Editorial Original Articles Review Article Case Reports Erratum News See in The Next Edition

118 Pages·2017·6.45 MB·English

Editorial Study with a Portable Gas Analyzer of the 6-Minute Walk
Test in Heart Failure with Normal Ejection Fraction
Relationship Between Social Factors and Cardiovascular
7
64 Diseases Drug-eluting stents Versus Coronary Artery Bypass Grafting
9-5 in Multivessel Disease and Left Main Obstruction: Meta-
35 Original Articles analysis of Randomized Clinical Trials
2
ne Impact of Risk Factors for Coronary Artery Disease Factors Associated with Post-Sternotomy Mediastinitis.
onli on Hospital Costs of Patients Undergoing Myocardial Case-Control Study
N
S Revascularization Surgery in the Brazilian Unified Health
S
2 | I System (SUS) Review Article
0
8 Chagas Disease Cardiomyopathy
4 Prevalence of Atherosclerotic Lesions in the Left
9-
5 Internal Thoracic Artery, Evidenced by Selective
3 Case Reports
2
N Angiographic Findings
SS Severe Mitral Regurgitation by Hyperthyroidism in the
pril | I CDoerlareyleadti oHno bspeittwael Aenrr iCvlainl iicna Ml aynodc aErdduiacla Itniofanraclt Fioanctors and Absence of Left Ventricular Dilatation
A
/ Improvement of Pacing-Induced Dyssynchrony by Right
h Decrease in the Inflammatory Marker TNF-α after
c Ventricular Septal Stimulation in a Child with Tetralogy
ar Consumption of Flaxseed by Hypercholesterolemic Rabbits
M of Fallot
o 2 | Evolution of Mortality from Diseases of the Circulatory
er System and of Gross Domestic Product per Capita in the Erratum
m
Nú Rio de Janeiro State Municipalities
1 - News
3 Predictors of Coronary Artery Obstructive Disease in Acute
e
m Pulmonary Edema of Unclear Origin See in The Next Edition
u
ol
V
SUMARY
• Editorial
Relationship between Social Factors and Cardiovascular Diseases ................................................................................ 87
Claudio Tinoco Mesquita
• Original Articles
Impact of Risk Factors for Coronary Artery Disease on Hospital Costs of Patients Undergoing Myocardial
Revascularization Surgery in the Brazilian Unified Health System (SUS) .................................................................... 90
João Luis Barbosa, Clarissa Antunes Thiers, Carlos Felipe dos Santos Cunha, Juliana Moutella, Bernardo Rangel Tura,
Giulia Principe Orsi, Karen Feldman, Nathália Rodrigues da Silva, Luiz Felipe Faria
Prevalence of Atherosclerotic Lesions in the Left Internal Thoracic Artery, Evidenced by Selective
Angiographic Findings ............................................................................................................................................................. 97
Hadrien Felipe Meira Balzan, Rafael Vinicius Lube Battilani, Otávio Celeste Mangili, Marcos Franchetti, Leonardo
Celeste Mangili, Julio de Paiva Maia, Dorane Dias de Moura, Bruna Felipe de Melo Lage
Correlation between Clinical and Educational Factors and Delayed Hospital Arrival in Myocardial Infarction .......... 107
Andressa Sardá Maiochi Takagui, Daniel Medeiros Moreira, Ana Teresa Glaser Carvalho, Thays Fraga Duarte, Roberto
Léo da Silva, Tammuz Fattah
Decrease in the Inflammatory Marker TNF-α after Consumption of Flaxseed by Hypercholesterolemic
Rabbits ................................................................................................................................................................................. 114
Maynara Leonardi Schuh Martins, Aniely Bacelar Rocco de Lima, Ana Flavia Champoski, Pamela Cristiani Pereira, Fernando
Martins, Carlos Tanizawa, Leonardo Précoma, Patrícia Campelo, Luiz César Guarita-Souza, Dalton Bertolim Précoma
Evolution of Mortality from Diseases of the Circulatory System and of Gross Domestic Product per Capita in
the Rio de Janeiro State Municipalities ................................................................................................................................ 123
Gabriel Porto Soares, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva
Predictors of Coronary Artery Obstructive Disease in Acute Pulmonary Edema of Unclear Origin ....................... 133
Maria das Neves Dantas da Silveira Barros, Vander Weyden Batista de Sousa, Isabelle Adjanine Borges de Lima, Cecília
Raquel Bezerra Marinho Nóbrega, Isabelle Conceição Albuquerque Machado Moreira, Suzana Marine Martins Dourado,
