Adriana Lopes Latado

Aspectos clínicos e terapêuticos da insuficiência cardíaca por doença de Chagas

OBJECTIVE Describe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS A prospective analysis of the patients treated between August 2003 and June 2004 at a HF referral outpatient clinic was conducted. RESULTS Three hundred and fifty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 +/- 4.1 vs. 5.7 +/- 4.2 years of study; p = 0.004), had a lower heart rate (69 +/- 12 vs. 73 +/- 13; p = 0.03) and a lower systolic blood pressure (121 +/- 25 vs. 129 +/- 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artificial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSION In this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients.

Preditores de letalidade hospitalar em pacientes com insuficiência cardíaca avançada

OBJECTIVE Describe the clinical characteristics and identify potential risk factors for in-hospital lethality in patients with decompensated heart failure admitted to an intensive care unit. METHODS Decompensated heart failure patients consecutively admitted to an intensive care unit between June 2001 and December 2003 were selected and followed during hospitalization until discharge or death. Clinical characteristics at admission were recorded and evaluated as independent risk predictors for in-hospital mortality by multiple logistic regression analysis. RESULTS A total of 299 patients (69+/-13 years of age and 54% men) were enrolled. Coronary artery disease was the main cause of heart failure in 49% of the cases. Diabetes mellitus and systemic arterial hypertension occurred in 37.5% and 78% of the patients, respectively. At admission, 22% of them had atrial fibrillation, 21.5% had renal dysfunction, and 48% anemia (16.5% with severe anemia). Severe systolic dysfunction (left ventricular ejection fraction <30%) affected 44% of the patients. In-hospital mortality was 17.4%. After the multivariate analysis had been performed, previous history of stroke, atrial fibrillation, renal failure, age > 70 years, and hyponatremia were independently associated with in-hospital mortality. CONCLUSION Patients admitted to an intensive care unit due to decompensated heart failure have high in-hospital lethality. In this study, variables recorded at admission, such as previous stroke, atrial fibrillation, hyponatremia, renal failure, and age > 70 years were predictors of in-hospital lethality.

Existe evidência para tratar insuficiência cardíaca baseada na raça ou etnia

OBJECTIVE To assess if there is evidence to support different interventions for treatment of heart failure based upon race/ethnicity. METHODS Systematic review of randomized clinical trials permitted comparisons between blacks and whites with systolic heart failure concerning the efficacy of angiotensin converting enzyme (ACE) inhibitors, beta blockers and a combination of hydralazine/ nitrate to reduce the risks of death and hospitalization. The literature search was based on articles published between 1980 and December 2006 cited in MEDLINE or LILACS. RESULTS Three studies fulfilled the criteria of the reiew. In SOLVD, enalapril was efficient in reducing the risks of death or hospitalization similarly in whites (relative risk reduction (RRR) =18%) and blacks (RRR=17%). In US Carvedilol, carvediol was also associated with significant reduction in the risk of death or hospitalization both in whites (RRR=49%) and blacks (RRR=43%). In V-HeFT II, enalapril was superior to the combination hydralazine with nitrate in reducing the death risk only in whites. CONCLUSION According to the data ACE inhibitors and beta blockers should be considered as the essential drugs to improve the prognosis of heart failure both in blacks and whites. The A-HeFT study was not included in the review because it was restricted to blacks; however, it should be viewed as evidence that the combination hydralazine/nitrate is beneficial to improve survival in patients with advanced heart failure. Data support development of a clinical trial especially designed to assess if the combination hydralazine/nitrate is also efficient in patients not classified as blacks, with advanced heart failure.OBJECTIVE: To assess if there is evidence to support different interventions for treatment of heart failure based upon race/ethnicity. METHODS: Systematic review of randomized clinical trials permitted comparisons between blacks and whites with systolic heart failure concerning the efficacy of angiotensin converting enzyme (ACE) inhibitors, beta blockers and a combination of hydralazine/ nitrate to reduce the risks of death and hospitalization. The literature search was based on articles published between 1980 and December 2006 cited in MEDLINE or LILACS. RESULTS: Three studies fulfilled the criteria of the reiew. In SOLVD, enalapril was efficient in reducing the risks of death or hospitalization similarly in whites (relative risk reduction (RRR) =18%) and blacks (RRR=17%). In US Carvedilol, carvediol was also associated with significant reduction in the risk of death or hospitalization both in whites (RRR=49%) and blacks (RRR=43%). In V-HeFT II, enalapril was superior to the combination hydralazine with nitrate in reducing the death risk only in whites. CONCLUSION: According to the data ACE inhibitors and beta blockers should be considered as the essential drugs to improve the prognosis of heart failure both in blacks and whites. The A-HeFT study was not included in the review because it was restricted to blacks; however, it should be viewed as evidence that the combination hydralazine/nitrate is beneficial to improve survival in patients with advanced heart failure. Data support development of a clinical trial especially designed to assess if the combination hydralazine/nitrate is also efficient in patients not classified as blacks, with advanced heart failure.

Diet prescription in chronic heart failure: why don't we do it?

Prescripcion no medicamentosa, dieta, insuficiencia cardiaca. Los programas de tratamiento para pacientes portadores de insuficiencia cardiaca cronica son eficaces para reducir desenlaces clinicos, especialmente reinternaciones. En estos programas participan equipos multidisciplinarios, que incluyen a medicos clinicos y cardiologos, enfermeros, fisioterapeutas, sicologos, nutricionistas, entre otros1. Recientemente se esta reconociendo la importancia de la nutricion en el pronostico y tratamiento de pacientes con insuficiencia cardiaca. Witte et al.2, en un ensayo clinico controlado, demostraron un efecto significativo del suplemento de una combinacion de micronutrientes en la funcion ventricular, ademas de una aparente mejoria en la calidad de vida de los portadores de insuficiencia cardiaca.

