Hospitals, Public – ABC CARDIOL

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Editorial

Prognosis of Coronary Artery Disease in Public Hospitals in Brazil: The ERICO Study and the Application of Knowledge in Public Health

The group of cardiovascular diseases (CVD) includes the leading causes of death in Brazil and in all developing countries.^, Ischemic heart disease (IHD) or coronary artery disease (CAD) has been the leading cause of death for many years in the Brazilian population, with the exception of the year 2020, when the disease caused by the novel coronavirus (COVID-19) was the leading cause of death, followed by IHD. IHD was the main cause of years of life lost in the Brazilian population in 2016.

In 2017, the prevalence of CAD was estimated to be of 1.75% (2,500,000 individuals) in the Brazilian population over 20 years of age. The highest prevalence was found in the South and Southeast Regions, with a decreasing standardized mortality rate, but an increased prevalence, since 1990. With an estimated incidence of about 121,000 cases per year in 2017, CAD has been an important public health problem in Brazil.

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ABC

Letter to the Editor

Teachers who were Academic Examples

Charles Mady

We currently live in an extremely competitive and individualistic society, which makes mistakes and defects more apparent. The health pandemic, in addition to the endemics of corruption in politics and the social fabric, has led us to a perfect storm. Its damage is difficult to solve, as several factors are chronic, ingrained, almost atavistic, and are present in all segments of society. The solution is called education. As Paulo Freire says, educated and respected, but criticized by the uneducated, education changes individuals, making them evolve. These change society. It is, therefore, a long-term project.^–

As I have commented in several articles in the press, we have human resources of high moral and intellectual level. However, with the current political system, malignant, consisting of corporatism and solid physiologisms, which dispute, command, and disengage, evolution is blocked. This criminal system removes most of the well-meaning people from the scene. Some manage to win by overcoming obstacles. Moreover, they make history. In addition, they leave positive marks, making us more educated and prepared to carry out their teachings. Quality is recognized by the heirs, carrying out the good school. InCor is an example to be followed; it has been recently qualified as one of the best public hospitals in the world. It is a source of pride for our country.

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Research Letter

Reduction in the Number of Patients with Suspected and Confirmed Acute Coronary Syndrome during the early months of the Covid-19 Pandemic: Analysis of a Brazilian Network

Pedro Gabriel Melo de Barros e Silva et al. Ana Amaral Ferreira Dutra Adriana Bertolami Manfredi Pedro Paulo Nogueres Sampaio … Celso Musa Correa Hemilo Borba Griz Daniel Setta Valter Furlan

Introduction

The first reports of infections by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in December of 2019 in Wuhan, China.^, This disease (named as coronavirus disease-2019, Covid-19) rapidly spread globally and, on March 11, 2020, the World Health Organization (WHO) declared the state of pandemic.^, Lockdown was a common recommendation for countries affected by the outbreak.

Despite all the attention put on Covid-19 by the health authorities, other diseases could also be impacted by this new circumstance. Rates of acute cardiovascular diseases changed in countries such as Italy and United States, with a reduction in hospital admissions.^– Previous national data regarding acute coronary syndrome (ACS) is already well and largely described, but these studies did not include the Covid-19 period.^, Thus, despite the fact that Brazil was the second most affected country when it comes to number of Covid-19 cases,⁹ the impact in hospital admissions due to suspected or confirmed ACS is still not well defined in both private and public Brazilian healthcare systems.

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Editorial

Statin Use and Hypercholesterolemia: Are the Current Guidelines' Recommendations Being Followed?

Renato Jorge Alves

Despite advances in treating cardiovascular diseases, acute myocardial infarction and stroke are still the main causes of death worldwide.