Bruna Maria Simões Andrade, Virgínia da Silva Batista, Maria Cleide Freire Clementino da Silva, Luís Cláudio Correia
Study with a Portable Gas Analyzer of the 6-Minute Walk Test in Heart Failure with Normal Ejection Fraction 143
José Antônio Caldas Teixeira, Leandro Rocha Messias, Kátia Pedreira Dias, Washington Luiz Batista da Costa, Roberto
Macedo Cascon, Sandra Marina Ribeiro de Miranda, Pedro Soares Teixeira, Juliana Grael Jorge, Antonio Claudio Lucas
da Nobrega, Denizar V. Araujo
Drug-eluting stents Versus Coronary Artery Bypass Grafting in Multivessel Disease and Left Main
Obstruction: Meta-analysis of Randomized Clinical Trials ............................................................................................. 152
Pedro José Negreiros de Andrade, Hermano Alexandre Lima Rocha, João Luiz de Alencar Araripe Falcão, Antonio
Thomaz de Andrade, Breno de Alencar Araripe Falcão
Factors Associated with Post-Sternotomy Mediastinitis. Case-Control Study ............................................................. 163
Débora Cristine Gomes Pinto, Antônio Fernandino de Castro Bahia Neto, Flávia Lage Gonçalves, Isabel Cristina Gomes,
Eduardo Back Sternick, Alessandra Maciel Almeida, Nulma Souto Jentzsch
• Review Article
Chagas Disease Cardiomyopathy ........................................................................................................................................... 173
Marcus Vinicius Simões, Minna Moreira Dias Romano, André Schmidt, Káryta Suely Macedo Martins, José Antonio
Marin-Neto
• Case Reports
Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation ........................... 190
Antonio José Lagoeiro Jorge, Wolney de Andrade Martins, Eliza de Almeida Gripp, Breno Macêdo de Almeida, Camila
Cezário Rocha Paz Figueroa, Cíntia Lobo Sabino
Improvement of Pacing-Induced Dyssynchrony by Right Ventricular Septal Stimulation in a Child with
Tetralogy of Fallot ..................................................................................................................................................................... 193
Alexander González Guillen, Michel Cabrera Ortega, Francisco Díaz Ramírez, Dunia Bárbara Benítez Ramos
• Erratum ...................................................................................................................................................................................... 196
• News ........................................................................................................................................................................................... 197
• See in The Next Edition ...................................................................................................................................................... 198
ISSN 2359-4802 / IJCS ONLINE: ISSN 2359-5647
Editor Guilherme Vianna e Silva (Interventionist Cardiology Area) – Texas Heart
Institute, USA
Cláudio Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP),
Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil João Augusto Costa Lima (Integrative Imaging Area) – Johns Hopkins
Hospital – Baltimore, USA
Lauro Casqueiro Vianna (Multiprofessional Area) – Faculdade de Educação
Associated Editors
Física, Universidade de Brasília (UnB), Brasília, DF – Brazil
Clério Francisco Azevedo Filho (Cardiovascular Imaging Area) – Universidade Miguel Mendes (Ergometric and Cardiac Rehabilitation Area) – Sociedade
do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil Portuguesa de Cardiologia, Portugal
Gláucia Maria Moraes de Oliveira (Clinical Cardiology Area) – Departamento Ricardo Mourilhe-Rocha (Heart Failure and Myocardiopathy Area) – Hospital
de Clínica Médica, Faculdade de Medicina (FM), Universidade Federal do Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ),
Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Rio de Janeiro, RJ - Brazil
EDITORIAL BOARD
Brazil Leopoldo Soares Piegas – Fundação Adib Jatene, Instituto Dante Pazzanese
Andréia Biolo – Faculdade de Medicina, Universidade Federal do Rio Grande de Cardiologia (IDPC/FAJ), São Paulo, SP - Brazil
do Sul (UFRGS), Porto Alegre, RS – Brazil Luís Alberto Oliveira Dallan – Serviço Coronariopatias, Instituto do Coração
Angelo Amato Vincenzo de Paola – Escola Paulista de Medicina (EPM), (INCOR), São Paulo, SP - Brazil
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brazil Marcelo Iorio Garcia – Clínica de Insuficiência Cardíaca, Universidade Federal
