Eduardo S. Darze

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.

FUNCTIONAL, PULMONARY, METABOLIC AND QUALITY OF LIFE RESPONSES AFTER CARDIOVASCULAR REHABILITATION PROGRAM

BACKGROUND: clinical trials showed improvement in functional capacity, quality of life, morbidity and mortality with cardiovascular rehabilitation (CVR). OBJECTIVE: to verify clinical responses of a CVR program in a tertiary center. METHODS: 85 patients evaluated in a CVR program. Results for functional capacity obtained by cardiopulmonary exercise test (CPET), sitting rising chair test (SRCT), six minute step test (6MST), inspiratory pressure (Pins), expiratory pressure (Pexp), peak-flow and quality of life score (Minnesota Living With Heart Failure Quality of Life Score - MLWHFS) were compared before and after the program. RESULTS: 69% were men, mean age was 61 ± 15 years and the mean ejection fraction was 61 ± 24%. There was an absolute mean increase of 2.4 ± 3.5 ml -1 .kg -1 .min -1 in peak VO 2 (p <0.001), 14 ± 17 repetitions on the SRCT (p <0.001), 44 ± 41 steps on the 6MST (p <0.001). In pulmonary function, there was an increase of -20 ± 40 cmH 2 O in Pins (p <0.01) and of 9 ± 29 cmH 2 O (p <0.001) in Pexp and 52 ± 77 L.min -1 in peak-flow (p <0.01) and there was a significant gain in quality of life with a mean reduction of 21 ± 15 points in the MLWHFS (P <0.001). CONCLUSION: CVR program resulted in a increase in functional, pulmonary capacity and improvement of quality of life. These data reproduce and reinforce the findings of randomized clinical trials, but in a real and uncontrolled clinical setting.

Highlights from the Ninth International Symposium of Thrombosis and Anticoagulation (ISTA IX), October 15, 2016, Salvador, Bahia, Brazil

To discuss and share knowledge about advances in the care of patients with thrombotic disorders, the Ninth International Symposium of Thrombosis and Anticoagulation was held in Salvador, Bahia, Brazil, on October 15, 2016. This scientific program was developed by clinicians for clinicians and was promoted by two major clinical research institutes—the Brazilian Clinical Research Institute and the Duke Clinical Research Institute of the Duke University School of Medicine. Comprising academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, thought-leaders, and dedicated clinician-scientists. This paper summarizes the symposium proceedings.