2018;31(4) – ABC CARDIOL

IJCS

ABC Family | IJCS

Original Article

Methods of Screening for Depression in Outpatients with Heart Failure

Thaís de Rezende Bessa Guerra et al. Isabella Cristina Diniz Venancio Daniel Mählmann de Moura Pinheiro Mauro Vitor Mendlowicz … Ana Carla Dantas Cavalcanti Evandro Tinoco Mesquita

Abstract

Background:

Depression is a syndromic clinical condition underdiagnosed in patients with heart failure. Several instruments are currently applied to screen for depression.

Objective:

To determine the prevalence of depression and the agreement among screening methods for depression in patients with heart failure.

Methods:

Cross-sectional study conducted between March 2015 and January 2017 including 76 outpatients following up at a clinic specialized in heart failure. Depression was screened with the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), and Patient Health Questionnaire-9 (PHQ-9). The agreement among the three instruments was analyzed with Fleiss’ kappa coefficient (k_F), Krippendorff’s alpha coefficient (C_k) and Cronbach’s alpha coefficient. The accuracy, sensitivity, and specificity, as well as false-positive and false-negative results of the HAM-D and PHQ-9 were calculated considering the BDI-II as the gold-standard instrument in the diagnosis of depression.

Results:

The prevalence rates of depression were 72.4% (n = 55) with the HAM-D, 67.1% (n = 51) with the BDI-II, and 40.8% (n = 31) with the PHQ-9 scales. The prevalence of depression simultaneously identified by all three instruments was 28.9% (n = 22) and the diagnostic agreement (presence or absence of depression) was 47.4% (n = 36). The analysis revealed a superficial agreement (k_F = C_k = 0.27) and moderate consistency ((↓C = 0.602, significantly not null, p = 0.000). Sociodemographic and clinical variables were not risk factors for depression in the evaluated sample.

Conclusion:

The screening methods analyzed showed agreement and were useful in detecting depression among outpatients with heart failure.

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Original Article

Waiting for Cardiac Procedure in Congenital Heart Disease: Portrait of an a Hospital in the Amazonian Region

Valeria Santos de Jesus et al. Aline Marques Nascimento Rogério dos Anjos Miranda Joel Silva Lima … Milene de Andrade Gouvea Tyll Adriana de Oliveira Lameira Veríssimo

Abstract

Background:

Congenital heart disease is an important cause of morbidity and mortality in childhood, and in 50% of cases, surgery is required in the first year of life. A high deficit of surgical procedures is estimated in Northern Brazil.

Objective:

To analyze the waiting time for elective surgical treatment and/ or intervention in children with congenital heart disease in a Cardiology referral center, and to make considerations about heart diseases and forms of treatment in that institution.

Methods:

A cross-sectional study of all patients aged less than 14 years, with a diagnosis of congenital heart disease that were waiting for elective surgical or percutaneous cardiac treatment.

Results:

Among the 407 children with congenital heart defects, the most prevalent age group was > 2 to 6 years (34.0%). The average waiting time was 23.1 ± 18.3 months, with a median of 19. The most frequent heart disease was ventricular septal defect (28.98%), patent ductus arteriosus (18.42%) and atrial septal defect (11.05%). Most children (63.4%) were not from the metropolitan area. The percutaneous interventions represented only 27.84% of the catheterization procedures and 14,85% of all heart treatments. Approximately 60% of the pediatric surgeries occurred in children who were not previously registered due to urgency cases.

Conclusion:

Most of the children waiting for a cardiac procedure were not from the metropolitan area and had malformations potentially treatable by catheterization. It is necessary to increase the capacity of the single referral center in the state of Pará, as well as decentralize the high-complexity cardiological care in the metropolitan region.

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Original Article

Carotid Atherosclerosis in Pre- and Post-Menopausal Women with a History of Pregnancy-Induced Hypertension: Case-Control Study

Rafael Alessandro Ferreira Gomes et al. Isly Maria Lucena de Barros Moacir de Novaes Lima Ferreira Laura Olinda Bregieiro Fernandes Costa

Abstract

Background:

Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk.

Objective:

To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension.

Methods:

Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%.

Results:

A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol (156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131).

Conclusion:

The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels.

