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Editorial

Importance of Clinical Examination in the Assessment of Hemodynamic Profiles and Their Relationship with Outcomes in Patients with Acute Heart Failure

Suellen Rodrigues Rangel Siqueira et al. Vera Maria Cury Salemi

Cardiovascular diseases are the main causes of mortality in Brazil and worldwide and heart failure (HF) is one of the most prevalent causes of morbidity and mortality. In the last three months, we had a monthly average of 15,406 hospitalizations for HF in Brazil according to data collected in DATASUS. It is a public health concern due to its high morbidity, mortality, and cost associated with frequent hospitalizations. Therefore, it is of fundamental importance that the diagnosis is rapid so that treatment is effective.

The first Brazilian registry of acute HF included 1263 patients from 51 Brazilian centers. BREATH showed that the main etiologies are ischemic, hypertensive, and dilated cardiomyopathy, followed by valvular and Chagas disease. The prevalence of etiologies is similar to international records, except for Chagas disease. The main cause of rehospitalization was poor medication adherence, in addition, the study showed a high in-hospital mortality rate. Such a prevalent and fatal disease requires a careful and systematic approach to avoid failures during treatment.

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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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Ponto de Vista

Pre-participation screening of the young athlete: is this the time for an agreement?

Roberto Peidro et al. Victor Froelicher Ricardo Stein

POINT OF VIEW

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Review Article

Competitive sports for children and adolescents: should an electrocardiogram be required in the pre-participation physical examination?

Cláudio Aparício Silva Baptista et al. Antonio Foronda Luciana de Pádua Silva Baptista

The growing number of children and adolescents, aged 7 to 17 years, that participate in competitive sports requires preventive medical care. The pre-participation physical examination (PPE) requires appropriate medical knowledge to insure safe medical clearance. Recent sudden death events related to sports practice have raised doubts concerning the need for a medical evaluation based on medical tests, which due to the delay in its implementation may result in demotivation and abandonment of the sports practice. This is a review study, including data collected during a period of 30 years at the Olympic Training and Research Center (COTP) of the Municipal Secretary of Sports of São Paulo, where future athletes are identified, socially included and trained; and the objective of the study was to evaluate the need for the involvement of medical organizations in the preparation of a EPP protocol for the cardiovascular assessment of this population, according to the Brazilian reality. We had no normative standard, and so we relied on data collected from protocols that were established by other countries, but we defined which conduct to be taken with each of our individuals.

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Importance of Clinical Examination in the Assessment of Hemodynamic Profiles and Their Relationship with Outcomes in Patients with Acute Heart Failure

Comparison of echocardiography request appropriateness between public and private hospitals

Pre-participation screening of the young athlete: is this the time for an agreement?

Competitive sports for children and adolescents: should an electrocardiogram be required in the pre-participation physical examination?

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)