Paulo Henrique Godoy

Letalidade por doenças isquêmicas do coração no Estado do Rio de Janeiro no período de 1999 a 2003

OBJECTIVE To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System/Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.

Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes

Background End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Departments database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.

Letalidad y complicaciones de la cirugía de revascularización miocárdica en el Rio de Janeiro, de 1999 a 2003

FUNDAMENTO: A cirurgia de revascularizacao do miocardio (RVM) e um procedimento consolidado no tratamento das doencas isquemicas do coracao (DIC), requerendo constante avaliacao. OBJETIVO: Avaliar a qualidade na RVM, atraves das caracteristicas clinicas dos pacientes, taxas de letalidade ate um ano apos a alta hospitalar, causas basicas de morte e complicacoes pos-operatorias, em quatro hospitais publicos do Municipio do Rio de Janeiro, de 1999 a 2003. METODOS: Foram selecionados aleatoriamente prontuarios de pacientes submetidos a RVM. Informacoes sobre caracteristicas clinicas, complicacoes e obitos foram coletadas retrospectivamente dos prontuarios e das declaracoes de obitos. As taxas de letalidade foram estimadas nos periodos intra-hospitalar e ate um ano pos-alta. RESULTADOS: As prevalencias das caracteristicas pre-operatorias foram: mulher: 31,9%, hipertensao arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doenca pulmonar obstrutiva cronica: 8,2%, acidente vascular encefalico previo: 5,8%, arteriopatia extracardiaca: 12,7%, elevacao da creatinina: 4,1%, estado critico pre-operatorio: 3,7%, infarto agudo do miocardio recente: 23,5%, angina instavel: 40,8%, sindrome coronariana aguda: 50,0%, RVM previa: 2,4%, disfuncao ventricular esquerda: 27,3%, lesao de tronco da coronaria esquerda: 3,9% e associada com lesao em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no periodo intra-hospitalar e de 8,5% a 20,2% ate um ano pos-alta. As DIC representaram as causas de mais de 80% dos obitos. O grupo de complicacoes pos-operatorias mais frequente foi de hemorragia ou baixo debito pos-procedimento. Sessenta por cento dos obitos apresentaram cinco ou mais complicacoes enquanto que 40% dos sobreviventes nenhuma. CONCLUSAO: As taxas de letalidade e de complicacoes foram elevadas. Mesmo nos sobreviventes as complicacoes foram mais frequentes do que o esperado.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010

Background Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCIs effectiveness should be conducted in a population of real-world patients. Objectives To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Trends and Hospital Mortality in Myocardial Revascularization Procedures Covered by the Brazilian Unified Health System in Rio de Janeiro State from 1999 to 2010

cerebrovascular diseases were responsible for 26.1% of deaths.1 Many techniques including coronary artery bypass grafting (CABG) and coronary angioplasty (CA) have been developed in attempt to minimize individual and collective health problems caused by IHD.2 However, although these procedures were introduced in Brazil over 30 years ago, and despite their increasing use in clinical practice and costs for the Brazilian Unified Health System (UHS), studies evaluating the performance of these procedures in terms of efficacy and effectiveness are still scarce.3 Introduction

Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study

BackgroundHeart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival.MethodsThis was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002–7.707).ResultsValve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001).ConclusionsRheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.