cause of death – ABC CARDIOL

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Original Article

Spatial Distribution of Patients in the Metropolitan Area of São Paulo Attending a Public Tertiary Cardiovascular Referral Hospital According to Diseases of the Circulatory, Respiratory, Endocrine, and Neoplastic Systems

Carlos Lederman et al. Sara Lopes de Moraes Antonio Carlos Pedroso de Lima Lucia Pereira Barroso … Lilian Cristina Correia Morais Magaly de Losso Perdigão Rosa Maria Vieira de Freitas Monica La Porte Teixeira Bernadette Cunha Waldvogel Marco Antonio Gutierrez Ligia Vizeu Barrozo Alfredo José Mansur

Abstract

Background

The spatial distribution of patients according to clinical characteristics, using geoprocessing techniques, enables the identification of disease clusters within a studied population. This approach supports the development of targeted interventions directed toward specific risk groups.

Objectives

To investigate geographical clusters of diseases of interest among patients attending a public tertiary hospital and to characterize their spatial distribution across the metropolitan area of São Paulo.

Methods

Based on the results of a previous study, two disease groups were defined: one representing the main diseases identified at the first hospital visit and another representing the main underlying causes of death. A detailed description is provided in the . Disease density was calculated by dividing the frequency of cases within each disease group by the population of each city/district and multiplying the result by 100,000 to enhance data visualization. Spatial data were subsequently analyzed and mapped to illustrate the spatial patterns and relationships identified in the study.

Results

Osasco and Taboão da Serra showed the highest density of underlying causes of death related to diseases of the circulatory system. Additionally, 12 cities/districts located at the borders of the study area showed no recorded neoplastic diseases.

Conclusions

Vargem Grande Paulista showed the highest case density for neoplasms as underlying causes of death and comorbidities. Notably, Embu das Artes, a city recognized for its extensive green areas, showed the highest density of diseases of the respiratory system.

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Editorial

Post-discharge Mortality in Heart Failure: Insights from a Multiple-Cause Analysis

Danielle Louvet Guazzelli et al. Monica S. Avila

Heart failure (HF) ranks among the leading causes of hospital admission and death. Nevertheless, the factors precipitating mortality—particularly after a decompensation-related admission—are far more heterogeneous than once assumed. In the article “Multiple Cause of Death Analysis in Heart Failure According to Ejection Fraction” published in this issue of the Arquivos Brasileiros de Cardiologia, 519 patients hospitalised for decompensated HF between 2011 and 2019 had their death certificates examined with a multiple-cause-of-death (MCOD) approach. Over a mean follow-up of 2.9 years, 52 % of patients died; however, only 36 % of the 977 recorded mentions were cardiovascular, a proportion clearly lower than the 50% previously reported in Brazilian series. Sepsis, HF itself, and pneumonia were the most frequent specific causes, and—contrary to studies linking reduced ejection fraction to worse prognosis—survival did not differ across preserved, mildly reduced, or reduced ejection-fraction groups. Remarkably, code I50 (HF), historically the leading line on Brazilian death certificates (≈ 23 % of mentions),³ ranked only third, surpassed by sepsis and pneumonia.

The post-discharge period is characterized by heightened vulnerability and multiple competing threats. International registries already show 20–30 % mortality in the first year, with a growing dominance of non-cardiovascular causes in late deaths.^, The Brazilian study reinforces this shift. Although in-hospital lethality was 14.5 %, infections and respiratory complications accounted for most post-discharge deaths, mirroring patterns seen in trials of SGLT2 inhibitors and sacubitril/valsartan.^,

[…]

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Original Article

Analysis of Mortality from Multiple Causes in Heart Failure Categorized by Ejection Fraction

Giovanni Possamai Dutra et al. Bruno Ferraz de Oliveira Gomes Thiago Moreira Bastos da Silva Leticia Souza Peres … Marco Antônio Netto Armando Rangel João Luiz Fernandes Petriz Plinio Resende do Carmo Junior Emilia Matos Nascimento Basilio de Bragança Pereira Gláucia Maria Moraes de Oliveira

Abstract

Background:

Mortality in heart failure (HF) may be underestimated when analyses rely solely on the underlying cause of death from death certificates (DCs), whereas including multiple causes of death enables a broader examination of mortality and its determinants.

Objective:

To analyze the multiple causes of in-hospital and late death in patients with decompensated HF and reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF).

Methods:

Retrospective analysis of a prospective cohort of patients admitted for decompensated HF to a cardiac intensive care unit at a private hospital. The analysis included multiple causes of in-hospital and late deaths. A significance level of 5% was adopted.

Results:

The analysis included 519 individuals with a mean age of 74.87 ± 13.56 years, of whom 57.6% were male. The distribution of HFpEF, HFmrEF, and HFrEF was 25.4%, 27%, and 47.6%, respectively. Cardiovascular diseases (I) were the main causes of in-hospital and late death across all three EF groups, with no significant differences among them. The primary isolated causes of in-hospital and late death were septicemia (A41), HF (I50, I50.0, I50.9), and pneumonia (J12-J18). In late death, septicemia and pneumonia showed significant differences among the groups. Chronic respiratory causes were more frequent in patients with lower EF (HFrEF and HFmrEF). Correspondence analysis revealed an association between circulatory causes and HFrEF, neoplastic causes and HFpEF, and endocrine and metabolic causes and HFmrEF.

Conclusion:

The analysis of multiple causes of death reveals a high rate of non-circulatory deaths in patients with decompensated HF, regardless of EF, linked to age and chronic comorbidities.

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Artigo Original

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Aline Fusco Fares et al. Jorge Fares Gislaine Fusco Fares José Antônio Cordeiro … Marcelo Arruda Nakazone Patrícia Maluf Cury

BACKGROUND: Discrepancies between clinical and autopsy diagnoses persists worldwide. OBJECTIVE: We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings. METHODS: Four hundred nine consecutive autopsies between 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman’s discrepancies classification. RESULTS: Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria. CONCLUSION: Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.

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Spatial Distribution of Patients in the Metropolitan Area of São Paulo Attending a Public Tertiary Cardiovascular Referral Hospital According to Diseases of the Circulatory, Respiratory, Endocrine, and Neoplastic Systems

Abstract

Background

Objectives

Methods

Results

Conclusions

Post-discharge Mortality in Heart Failure: Insights from a Multiple-Cause Analysis

Analysis of Mortality from Multiple Causes in Heart Failure Categorized by Ejection Fraction

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

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