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Abstract Background: Due to its poor prognosis and mortality rates, heart failure (HF) has been recognized as a malignant condition, comparable to some cancers in developed countries. Objectives: To compare mortality from HF and prevalent cancers using data from a nationwide database in Brazil. Methods: This was a descriptive, cross-sectional study using secondary data obtained from Brazilian administrative databases of death records and hospitalization claims maintained by the Ministry of Health. Data were analyzed according to main diagnosis, year of occurrence (2005-2015), sex and age group. Descriptive analyses of absolute number of events, hospitalization rate, mortality rate, and in-hospital mortality rate were performed. Results: The selected cancers accounted for higher mortality, lower hospitalization and higher in-hospital mortality rates than HF. In a group analysis, HF showed mortality rates of 100-150 per 100,000 inhabitants over the period, lower than the selected cancers. However, HF had a higher mortality rate than each type of cancer, even when compared to the most prevalent and deadly ones. Regarding hospitalization rates, HF was associated with a higher risk of hospitalization when compared to cancer-related conditions as a group. Conclusions: Our findings indicate that HF has an important impact on mortality, hospitalization and in-hospital mortality, comparable to or even worse than some types of cancer, representing a potential burden to the healthcare system.

https://doi.org/10.36660/ijcs.20200382

COVID-19 containment management strategies in a nursing home
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Barretto Filho, Antonio Carlos Pereira

; Salotto, Danute Bareisys

; Schoueri, João Francisco Lindenberg

; Tsutsui, Jeane Mike

; Granato, Celso Francisco Hernandes

; Yamaguchi, Marianna Barbosa

; Carvalho, Riciane de

; Zacarias, Nadir

; Marcelino, Antônio Sérgio Zafred

; Rabelo, Rogerio

; Jacob Filho, Wilson

einstein (São Paulo)

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2022, Volume 20 elocation eAO6175

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To describe the first COVID-19 pandemic at Casa Ondina Lobo, a philanthropic nursing home in São Paulo city, and the containment measures against the pandemic that proved to be effective. Methods: Several preventive measures were taken before and during the pandemic, with emphasis on universal testing by reverse transcription polymerase chain reaction for COVID-19. All residents and employees were tested twice in a D9 period. Results: Among the 62 residents and 55 employees, in both testing, eight residents and nine employees tested positive for COVID-19. Of 22% of employees and 75% of residents evolved asymptomatic, emphasizing the importance of universal testing for the detection and isolation of these cases. A quarter of residents evolved without any symptoms, however, with COVID-19 signs, reinforcing the importance of monitoring vital signs. The second testing did not detect any new cases among residents, demonstrating the effectiveness of the containment measures, however, it found four new cases among employees. This emphasized their role in COVID-19 outbreaks in nursing homes. Only one patient died, a 12.5% lethality among those known to be infected and a 1.6% mortality in the total population of residents were seen. Conclusion: The adoption of appropriate containment measures enabled to contain an COVID-19 pandemic in studied nursing home. Universal reverse transcription polymerase chain reaction testing for COVID-19 has proved to be particularly important and effective.

https://doi.org/10.31744/einstein_journal/2022ao6175

Atualização de Tópicos Emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021
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Marcondes-Braga, Fabiana G.

; Moura, Lídia Ana Zytynski

; Issa, Victor Sarli

; Vieira, Jefferson Luis

; Rohde, Luis Eduardo

; Simões, Marcus Vinícius

; Fernandes-Silva, Miguel Morita

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Albuquerque, Denilson Campos de

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Ramires, Felix José Alvarez

; Bacal, Fernando

; Rossi Neto, João Manoel

; Danzmann, Luiz Claudio

; Montera, Marcelo Westerlund

; Oliveira Junior, Mucio Tavares de

; Clausell, Nadine

; Silvestre, Odilson Marcos

; Bestetti, Reinaldo Bulgarelli

; Bernadez-Pereira, Sabrina

; Freitas Jr, Aguinaldo F.

