Lucia Brandão de Oliveira

Vacinação contra influenza e pneumococo na insuficiência cardíaca: uma recomendação pouco aplicada

BACKGROUND Heart failure (HF) is associated with frequent decompensation and admissions to the emergency service. Influenza (INF) and Pneumococcal (pneumonia) vaccinations are recommended in the guidelines, however, respiratory infections are the third leading cause of hospitalization in heart failure. OBJECTIVE To assess the frequency of vaccination against INF and PNM in patients with HF in government healthcare units. METHODS An observational study carried out in Teresópolis, a mountain region in Rio de Janeiro, employed three strategies: (I) study of requests for vaccine against INF and/or PNM in the Health Department of Teresópolis between 2004 and 2006; (II) direct inquiry to 61 patients with heart failure treated in primary care about their vaccination status against INF and PNM; (III) direct inquiry about their vaccination status against INF and PNM to 81 patients with decompensated chronic heart failure treated in the only emergency service open to the public. RESULTS In strategy I, INF and/or PNM vaccination was 15.3% of those with indications for cardiovascular and respiratory diseases. The median time between indication and vaccination was 32 days. In strategy II, the percentage of patients vaccinated against INF, aged > 60, was 23.1% and 24.6% against PMN at all ages. In strategy III, the percentage of patients vaccinated against INF was 35.8% and against PNM was 2.5%. CONCLUSION The rate of vaccination against INF and PNM in patients with HF is very low and even lower in those with decompensated HF treated in emergency services.FUNDAMENTO: La insuficiencia cardiaca (IC) cursa con frecuentes descompensaciones y admisiones al servicio de emergencia. Vacunacion contra Influenza (INF) y Neumococo (PNM) son recomendadas en las directrices, entre tanto, las infecciones respiratorias son la tercera causa de hospitalizacion en la IC. OBJETIVO: Evaluar la frecuencia de la vacunacion contra INF y PNM en pacientes con IC en la red publica. METODOS: En estudio observacional realizado en Teresopolis, region serrana fluminense, fueron utilizadas tres estrategias: (I) estudio de las requisiciones para vacuna contra INF y/o PNM en la Secretaria Municipal de Salud, entre 2004 y 2006; (II) averiguacion directa a 61 pacientes con IC atendidos en la atencion basica sobre su situacion de vacuna contra INF y PNM; (III) averiguacion directa sobre situacion de vacuna contra INF y PNM a 81 pacientes con IC cronica descompensada atendidos en la unica emergencia abierta a la red publica. RESULTADOS: En la estrategia I, la vacunacion contra INF y/o PNM fue de 15,3% de aquellos con indicaciones por enfermedades cardiovasculares y respiratorias. La mediana del tiempo entre la indicacion y la vacunacion fue de 32 dias. En la estrategia II, el porcentual de vacunados contra INF, con edad > 60 anos, fue de 23,1%, y de 24,6% contra PMN en todas las edades. En la estrategia III, el porcentual de pacientes vacunados contra INF fue de 35,8% y contra PNM fue de 2,5%. CONCLUSION: La tasa de vacunacion contra INF y PNM en pacientes con IC es muy baja y aun menor en aquellos descompensados atendidos en servicio de emergencia.

Monitorização ambulatorial da pressão arterial e pressão casual em hiper-reatores ao esforço

BACKGROUND Developing hypertension is likely to be at least two times greater in individual with exaggerated blood pressure response on exercise testing (ET). Few reports have evaluated the parameters of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in normotensive individuals with exaggerated blood pressure response to exercise. OBJECTIVE To evaluate the relationship among the casual blood pressure with hyper-reactive response on ET and to compare Ambulatory Blood Pressure Monitoring (ABPM) data of hyper-reactive individuals with a control group in order to detect early disorders, that allows a preventive action with prognostic implication. METHODS Casual BP measurement and parameters of ABPM of 26 adult individuals, with mean age of 41.50+/-11.78 years, normotensive at rest and hyper-reactive on ET was compared to those of 16 adult individuals, with mean age of 41.38+/-11.55 years, normotensive at rest with normal BP response on exercise. The values <140 x 90 mmHg were considered normal for casual BP. The values <220 mmHg for systolic BP and/or an increase > or = 5 mmHg diastolic BP on ET for hyper-reactive response diagnosis. RESULTS Hyper-reactive individuals presented the systolic (p=0.03) and diastolic (p=0.002) casual BP and mean systolic BP (p=0.050), systolic pressure load during the day (p=0.011), and systolic (p=0.017) pressure load higher when compared to the control group. CONCLUSION Casual high normal BP had a positive correlation with exaggerated BP response. The hyper-reactive individuals showed particular characteristics in casual BP as well as in ABPM parameters, which, although within the range of reference values, differed from those of individuals with normal response to exercise.

Influenza and pneumococcal vaccination in heart failure: a little applied recommendation.

