations like Greece, Rome, India, and China. The first modern publication in mortality studies dates from 1662 in England, carried out by a London councilor, John Graunt, who published the work entitled “Natural and Political Observations upon the Bills of Mortality” (), using data of burials in London as information. Through this study, it can be known, for example, that one third of London children died before turning sixteen.^,

In the last century, humanity has gone through an epidemiological transition in terms of causes of death. Infectious diseases are no longer the leading cause of death and have given way to chronic non-communicable diseases (NCDs), especially circulatory system diseases (CAD). NCDs are the main cause of death worldwide, and they are responsible for premature deaths, loss of quality of life, and adverse economic and social impacts. NCDs are responsible for about 70% of global deaths, equivalent to more than 38 million deaths per year, significantly exceeding deaths from external causes and infectious diseases. About 45% of all NCD deaths worldwide, more than 17 million, are caused by CAD. A similar distribution is observed in Brazil, where 72% of deaths result from chronic NCDs, with 30% due to CAD and 16% to neoplasms.

[…]

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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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Original Article

Mortality from Cardiovascular Diseases: A Comparative Analysis between the Medical and Non-Medical Populations in Brazil

Giulia Guimarães Matos et al. Roberta Luise Carrilho Bittencourt Pacheco Lucélia Batista Neves Cunha Magalhães Katia de Miranda Avena

Abstract

Background:

Cardiovascular disease (CVD) is the leading cause of death worldwide, including among physicians. Professional peculiarities increase cardiovascular risk in this population, making it relevant to analyze mortality in the medical population (MPop) and non-medical population (NMPop).

Objectives:

To compare the CVD mortality coefficient (MC) in between MPop and NMPop in Brazil by analyzing the epidemiological profile and the main causes of deaths from CVD.

Methods:

Time-series study with data obtained from the Mortality Information System of the Federal Council of Medicine and the Brazilian Institute of Geography and Statistics, from 2014 to 2018. The variables age group, sex, race, occupation, and CVD that caused the death were assessed in MPop and NMPop. MC, relative risk and odds ratio between the populations were calculated. Tests for difference in proportions, with approximation to the normal distribution, and chi-squared tests were performed, assuming p<0.01 as statistically significant.

Results:

Both MPop and NMPop had a predominance of men (86.7% and 52.3%), senior citizens (85.9% and 79.7%) and white individuals (86.4% and 52.2%). The MCs of the MPop and NMPop was 92.2 and 255.1 deaths/100,000 individuals, respectively. The main cause of death was acute myocardial infarction (AMI) (32.5% and 24.6% in MPop and NMPop, respectively) followed by cerebrovascular accident (CVA) (5.1% and 10.5% in MPop and NMPop, respectively).

Conclusion:

In Brazil, mortality from CVD was more prevalent in white elderly males, and mainly caused by AMI and CVA. Being a doctor, man and over 60 years old represents a greater chance of death from CVD in comparison with non-physicians.

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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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Original Article

Overview of Cardiovascular Disease Risk Factors in Adults in São Paulo, Brazil: Prevalence and Associated Factors in 2008 and 2015

Jaqueline L. Pereira et al. Michelle A de Castro Jean M. R. S. Leite Marcelo M. Rogero … Flavia M. Sarti Chester Luís Galvão César Moisés Goldbaum Regina M. Fisberg

Abstract

Background

Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in Brazil.

Objective

To provide population-based data on prevalence and factors associated with CVD risk factors.

Methods

Individuals aged ≥20 years from two editions of the cross-sectional Health Survey of São Paulo focusing on Nutrition (ISA-Nutrition), performed in Sao Paulo city in 2008 (n=590) and 2015 (n=610), were evaluated for: obesity, central obesity, waist/height ratio, high blood pressure (HBP), dyslipidemia, diabetes, and number of CVD risk factors ≥3. Prevalence was estimated according to complex survey procedures. Factors associated with cardiovascular risk factors were assessed using logistic regression, with statistical significance of p<0.05.

Results

Obesity and older age were associated with higher odds of all cardiovascular risk factors investigated, except for dyslipidemia. HBP was positively associated with being Black/Brown and negatively associated with being physicaly active in leisure time. Women were more likely to have increased adiposity indicators and three or more cardiovascular risk factors than men. Those with higher education had lower chances of having diabetes, HBP and dyslipidemia, and those with higher income had higher chances of having three or more risk factors. Former smokers had higher odds of diabetes, obesity, and high waist/height ratio, and smokers had higher odds of high non-HDL cholesterol levels. From 2008 to 2015, there was an increase (p<0.001) in the prevalence of diabetes (6.9% to 17.3%), HBP (31.9% to 41.8%), dyslipidemia (51.3% to 67.6%), and number of CVD risk factors ≥3 (18.9% to 34.1%).

Conclusion

This study shows increasing prevalence of CVD risk factors in adult population in Sao Paulo and may support the definition of target groups and priority actions on CVD prevention and treatment.

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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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Editorial

Clinical Characteristics and Mid-Term Follow-Up of Patients with Severe Aortic Stenosis and Those not Eligible for TAVI

Gilberto Eder de Oliveira Júnior et al. Rogerio Sarmento-Leite

Aortic stenosis is an insidious disease with a long-term period of latency. It progresses rapidly after symptoms appear, esulting in a high mortality rate (approximately 50% in the first 2 years) in untreated symptomatic patients, with sudden death being common in these individuals.

Approximately 30% of the patients aged 75 years or over are not candidates for surgical procedure due to their advanced age, female sex, functional class, operatory emergency, ventricular dysfunction, pulmonary hypertension, previous heart surgery, associated coronary artery disease, among others. In the age range of patients in their 80s, those who remain in clinical treatment have a survival rate of 65.8% in the first year and 41.8% in the second year of follow-up.

[…]

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Original Article

Predictive Value of Myocardial injury in Patients with COVID-19 Admitted to a Quaternary Hospital in the City of Rio de Janeiro

Antônio Sérgio Cordeiro da Rocha et al. Andre Volschan Luiz Antonio Almeida Campos Roberta Pereira dos Santos Coelho … Dominique Cardoso de Almeida Thielmann Carlos Augusto Lobbe Cotta Ferreira Alexandre Siciliano Colafranceschi

Abstract

Background

In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established.

Objective

To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19.

Methods

Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant.

Results

This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P 1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI 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) increased the chance of in-hospital mortality.

Conclusion

This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.

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