Health Profile – ABC CARDIOL

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Letter to the Editor

Hypertension in Indigenous Populations: Diagnostic Challenges and Nuances of the Epidemiological Transition

Letícia Lemos Belo et al. Maria Clara Gomes Pontes Thalisson Gonçalves Almeida Tales Gabriel Ferro de Oliveira Pedro Pereira Tenório

Dear editor,

We are submitting this letter to offer our considerations on the relevant article entitled: “Prevalence of Systemic Arterial Hypertension and Associated Factors in Indigenous People Attended at a Specialized Outpatient Clinic in Southern Brazil”. The study addresses a critical gap in the epidemiological knowledge of the native populations of the Southern region, offering valuable insight into the epidemiological transition affecting them. The work stands out for its social and technical importance in filling a data void on indigenous people in Southern Brazil, a group that faces unique challenges in accessing healthcare and preserving their culture.

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Editorial

Cardiac Involvement in Infectious Diseases

João Marcos Bemfica Barbosa Ferreira

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Research Letter

Safety of Interventional Cardiology Procedures in Chronic Coronary Syndrome during the COVID-19 Pandemic

Esmeralci Ferreira et al. Thales Siqueira Alves Ricardo Mourilhe-Rocha Ana Luiza Iannarella Lacerda … Felipe Neves Albuquerque Pedro Pimenta de Mello Spineti Daniel Xavier de Brito Setta Roberto Esporcatte Denilson Campos Albuquerque

Methods

In this prospective study conducted during the COVID-19 pandemic, 105 SUS patients with CCS undergoing elective coronary angiography at a teaching hospital between March and May 2020 were evaluated. Four patients were excluded for not attending the test on the scheduled date. All patients were previously evaluated by a cardiologist in a medical appointment, including data on each patient’s clinical profile. During the appointment and when signing the informed consent form, patients were advised to make social isolation, and the guidance was understood by all. The procedures were performed safely with both staff and patients wearing personal protective equipment (PPE). The approaches were taken based on the coronary lesions. Those above 70% of the lumen in epicardial coronary vessels and those above 50% in the left main coronary artery (LMCA) were considered severe. The lesions were assessed by two or more experienced observers. The assessment of clinical symptoms for presence of COVID-19 was made during the appointment, in the hospital stay, and after 15 days of being at the hospital. The guidance for performing the test was scheduled only in case of suspicion of the disease. The study was approved by the institution’s research ethics committee (registration number: CAAE 31784420.7.0000.5259; opinion number: 4.035.853).

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Original Article

Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais

Milena Soriano Marcolino et al. João Antonio de Queiroz Oliveira Grace Kelly Matos e Silva Thatiane Dantas Dias … Barbara Campos Abreu Marino André Pires Antunes Antonio Luiz Ribeiro Clareci Silva Cardoso

Abstract

Background:

The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals.

Objective:

To assess physicians’ satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care.

Methods:

This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant.

Results:

Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians.

Conclusion:

This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.

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Original Article

Physical Activity and Lipid Profile in the ELSA- Brasil Study

Raquel Caroline da Silva et al. Maria de Fátima Haueisen Sander Diniz Sheila Alvim Pedro Guatimosim Vidigal … Ligia Maria Giongo Fedeli Sandhi Maria Barreto

Abstract

Background:

Regular physical activity (PA) induces desirable changes in plasma levels of high- and low-density lipoproteins (HDL and LDL, respectively) and triglycerides (TG), important risk factors for cardiometabolic diseases. However, doubts whether intensity and duration have equivalent benefits remain.

Objective:

To assess the association of PA intensity and duration with HDL, LDL and TG levels.

Methods:

Cross-sectional study with 12,688 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline, who were not on lipid-lowering medication. After adjustment for important covariates, multiple linear regression was used to assess the association of PA intensity and duration with HDL, LDL and TG (natural logarithm) levels.