; Biolo, Andréia

; Barretto, Antonio Carlos Pereira

; Jorge, Antônio José Lagoeiro

; Biselli, Bruno

; Montenegro, Carlos Eduardo Lucena

; Santos Júnior, Edval Gomes dos

; Figueiredo, Estêvão Lanna

; Fernandes, Fábio

; Silveira, Fabio Serra

; Atik, Fernando Antibas

; Brito, Flávio de Souza

; Souza, Germano Emílio Conceição

; Ribeiro, Gustavo Calado de Aguiar

; Villacorta, Humberto

; Souza Neto, João David de

; Goldraich, Livia Adams

; Beck-da-Silva, Luís

; Canesin, Manoel Fernandes

; Bittencourt, Marcelo Imbroinise

; Bonatto, Marcely Gimenes

; Moreira, Maria da Consolação Vieira

; Avila, Mônica Samuel

; Coelho Filho, Otavio Rizzi

; Schwartzmann, Pedro Vellosa

; Mourilhe-Rocha, Ricardo

; Mangini, Sandrigo

; Ferreira, Silvia Moreira Ayub

; Figueiredo Neto, José Albuquerque de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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jun 2021, Volume 116 N. 6 Pages 1174 - 1212

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210367 3168 downloads

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides

; Moreira, Henrique Turin

; Nakamuta, Juliana Sanajotti

; Simões, Marcus Vinicius

; Casas, Alberto de Almeida Las

; Costa, Altamiro Reis da

; Assis, Amberson Vieira de

; Durães, André Rodrigues

; Pereira-Barretto, Antonio Carlos

; Ravessa, Antonio Delduque de Araujo

; Macedo, Ariane Vieira Scarlatelli

; Biselli, Bruno

; Pinto, Carolina Maria Nogueira

; Filho, Conrado Roberto Hoffmann

; Costantini, Costantino Roberto

; Almeida, Dirceu Rodrigues

; Santos Jr, Edval Gomes dos

; Soliva Junior, Erwin

; Figueiredo, Estevão Lanna

; Albuquerque, Felipe Neves de

; Paulitsch, Felipe

; Neuenschwander, Fernando Carvalho

; Figueiredo Neto, José Albuquerque de

; Brito, Flavio de Souza

; Lopes, Heno Ferreira

; Villacorta, Humberto

; Souza Neto, João David de

; Sepulveda, João Mariano

; Ayoub, José Carlos Aidar

; Vilela-Martin, José F.

; Cardoso, Juliano Novaes

; Uemura, Laercio

; Moura, Lidia Zytynski

; Maia, Lilia Nigro

; Oliveira, Lucia Brandão de

; Maia, Lucimir

; Silva, Luís Beck da

; Gowdak, Luís Henrique Wolff

; Danzmann, Luiz Claudio

; Andrade, Marcus

; Braile-Sternieri, Maria Christiane Valeria Braga

; Moreira, Maria da Consolação Vieira

; França Neto, Olimpio R

; Filho, Otavio Rizzi Coelho

; Esteves, Paulo Frederico

; Raupp-da-Rosa, Priscila

; Silva, Ricardo Jorge de Queiroz e

; Mourilhe-Rocha, Ricardo

; Viégas, Ruy Felipe Melo

; Rassi, Salvador

; Mangili, Sandrigo

; Kaiser, Sergio Emanuel

; Martins, Silvia Marinho

; Kawabata, Vitor Sergio

Clinics

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2021, Volume 76 elocation e1991

Abstract: En | Text: En | PDF: En

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

https://doi.org/10.6061/clinics/2021/e1991 870 downloads

O Tratamento Medicamentoso Habitual é Suficiente para Manter o Controle da Frequência Cardíaca nos Pacientes com Insuficiência Cardíaca?
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Cardoso, Juliano

; Espíndola, Mateus Dressler de

; Cunha, Mauricio

; Netto, Enock

; Cardoso, Cristina

; Novaes, Milena

; Del Carlo, Carlos Henrique

; Brancalhão, Euler

; Name, Alessandro Lyra

; Barretto, Antonio Carlos Pereira

Arquivos Brasileiros de Cardiologia

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dec 2020, Volume 115 N. 6 Pages 1063 - 1069