[Heart failure mortality trend in Salvador, Bahia, Brazil].

OBJECTIVE To assess mortality trend due to heart failure (HF) in Salvador--Bahia, from 1979 to 1995. METHODS HF was defined by notations from the 9th Review of International Disease Code (IDC9) 428.0, 428.1 and 428.9. HF death and population data (metropolitan area of Salvador) were obtained by means of Secretaria de Saúde da Bahia (Bahia State Health Secretariat) and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality rates (/100,000) were total or per gender and age, and gross or adapted per age (straight standardization). RESULTS Mortality rates due to HF had a progressive reduction in the period of time assessed, for both genders, especially up to 1992. From then and up to 1995, there was an apparent stabilization of the curves. Gross mortality rate went from 25.0/10(5), in 1979, to 16.4/10(5) inhabitants, in 1995 (a decrease of 34.4%). The reduction was 34.0% (23.3/10(5), in 1979, to 15.4/10(5) inhabitants, in 1995) for male sex and 35.2% (26.7/10(5), in 1979, to 17.3/10(5) inhabitants, in 1995), for female sex. The same trend took place in several age ranges, including the population > or = 40 years old, which has a greater risk for HF. After adaptation per age (standard population of 1979), it is observed that relative reductions in the rates were even greater. CONCLUSION Mortality due to HF, in Salvador-Bahia, decreased from 1979 to 1992, becoming stable from then to 1995.

Pulmonary Embolism Mortality in Brazil from 1989 to 2010: Gender and Regional Disparities

Background A significant variation in pulmonary embolism (PE) mortality trends have been documented around the world. We investigated the trends in mortality rate from PE in Brazil over a period of 21 years and its regional and gender differences. Methods Using a nationwide database of death certificate information we searched for all cases with PE as the underlying cause of death between 1989 and 2010. Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). We calculated age-, gender- and region-specific mortality rates for each year, using the 2000 Brazilian population for direct standardization. Results Over 21 years the age-standardized mortality rate (ASMR) fell 31% from 3.04/100,000 to 2.09/100,000. In every year between 1989 and 2010, the ASMR was higher in women than in men, but both showed a significant declining trend, from 3.10/100,000 to 2.36/100,000 and from 2.94/100,000 to 1.80/100,000, respectively. Although all country regions showed a decline in their ASMR, the largest fall in death rates was concentrated in the highest income regions of the South and Southeast Brazil. The North and Northeast regions, the lowest income areas, showed a less marked fall in death rates and no distinct change in the PE mortality rate in women. Conclusions Our study showed a reduction in the PE mortality rate over two decades in Brazil. However, significant variation in this trend was observed amongst the five country regions and between genders, pointing to possible disparities in health care access and quality in these groups.

Síndrome o seudosíndrome metabólico

Metabolic syndrome has been proposed as a predictor of cardiovascular risk. However, such idea lacks strong scientific basis. This article reviews the evidence regarding that issue, challenging the existing paradigm of the prognostic value of metabolic syndrome.Sindrome metabolico ha sido propuesto como predictor de riesgo cardiovascular. Mientras tanto, esta idea no posee fuerte basamento cientifico. El presente articulo revisa las evidencias a este respecto, cuestionando el paradigma vigente del valor pronostico del sindrome metabolico.

Metabolic or pseudometabolic syndrome

Metabolic syndrome has been proposed as a predictor of cardiovascular risk. However, such idea lacks strong scientific basis. This article reviews the evidence regarding that issue, challenging the existing paradigm of the prognostic value of metabolic syndrome.Sindrome metabolico ha sido propuesto como predictor de riesgo cardiovascular. Mientras tanto, esta idea no posee fuerte basamento cientifico. El presente articulo revisa las evidencias a este respecto, cuestionando el paradigma vigente del valor pronostico del sindrome metabolico.

Síndrome ou pseudossíndrome metabólica

Metabolic syndrome has been proposed as a predictor of cardiovascular risk. However, such idea lacks strong scientific basis. This article reviews the evidence regarding that issue, challenging the existing paradigm of the prognostic value of metabolic syndrome.Sindrome metabolico ha sido propuesto como predictor de riesgo cardiovascular. Mientras tanto, esta idea no posee fuerte basamento cientifico. El presente articulo revisa las evidencias a este respecto, cuestionando el paradigma vigente del valor pronostico del sindrome metabolico.

Prescripción de dieta en la insuficiencia cardíaca crónica: ¿por qué no lo hacemos?

Prescripcion no medicamentosa, dieta, insuficiencia cardiaca. Los programas de tratamiento para pacientes portadores de insuficiencia cardiaca cronica son eficaces para reducir desenlaces clinicos, especialmente reinternaciones. En estos programas participan equipos multidisciplinarios, que incluyen a medicos clinicos y cardiologos, enfermeros, fisioterapeutas, sicologos, nutricionistas, entre otros1. Recientemente se esta reconociendo la importancia de la nutricion en el pronostico y tratamiento de pacientes con insuficiencia cardiaca. Witte et al.2, en un ensayo clinico controlado, demostraron un efecto significativo del suplemento de una combinacion de micronutrientes en la funcion ventricular, ademas de una aparente mejoria en la calidad de vida de los portadores de insuficiencia cardiaca.