Mortalidade por Doenças Cardiovasculares Segundo o Sistema de Informação sobre Mortalidade e as Estimativas do Estudo Carga Global de Doenças no Brasil, 2000-2017

BackgroundThe Brazilian Information System on Mortality (SIM) is of vital importance in monitoring the trends of cardiovascular diseases (CVDs) and is aimed at supporting public policies.ObjectiveTo compare historical series of CVD mortality based on data from the SIM, with and without correction, and from the Brazil Global Burden of Disease (GBD) Study 2017, in the 2000-2017 period.MethodsAnalysis of CVD mortality in Brazil between 2000 and 2017. Three CVD mortality estimates were compared: Crude SIM, Corrected SIM, and GBD 2017. Absolute numbers and age-standardized rates were used to compare the estimates for Brazil, its states and the Federal District.ResultsIn the SIM, the total of deaths ranged from 261,000, in 2000, to 359,000, in 2017. In the GBD 2017, the total of deaths ranged from 292,000 to 388,000, for the same years, respectively. A high proportion of the causes of death from CVD corresponded to garbage codes, classified according to the GBD 2017, reaching 42% in 2017. The rates estimated by GBD ranged from 248.8 (1990) to 178.0 (2017) deaths per 100,000 inhabitants. The rates of the Crude SIM and Corrected SIM also showed a reduction for the whole series analyzed, the Crude SIM showing lower rates: 204.9 (1990) and 155.1 (2017) deaths per 100 thousand inhabitants. When analyzing by the states and Federal District, the Crude SIM trends reversed, with an increase in mortality rates in the Northern and Northeastern states.ConclusionThis study shows the decrease in CVD mortality rates in Brazil in the period analyzed. Conversely, when analyzing by the states and Federal District, the Crude SIM showed an increase in those rates for the Northern and Northeastern states. The use of crude data from the SIM can result in interpretation errors, indicating an increase in rates, due to the increase in death data capture and the improvement in the definition of the underlying causes of death in the past decade, especially in the Northern and Northeastern regions, justifying the use of corrected data in mortality analyses. (Arq Bras Cardiol. 2020; 115(2):152-160)     

Conhecimento sobre a Doença e a Prática de Atividade Física em Crianças e Adolescentes com Cardiopatia Congênita

Background Knowledge about the disease itself can be important for self-care in patients with several problems and comprehends information about the diagnosis up to the most important clinical implications.Objective To identify the level of knowledge of children and adolescents with congenital heart disease (CHD) about their illness, and to analyze the association between the level of knowledge and the practice of physical activity.Methods Cross-sectional study with 335 patients with CHD, aged 8 to 13 years, followed at a referral pediatric cardiology service in Southern Brazil. Patients were interviewed regarding their knowledge about CHD and a review of medical records was performed to obtain details on heart disease and procedures. A significance level p<0.05 was used.Results More than 50% of the children and adolescents did not know how to say the name of their disease or explain it. After adjusted OR (AOR), cyanotic patients in comparison to acyanotic ones (AOR: 2.29; 95%CI: 1.76-6.71; p = 0.019); children with lower level of schooling (AOR: 2.20; 95%CI: 1.81-5.86; p = 0.025); and those who did not practice physical activity (AOR: 1.88; 95%CI: 1.09-3.45; p = 0.011) showed potential for incorrect answers or did not know their disease.Conclusion Cyanotic children and adolescents, with a lower level of schooling and who did not practice physical activity, had little knowledge about their disease. It is necessary to develop educational intervention strategies to increase knowledge and change behavior in physical activity promotion, according to the CHD complexity. (Arq Bras Cardiol. 2020; 114(5):786-792)     

Implementação do Programa Boas Práticas em Cardiologia adaptado do Get With The Guidelines ® em Hospitais Brasileiros: Desenho do Estudo e Fundamento

BackgroundThere are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program.ObjectiveTo evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals.MethodsThe Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association’s (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients’ health perception and patients’ adherence to prescribed interventions.ResultsIt is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries.ConclusionsThis real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral – Experiência Multicêntrica Brasileira

Background Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment.Objectives To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV).Methods Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05.Results From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm²; post-intervention, 2.18±0.36 cm²; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up.Conclusion The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients’ selection and of procedural planning. (Arq Bras Cardiol. 2020; 115(3):515-524)     

Fístulas da Artéria Coronária

Coronary artery fistula is a rare anatomic abnormality of the coronary arteries that affects 0.002% of the general population and represents 14% of all anomalies of coronary arteries. Its clinical relevance focuses mainly on the mechanism of the coronary steal phenomenon, causing myocardial functional ischemia, even in the absence of stenosis; therefore, angina and effort dyspnea are common symptoms. The suggested diagnostic approach is driven by patients’ symptoms, and it consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance, and coronary angiography. If it is not an incidental finding, coronary angiography is required in view of optimal therapeutic planning. Small fistulae are usually asymptomatic, and prognosis is excellent if they are managed medically with clinical follow-up and echocardiography every 2 to 5 years. Large/giant, symptomatic fistulae, on the contrary, should undergo invasive closure, via either transcatheter approach or surgical ligation, whose results are equivalent at long-term follow-up. Antibiotic prophylaxis for prevention of bacterial endocarditis is recommended in all patients with coronary artery fistulae who undergo dental, gastrointestinal, or urological procedures. Life-long follow-up is always essential to ensure that the patient does not undergo progression of the disease or further cardiac complications.