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Estudos revelam que pacientes com insuficiência cardíaca (IC) e frequência cardíaca (FC) <70 batimentos por minuto (bpm) evoluem melhor e têm menor morbimortalidade em comparação com FC >70. Entretanto, muitos pacientes com IC mantêm FC elevada. Objetivo Avaliar se os pacientes acompanhados em ambulatório de cardiologia têm sua FC controlada e como estava a prescrição dos medicamentos que reduzem a mortalidade na IC. Métodos Foram analisados de forma consecutiva pacientes que passaram em consulta e que já acompanhavam em ambulatório de cardiologia, idade > 18 anos e com diagnóstico de IC e fração de ejeção do ventrículo esquerdo (FEVE) <45%. Os pacientes em ritmo sinusal foram divididos em dois grupos: FC ≤70 bpm (G1) e FC >70 bpm (G2). Na análise estatística, foram utilizados os testes t de Student, Qui-quadrado. Foi considerado significante p <0,05. Utilizamos o programa Statistical Package for the Social Sciences (SPSS) para análise. Resultados Foram avaliados 212 pacientes de forma consecutiva. Destes, 41 (19,3%) apresentavam fibrilação atrial ou eram portadores de marca-passo e foram excluídos desta análise; assim, 171 pacientes foram analisados. Os pacientes em ritmo sinusal tinham idade média de 63,80 anos (±11,77), sendo 59,6% homens e FEVE média de 36,64% (±7,79). Com relação à etiologia, a isquêmica estava presente em 102 pacientes (59,65%), enquanto a cardiopatia chagásica em 17 pacientes (9,9%); 131 pacientes eram hipertensos (76,6%), enquanto 63 pacientes (36,84%) eram diabéticos. Quanto à FC, 101 pacientes apresentaram FC ≤70 bpm (59,06%) G1 e 70 pacientes (40,93%) FC >70 bpm (G2). A FC média no G1 foi de 61,53 bpm (±5,26) e no G2, 81,76 bpm (±9,52), p <0,001. A quase totalidade dos pacientes (98,8%) estava sendo tratada com carvedilol prescrito na dose média de 42,14 mg/dia (±18,55) no G1 versus 42,48 mg/dia (±21,14) no G2, p=0,911. A digoxina foi utilizada em 5,9% dos pacientes no G1 versus 8,5% no G2, p=0,510. A dose média de digoxina no G1 foi de 0,19 mg/dia (±0,06) e no G2 foi de 0,19 mg/dia (±0,06), p=0,999. A maioria dos pacientes (87,72%) utilizou o inibidor da enzima de conversão da angiotensina (IECA) ou bloqueador do receptor da angiotensina (BRA), e 56,72% utilizaram espironolactona. A dose média de enalapril foi de 28,86 mg/dia (±12,68) e de BRA foi de 87,80 mg/dia (±29,80). A maioria dos pacientes utilizou IECA ou BRA e com doses adequadas. Conclusão O estudo revelou que 40,93% dos pacientes estavam com FC acima de 70 bpm, apesar de o betabloqueador ter sido prescrito para praticamente todos os pacientes e em doses elevadas. Outras medidas precisam ser adotadas para manter a FC mais controlada nesse grupo de frequência mais elevada. (Arq Bras Cardiol. 2020; 115(6):1063-1069)

Abstract Background Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR. Objective To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic. Methods We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups – HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student’s t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses. Results A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients. Conclusion The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069)

https://doi.org/10.36660/abc.20190090 960 downloads

Tópicos Emergentes em Insuficiência Cardíaca: Perspectivas Futuras
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Oliveira Jr, Mucio Tavares de

; Villacorta, Humberto

; Bittencourt, Marcelo Imbroinise

; Barretto, Antônio Carlos Pereira

; Mesquita, Evandro Tinoco

; Rohde, Luis Eduardo

Arquivos Brasileiros de Cardiologia

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dec 2020, Volume 115 N. 6 Pages 1197 - 1200

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20201205 449 downloads

Minieditorial: O Polimorfismo Genético do Receptor Beta-Adrenérgico Tipo 1 Ser49Gly é Preditor de Morte em Pacientes Brasileiros com Insuficiência Cardíaca
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Pereira-Barretto, Antonio Carlos

Arquivos Brasileiros de Cardiologia

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apr 2020, Volume 114 N. 4 Pages 625 - 626

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20200183 515 downloads

Infection in Patients with Decompensated Heart Failure: In-Hospital Mortality and Outcome
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Cardoso, Juliano Novaes

; Del Carlo, Carlos Henrique

; Oliveira Junior, Mucio Tavares de

; Ochiai, Marcelo Eidi

; Kalil Filho, Roberto

; Barretto, Antônio Carlos Pereira

Arquivos Brasileiros de Cardiologia

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apr 2018, Volume 110 N. 4 Pages 364 - 370