Results:

Both moderate and vigorous PA and PA practice ≥ 150 min/week were significantly associated with higher HDL and lower TG levels. Vigorous PA was associated with lower LDL only on univariate analysis. After adjustments, moderate and vigorous PA increased mean HDL level by 0.89 mg/dL and 1.71 mg/dL, respectively, and reduced TG geometric mean by 0.98 mg/dL and 0.93 mg/dL, respectively. PA practice ≥ 150 min/week increased mean HDL level by 1.05 mg/dL, and decreased TG geometric mean by 0.98 mg/dL.

Conclusion:

Our findings reinforce the benefits of both PA parameters studied on HDL and TG levels, with a slight advantage for vigorous PA as compared to the recommendation based only on PA duration.

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Original Article

Epidemiological Profile and Quality Indicators in Patients with Acute Coronary Syndrome in Northern Minas Gerais – Minas Telecardio 2 Project

Bárbara Campos Abreu Marino et al. Milena Soriano Marcolino Rasível dos Santos Reis Júnior Ana Luiza Nunes França … Priscilla Fortes de Oliveira Passos Thais Ribeiro Lemos Izabella de Oliveira Antunes Camila Gonçalves Ferreira André Pires Antunes Antonio Luiz Pinho Ribeiro

Abstract

Background:

Coronary artery disease is the main cause of death in Brazil. In the Brazilian public health system, the in-hospital mortality associated with acute myocardial infarction is high. The Minas Telecardio 2 Project (Projeto Minas Telecardio 2) aims at implementing a myocardial infarction system of care in the Northern Region of Minas Gerais (MG) to decrease hospital morbidity and mortality. The aim of this study was to describe the profile of the patients with acute coronary syndrome (ACS) cared for in the period that preceded the implementation of the system of care.

Methods:

Observational, prospective study of patients with ACS admitted between June 2013 and March 2014 to six emergency departments in Montes Claros, MG, and followed up until hospital discharge.

Results:

During the study period, 593 patients were admitted with a diagnosis of ACS (mean age 63 ± 12 years, 67.6% men), including 306 (51.6%) cases of unstable angina, 214 (36.0%) of ST-elevation myocardial infarction (STEMI), and 73 (12.3%) of non-ST-elevation myocardial infarction (NSTEMI). The total STEMI mortality was 21%, and the in-hospital mortality was 17.2%. In the STEMI patients, 46,0% underwent reperfusion therapy, including primary angioplasty in 88 and thrombolysis in six. Overall, aspirin was administered to 95.1% of the patients within 24 hours and to 93.5% at discharge, a P2Y₁₂ inhibitor was administered to 88.7% participants within 24 hours and to 75.1% at discharge. A total of 73.1% patients received heparin within 24 hours.

Conclusion:

We observed a low reperfusion rate in patients with STEMI and limited adherence to the recommended ACS treatment in the Northern Region of MG. These observations enable opportunities to improve health care.

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Artigo Original

Mortality impact of thoracic aortic disease in São Paulo state from 1998 to 2007

Ricardo Ribeiro Dias et al. Omar Asdrubal Vilca Mejia Fábio Fernandes Félix José Alvarez Ramires … Charles Mady Noedir Antonio Groppo Stolf Fabio Biscegli Jatene

BACKGROUND: The epidemiological characteristics of thoracic aortic diseases (TAD) in the State of São Paulo and in Brazil, as well as their impact on the survival of these patients have yet to be analyzed. OBJECTIVES: To evaluate the mortality impact of TAD and characterize it epidemiologically. METHODS: Retrospective analysis of data from the public health system for the TAD registry codes of hospitalizations, procedures and deaths, from the International Code of Diseases (ICD-10), registered at the Ministry of Health of São Paulo State from January 1998 to December 2007. RESULTS: They were 9.465 TAD deaths, 5.500 men (58.1%) and 3.965 women (41.9%); 6.721 dissections (71%) and 2.744. aneurysms. In 86.3% of cases the diagnosis was attained during autopsy. There were 6.109 hospitalizations, of which 67.9% were males; 21.2% of them died (69% men), with similar proportions of dissection and aneurysm between sexes, respectively 54% and 46%, but with different mortality. Men with TAD die more often than women (OR = 1.5). The age distribution for deaths and hospitalizations was similar with predominance in the 6th decade. They were 3.572 surgeries (58% of hospitalizations) with 20.3% mortality (patients kept in clinical treatment showed 22.6% mortality; p = 0.047). The number of hospitalizations, surgeries, deaths of in-patients and general deaths by TAD were progressively greater than the increase in population over time. CONCLUSIONS: Specific actions for the early identification of these patients, as well as the viability of their care should be implemented to reduce the apparent progressive mortality from TAD seen among our population.