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Original Article

Evaluation of Lipid Profile in Adolescents

Eduardo del Bosco Brunetti Cunha et al. Rafael Pereira Fagundes Edson Emílio Scalabrin Roberto Hirochi Herai

Abstract

Background:

Atherosclerosis is a chronic, multifactorial and insidious disease that can begin in childhood and adolescence, and whose major consequences appear during adulthood. Serum levels of lipoproteins, such as LDL-c, total cholesterol (TC), HDL-c, and non-HDL-c can be used as a screening method for disease diagnosis. In Brazil, few studies have correlated the serum levels of those lipoproteins with age.

Objective:

To evaluate the serum concentrations of TC, LDL-c, HDL-c, VLDL-c, non-HDL-c and triglycerides (TG) of adolescents aged 10 to 19 years in the municipality of Araucária, Paraná state.

Methods:

Cross-sectional retrospective study, collecting the following data from 600 adolescents: age, sex and serum levels of TC, LDL-c, HDL-c and TG from June to December 2016. Data were analyzed using the SPSS software 2.0, with Mann-Whitney U test and Spearman coefficient of correlation to identify statistical significance (p < 0.05).

Results:

The female sex showed higher serum levels of TC, TG and LDL-c than the male sex. The HDL-c levels were identical in both sexes, with 48% of desirable values and 52% of low values. This study identified a strong correlation between the lipids and association with the age group of 10 to 14 years.

Conclusion:

Non-HDL-c showed stronger correlation with the other lipids (TG, LDL-c and TC) as compared to LDL-c, suggesting that non-HDL-c can be used as an effective complementary diagnostic method to assess the risks for atherosclerosis in adolescents.

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Original Article

Prevalence of Peripheral Artery Disease and Associated Risk Factors in a Brazilian Rural Population: The Baependi Heart Study

Rafael de Oliveira Alvim et al. Fernando Augusto Lavezzo Dias Camila Maciel de Oliveira Andréa Roseli Vançan Russo Horimoto … Anderson Zampier Ulbrich José Eduardo Krieger Alexandre da Costa Pereira

Abstract

Background:

The identification of peripheral artery disease (PAD) can help prevent further progression of the disease and additional complications, considering that this condition is a risk factor for all-cause mortality and cardiovascular death.

Objective:

To assess the prevalence of PAD in the Baependi Heart Study and investigate associated risk factors in different age groups.

Methods:

A total of 1,627 individuals (of both genders and aged 18 – 102 years) residing in the municipality of Baependi (Minas Gerais, Brazil) were selected for this study. Anthropometric and biochemical parameters were evaluated by standard techniques. Physical activity level was determined by the International Physical Activity Questionnaire – Short Form (IPAQ-SF). The screening of PAD was performed by determination of the ankle-brachial index (ABI). The level of statistical significance was set at 5%.

Results:

In the overall sample, the prevalence of PAD was 1.05%, and reached 5.2% after the age of 70 years. The frequency and intensity of smoking were higher in individuals with PAD. A prior history of myocardial infarction and a higher prevalence of hypertension, diabetes, obesity, and sedentary lifestyle were also associated with PAD. In addition, PAD was more frequent in blacks than whites. In multivariable analysis, age, diabetes, smoking, and physical inactivity remained independently associated with PAD.

Conclusion:

The prevalence of PAD was low and increased clearly with age in our sample from a Brazilian rural population. Furthermore, the main risk factors for PAD in the investigated sample were smoking, sedentary lifestyle, diabetes mellitus, and age. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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Original Article

Adherence score for Users of Oral Anticoagulants

Sérgio Henrique Simonetti et al. Ana Cristina Mancussi e Faro Estela Regina Ferraz Bianchi

Abstract

Background:

The score is an effective instrument for the assessment of treatment adherence in users of oral anticoagulants and maintenance of INR (international normalized ratio) within the therapeutic range.

Objective:

To develop an adherence score for oral anticoagulant users for the maintenance of INR within the therapeutic range.

Methods:

This was an analytical, observational, cross-sectional study, with a quantitative approach, conducted in a public cardiology hospital. A total of 607 patients who met the inclusion criteria were evaluated. Variables with a significance level of 5% in the exploratory analysis and considered clinically relevant were included and subjected to a multiple logistic regression model. Predictive accuracy of the model was determined using the C statistic.

Results:

The variables with a significance level of 5% in the multivariate analysis were: education, family income, inadequate use of medications, drug-drug interactions, invasive procedures, food-drug interactions, physical activity, medical conditions, other factors, and complications related to oral anticoagulant therapy. The following prognostic variables were identified: family income, inadequate use of medications, invasive procedures, drug-drug interactions, dietary habits, medical conditions, other factors (stress, thinness, weight loss). C-statistic for adherence score was 0.94.