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A insuficiência cardíaca (IC) é uma síndrome cujas formas avançadas têm mau prognóstico, que é mais agravado pela presença de comorbidades. Objetivo: Avaliamos o impacto da infecção em pacientes com IC descompensada que internaram em hospital universitário terciário de São Paulo. Métodos: Estudamos 260 pacientes consecutivos que internaram em nossa unidade com IC descompensada. Avaliamos a presença de infecção e de outras morbidades. Avaliaram-se mortalidade hospitalar e evolução após a alta. A chance de óbito foi estimada pela análise de regressão logística univariada para as variáveis estudadas. Considerou-se P < 0,05 significativo. Resultados: Dos pacientes estudados, 54,2% eram homens, sendo a idade média ± DP de 66,1 ± 12,7 anos. Durante a internação, 119 pacientes (45,8%) apresentaram infecção: 88 (33,8%) tiveram diagnóstico de infecção pulmonar e 39 (15%), de infecção urinária. A mortalidade hospitalar ocorreu em 56 pacientes (21,5%) e, após a alta, 36 pacientes (17,6%) morreram no seguimento. Durante a internação, 26,9% do grupo com infecção morreu vs 17% do grupo sem infecção (p = 0,05). Entretanto, após a alta, a mortalidade foi menor no grupo com infecção: 11,5% vs 22,2% (p = 0,046). Conclusões: Infecção é uma comorbidade frequente entre os pacientes com IC internados para compensação, causando um aumento da mortalidade durante a hospitalização. Entretanto, após a alta, os pacientes inicialmente com infecção apresentaram melhor evolução.

Abstract Background: Heart failure (HF) is a syndrome, whose advanced forms have a poor prognosis, which is aggravated by the presence of comorbidities. Objective: We assessed the impact of infection in patients with decompensated HF admitted to a tertiary university-affiliated hospital in the city of São Paulo. Methods: This study assessed 260 patients consecutively admitted to our unit because of decompensated HF. The presence of infection and other morbidities was assessed, as were in-hospital mortality and outcome after discharge. The chance of death was estimated by univariate logistic regression analysis of the variables studied. The significance level adopted was P < 0.05. Results: Of the patients studied, 54.2% were of the male sex, and the mean age ± SD was 66.1 ± 12.7 years. During hospitalization, 119 patients (45.8%) had infection: 88 (33.8%) being diagnosed with pulmonary infection and 39 patients (15.0%), with urinary infection. During hospitalization, 56 patients (21.5%) died, and, after discharge, 36 patients (17.6%). During hospitalization, 26.9% of the patients with infection died vs 17% of those without infection (p = 0.05). However, after discharge, mortality was lower in the group that had infection: 11.5% vs 22.2% (p = 0.046). Conclusions: Infection is a frequent morbidity among patients with HF admitted for compensation of the condition, and those with infection show higher in-hospital mortality. However, those patients who initially had infection and survived had a better outcome after discharge.

https://doi.org/10.5935/abc.20180037 3071 downloads

10.

Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure
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Santos, Marcelo Rodrigues dos

; Sayegh, Ana Luiza Carrari

; Groehs, Raphaela Vilar Ramalho

; Fonseca, Guilherme

; Trombetta, Ivani Credidio

; Barretto, Antônio Carlos Pereira

; Arap, Marco Antônio

; Negrão, Carlos Eduardo

; Middlekauff, Holly R.

; Alves, Maria-Janieire de Nazaré Nunes

Arquivos Brasileiros de Cardiologia

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sep 2015, Volume 105 N. 3 Pages 256 - 264

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Fundamento:A deficiência de testosterona na insuficiência cardíaca (IC) está associada à diminuição da capacidade de exercício e mortalidade, mas o seu impacto sobre as readmissões é incerto. Além disso, sua relação com a ativação simpática é desconhecida.Objetivo:O presente estudo investigou o papel dos níveis de testosterona nas reinternações hospitalares, na mortalidade e na atividade nervosa simpática em pacientes com IC.Métodos:A testosterona total (TT) e a testosterona livre (TL) foram medidas em 110 pacientes do sexo masculino hospitalizados, com fração de ejeção < 45% eclassificação funcional da New York Heart Association (NYHA) IV, qualificados em dois grupos: 66 com baixos níveis de testosterona (BT) e 44 com testosterona normal (TN). Hipogonadismo foi definido como TT < 300 ng/dL e TL < 131 pmol/L. A atividade nervosa simpática muscular (ANSM) foi gravada por microneurografia em uma subpopulação de 27 pacientes.Resultados:O tempo de permanência hospitalar foi maior em pacientes BT em comparação com pacientes TN (37 ± 4 vs. 25 ± 4 dias; p = 0,008). Da mesma forma, o risco cumulativo de readmissão no período de um ano foi maior em pacientes BT (44% vs. 22%, p = 0,001). Na análise de uma única variável preditora, a testosterona total (HR = 2,77, IC 95% 1,58-4,85, p = 0,02) previu readmissão hospitalar no prazo de 90 dias. Na análise de uma única variável preditora, testosterona total (HR = 4,65, IC 95% 2,67-8,10, p = 0,009) e readmissão dentro de 90 dias (HR = 3,27, IC 95% 1,23-8,69, p = 0,02) previram aumento de mortalidade. Ativação neuro-humoral, estimada pela ANSM, foi significativamente maior nos pacientes BT em comparação aos do grupo TN (65 ± 3 vs. 51 ± 4 disparos/100BC; p < 0,001).Conclusão:Estes resultados sustentam o conceito de que BT é um fator de risco independente para a readmissão hospitalar dentro de 90 dias e para aumento de mortalidade em pacientes com IC. Além disso, observou-se aumento da ANSM em pacientes com baixos níveis de testosterona.