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Artigo Original

Epidemiological, clinical e therapeutic profile of heart failure in a tertiary hospital

Patrícia Resende Nogueira et al. Salvador Rassi Krislainy de Sousa Corrêa

BACKGROUND: Heart failure is a complex syndrome with multiple risk factors involved in its genesis, making its prevention and management difficult to achieve. OBJECTIVE: To identify the main etiologies and risk factors in heart failure; to compare clinical and demographic characteristics of patients according to the etiology; analyze whether the treatment is according to that recommended by the Brazilian guidelines. METHODS: Retrospective, descriptive and observational study, carried out at Hospital das Clínicas of Universidade Federal de Goiás. The patients were divided in four groups, according to the etiology, for comparison: chagasic cardiomyopathy, hypertensive cardiomyopathy, dilated cardiomyopathy and others, ischemic cardiomyopathy. The Chi-square and Fisher’s Exact tests, ANOVA and Kruskal-Wallis tests were used in the analysis of the groups and types of treatment. RESULTS: A total of 144 patients’ files were analyzed; the patients’ mean age was 61 ± 15 years and 54.2% of them were males. Chagasic cardiomyopathy was the main etiology (41%). Arterial hypertension (48.6%), anemia (22.9%), coronary disease (19.4%), dyslipidemia (17.3%) and diabetes (16.6%) were the main risk factors. There was a higher prevalence of female individuals among the hypertensive patients (p=0.044) as well as a higher frequency of pulmonary rales (p < 0.01). Heart rate was lower among chagasic patients (p < 0.001). The most often prescribed medications were diuretics (81.2%), angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (77.7%), beta-blockers (45.8%), spironolactone (35.4%), digitalis (30.5%) and vasodilators (8.3%). CONCLUSION: Chagasic cardiomyopathy was the main cause of heart failure. No significant clinical differences were observed among patients from the four etiologic groups.

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Artigo Original

Profile of patients in the Unified Waiting List for heart transplantation in state of Ceará

Francisca Elisângela Teixeira Lima et al. Adriana Kelly Almeida Ferreira Kelly de Araújo Fontenele Eliana Régia Barbosa de Almeida

BACKGROUND: Organ transplants have increased considerably in recent years because of technological developments and society’s awareness for organ donation. OBJECTIVE: To describe the characteristics of the single list of patients waiting for heart transplantation; to identify the main heart diseases; and determine the average time a patient stays in the list until the surgery. METHODS: This is a descriptive, documentary and retrospective study with a quantitative approach. It was developed at the Transplant Center of the State of Ceará, with 156 patients included in Unified Waiting List from 1999 to 2006. Data were organized into figures. RESULTS: There were: 81% males; 22.4% of young adults (20 to 40 years old) and 56.4% middle-aged adults (40 to 64 years old), averaging 36 years old; 79% from Fortaleza-CE; 91% with cardiomyopathy as a cause of heart transplantation. Among these, 102 patients (69%) were transplanted; 37 (25%) died before transplantation; and 8 (6%) were excluded due to improvement or worsening of clinical status. CONCLUSION: The patients from the Unified Waiting List for Heart Transplantation in the state of Ceará, from 1999 to 2006, were male (80%), with ages ranging from 1 to 71 years, with a predominance of dilated cardiomyopathy (53.4%), and the average waiting time was 136 days until the day of cardiac transplantation.