Conclusion:

The Simonetti adherence score proved to be easily applicable and feasible, with high predictive value for influencing factors, promoting the improvement of adherence and maintenance of INR in the ideal range. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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Original Article

Cardiorespiratory Optimal Point in Professional Soccer Players: A Novel Submaximal Variable During Exercise

Christina Grüne de Souza e Silva et al. Claudia Lucia Barros de Castro João Felipe Franca Altamiro Bottino … Jonathan Myers Claudio Gil Soares de Araújo

Abstract

Background:

Maximal oxygen consumption (VO₂max) and ventilatory threshold (VT) obtained during a cardiopulmonary exercise test (CPX) are used in the evaluation of athletes. However, the identification of these variables may sometimes be unreliable, which limits their use. In contrast, the cardiorespiratory optimal point (COP) is a submaximal variable derived from CPX with objective measurement and prognostic significance. However, its behavior in athletes is unknown.

Objective:

To describe the behavior of COP in professional soccer players and its association with VO₂max and VT.

Methods:

VO₂max, VT and COP were obtained retrospectively from 198 soccer players undergoing maximal treadmill CPX using ramp protocol. COP was defined as the lowest value of the ventilation/oxygen consumption ratio in a given minute of the CPX. The soccer players were stratified according to their field position: goalkeeper, center-defender, left/right-back, midfielder and forwarder. Continuous variables were compared using unpaired Student t test or ANOVA, or Mann-Whitney test or Kruskal-Wallis test depending on their distribution, and categorical variables were compared using chi-square test. Pearson correlation was used to test the association between COP and other ventilatory variables. A level of 5% was used for statistical significance.

Results:

COP (mean ± SD) was 18.2 ± 2.1 and was achieved at a speed 4.3 ± 1.4 km.h^-1 lower than that achieved at the VT. While VO₂max (62.1 ± 6.2 mL.kg^-1.min^-1) tended to be lower in goalkeepers (p < 0.05), the COP did not vary according to field position (p = 0.41). No significant association was observed between COP and VO₂max (r = 0.032, p = 0.65) or between COP and VT (r = -0.003, p = 0.96).

Conclusion:

COP can be easily determined during submaximal exercise performed with incremental speed in soccer players and does not vary according to the athlete’s field position. The absence of association with VO₂max and VT indicates that COP provides distinct and complementary information to these variables. Future studies are needed to determine the practical implications of COP in assessing athletes. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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Review Article

Vitamin D Deficiency and Cardiovascular Diseases

Antonio José Lagoeiro Jorge et al. Jamerson Reis Cordeiro Maria Luiza Garcia Rosa Diego Braga Campos Bianchi

Abstract

Vitamin D is considered a steroid hormone with a broad spectrum of action in the human body. Its action arises from the binding of its active metabolite (1α,25-dihydroxyvitamin D) to its receptor (VDR), which is present throughout the body, including vascular smooth muscle cells and cardiomyocytes. Initially, vitamin D deficiency was related only to changes in the musculoskeletal system, but in recent years, researchers have demonstrated its relationship with several pathologies related to other systems, such as cardiovascular diseases. The objective of this study is to review vitamin D’s pathophysiology, describe its relationship with cardiovascular diseases based on the most recent publications, and highlight the results of vitamin supplementation in the prevention of such pathologies.

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Original Article

Comparison between Myocardial Ischemia Evaluation by Fractional Flow Reserve and Myocardial Perfusion Scintigraphy

Aurora Felice Castro Issa et al. Felipe Pittella Sergio Martins Leandro Patricia Paço … Judas Tadeu Renata Felix

Abstract

Background:

Moderate coronary artery lesions can be, or not, responsible for myocardial ischemia. The functional analysis of these lesions can be performed by invasive and noninvasive methods.

Objective:

To compare the functional analysis of moderate coronary lesions by fractional flow reserve and myocardial perfusion scintigraphy.