Background:Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.Objective:We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.Methods:Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.Results:Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001).Conclusion:These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

https://doi.org/10.5935/abc.20150078 2300 downloads

11.

Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure
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Reis Filho, José Rosino de Araújo Rocha

; Cardoso, Juliano Novaes

; Cardoso, Cristina Martins dos Reis

; Pereira-Barretto, Antonio Carlos

Arquivos Brasileiros de Cardiologia

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jun 2015, Volume 104 N. 6 Pages 502 - 506

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Na síndrome da insuficiência cardíaca, a disfunção do miocárdio gera um aumento da atividade neuro-hormonal, que é um mecanismo adaptativo e compensatório em resposta à redução do débito cardíaco. A atividade neuro-hormonal é estimulada inicialmente na tentativa de manter o paciente compensado, mas quando permanece aumentada, contribui para a intensificação das manifestações clínicas e do dano miocárdico. A remodelação cardíaca consiste nas alterações no volume do ventrículo bem como na espessura e forma da parede do miocárdio. Com o tratamento otimizado, pode ocorrer a reversão da remodelação, com melhora gradual da função cardíaca e consequente melhora do prognóstico.

In heart failure syndrome, myocardial dysfunction causes an increase in neurohormonal activity, which is an adaptive and compensatory mechanism in response to the reduction in cardiac output. Neurohormonal activity is initially stimulated in an attempt to maintain compensation; however, when it remains increased, it contributes to the intensification of clinical manifestations and myocardial damage. Cardiac remodeling comprises changes in ventricular volume as well as the thickness and shape of the myocardial wall. With optimized treatment, such remodeling can be reversed, causing gradual improvement in cardiac function and consequently improved prognosis.

https://doi.org/10.5935/abc.20150025 5473 downloads

12.

Variação Temporal no Prognóstico e Tratamento da Insuficiência Cardíaca Avançada - Antes e Após 2000
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Carlo, Carlos Henrique Del

; Cardoso, Juliano Novaes

; Ochia, Marcelo Eidi

; Oliveira Jr., Mucio Tavares de

; Ramires, José Antonio Franchini

; Pereira-Barretto, Antonio Carlos

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

jun 2014, Volume 102 N. 5 Pages 495 - 504

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Fundamento: O tratamento da insuficiência cardíaca evoluiu nas últimas décadas, sugerindo que sua sobrevida tem aumentado. Objetivo: Verificar se houve melhora na sobrevida dos pacientes com insuficiência cardíaca avançada. Métodos: Comparamos retrospectivamente os dados de seguimento e tratamento de duas coortes de pacientes com insuficiência cardíaca sistólica admitidos para compensação até o ano 2000 (n = 353) e após 2000 (n = 279). Foram analisados: morte hospitalar, re-hospitalizações e morte no seguimento de 1 ano. Utilizamos os testes U de Mann-Whitney e qui-quadrado para comparação entre os grupos. Os preditores de mortalidade foram identificados pela análise de regressão por meio do método dos riscos proporcionais de Cox e análise de sobrevida pelo método de Kaplan-Meier. Resultados: Os pacientes internados até o ano 2000 eram mais jovens, tinham menor comprometimento ventricular esquerdo e receberam menor proporção de betabloqueadores na alta. A sobrevida dos pacientes hospitalizados antes de 2000 foi menor do que a dos hospitalizados após 2000 (40,1% vs. 67,4%; p < 0,001). Os preditores independentes de mortalidade na análise de regressão foram: a etiologia chagásica (hazard ratio: 1,9; intervalo de confiança de 95%: 1,3-3,0), inibidores da enzima conversora da angiotensina (hazard ratio: 0,6; intervalo de confiança de 95%: 0,4-0,9), betabloqueador (hazard ratio: 0,3; intervalo de confiança de 95%: 0,2-0,5), creatinina ≥ 1,4 mg/dL (hazard ratio: 2,0; intervalo de confiança de 95%: 1,3-3,0), sódio sérico ≤ 135 mEq/L (hazard ratio: 1,8; intervalo de confiança de 95%: 1,2-2,7). Conclusões: Pacientes com insuficiência cardíaca avançada apresentaram melhora significativa na sobrevida e redução nas re-hospitalizações. O bloqueio neuro-hormonal, com inibidores da enzima conversora da angiotensina e betabloqueadores, teve papel importante no aumento da sobrevida desses pacientes com insuficiência cardíaca avançada.

