Comorbidities – ABC CARDIOL

IJCS

Original Article

Is Age Associated with Complications of Atrial Fibrillation Catheter Ablation?

Carlos Volponi Lovatto et al. Vinicius Louback Baldon Júlia Henriques Fabrício Vassallo … Eduardo Serpa Aloyr Simões Hermes Carloni Christiano Lemos Cunha Dalbian Gasparini Roberto Barbosa Osmar Araujo Calil Renato Giestas Serpa Luiz Fernando Machado Barbosa

Abstract

Background

Atrial fibrillation (AF) is the most frequent arrhythmia, and its prevalence increases with age. The management of AF in the elderly is challenging, as it is normally associated with comorbidities and frailty. AF catheter ablation (CA) is a safe and superior alternative to antiarrhythmic drugs (AADs) for the maintenance of sinus rhythm.

Objectives

To evaluate the rate of complications associated with CA for AF across different age groups.

Methods

A retrospective analysis of 219 patients who underwent CA for AF between 2016 and 2020 were divided into 3 age groups: less than 60 years, 60 to 70 years, and > 70 years. All the included patients underwent radiofrequency ablation using an electroanatomic mapping system. Categorical variables were evaluated with chi-square and Fisher’s test, and continuous variables were evaluated by Kruskal-Wallis and post-hoc Tamhane’s T2. P values less than 0.05 were considered significant.

Results

We found an overall total complication rate of 4.6%. The total complication rate was 3.3% in patients 70 years (p = 0.742). No deaths occurred.

Conclusion

There was no significant difference in the AF CA-related complications when comparing the patients by age group.

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IJCS

Original Article

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Luan George Xavier et al. Renato Sampaio Mello Neto Marcos Henrique de Oliveira Morais Pedro Jorge Cronemberger … Maria do Carmo Carvalho Martins Marta Rosal

Abstract

Background

In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH).

Objective

To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease.

Methods

A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05.

Results

Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters.

Conclusions

This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

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IJCS

Editorial

Exercise Is Medicine! How to Safely Return to Sports after COVID-19? A Meta-Analysis and a Practical Flowchart for Cardiovascular Risk Assessment may Help you

Clea Colombo

Exercise is medicine! Although this premise is well established, how to maintain this “treatment” for various diseases during the COVID-19 pandemic? This has been a concern of all doctors in the world since exercise contributes to the control of cardiovascular diseases and other comorbidities recognized as risk factors for a worse outcome in COVID-19. Moreover, it has already been shown that higher cardiorespiratory fitness is inversely associated with the likelihood of hospitalization due to COVID-19.

In addition to the hygiene and social distancing measures necessary to prevent coronavirus infection, cardiovascular sequelae in individuals recovering from COVID-19 may contribute to the delay in resuming exercise. Cardiovascular complications, including myocarditis, are relatively common in patients affected by SARS-CoV-2. Although the occurrence of myocarditis as a consequence of COVID-19 was initially described in hospitalized patients with severe presentation of the disease, subsequent studies have reported its occurrence in individuals with mild COVID-19 and even in asymptomatic patients.

[…]

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IJCS

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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ABC

Editorial

The High Pressure of Fighting the COVID-19 Pandemic

Isabela Bispo Santos da Silva Costa et al. Hugo Bizetto Zampa

Although we have been facing the challenges posed by the new coronavirus for almost two years, we still have a long way to go. The rapid and easy spread of the virus not only worries the population and scientific society as a whole but also exposes the fragility of the Brazilian public health system. The numbers speak for themselves – the exorbitant rates of infected people and, consequently, the number of deaths made us question the handling of this health crisis.

In this scenario, elderly individuals with comorbidities such as hypertension, diabetes, obesity and coronary artery disease were the ones who suffered most from COVID-19. The virus in the body leads to extensive endothelial dysfunction, mediated by inflammatory cytokines and thrombogenic factors, disseminated microvascular lesions and serious complications, such as pulmonary and systemic embolism, myocardial injury and renal dysfunction. These manifestations proved to be potentially fatal, especially in the group listed here, mainly due to the concomitant presence of cardiovascular diseases (CVD).

