Outcome Assessment (Health Care)

ABC

Original Article

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

Leonardo Lacava et al. Fabiane Letícia de Freitas Gabrielle Barbosa Borgomoni Pedro Gabriel Melo de Barros e Silva … Marcelo Arruda Nakazone Valquiria Pelisser Campagnucci Marcos Gradim Tiveron Luiz Augusto Lisboa Fabio Biscegli Jatene Omar Asdrúbal Vilca Mejia

Abstract

Background

Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness.

Objective

To compare adjusted hospital outcomes between men and women undergoing CABG.

Methods

From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05.

Results

After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03).

Conclusions

Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

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ABC

Editorial

From Volume to Value Creation in Cardiac Surgery: What is Needed to Get off the Ground in Brazil?

Omar Asdrúbal Vilca Mejia et al. Fabio Biscegli Jatene

Some characteristics favored the great development of cardiovascular surgery; among them, creativity for developing techniques and devices and, mainly, much courage. Thus, cardiovascular surgery had a fantastic evolution, driven by its impact on the patient’s quality of life, quickly becoming one of the most performed procedures in the world. Maybe this would not have happened if not for two factors: on the one hand, the improvement of technical skills as a result of the increased surgical volume, and, on the other hand, the information from the databases analyzes.^, This has led to continuous improvement in perioperative techniques, devices, and outcomes.

This may explain the outcome improvement, even when procedures have become more complex and performed in increasingly severe patients. From the analysis of these records, some issues emerged to be resolved. This was when mortality risk scores were introduced to adjust and better understand the results. From that moment, and to achieve continuous improvement, implementing quality programs has become a necessity. Another important step was the hospitals’ public reporting initiatives, introducing the concept of transparency.

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ABC

Editorial

Waist Circumference: A Parameter of Vascular Health

Erika Maria Gonçalves Campana et al. Andréa Araujo Brandão

Obesity plays a central role in chronic noncommunicable diseases due to its high prevalence and strong correlation with risk factors like hypertension, dyslipidemia, diabetes mellitus, and morbidity and mortality. In particular, abdominal obesity has been renowned as an emerging risk factor for an inflammatory and prothrombotic state, which is associated with an increased prevalence of hypertension and increased risk of cardiovascular (CV) events. These data are of utmost importance in the scenario of increasing prevalence of obesity not only in adults, but also among children and adolescents.^, Results of a study conducted in Rio de Janeiro showed an unfavorable relationship of elevated blood pressure (BP) and excess weight in adolescents with increased BP levels and anthropometric and metabolic variables in young adults.

Over the last years, the understanding of the CV continuum has grown, and CV disease has been seen in the context of vascular damage. In this sense, endothelial dysfunction, which results in atherosclerotic disease and its complications, involves the tunica media of large arteries, affected by an accelerated aging of the vessel, resulting in early arterial stiffness and arteriosclerosis, which in turn contributes to CV morbidity and mortality.^–

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IJCS

Original Article

Cardioprotective Effects of Sodium-glucose Cotransporter 2 Inhibitors Regardless of Type 2 Diabetes Mellitus: A Meta-analysis

Lucas Silva Sousa et al. Felipe de Araújo Nascimento Juliano Rocha Michelle Rocha-Parise

Abstract

Background:

Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular impairment, increasing the rates of atherosclerotic and non-atherosclerotic events. Additionally, adverse kidney events are directly linked with T2DM and cardiovascular diseases. In this context, the sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated both cardioprotective and renoprotective effects in patients with or without T2DM. Therefore, the present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or other add-on antidiabetic agents (ADA) in patients with or without T2DM.

Objetive:

The present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or add-on other ADA in patients with or without T2DM.

Methods:

The entrance criteria to SGLT2i studies were: describing any data regarding cardiovascular effects; enrolling more than 1,000 participants; being approved by either the FDA or the EU, and having available access to the supplementary data. The trial had to exhibit at least one of the following results: major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure, cardiovascular death, hospitalization for heart failure, renal or cardiovascular adverse events, or non-cardiovascular death. The significance level of 0.05 was adopted in the statistical analysis.

Results:

Nine trials with a total of 76,285 participants were included in the meta-analysis. SGLT2i reduced MACE (RR 0.75, 95% CI [0.55-1.01]), cardiovascular death or hospitalization for heart failure (RR 0.72, 95% CI [0.55-0.93]), cardiovascular death (RR 0.66, 95% CI [0.48-0.91]), hospitalization for heart failure (RR 0.58, 95% CI [0.46-0.73]), renal or cardiovascular adverse events (RR 0.55, 95% CI [0.39-0.78]), and non-cardiovascular death (RR 0.88, 95% CI [0.60-1.00]).

Conclusions:

Conjunction overall data suggests that these drugs can minimize the risk of cardiovascular events, thus decreasing mortality in patients, regardless of the presence of T2DM.

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ABC

Special Article

III SBC Guidelines on the Analysis and Issuance of Electrocardiographic Reports – Executive Summary

Carlos Alberto Pastore et al. Nelson Samesima Horacio Gomes Pereira-Filho

Abstract

The third version of the guidelines covers recently described topics, such as ion channel diseases, acute ischemic changes, the electrocardiogram in athletes, and analysis of ventricular repolarization. It sought to revise the criteria for overloads, conduction disorders, and analysis of data for internet transmission.

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ABC

Letter to the Editor

Circulatory Support as a Bridge to Pediatric Heart Transplantation

Fernando A . Atik

Dear Editor,

The article “Use of short-term circulatory support as a bridge in pediatric transplantation”, recently published in Arquivos Brasileiros de Cardiologia has aroused great interest.

[…]

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ABC

Editorial

Public Health Policy Based on “Made-In-Brazil” Science: A Challenge for the Arquivos Brasileiros de Cardiologia

Jussiely Cunha Oliveira et al. José Augusto Barreto-Filho

Scrutinizing the quality of the Brazilian health system

Since the Brazilian 1998 Federal Constitution (Constitution of the Citizen) was signed and the Brazilian National Unified Health Care System (SUS) was created in 1990, the right to integral, universal, equalitarian and free access to health services of quality has been granted to all Brazilians. The State would have to finance, provide and operate the infrastructure necessary to fulfill the Law 8.080/1990. The constitutional recognition that health is a universal right was a substantial ideological advance. On paper, the public health model idealized for Brazil has become an example to the world. Approximately 75% of Brazilians are estimated to depend on the SUS for health care, while the remaining Brazilians have private complementary coverage.

If the objective is to generate relevant information to guide decision making regarding public policies on health, we should systematically dedicate ourselves to scientifically assess the health care outcomes of SUS. However, after 25 years from SUS implantation, there is little scientific evidence, especially that representing the continental country Brazil is, on the final health care outcomes of SUS. For example, representative data on post-acute myocardial infarction mortality, reperfusion treatment rate or hospital readmission rate in 30 days are not available. Moreover, little is known about the disparities of the health care outcomes between the SUS and the private health care system.

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Artigo Original

Validation of the short form of the spanish hypertension quality of life questionnaire (MINICHAL) for portuguese (Brazil)

Renata Berberi Schulz et al. Paula Rossignoli Cassyano J. Correr Fernando Fernández-Llimós Plínio Marco de Toni

BACKGRAOUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as “Mini Cuestionario de Calidad de Vida en Hipertensión Arterial” (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbach’s alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbach’s alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges’ assessment attained a high level of agreement (75.44%). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.

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