Background: The treatment of heart failure has evolved in recent decades suggesting that survival is increasing. Objective: To verify whether there has been improvement in the survival of patients with advanced heart failure. Methods: We retrospectively compared the treatment and follow-up data from two cohorts of patients with systolic heart failure admitted for compensation up to 2000 (n = 353) and after 2000 (n = 279). We analyzed in-hospital death, re-hospitalization and death in 1 year of follow-up. We used Mann-Whitney U test and chi-square test for comparison between groups. The predictors of mortality were identified by regression analysis through Cox proportional hazards model and survival analysis by the Kaplan-Meier survival analysis. Results: The patients admitted until 2000 were younger, had lower left ventricular impairment and received a lower proportion of beta-blockers at discharge. The survival of patients hospitalized before 2000 was lower than those hospitalized after 2000 (40.1% vs. 67.4%; p<0.001). The independent predictors of mortality in the regression analysis were: Chagas disease (hazard ratio: 1.9; 95% confidence interval: 1.3-3.0), angiotensin-converting-enzyme inhibitors (hazard ratio: 0.6; 95% confidence interval: 0.4-0.9), beta-blockers (hazard ratio: 0.3; 95% confidence interval: 0.2-0.5), creatinine ≥ 1.4 mg/dL (hazard ratio: 2.0; 95% confidence interval: 1.3-3.0), serum sodium ≤ 135 mEq/L (hazard ratio: 1.8; 95% confidence interval: 1.2-2.7). Conclusions: Patients with advanced heart failure showed a significant improvement in survival and reduction in re-hospitalizations. The neurohormonal blockade, with angiotensin-converting-enzyme inhibitors and beta-blockers, had an important role in increasing survival of these patients with advanced heart failure.

https://doi.org/10.5935/abc.20140050 2844 downloads

13.

Tratamento otimizado e redução da frequência cardíaca na insuficiência cardíaca crônica
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Moreno, Irineu Blanco

; Carlo, Carlos Henrique Del

; Pereira-Barretto, Antônio Carlos

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

nov 2013, Volume 101 N. 5 Pages 442 - 448

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A Insuficiência Cardíaca (IC) é uma síndrome que cursa com má evolução nas formas avançadas. O bloqueio neuro-hormonal modifica essa história natural; no entanto, ele com frequência é subotimizado. OBJETIVO: Neste estudo procuramos verificar em qual percentual médicos cardiologistas habituados no tratamento da IC conseguem prescrever as doses-alvo dos medicamentos de comprovada eficácia. MÉTODOS: Foram selecionados consecutivamente 104 pacientes ambulatoriais com disfunção sistólica, todos sob tratamento estabilizado. Avaliaram-se dados demográficos e o tratamento verificando-se as doses atingidas. Os achados são apresentados em percentual e fizeram-se correlações entre as diferentes variáveis. RESULTADOS: A idade média dos pac. foi de 64,1 ± 14,2 anos, com PAS 115,4 ± 15,3 mmHg, FC de 67,8 ± 9,4 bpm, peso 76,0 ± 17,0 kg e em ritmo sinusal (90,4%). Quanto ao tratamento, 93,3% estavam recebendo um bloqueador do SRA (52,9% IECA), todos recebiam betabloqueador (BB), sendo o carvedilol o mais prescrito (92,3%). Quanto às doses: 97,1% dos que recebiam um BRA estavam com dose abaixo da ideal; os que recebiam IECA 52,7% receberam dose otimizada. Quanto ao BB, em 76,0% foi possível prescrever as doses alvos. Nesse grupo de pac. a maioria com dose alvo do BB, pode-se observar que 36,5% apresentavam frequência cardíaca igual ou maior que 70 bpm em ritmo sinusal. CONCLUSÕES: Médicos cardiologistas habituados no tratamento da IC conseguem prescrever as doses-alvo de inibidores da ECA e BB para a maioria dos pac. Mesmo recebendo as doses preconizadas, cerca de um terço dos pac. persiste com FC acima de 70 bpm e deveria ter seu tratamento otimizado.