The prevention of coronary atherosclerotic disease (CAD), represented by the treatment of low-density lipoprotein cholesterol (LDL-c), is one of the main alternatives for increasing the survival of patients with cardiovascular risk factors. Case-control, observational, and genetic studies confirm the importance of increased cholesterol level as one of the main modifiable risk factors for cardiovascular disease, especially for CAD and ischemic stroke. The reduction in LDL-c throughout life has been associated with a lower risk of developing CAD. There seems to be a causal relationship between LDL-c and CAD, which is continuous and which depends on the magnitude of the reduction in LDL-c.^–

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Original Article

Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network – VICTIM Register

Jussiely Cunha Oliveira et al. Laís Costa Souza Oliveira Jeferson Cunha Oliveira Ikaro Daniel de Carvalho Barreto … Marcos Antonio Almeida-Santos Ticiane Clair Remacre Munareto Lima Larissa Andreline Maia Arcelino Isadora Soares Bispo Santos Silva Antônio Carlos Sobral Sousa José Augusto Soares Barreto-Filho

Abstract

Background:

Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages.

Objectives:

To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe.

Methods:

This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017.

Results:

A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05).

Conclusions:

The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

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IJCS

Original Article

Clinical Course of Patients Undergoing Myocardial Revascularization Surgery in a Public Cardiology Referral Hospital in Pará, Brazil

Patrick Hernani Matias Lobato et al. Feliciano Mendes Vieira Junior Mário Barbosa Guedes Nunes Valleria Adriana Queiroz Lima Galucio Ercielem da Lima Barreto

Abstract

Background:

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce.

Objective:

To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon.

Methods:

Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014.

Results:

A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 – 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 – 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 – 39.54, p = 0.001) were predictors of mortality after CABG.

Conclusion:

A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil.

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Original Article

Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil

André Wajner et al. Priccila Zuchinali Vírgilio Olsen Carisi A. Polanczyk Luis Eduardo Rohde

Abstract

Background:

Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons.

Objective:

To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF).

Methods:

Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI).

Results:

A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups.

Conclusion:

Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital.

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IJCS

Original Article

Inadequacies of Sphygmomanometers Used in Emergency Care Services in a Large Capital City in Brazil

Kleisson Antonio Pontes Maia et al. Marcus Vinícius Bolívar Malachias Isabela Viana de Paiva Rafael da Mota Mariano Rodrigo Viana de Paiva

Abstract

Background:

Hypertension is the main risk factor for cardiovascular diseases. Technical quality of sphygmomanometers is a prerequisite for the correct measurement of arterial pressure.

Objectives:

To evaluate sphygmomanometers available in emergency services in the city of Belo Horizonte, Brazil.

Methods:

We performed a cross-sectional, observational, non-interventional study to evaluate characteristics of the sphygmomanometers available in adult emergency services of public and private hospitals in the city of Belo Horizonte, Brazil. We evaluated 337 sphygmomanometers of 25 hospitals – 15 (of 16) public hospitals and 10 (of 12) private hospitals.

Results:

Twenty-six percent (88/337) of devices were considered inadequate regarding the INMETRO (National Institute of Metrology, Quality and Technology) standards, 39.2% (132/337) for calibration dates, and 54% (188/337) for the mismatching between cuff’s and device’s brands. In 13 of 25 hospitals (52%), there were no spare cuffs in different sizes for different arm circumferences. Higher adequacy was found for aneroid and mercury sphygmomanometers used in private hospitals (p = 0.038 and p < 0.001, respectively) and electronic devices used in public hospitals (p < 0.001) compared with others.

Conclusion:

Seventy-eight percent of sphygmomanometers available in emergency services had technical inadequacies, and half of these services had no spare cuffs in different sizes available. These findings serve as a warning of the conditions of the equipment used in healthcare services provided to the general population in Brazil.

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Artigo Original

Comparison of echocardiography request appropriateness between public and private hospitals

Flávia Candolo Pupo Barbosa et al. Evandro Tinoco Mesquita Laiz Baniziolli Barachi Angelo Salgado … Rafael Kazuo Maria Luiza Garcia Rosa Claudio Tinoco Mesquita

BACKGROUND: Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC). OBJECTIVE: To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile. METHODS: We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test. RESULTS: There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p <0.001). In the UH, physicians who had graduated between 5 and 10 years before had a higher rate of inappropriate requests (p = 0.02). The variables that were independent predictors of appropriate tests in the PH were: female sex (p = 0.001) and age <60 years (p = 0.001). CONCLUSION: In this evaluation, the PH and the UH profiles showed similar request appropriateness profiles. Female gender, time since graduation of the requesting physician and the patient's age influenced the appropriateness of requests.

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