BACKGROUND Heart failure (HF) is associated with frequent decompensation and admissions to the emergency service. Influenza (INF) and Pneumococcal (pneumonia) vaccinations are recommended in the guidelines, however, respiratory infections are the third leading cause of hospitalization in heart failure. OBJECTIVE To assess the frequency of vaccination against INF and PNM in patients with HF in government healthcare units. METHODS An observational study carried out in Teresópolis, a mountain region in Rio de Janeiro, employed three strategies: (I) study of requests for vaccine against INF and/or PNM in the Health Department of Teresópolis between 2004 and 2006; (II) direct inquiry to 61 patients with heart failure treated in primary care about their vaccination status against INF and PNM; (III) direct inquiry about their vaccination status against INF and PNM to 81 patients with decompensated chronic heart failure treated in the only emergency service open to the public. RESULTS In strategy I, INF and/or PNM vaccination was 15.3% of those with indications for cardiovascular and respiratory diseases. The median time between indication and vaccination was 32 days. In strategy II, the percentage of patients vaccinated against INF, aged > 60, was 23.1% and 24.6% against PMN at all ages. In strategy III, the percentage of patients vaccinated against INF was 35.8% and against PNM was 2.5%. CONCLUSION The rate of vaccination against INF and PNM in patients with HF is very low and even lower in those with decompensated HF treated in emergency services.FUNDAMENTO: La insuficiencia cardiaca (IC) cursa con frecuentes descompensaciones y admisiones al servicio de emergencia. Vacunacion contra Influenza (INF) y Neumococo (PNM) son recomendadas en las directrices, entre tanto, las infecciones respiratorias son la tercera causa de hospitalizacion en la IC. OBJETIVO: Evaluar la frecuencia de la vacunacion contra INF y PNM en pacientes con IC en la red publica. METODOS: En estudio observacional realizado en Teresopolis, region serrana fluminense, fueron utilizadas tres estrategias: (I) estudio de las requisiciones para vacuna contra INF y/o PNM en la Secretaria Municipal de Salud, entre 2004 y 2006; (II) averiguacion directa a 61 pacientes con IC atendidos en la atencion basica sobre su situacion de vacuna contra INF y PNM; (III) averiguacion directa sobre situacion de vacuna contra INF y PNM a 81 pacientes con IC cronica descompensada atendidos en la unica emergencia abierta a la red publica. RESULTADOS: En la estrategia I, la vacunacion contra INF y/o PNM fue de 15,3% de aquellos con indicaciones por enfermedades cardiovasculares y respiratorias. La mediana del tiempo entre la indicacion y la vacunacion fue de 32 dias. En la estrategia II, el porcentual de vacunados contra INF, con edad > 60 anos, fue de 23,1%, y de 24,6% contra PMN en todas las edades. En la estrategia III, el porcentual de pacientes vacunados contra INF fue de 35,8% y contra PNM fue de 2,5%. CONCLUSION: La tasa de vacunacion contra INF y PNM en pacientes con IC es muy baja y aun menor en aquellos descompensados atendidos en servicio de emergencia.

Vacunación contra influenza y neumococo en la insuficiencia cardíaca: una recomendación poco aplicada

BACKGROUND Heart failure (HF) is associated with frequent decompensation and admissions to the emergency service. Influenza (INF) and Pneumococcal (pneumonia) vaccinations are recommended in the guidelines, however, respiratory infections are the third leading cause of hospitalization in heart failure. OBJECTIVE To assess the frequency of vaccination against INF and PNM in patients with HF in government healthcare units. METHODS An observational study carried out in Teresópolis, a mountain region in Rio de Janeiro, employed three strategies: (I) study of requests for vaccine against INF and/or PNM in the Health Department of Teresópolis between 2004 and 2006; (II) direct inquiry to 61 patients with heart failure treated in primary care about their vaccination status against INF and PNM; (III) direct inquiry about their vaccination status against INF and PNM to 81 patients with decompensated chronic heart failure treated in the only emergency service open to the public. RESULTS In strategy I, INF and/or PNM vaccination was 15.3% of those with indications for cardiovascular and respiratory diseases. The median time between indication and vaccination was 32 days. In strategy II, the percentage of patients vaccinated against INF, aged > 60, was 23.1% and 24.6% against PMN at all ages. In strategy III, the percentage of patients vaccinated against INF was 35.8% and against PNM was 2.5%. CONCLUSION The rate of vaccination against INF and PNM in patients with HF is very low and even lower in those with decompensated HF treated in emergency services.FUNDAMENTO: La insuficiencia cardiaca (IC) cursa con frecuentes descompensaciones y admisiones al servicio de emergencia. Vacunacion contra Influenza (INF) y Neumococo (PNM) son recomendadas en las directrices, entre tanto, las infecciones respiratorias son la tercera causa de hospitalizacion en la IC. OBJETIVO: Evaluar la frecuencia de la vacunacion contra INF y PNM en pacientes con IC en la red publica. METODOS: En estudio observacional realizado en Teresopolis, region serrana fluminense, fueron utilizadas tres estrategias: (I) estudio de las requisiciones para vacuna contra INF y/o PNM en la Secretaria Municipal de Salud, entre 2004 y 2006; (II) averiguacion directa a 61 pacientes con IC atendidos en la atencion basica sobre su situacion de vacuna contra INF y PNM; (III) averiguacion directa sobre situacion de vacuna contra INF y PNM a 81 pacientes con IC cronica descompensada atendidos en la unica emergencia abierta a la red publica. RESULTADOS: En la estrategia I, la vacunacion contra INF y/o PNM fue de 15,3% de aquellos con indicaciones por enfermedades cardiovasculares y respiratorias. La mediana del tiempo entre la indicacion y la vacunacion fue de 32 dias. En la estrategia II, el porcentual de vacunados contra INF, con edad > 60 anos, fue de 23,1%, y de 24,6% contra PMN en todas las edades. En la estrategia III, el porcentual de pacientes vacunados contra INF fue de 35,8% y contra PNM fue de 2,5%. CONCLUSION: La tasa de vacunacion contra INF y PNM en pacientes con IC es muy baja y aun menor en aquellos descompensados atendidos en servicio de emergencia.