BACKGROUND: Heart failure (HF) is a syndrome that leads to poor outcome in advanced forms. The neurohormonal blockade modifies this natural history; however, it is often suboptimal. OBJECTIVE: The aim of this study is to assess at what percentage cardiologists used to treating HF can prescribe target doses of drugs of proven efficacy. METHODS: A total of 104 outpatients with systolic dysfunction were consecutively enrolled, all under stabilized treatment. Demographic and treatment data were evaluated and the doses achieved were verified. The findings are shown as percentages and correlations are made between different variables. RESULTS: The mean age of patients was 64.1 ± 14.2 years, with SBP =115.4 ± 15.3, HR = 67.8 ± 9.4 bpm, weight = 76.0 ± 17.0 kg and sinus rhythm (90.4%). As for treatment, 93.3% received a RAS blocker (ACEI 52.9%), all received beta-blockers (BB), the most often prescribed being carvedilol (92.3%). As for the doses: 97.1% of those receiving an ARB were below the optimal dose and of those who received ACEI, 52.7% received an optimized dose. As for the BB, target doses were prescribed to 76.0% of them. In this group of patients, most with BB target dose, it can be seen that 36.5% had HR > 70 bpm in sinus rhythm. CONCLUSION: Cardiologists used to treating HF can prescribe target doses of ACEI and BB to most patients. Even though they receive the recommended doses, about one third of patients persists with HR > 70 bpm and should have their treatment optimized.

https://doi.org/10.5935/abc.20130201 7550 downloads Cited 1 time in SciELO

14.

Papel dos níveis de BNP no prognóstico da insuficiência cardíaca avançada descompensada
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Pereira-Barretto, Antônio Carlos

; Del Carlo, Carlos Henrique

; Cardoso, Juliano Novaes

; Ochiai, Marcelo Eid

; Lima, Marcelo Villaça

; Curiati, Milena Cardoso

; Scipioni, Airton Roberto

; Ramires, José Antônio Franchini

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

mar 2013, Volume 100 N. 3 Pages 281 - 287

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A insuficiência cardíaca (IC) é doença que cursa com má evolução, especialmente naqueles com IC avançada. A dosagem de peptídeo natriurético tipo B(BNP), ao lado da utilidade no diagnóstico da descompensação cardíaca, vem se mostrando útil na avaliação prognóstica. OBJETIVOS: Verificar se os níveis de BNP identificam quais pacientes evoluiriam pior e se o BNP seria fator independente de mortalidade considerando-se idade, sexo, funções cardíaca e renal e etiologia da cardiopatia. MÉTODOS: 189 pacientes com IC avançada em classe funcional III/IV foram estudados. Todos tinham disfunção sistólica e dosaram-se os níveis de BNP na hospitalização. Analisaram-se as variáveis relacionadas com a mortalidade através de análises univariada e multivariada. RESULTADOS: Os níveis de BNP foram mais elevados nos pacientes que morreram no primeiro ano de seguimento (1.861,9 versus 1.408,1 pg/dL; p = 0,044) e nos chagásicos (1.985 versus 1.452 pg/mL; p = 0,001), e esses pacientes chagásicos tiveram maior mortalidade no primeiro ano de seguimento (56% versus 35%; p = 0,010). Pela curva ROC, o valor de BNP de 1.400 pg/mL foi o melhor preditor de eventos, estando os valores elevados associados a FEVE mais baixa (0,23 versus 0,28; p = 0,002) e maior grau de disfunção renal (ureia média 92 versus 74,5 mg/dL; p = 0,002). CONCLUSÃO: Na IC avançada, os níveis elevados de BNP identificam pacientes com maior potencial de pior evolução. Os pacientes chagásicos apresentam níveis mais elevados de BNP do que as outras etiologias e têm pior evolução.