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Artigo Original

Congenital heart disease in adults: outpatient clinic profile at the Hospital das Clínicas of Ribeirão Preto

Fernando Amaral et al. Paulo Henrique Manso João Antonio Granzotti Walter Villela de Andrade Vicente Andre Schmidt

BACKGROUND: Service experiences for adults with congenital heart disease have not been reported in our country. OBJECTIVE: To describe the basic clinical profile of adults with congenital heart disease in an outpatient tertiary care center. METHODS: We compiled data on age, gender, place of residence, primary diagnosis, and secondary diagnoses of 413 patients treated for seven years. RESULTS: G1 (untreated): 195 patients, 51% women, 57% between 14 and 30 years, 80% living in the region. The most frequent heart diseases were ventricular septal defect (VSD) (31%), atrial septal defect (ASD) (29%), and pulmonary stenosis (7%). The predominant secondary diagnoses were hypertension (9%) and arrhythmias (5%). G2 (treated): 218 patients, 56% women, 57% between 14 and 30 years, 81% living in the region. The most frequently treated heart diseases were: ASD (36%), tetralogy of Fallot (14%), coarctation of the aorta (12%), and VSD (11%). Sixty-nine (32%) patients were operated on for congenital heart diseases in adulthood. Sixteen (7%) underwent an interventional catheterization. The predominant secondary diagnoses were hypertension (18%) and arrhythmias (8%). CONCLUSION: In the study, most patients were treated invasively, all of them were residents in the region, and most of them were under 40 years of age. Defects such as ASD, VSD, and pulmonary stenosis predominated in the untreated group, whereas in the treated group, most patients had undergone surgical correction of ASD, tetralogy of Fallot, aortic coarctation, and VSD. Hypertension and arrhythmias were relevant in both groups, and a large variety of other comorbidities were also observed.

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Clinical and demographic profile and quality indicators for heart failure in a rural area

Henrique Miller Balieiro et al. Raphael Kasuo Osugue Samuel Pereira Rangel Raphael Brandão … Tatiana Leal Balieiro Sabrina Bernardez Evandro Tinoco Mesquita

BACKGROUND: data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE: To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS: Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fisher’s exact tests were used for analysis of proportion, as well as the Student’s t-test for numeric variables, in order to establish the population’s characteristics. RESULTS: Mean age was 61±14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant. CONCLUSION: In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.

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Artigo Original

Treatment of a cohort of patients with acute myocardial infarction and ST-segment elevation

Jamil da Silva Soares et al. Nelson Robson Mendes de Souza Jair Nogueira Filho Cristiane C. Cunha … Georgina Severo Ribeiro Ronald Souza Peixoto Carlos Eduardo C. Soares Leandro C. Soares Aldo Franklyn Reis Carlos Augusto Cardozo de Faria

BACKGROUND: Although thrombolysis and primary CTA are well-established procedures, they are not administered in a large proportion of the patients with STEMI who arrive to the emergency rooms. OBJECTIVE: Describe initial and final the results in a cohort of STEMI patients METHODS: The study included, from hospital admission to the discharge, 158 patients diagnosed with STEMI, from a total of 351 patients with ACS admitted to hospitals in Campos dos Goytacazes, RJ, Brazil, between 2004 and 2006. RESULTS: Of the 158 patients with STEMI, 67.7% arrived to the hospital within 180 minutes, 81.3% within 360 minutes, and 8.4% after twelve hours from the symptoms. Cinecoronariographic studies (148) were performed (93,7%). Lesions of over 70% were observed in 266 artery territories. The initial treatment was CTA in 41 (26%), thrombolytics in 50 (32%), 80% of success. Clinical treatment in 67 (42%). Approximately 35% of the patients should have undergone thrombolysis, but they didn´t. During the final treatment, 93 CTAs were performed: 89 with angiographic success (95.7%), bleeding 2 (2.2%), subacute occlusion 2 (2.2%), trunk dissection 1 (1.1%), pseudoaneurism 1 (1.1%). No deaths during angioplasty; during evolution, there were two deaths (2.1%). Twelve patients underwent myocardial revascularization surgery (MRS), while 53 underwent clinical treatment, with 11 deaths (20.7%). Global lethality was 9.5%, considering the three types of treatment. CONCLUSIONS: Patients were suitable for reperfusion, but one third of them did not have the procedure. Two deaths during evolution. The most predominant treatment was CTA, with low morbidity. Low global lethality.

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