Resumo em Inglês:

Abstract Background: Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes. Objectives: To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis. Methods: Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher’s exact test were used to compare frequencies, as well as correlation measurements. Results: 45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol. Conclusions: There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.

Resumo em Inglês:

Abstract Background: Resistant hypertension (RH) consists of increased blood pressure (BP) despite the use of 3 or more antihypertensives or BP control only when is use of 4 or more antihypertensives. It is fundamental to exclude pseudoresistance, which can be attributed to poor therapeutic adherence. Adherence evaluation, generally by the Morisky-Grenn test, is important because, when appropriate, it is associated with fewer cardiovascular complications and better BP control. Objectives: To evaluate the adherence of patients with RH and to investigate its relation with epidemiological, anthropometric and clinical characteristics, as well as to estimate the prevalence of pseudoresistance and to outline strategies to improve adherence. Methods: Retrospective observational cohort from an interview with patients followed at an outpatient clinic for RH. Therapeutic adherence, demographic, anthropometric data, cardiovascular risk factors, comorbidities, complementary exams and BP level were collected. One-way ANOVA and Student's t-tests were used for normal variables, and the Kruskal-Wallis and Mann-Whitney tests were used for non-normal tests. Categorical variables were compared using the Chi-Square test. We considered a 5% significance level in all tests. Results: 217 individuals were included. Of these, 17% had poor adherence. Epidemiological and clinical characteristics, complications, comorbidities, BP level or drugs used were statistically insignificant between groups. The poor adherence group used significantly more drugs (p = 0.0313) and 28% of pseudoresistance was estimated. Conclusions: Most of the individuals presented good therapeutic adherence by the Morisky test. Only the number of antihypertensive drugs had a statistically significant influence on adherence, while the epidemiological, anthropometric and clinical characteristics were statistically insignificant.

Resumo em Inglês:

Abstract Background Hypertensive patients present, in addition to worse cardiovascular health, lower health-related quality of life compared to normotensive subjects. Factors such as functional capacity, functional status, pain, participation in social activities, mental and emotional health, fatigue and energy level, along with perception of general health, seem to be relevant for evaluation in this population. However, evidence is unclear in hypertensive patients. Objective To analyze the factors associated with quality of life in hypertensive patients. Methods Forty-five patients were recruited. The dependent variables of the present study are the quality of life domains. Demographic data and clinical conditions were considered independent variables. The Medical Outcomes Short-Form Health Survey (SF-36) questionnaire was used to measure quality of life. Handgrip strength, blood pressure and anthropometric indicators were evaluated. Crude and adjusted linear regression analysis was used. Results It was verified that education level, body mass index and muscle strength were associated with the functional capacity domain (p < 0,05), whereas systolic blood pressure was associated with the physical domain (p < 0,05). Women presented lower quality of life on the pain domain compared to men and educational level was associated with the social domain (p < 0,05). Conclusion Hypertensive patients with lower levels of body mass index, higher levels of education and muscle strength presented a better quality of life on the physical domain, while the social aspects presented a positive relationship with education level. Women presented a worse quality of life on the pain domain compared to men. (Int J Cardiovasc Sci. 2020; 33(2):133-142)

Resumo em Inglês:

Abstract Background Changes in arterial compliance are among the first changes detectable in hypertensive syndrome. Methods with good reproducibility as compared with the gold standard for identifying such changes are desirable in clinical practice. Objectives To compare central pressure measurements and arterial stiffness obtained by two non-invasive methods (tonometry and oscillometry). Methods This was a descriptive, cross-sectional study with a convenience sample of patients with borderline hypertension or stage 1 hypertension. Peripheral and central blood pressure measurements were obtained by tonometry (SphygmoCor®), considered the gold standard, and oscillometry (Mobil O´graph®). Comparisons of results were made by unpaired t-test, and p values < 0.05 were considered statistically significant. Results No difference was found in central pressure measurements obtained by SphygmoCor® (117 x 80.1 mmHg) compared with Mobil O’graph (112 x 81.4 mmHg). Mean augmentation index (AIx) was 26.1% and 21.3%, and mean pulse pressure (PP) amplification 10.7 mmHg and 10.0 mmHg by Sphygmocor® and Mobil O´graph®, respectively (p > 0.05). Mean pressure wave velocity (PWV), 8.4 m/s vs. 7.4 m/s (p = 0.013) and mean central pulse pressure, 37.7 mmmHg and 30.9 mmHg (p = 0.013) were significantly higher by SphygmoCor® than Mobil O´graph®. Conclusion Values of central systolic blood pressure, AIx and pulse pressure amplification obtained by oscillometry were not statistically different compared with tonometry; values of PWV and cPP, however, were underestimated by oscillometry. (Int J Cardiovasc Sci. 2020; 33(2):145-150)

Resumo em Inglês:

Abstract Background: The Advanced Cardiac Life Support (ACLS) course is designed to teach cardiovascular emergency, aiming to promote a harmonious and synchronized work of the entire hospital team, making the multidisciplinary job more effective in the execution of cardiopulmonary resuscitation (CPR). Objective: To compare the effectiveness of CPR performed between physicians trained on ACLS and non-trained physicians. Methods: A questionnaire was applied to physicians working at the emergency room of hospitals in Curitiba, state of Paraná, whose resolution required theoretical and practical knowledge about CPR. For analysis, descriptive statistics and Fisher's association analysis were used, and the medians of the groups were evaluated by Mann-Whitney/Kruskal-Wallis with significance of 5%. Results: Thirty-four physicians were volunteers, of whom 20 had taken the ACLS course (Group A) and 14 had not (Group B). The trained physicians obtained the highest median (4.00 vs. 3.00, p = 0.06) of correct answers. Group A scored at least 3 of the 5 questions in the questionnaire, showing better performance than Group B (OR = 6.75, 95% CI, 1.1 < OR < 41.0, p = 0.04). The year of the course did not significantly change the performance in the questionnaire. Conclusion: It is suggested that the ACLS course was effective in qualifying physicians to handle situations of cardiorespiratory arrest properly, which was reproduced by the better performance in the resolution of the questionnaire. It is believed that when the sample of volunteers is increased, the trends found materialize the other hypotheses proposed.

