Data Interpretation, Statistical

ABC

Letter to the Editor

CHA2DS2-VASc Score: What More Can it Predict?

Dear Editor,

Kalkan et al. assessed the predictive value of the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA₂DS₂-VASc) score for residual SYNTAX score (rSS) among patients with ST-segment elevation acute myocardial infarction (STEMI). The study included 688 patients divided into a low rSS group (group 1; scores up to 8) and a high rSS group (group 2; scores above 8).

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ABC

Editorial

Pre-Clinical Meta-Analysis: Another Brick in the Wall

Amanda Gomes Pereira et al. André Monti Garzesi Sergio Alberto Rupp Paiva Bertha Furlan Polegato

Currently, systematic review and meta-analysis are considered level 1 of scientific evidence and it is widely used in epidemiology and evidence-based medicine. The term meta-analysis comes from the Greek and means “analysis of analyses”, referring to its definition “statistical analysis of a large collection of analysis results from individual studies for the purpose of integrating the findings” proposed by the statistician Gene V. Glass in 1976.

Despite the similarities, it is important to note that meta-analysis and systematic review are not synonymous. Meta-analysis is often, but not always, preceded by a systematic review, which aim to gather similar studies that meet the strict approach eligibility criteria in order to answer a specific research question, whereas meta-analysis integrates the results of included studies by statistical techniques.^,

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ABC

Editorial

Clinical Significance of Statistical Differences

Luiz Maurino Abreu

Diabetes is a serious chronic condition that occurs when your body cannot produce any or enough insulin or cannot effectively use the insulin it produces, resulting in high blood glucose levels. The so-called type 1 diabetes is caused by a set of genetic, environmental and autoimmune factors affecting insulin-producing pancreatic beta cells.

Elevated blood glucose levels even below the diagnostic threshold of diabetes are associated with complications with the greatest impact on morbidity and mortality among people with diabetes. Systematic reviews involving 102 prospective studies in diabetic patients indicate that the relative risk of cardiovascular disease (CVD) is between 1.6 and 2.6, greater in younger people and slightly higher in women.

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IJCS

Original Article

Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Carolina de Deus Leite et al. Thiago Carvalho Pereira Matheus Pamponet Freitas Natália Lima Walsh Tinôco … Flávia Guimarães Pereira Roberta Vicente Leite Viana Menezes Milena Quadros Sampaio Andrade Samantha Pereira Rosa Vilas Boas Paulo José Bastos Barbosa Gilson Soares Feitosa-Filho

Abstract

Background:

Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients.

Objetive:

To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed.

Methods:

Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher’s exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05.

Results:

372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison.

Conclusion:

After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

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IJCS

Original Article

The Relationship Between Gensini Score and In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction

Erkan Yildirim et al. Atila Iyisoy Murat Celik Uygar Cagdas Yuksel … Cengizhan Acikel Baris Bugan Yalcin Gokoglan

Abstract

Background:

To date, several validated patient-based risk scores have been established to predict mortality and morbidity in patients presenting with ST-segment elevation myocardial infarction (STEMI). The Gensini score was originally developed to quantify the severity of coronary artery disease (CAD).

Objectives:

We intend to assess the association between severity of CAD assessed by Gensini score and in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention (P-PCI).

Methods:

A total of 539 patients presenting with acute STEMI, who underwent P-PCI within the first 12 hours from the onset of symptoms, were included. The severity of CAD was expressed as the sum of the Gensini scores for each lesion. Patients’ demographic variables, medical histories and clinical features, as well as in hospital major adverse events were obtained from the medical reports.

Results:

Of these 539 patients, 416 (77.2%) were male and mean age was 59.14 ± 12.68 years. In-hospital mortality rate was 5.4% (29 patients; 16 men). Mortality rate was 10.5% in female patients and 3.8% in males (P = 0.004). Mean Gensini scores were significantly different in the comparison between patients who survived (54.54 ± 26.34) and those who died (80.17 ± 26.51) (P = 0.001). The multivariable Cox proportional hazards regression analysis model revealed that the Gensini score (P = 0.037), female gender (P = 0.039), serum urea levels (P = 0.041), uric acid levels (P = 0.008) and LVEF (P = 0.001) were independently associated with in-hospital mortality in patients with STEMI undergoing P-PCI.

Conclusion:

The Gensini score is independently associated with in-hospital mortality in STEMI patients treated with P-PCI. Therefore, it might play an important role in risk stratification of STEMI patients.

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ABC

Editorial

Cardiovascular Risk Factors: From Consolidated Knowledge to a Call for Action

Guilherme Brasil Grezzana et al. Lucia Campos Pellanda

Since the decade of 1950, the most prominent journal in cardiology in Brazil, Arquivos Brasileiros de Cardiologia (ABC), has been indexed in Medline. A total of 7,102 articles have been published since then, on various subjects related to clinical, invasive, surgical cardiology, as well as diagnostic methods.

We performed a systematic review of articles published in ABC during the period from January 2001 to June 2015 containing the MeSH term “cardiovascular risk factors”. Of the 3,087 titles of articles published in the period, 116 articles were identified. The abstracts of these articles were reviewed, and 107 articles, in which assessment of cardiovascular risk factors was the main topic, were included. The sample was composed by 102 original articles, 3 letters and 2 editorials. When specific topics were assessed, “cardiovascular factor or cardiovascular risk” was generally described in 88 articles, 6 articles focused on quality of life and cardiovascular risk factor, 4 articles described epidemiological factors and risk factors, 5 articles specifically explored systemic arterial hypertension and risk factors, 3 were guidelines on risk factors and 1 articles related risk factor with public health. However, when we focused only on isolated risk factors, there has been a clear preponderance of articles involving arterial hypertension (18% between 2010 and 2013) and a trend of increase in the number of articles on diabetes (approximately 10%) published on ABC in the last years.

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ABC

Original Article

Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System

Vanessa Teich et al. Tony Piha Lucas Fahham Haline Bianca Squiassi … Everton de Matos Paloni Paulo Miranda Denizar Vianna Araújo

Abstract

Background:

Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.

Objective:

To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).

Methods:

A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.

Results:

The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.

Conclusion:

Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

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ABC

Original Article

Evolution of Cardiovascular Diseases Mortality in the Counties of the State of Rio de Janeiro from 1979 to 2010

Gabriel Porto Soares et al. Carlos Henrique Klein Nelson Albuquerque de Souza e Silva Glaucia Maria Moraes de Oliveira

Background:

Cardiovascular Diseases (CVD) are the leading cause of death in Brazil.

Objective:

To estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010.

Methods:

The counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979–1989, 1990–1999, and 2000–2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period.

Results:

There was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000–2010). The drop in CBVD mortality was greater than that in IHD mortality.

Conclusion:

Mortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population.

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