Methods:

47 patients with stable coronary artery disease and at least one moderate coronary artery obstruction were prospectively studied. They were submitted to fractional flow reserve and myocardial perfusion scintigraphy with a median interval of 24.5 days between January 2013 and December 2015. There was no change in clinical status or revascularization procedure between the exams. The population variables were described as medians and interquartile range. Fractional flow reserve was performed in one left main coronary artery; 37 left descending coronary arteries; 12 circumflex arteries and 4 right coronary arteries. Fractional flow reserve < 0.8 was considered positive. The comparative analysis between the results of the tests was performed by two-tailed Fisher’s test and a p-value ≤ 0.05 was considered significant.

Results:

Fractional flow reserve < 0.8 was found in the left main coronary artery (100%); 13 in the left descending coronary artery (35.14%); 6 in circumflex artery (50%) and 2 in the right coronary artery (50%). Among the patients with positive fractional flow reserve, 83% had myocardial ischemia demonstrated by the myocardial perfusion scintigraphy (p = 0.058). When analyzing specifically the left descending coronary artery, 83% of the patients with negative fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy, but 69% of the patients with positive fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy (p = 0.413).

Conclusion:

Disagreements can occur between the results of the functional analysis of moderate coronary lesions by invasive and noninvasive tests.

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Original Article

Superior Cardiovascular Effect of the Periodized Model for Prescribed Exercises as Compared to the Conventional one in Coronary Diseases

Rafael Michel de Macedo et al. Ana Carolina Brandt de Macedo Jose R. Faria-Neto Costantino R. Costantini … Costantino O. Costantini Marcia Olandoski Flavio Sebastião Neto Rafael P. da Silveira Katherine A. Teixeira de Carvalho Luiz Cesar Guarita-Souza

Abstract

Background:

Physical exercise improves the survival and quality of life of coronary patients, but the ideal way of prescribing these exercises is still controversial.

Objective:

To create a new periodized model for the prescription of exercises for coronary patients and compare it with a conventional model.

Methods:

62 coronary patients under pharmacological treatment were randomized into two groups: conventional (NPG, n = 33) and periodized (PG, n = 29) training. The two groups were submitted to the same exercises during the 36 sessions making up the program, but prescribed in different ways. All patients underwent an evaluation consisting of: medical admission consultancy, cardiopulmonary endurance testing, 1 maximum repetition test (1MR) and body composition evaluation.

Results:

The VO₂ peak improved in both groups, although more effectively in the PG (4% against 1.7%, p < 0.001). In addition, the functional capacity of this group improved by 13%, and there was a significant reduction in the percent body fat (2.1%, p < 0.005) and body weight (1.9 kg, p < 0.005). The muscle strength of both groups improved as diagnosed by the 1RM test for six different muscle groups (quadriceps, hamstrings, brachial biceps, brachial triceps, pectoral and large dorsal), and showed no significant difference between the groups, evidencing that the two models had the same efficiency.

Conclusions:

The present study showed that periodization of the training of cardiac patients can improve their cardiorespiratory capacity and reduce the percent body fat more effectively than the conventional one.

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Editorial

Can Cardiopulmonary Exercise Test Contribute to Train Soccer Players?

Soccer, which draws crowds and moves huge sums of money, has not been dissociated from science, being frequently approached in studies conducted by the academy or upon request of technical teams, aimed at optimizing the sports outcomes.

A training plan is used to prepare for the soccer competition and comprises purely physical, psychological, technical (p. ex.: pass, dribble, feint, leaps) and tactical components. In the preseason and during the competitive season, coaches measure and monitor different variables of the training.

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Case Report

Sirolimus-Eluting Balloon Treatment of Distal Internal Mammary Artery Anastomosis: Optical Coherence Tomography Findings

Marcos Garcia-Guimarães et al. Ramón Maruri-Sanchez Javier Cuesta Fernando Rivero … Teresa Bastante Fernando Alfonso

Drug-eluting balloons (DEB) represent an interesting alternative to current generation drug-eluting stents (DES) in selected anatomic scenarios, such as in-stent restenosis, small-vessel disease and bifurcation lesions, where the systematic implantation of DES may result less appealing.^, In particular, lesions located at the distal anastomosis of a bypass graft (an artificially created bifurcation) constitute a unique anatomic setting, where DEB may overcome some inherent limitations of DES resulting from the implantation of a metallic platform throughout the bypass graft into and across the native distal vessel.

Herein we present, to the best of our knowledge, the first report of the treatment of a lesion located at the distal anastomosis of a left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) with a novel sirolimus-DEB. Interestingly, optical coherence tomography (OCT) findings proved to be of major value to guide the procedure.