Resumo em Inglês:

Abstract Background: Postoperative atrial fibrillation (POAF) after cardiac surgery has great clinical and economic implications. Many attempts have been made to identify risk factors aiming at a better evaluation of prophylactic treatment strategies. Objective: To perform an internal validation of a risk score for POAF. Methods: A prospective cohort of 1,054 patients who underwent myocardial revascularization and/or valve surgery was included. The risk score model was developed in 448 patients, and its performance was tested in the remaining 606 patients. Variables with a significance level of 5% in the cohort were included and subjected to a multiple logistic regression model with backward selection. Performance statistics was performed using the c-statistic, the chi-square and the Hosmer-Lemeshow (HL) goodness-of-fit, Pearson's correlation coefficient. Results: Four variables were considered predictors of outcome: age (≥ 70 years), mitral valve disease, the non-use or discontinuation of beta-blockers and a positive water balance (> 1,500 mL). The ROC curve was 0.76 (95% confidence interval [CI]: 0.72-0.79). The risk model showed a good ability according to the performance statistics - HL test x(2) = 0.93; p = 0.983 and r = 0.99 (Pearson's coefficient). There was an increase in the frequency of POAF with the increase of the score: very low risk = 0.0%; low risk = 3.9%; intermediate risk = 10.9%; and high risk = 60.0%; p < 0.0001. Conclusion: The predictive variables of POAF allowed us to construct a simplified risk score. This scoring system showed good accuracy and can be used in routine clinical practice.

Resumo em Inglês:

Abstract Background: Knowledge of cardiac arrest by health professionals is associated with sociodemographic, occupational and training characteristics. Objectives: To evaluate the factors associated with the knowledge of health professionals on Cardiac Arrest. Methods: A cross-sectional study conducted in a large public hospital in the countryside of Bahia - Brazil. The sample consisted of 18 doctors, 32 nurses and 50 nursing technicians. To evaluate the knowledge of the professionals, a questionnaire was constructed according to the current guidelines for resuscitation of the American Heart Association of 2015, and after that, it was submitted to three judges with expertise in PCR to verify content validity. Data were analyzed through descriptive statistics with univariate, bivariate and multivariate analyses using the logistic regression model. A value of p < 0.05 was adopted as level of significance. Results: The prevalence of insufficient knowledge of cardiac arrest among health professionals was 78%. After logistic regression, belonging to the professional category of nursing technician (p = 0.003) and nurse (p = 0.001) and working in the form of on-call duty for 24h (p = 0.005) was associated to insufficient knowledge. Conclusions: Insufficient knowledge of cardiac arrest among health professionals is high, which is a problem that requires urgent interventions in order to guarantee the quality of care. These actions should be based on realistic scenarios involving theoretical and practical activities. The periodicity of training should be short, given the deterioration of knowledge. The creation and validation of the data collection instrument allows for its applicability in other studies.

Resumo em Inglês:

Abstract Background Heart failure (HF) is worldwide known as a public health issue with high morbimortality. One of the issues related to the evolution of HF is the high rate of hospital readmission caused by decompensation of the clinical condition, with high costs and worsening of ventricular function. Objective To quantify the readmission rate and identify the predictors of rehospitalization in patients with acute decompensated heart failure. Methods Hospital-based historic cohort of patients admitted with acute decompensated HF in a private hospital from Recife/PE, from January 2008 to February 2016, followed-up for at least 30 days after discharge. Demographic and clinical data of admission, hospitalization, and clinical and late outcomes were analyzed. Logistic regression was used as a strategy to identify the predictors of independent risks. Results 312 followed-up patients, average age 73 (± 14), 61% males, 51% NYHA Class III, and 58% ischemic etiology. Thirty-day readmission rate was 23%. Multivariate analysis identified the independent predictors ejection fraction < 40% (OR = 2.1; p = 0.009), hyponatremia (OR = 2.9; p = 0.022) and acute coronary syndrome (ACS) as the cause of decompensation (OR = 1.1; p = 0,026). The final model using those three variables presented reasonable discriminatory power (C-Statistics = 0.655 – HF 95%: 0.582 – 0.728) and good calibration (Hosmer-Lemeshow p = 0.925). Conclusions Among hospitalized patients with acute decompensated heart failure, the rate of readmission was high. Hyponatremia, reduced ejection fraction and ACS as causes of decompensation were robust markers for the prediction of hospital readmission within 30 days of discharge. (Int J Cardiovasc Sci. 2020; 33(2):175-184)

Resumo em Inglês:

Abstract José Saramago, Nobel Prize in Literature, is the author of a statement that provokes adult readers: “What if children’s stories become mandatory reading for adults? Would they really learn what they’ve been teaching for so long?”. 1 It is in this context that literary texts dedicated to children have been used at times in medical education and clinical practice to bring up often invisible subjectivities.