BACKGROUND: Heart failure (HF) is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP) levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation. OBJECTIVES: To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an independent prognostic factor considering age, gender, cardiac and renal functions, as well as the cause of heart disease. METHODS: 189 patients in functional class III/IV advanced HF were studied. All had systolic dysfunction and had their BNP levels determined during hospitalization. Variables related to mortality were studied using univariate and multivariate analyses. RESULTS: BNP levels were higher in patients who died in the first year of follow-up (1,861.9 versus 1,408.1 pg/dL; p = 0.044) and in chagasic patients (1,985 versus 1,452 pg/mL; p = 0.001); the latter had a higher mortality rate in the first year of follow-up (56% versus 35%; p = 0.010). The ROC curve analysis showed that the BNP level of 1,400 pg/mL was the best predictor of events; high levels were associated with lower LVEF (0.23 versus 0.28; p = 0.002) and more severe degree of renal dysfunction (mean urea 92 versus 74.5 mg/dL; p = 0.002). CONCLUSION: In advanced HF, high BNP levels identified patients at higher risk of a poorer outcome. Chagasic patients showed higher BNP levels than those with heart diseases of other causes, and have poorer prognosis.

https://doi.org/10.5935/abc.20130066 12672 downloads

15.

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada
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Lima, Marcelo Villaça

; Ochiai, Marcelo Eidi

; Vieira, Kelly Novaes

; Cardoso, Juliano Novaes

; Brancalhão, Euler Cristovan

; Puig, Raphael

; Barretto, Antônio Carlos Pereira

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

sep 2012, Volume 99 N. 3 Pages 843 - 847

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A avaliação clínico-hemodinâmica à beira do leito e o uso do cateter de artéria pulmonar para a estimativa de dados hemodinâmicos têm sido utilizados na insuficiência cardíaca descompensada. Entretanto, não existem dados com o uso da monitorização hemodinâmica contínua não invasiva. OBJETIVO: Comparar as medidas obtidas com a monitorização hemodinâmica não invasiva com as invasivas em pacientes com insuficiência cardíaca descompensada e refratária ao tratamento. MÉTODOS: As medidas hemodinâmicas não invasivas foram obtidas através da monitorização contínua da pressão arterial sistêmica pelo modelo de ondas de pulso (modelflow) e foram comparadas com as medidas obtidas pela passagem do cateter de artéria pulmonar, simultaneamente. RESULTADOS: Foram realizadas 56 medidas em 14 pacientes estudados em dias e horários diferentes. O índice de correlação entre as medidas da pressão arterial sistólica foi de r = 0,26 (IC 95% = 0,00 a 0,49, p = 0,0492) e da diastólica de r = 0,50 (IC 95% = 0,27 a 0,67, p < 0,0001). A correlação foi de r = 0,55 (IC 95% = 0,34 a 0,71, p 0,0001) para o índice cardíaco e de r = 0,32 (IC 95% = 0,06 a 0,53, p = 0,0178) para a resistência vascular sistêmica. CONCLUSÃO: Houve correlação entre as medidas hemodinâmicas não invasivas quando comparadas às medidas do cateter de artéria pulmonar. A monitorização hemodinâmica contínua não invasiva pode ser útil para pacientes internados com insuficiência cardíaca descompensada.

BACKGROUND: The clinical and hemodynamic assessment at the bedside and the use of pulmonary artery catheter for the estimation of hemodynamic data have been used in decompensated heart failure. However, there are no data on the use of continuous noninvasive hemodynamic monitoring. OBJECTIVE: To compare the data obtained through noninvasive hemodynamic monitoring with invasive ones in patients with decompensated heart failure and refractory to treatment. METHODS: The non-invasive hemodynamic measurements were obtained through continuous monitoring of systemic blood pressure by the pulse wave model (Modelflow) and compared with measurements obtained by the passage of a pulmonary artery catheter, simultaneously. RESULTS: A total of 56 measurements were performed in 14 patients studied on different days and time periods. The correlation index between systolic blood pressure measurements was r = 0.26 (95% CI = 0.00 to 0.49, p = 0.0492) and diastolic ones, r = 0.50 (95% CI = 0.27 to 0.67, p <0.0001). The correlation was r = 0.55 (95% CI = 0.34 to 0.71, p <0.0001) for cardiac index and r = 0.32 (95% CI = 0.06 to 0 53, p = 0.0178) for systemic vascular resistance. CONCLUSION: There was a correlation between the hemodynamic measurements when compared to noninvasive pulmonary artery catheter measurements. The continuous noninvasive hemodynamic monitoring may be useful for hospitalized patients with decompensated heart failure.

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