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Case Report

Cardiac Amyloidosis with Heart Failure and Middle Range Ejection Fraction

Antonio Jose Lagoeiro Jorge et al. Diane Xavier de Ávila Enoï Guedes Vilar Mario Luiz Ribeiro … Karima Elias Hallack Bruno Ana Carolina Pires

Introduction

Cardiac amyloidosis (CA) is a disease with a difficult diagnosis, limited management and a reserved prognosis.^, A high level of suspicion is necessary for its identification. There are some clinical clues, such as elderly individuals with unexplained left ventricular hypertrophy (LVH), heart failure with preserved ejection fraction (HFpEF) and restrictive pattern, dissociation between LVH on echocardiography and low voltage on the electrocardiogram, among others.^,

CA can occur with several hemodynamic forms and patterns of remodeling, according to the disease evolution stage. It may occur as the restrictive form, with left ventricular ejection fraction > 50%; and dilated form, with reduced ejection fraction.^, Recently, the European Society of Cardiology has established a new classification with the creation of “Heart Failure with Mid-Range Ejection Fraction” (HFmrEF). We report a case of CA with HFmrEF.

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Editorial

Is Cardiorespiratory Optimal Point Measured During the Maximal Cardiopulmonary Exercise Test a Relevant Indicator of Sports Performance?

Jari A. Laukkanen

Cardiorespiratory fitness (CRF) is considered the gold standard for assessing aerobic performance among athletes and normal population and has recently been named as a clinical vital sign, being an essential indicator of cardiovascular and pulmonary function. Cardiorespiratory fitness is associated with lower risk of non-fatal and fatal cardiovascular disease (CVD) events, with studies demonstrating a consistent, inverse association between CRF and mortality even after adjustment for the traditional risk factor burden. Additionally, both maximal oxygen consumption (VO₂max) and VO₂ at ventilatory threshold (VT) have been associated with a reduced risk of adverse health outcomes.^,^– A literature-based meta-analysis of 33 observational cohort studies has better delineated the relationship of CRF with CVD and all-cause mortality outcomes. However, VO₂max and VT are often used to evaluate athletes’ performance and to monitor their training responses. During the cardiopulmonary exercise test (CPX), many variables could be used to assess specific training responses to the cardiovascular, respiratory and musculoskeletal systems based on the analysis of submaximal and maximal responses to a progressively incremental exercise.

Modern CPX systems allow for the analysis of gas exchange at rest, during mild, moderate and maximal exercise levels, and during recovery and yield measures of VO₂, carbon dioxide output (VCO₂), and ventilation (VE). These advanced computerized systems provide both simple and complex analyses of these data that are easy to retrieve and store, which makes CPX widely available. Oxygen uptake at VT, often referred to as the anaerobic threshold, is a variable assessed at submaximal level of CPX. For majority of healthy individuals, the anaerobic threshold lies at exercise intensities between 50% and 75% of VO₂max, while in trained endurance athletes, it can reach intensities as high as 80% of VO₂max.

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Review Article

Telerehabilitation for Cardiac Patients: Systematic Review

Danieli de Cristo et al. Natan Pinto do Nascimento Alexandre Simões Dias Amanda Sachetti

Abstract

Cardiovascular rehabilitation is one nonpharmacological intervention used to treat cardiovascular diseases. Despite the proven benefits of cardiovascular rehabilitation, the adherence of patients with heart disease is low. Thus, the alternative of telerehabilitation has gained importance, and many studies are being carried out to verify its efficacy.

To review the literature and assess the efficacy of telerehabilitation for the cardiac population.

This is a systematic review of the literature. The search was conducted in the electronic databases MEDLINE/PubMed (Medical Literature Analysis and Retrieval System Online), PubMed Central^® (PMC), Cochrane Library, and Physiotherapy Evidence Database (PEDro), using the combination of descriptors, including terms of the Medical Subject Headings (MeSH) and its entry terms. The MeSH terms used in combination were: “telerehabilitation” AND “cardiac rehabilitation” (). Then, a manual search by use of the articles selected, as well as a search in the gray literature, was conducted.

The search strategy collected 154 studies, of which 109 were excluded because of duplication in the databases and 29 for not being clinical studies. Sixteen clinical studies were included for full analysis, of which 2 were excluded for being prospective, 2 for being duplicate and 5 for not including any outcome. Thus, 7 studies were included.

