Élide Sbardellotto Mariano da Costa

Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center

BACKGROUND Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation. OBJECTIVE To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service. METHODS A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used. RESULTS Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors. CONCLUSION The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes.

Analysis of the costs and quality of cardiovascular care in oncological monitoring

Objective: To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. Method: We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. Results: 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%), followed by complementary exams (37%), consultations (8%) and emergency care (4%). Conclusion: The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam) as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

Chronic case management: Clinical governance with cost reductions

INTRODUCTION With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. METHOD We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. RESULTS We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. CONCLUSION Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

Working Environment and Burnout Syndrome

Purpose: The excessive and prolonged occupational stress can result in worker´s emotional exhaustion known as burnout syndrome. The aim of this study was evaluated the relationship between perceived organizational support and the risk of developing burnout. Methods: It’s a descriptive observational cross-sectional study. The burnout´s risk was assessed by the Maslash Invetory Burnout and the organizational support through the Perceived Organizational Support Scale. Results: From the research subjects, 36 (55.38%) presented a risk for burnout. Comparing this group with the employees without risk for burnout, three organization support factors were perceived as critical: The supervisor support (p=0.036), the relationship at work (p=0.012) and the professional valorization (p=0.0009). Conclusion: The organizational support at work has a significant relationship with the risk of burnout, especially the role of leader in management of employees.

Infarto agudo do miocárdio de parede inferior sem lesão obstrutiva coronária

ABSTRACT Inferior Acute Myocardial Infarctionwithout Coronary Lesions We describe the case of a 70-year-old patient admittedwith acute myocardial infarction, with clinical, electrocar-diographic, enzymatic and left ventricular regional wallmotion abnormalities. Coronary angiography showed noobstructive lesions, which was confirmed by intravascularultrasound (IVUS). Different hypothesis are raised to explainmyocardial infarction with normal coronary arteries inthis patient. DESCRIPTORS: Myocardial infarction. Coronary disease.Coronary angiography. Ultrasonography, interventional. O infarto agudo do miocardio e a principal causade morbidade e mortalidade em todo o mun-do 1 . A maioria dos casos decorre da instabili-zacao de uma placa aterosclerotica com trombosesobrejacente. Varios outros mecanismos foram identi-ficados como causa de sindrome coronaria aguda,como obstrucao dinâmica, inflamacao, obstrucao me-cânica e aumento de consumo miocardico de oxige-nio. Descrevemos a seguir um caso de infarto agudodo miocardio com coronarias normais.