[…]

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ABC

Editorial

Should Patients with Heyde’s Syndrome Undergo Early Valve Intervention?

Marcelo Dantas Tavares de Melo et al. Jose Luiz Barros Pena Jorge de Oliveira Júnior Vera Maria Cury Salemi

The epidemiological profile of patients with aortic stenosis has changed with the aging of the population, characterized by an increase in associated comorbidities. Thanks to the revolution in percutaneous aortic valve treatment, many patients who previously would have limited survival and quality of life have benefited from the possibility of curative treatment. On the other hand, the clinical challenges that arise in this population reinforce not only the consolidated relevance of the heart team but also of other specialties such as oncology and hematology.

The interesting study published in the current issue reinforces the importance of the association between Heyde’s syndrome and aortic stenosis, with increased bleeding in this population. However, it is important to highlight in this context the frequently associated comorbidities that may contribute to eventual digestive bleeding, such as the association between aortic stenosis and neoplasm, since both share the same risk factors, particularly colon cancer neoplasm. This one presents with cardinal clinical signs: anemia and low gastrointestinal bleeding. In this context, the exclusion of neoplasm is mandatory, even in the suspicion of Heyde’s Syndrome. We can also describe other frequently associated comorbidities that add bleeding risk due to the therapy used, such as coronary artery disease, which usually uses antiplatelet therapy, or dual anti-aggregation after percutaneous coronary intervention with a drug-eluting stent.

[…]

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ABC

Original Article

Association of Hypertension with Severity and Mortality in Hospitalized Patients with COVID-19 in Wuhan, China: A Single-centered, Retrospective Study

You-ping Deng et al. Wen Xie Tao Liu Shou-yi Wang … Mei-rong Wang Yu-xing Zan Xiao-bo Meng Yu-qing Deng Hai-rong Xiong Xue-dong Fu

Abstract

Background

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide.

Objective

To investigate the association between hypertension and severity/mortality in hospitalized patients with COVID-19 in Wuhan, China.

Methods

A total of 337 patients diagnosed with COVID-19 at the Seventh Hospital of Wuhan City, from January 20 to February 25, 2020, were enrolled and analyzed in a retrospective, single-center case study. The significance level adopted in the statistical analysis was 0.05.

Results

Of the 337 patients with confirmed diagnosis of COVID-19, 297 (87.8%) were discharged from the hospital and 40 patients (22.9%) died. The median age was 58 years (range, 18-91 years). There were 112 (33.2%) patients diagnosed with hypertension at admission (median age, 65.0 years [range, 38-91 years]; 67 [59.8%, 95%CI: 50.6%-69.0%] men, p=0.0209). Patients with hypertension presented a significantly higher portion of severe cases (69 [61.6%, 95%CI:52.5%-70.8%] vs. 117 [52.0%, 95%CI: 45.4%-58.6%] in severe patients and 23 [19.3%, 95%CI:12.9%-28.1%] vs. 27 [12.0%, 95%CI: 7.7%-16.3%] in critical patients, p=0.0014) and higher mortality rates (20 [17.9%, 95%CI: 10.7%-25.1%] vs. 20 [8.9%, 95%CI: 5.1%-12.6%, p=0.0202). Moreover, hypertensive patients presented abnormal levels of multiple indicators, such as lymphopenia, inflammation, heart, liver, kidney, and lung function at admission. The hypertension group still displayed higher levels of TnT and creatinine at approaching discharge.

Conclusion

Hypertension is strongly associated with severity or mortality of COVID-19. Aggressive treatment may be considered for COVID-19 patients with hypertension, especially regarding cardiac and kidney injury.

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ABC

Original Article

Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil

Paulo Garcia Normando et al. José de Arimatéia Araujo-Filho Gabriela de Alcântara Fonseca Rodrigo Elton Ferreira Rodrigues … Victor Agripino Oliveira Ludhmila Abrahão Hajjar André Luiz Cerqueira Almeida Edimar Alcides Bocchi Vera Maria Cury Salemi Marcelo Melo

Abstract

Background

In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated.

Objectives

To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System.

Methods

Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05.

Results

Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively).

Conclusions

During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

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