Cardiac rehabilitation using telerehabilitation is a feasible and safe alternative to conventional rehabilitation, and has high adherence of patients with heart disease. It can be added to conventional cardiovascular rehabilitation programs or used in isolation.

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Review Article

Fatigue: A Complex Symptom and its Impact on Cancer and Heart Failure

Jacqueline Aparecida Borges et al. Mônica Maria Pena Quintão Sergio S. M.C. Chermont Hugo Tannus Furtado de Mendonça Filho Evandro Tinoco Mesquita

Abstract

In chronic diseases like cancer and heart failure (HF), fatigue is a common and complex symptom from an etiological and pathophysiological point of view, thus, a relevant issue in the recent area of oncocardiology. Fatigue is prevalent in 80-90% of the oncological patients treated with chemotherapy and/or radiotherapy and affects approximately 50-96% of the individuals with IC. The toxicity attributed to chemotherapeutic agents can determine the patients’ degree of fatigue and may even predict their survival. In recent decades, the advancement of antineoplastic therapies has substantially impacted the survival of patients with cancer, and the risks of harmful effects from these therapies to the cardiovascular system have been increasingly described. Therefore, the cooperation between oncologists and cardiologists has led to the emergence of oncocardiology and the new concept of cardiac surveillance. Cardiotoxicity is one of the clinical complications in the treatment of cancer, and its typical manifestation is left ventricular systolic dysfunction. New diagnostic and therapeutic strategies have been employed in the cardiac surveillance of patients with cancer. Fatigue in these patients has been carefully studied with a multidisciplinary approach and with the development of visual scales to quantify and correlate better its real impact on these individuals’ quality of life and survival. The Fatigue Pictogram and Piper Fatigue Scale are tools increasingly used in research and clinical practice. The mechanisms involved in fatigue, from a conceptual point of view, may be of central (central nervous system) or peripheral (muscular skeletal) origin, both of which may be present in patients with cancer. The present review aims to discuss the new concepts in the assessment of fatigue in oncological patients. These concepts are fundamental to professionals who work in the emerging area of oncocardiology.

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Original Article

Disparities in Acute Myocardial Infarction Treatment Between Users of the Public and Private Healthcare System in Sergipe

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 Luiz Flávio Andrade Prado Fábio Serra Silveira Thiago Augusto Nascimento Eduardo José Pereira Ferreira Rafael Vasconcelos Barreto Enilson Vieira Moraes José Teles de Mendonça Antonio Carlos Sobral Sousa José Augusto Barreto-Filho

Abstract

Background:

The Brazilian Unified Health System (SUS) was created to ensure universal, integral and equitable access to quality healthcare to Brazilians. However, studies scrutinizing the quality of the healthcare provided by the SUS are scarce. This is especially critical for patients with ST-elevation myocardial infarction (STEMI), who depend on healthcare system responsiveness and timely reperfusion to achieve better outcomes.

Objective:

To describe the methodology of the VICTIM Registry aimed at characterizing and comparing the access to effective therapies and the outcomes of patients with STEMI, who use the SUS and the private healthcare system at hospitals capable of performing angioplasty in Sergipe. In addition, that registry aimed at identifying and measuring possible disparities in the quality of the care provided.

Methods and Results:

The VICTIM Registry is an observational study, launched in December 2014, being still in the data collection phase, to investigate: the epidemiology of STEMI in Sergipe, the temporal and geographic courses of the patients up to their admission to one of the hospitals capable of performing angioplasty, the reperfusion therapy rates, the quality of the healthcare provided during the event, and the 30-day mortality. It compares the results obtained in the SUS with those of the private healthcare system.

Conclusions:

The VICTIM Registry is an interinstitutional effort to identify opportunities for healthcare improvement for SUS and private healthcare system patients with STEMI. It is expected to provide healthcare managers with information to support new, more efficient and equitable healthcare policies.

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Viewpoint

Cardiology and Films: An Important Teaching Tool

Ana Luisa Rocha Mallet et al. Fatima Geovanini Luciana Andrade David Kestenberg

Conclusion

The use of films or film scenes is an important tool to discuss heart conditions, not only regarding the disease’s technical aspects, but also the social, ethical and existential aspects involved in the diagnosis of a severe heart disease. To quote Arthur Kleinman, the laureate films “Manchester by the Sea” and “I, Daniel Blake” are examples that can help us practice medicine in a more sensitive and reflexive, alert and morally responsible way in face of the emotional and experiential challenges presented by the profession.

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