Maria Karolina Echer Ferreira Feijó

Cross-cultural adaptation and validation of the European Heart Failure Self-care Behavior Scale for Brazilian Portuguese

OBJECTIVE To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale. METHODS The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting) and validation (assessment of face validity, content validity, and internal consistency reliability) were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF) and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care). RESULTS The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbachs Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87. CONCLUSION Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.

Fatores de risco para doença arterial coronariana em pacientes admitidos em unidade de hemodinâmica

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.Estudo transversal para avaliar a prevalencia de fatores de risco (FR) para doenca arterial coronariana (DAC) em pacientes submetidos a procedimentos cardiacos em unidade de hemodinâmica. Incluiu-se 302 pacientes, com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR mais prevalente foi o sedentarismo 227 (75%), seguido da hipertensao 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabete mellitus 81 (27%), tabagismo 77 (25,5%), consumo de alcool 67 (22%) e alimentacao pobre em frutas e verduras 15 (5%). A correlacao entre o numero de FR e as variaveis: escolaridade, renda, idade, estado civil, atividade profissional e sexo, alem do numero de procedimentos a que foram submetidos, comparado aqueles que apresentavam mais do que cinco FR para DAC nao foi significativa; no entanto, existe uma associacao positiva, reforcando a importância de estrategias que visem a diminuicao ou eliminacao dos FR modificaveis.

Pharmacological adherence to oral anticoagulant and factors that influence the international normalized ratio stability.

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Adaptação e aplicabilidade de um algoritmo de diurético para pacientes com insuficiência cardíaca

BACKGROUND Congestive states can be identified and managed through algorithms such as the Diuretic Treatment Algorithm (DTA) to adjust the diuretic over the telephone, focused on the clinical evaluation. However, the DTA is currently available only in English. OBJECTIVE To adapt the DTA and test its applicability for Brazil in outpatients with heart failure. METHODS The stages of translation, synthesis, back-translation, review by an expert committee, and pre-test (clinical applicability by means of a random clinical trial) were followed. The Brazilian version of the DTA was called algoritmo de ajuste de diurético (AAD; as per its acronym in Portuguese, standing for diuretic adjustment algorithm). Patients were randomized to the intervention group (IG) - diuretic adjustment according to the AAD - or control group (CG) - conventional adjustment. The clinical congestion score (CCS) and weight values were obtained for both groups. RESULTS A total of 12 changes were made to the DTA. Thirty-four patients were included. For those with congestion, the increase in the diuretic as guided by the AAD solved their condition, reducing the CCS by two points for 50% of the sample -2 (-3.5; -1.0), while the median for the CG was 0 (-1.25; -1.0), (p < 0.001). The median for weight variation was greater in IG -1.4 (-1.7; -0.5) compared to the CG 0.1 (1.2; -0.6), p = 0.001. CONCLUSIONS The AAD proved applicable in clinical practice after adaption and appears to result in better congestion management in patients with heart failure. The clinical effectiveness of the tool should be tested in a larger patient sample aiming at validating the instrument for Brazil.

Adesão farmacológica ao anticoagulante oral e os fatores que influenciam na estabilidade do índice de normatização internacional

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial

BackgroundOne of the challenges in treating patients with heart failure (HF) is achieving clinical stability and reducing the hospital readmission rate. A diuretic dose adjustment algorithm developed in the United States (Diuretic Treatment Algorithm, DTA) and later validated for use in Brazil (as the Algoritmo de Ajuste de Diurético, AAD) has proved feasible and readily applicable, but its effect on clinical outcomes has yet to be assessed. This report aims to describe a randomized clinical trial protocol designed to assess the effectiveness of the AAD and of nonpharmacologic management in improving clinical stability and reducing the readmission rate at 90 days in patients with HF.Methods/DesignA PROBE (prospective randomized open blinded endpoint) parallel-group design will be used. Adult patients with a diagnosis of reduced ejection fraction HF, who are being treated at a specialized HF clinic are being recruited. Those with indications for loop diuretic dose adjustment during routine clinic visits will be randomized to take part in the trial. Participants in the intervention group (IG) shall have their diuretic doses adjusted in accordance with the AAD and receive four telephone calls (one per week) over 30 days to reinforce guidance on nonpharmacological management (fluid and sodium restriction). Participants in the control group (CG) shall have their diuretic doses adjusted by a physician during the first trial visit and shall not receive any telephone calls. Patients in both groups shall return at 1 month for face-to-face reassessment. The study endpoints shall comprise readmission and/or emergency department visits due to HF decompensation within 90 days and clinical instability. All participants shall be required to have a scale at home (or easy access to one), a telephone number, agree to telephone-based follow-up, and be available to return for a 1-month trial visit. Overall, 135 patients are expected to be enrolled in each group.DiscussionThis trial shall assess the effectiveness of the AAD algorithm and non-pharmacologic management by early identification of clinical deterioration and establishment of a combined intervention to reduce emergency department visits, readmission rate, or a composite endpoint thereof.Trial registration numberClinicalTrials.gov Identifier, NCT02068937 (23 February 2014).

Adhesión farmacológica al anticoagulante oral y factores que influyen en la estabilidad del índice de estandarización internacional

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

ABSTRACT Objective: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. Method: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. Results: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. Conclusion: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

Fatores precipitantes de descompensação da insuficiência cardíaca relacionados a adesão ao tratamento: estudo multicêntrico-EMBRACE

OBJECTIVE To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment. METHODS Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment. RESULTS A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment. CONCLUSION The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.Objetivo: Descrever os fatores precipitantes de descompensacao da insuficiencia cardiaca entre pacientes aderentes e nao aderentes ao tratamento. Metodos: Estudo transversal de uma coorte multicentrica. Pacientes acima de 18 anos com insuficiencia cardiaca descompensada (classe funcional III/IV) foram elegiveis. Para a coleta dos dados foi utilizado um questionario estruturado avaliando os motivos da descompensacao. O uso irregular de medicacao previo a internacao, controle inadequado de sal e liquidos foram considerados como grupo de ma adesao ao tratamento. Resultados: Foram incluidos 556 pacientes, com idade media de 61±14 anos, 362(65%) homens. O principal fator de descompensacao foi a ma adesao, representando 55% da amostra. Os pacientes que referiram o uso irregular das medicacoes na ultima semana apresentaram 22% mais risco de internacao por ma adesao quando comparados aos pacientes aderentes. Conclusao: O estudo EMBRACE demonstrou que em pacientes com insuficiencia cardiaca, a ma adesao mostrou-se como o principal fator de exacerbacao. Palavras-chave: Insuficiencia cardiaca. Estudo multicentrico. Fatores desencadeantes.

Risk factors for coronary artery disease in patients admitted in hemodynamics unit

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.Estudo transversal para avaliar a prevalencia de fatores de risco (FR) para doenca arterial coronariana (DAC) em pacientes submetidos a procedimentos cardiacos em unidade de hemodinâmica. Incluiu-se 302 pacientes, com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR mais prevalente foi o sedentarismo 227 (75%), seguido da hipertensao 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabete mellitus 81 (27%), tabagismo 77 (25,5%), consumo de alcool 67 (22%) e alimentacao pobre em frutas e verduras 15 (5%). A correlacao entre o numero de FR e as variaveis: escolaridade, renda, idade, estado civil, atividade profissional e sexo, alem do numero de procedimentos a que foram submetidos, comparado aqueles que apresentavam mais do que cinco FR para DAC nao foi significativa; no entanto, existe uma associacao positiva, reforcando a importância de estrategias que visem a diminuicao ou eliminacao dos FR modificaveis.