Antonio Cláudio Lucas da Nóbrega – Centro de Ciências Médicas, do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brazil
Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Marcelo Westerlund Montera – Centro de Insuficiência Cardíaca, Hospital
Ari Timerman – Unidades de Internação, Instituto Dante Pazzanese de Pró Cardíaco (PROCARDIACO), Rio de Janeiro, RJ – Brazil
Cardiologia (IDPC), São Paulo, SP - Brazil Marcio Luiz Alves Fagundes – Divisão de Arritmia e Eletrofisiologia, Instituto
Armando da Rocha Nogueira – Departamento de Clínica Médica, Nacional de Cardiologia Laranjeiras (INCL), Rio de Janeiro, RJ – Brazil
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Marco Antonio Mota Gomes - Fundação Universitária de Ciências da Saúde
Carísi Anne Polanczyk – Hospital de Clínicas de Porto Alegre, Universidade Governador Lamenha Filho (UNCISAL), Maceió, AL - Brazil
Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil Marco Antonio Rodrigues Torres – Departamento de Medicina Interna,
Carlos Eduardo Rochitte – Departamento de Cardiopneumologia, Hospital Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brazil
das Clínicas da Faculdade de Medicina da Universidade de São Paulo Marcus Vinicius Bolivar Malachias – Instituto de Pesquisas e Pós-
(HCFMUSP), São Paulo, SP – Brazil graduação (IPG), Faculdade de Ciências Médicas de Minas Gerais
Carlos Vicente Serrano Júnior – Faculdade de Medicina da Universidade de (FCMMG), Belo Horizonte, MG – Brazil
São Paulo, Instituto do Coração (InCor), São Paulo, SP – Brazil Maria Eliane Campos Magalhães – Departamento de Especialidades Médicas,
Cláudio Gil Soares de Araújo – Instituto do Coração Edson Saad, Universidade Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil
Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Mário de Seixas Rocha – Unidade Coronariana, Hospital Português,
Cláudio Pereira da Cunha – Departamento de Clínica Médica, Universidade Salvador, BA – Brazil
Federal do Paraná (UFPR), Paraná, PR – Brazil Maurício Ibrahim Scanavacca – Unidade Clínica de Arritmia, Instituto do
Cláudio Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP), Coração do Hospital das Clínicas da FMUSP, São Paulo, SP – Brazil
Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Nadine Oliveira Clausell – Faculdade de Medicina, Universidade Federal do
Denílson Campos de Albuquerque – Faculdade de Ciências Médicas, Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil
Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil Nazareth de Novaes Rocha – Centro de Ciências Médicas, Universidade
Denizar Vianna Araujo – Departamento de Clínica Médica, Universidade do Federal Fluminense, UFF - Rio de Janeiro, RJ – Brazil
Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil Nelson Albuquerque de Souza e Silva – Departamento de Clínica
Esmeralci Ferreira – Hospital Universitário Pedro Ernesto (HUPE), Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro,
Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil RJ – Brazil
Evandro Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP), Paola Emanuela Poggio Smanio – Seção Médica de Medicina Nuclear, Instituto
Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Dante Pazzanese de Cardiologia (IDPC) São Paulo, SP - Brazil
Fernando Nobre – Faculdade de Medicina de Ribeirão Preto (FMRP), Paulo Cesar Brandão Veiga Jardim – Liga de Hipertensão Arterial,
Universidade de São Paulo, São Paulo, SP – Brazil Universidade Federal de Goiás (UFGO), Goiânia, GO – Brazil
Gabriel Blacher Grossman – Serviço de Medicina Nuclear, Hospital Moinhos Ronaldo de Souza Leão Lima – Pós-Graduação em Cardiologia, Universidade
de Vento, Porto Alegre, RS – Brazil Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brazil
Henrique César de Almeida Maia – Governo do Distrito Federal (GDF), Salvador Manoel Serra – Setor de Pesquisa Clínica, Instituto Estadual de
Brasília, DF - Brazil Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ – Brazil
Humberto Villacorta Júnior – Hospital Universitário Antônio Pedro (HUAP), Sandra Cristina Pereira Costa Fuchs – Departamento de Medicina Social,
Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil
Iran Castro – Fundação Universitária de Cardiologia (FUC), Instituto de Tiago Augusto Magalhães – Ressonância Magnética e Tomografia Cardíaca,
Cardiologia do Rio Grande do Sul (IC), Porto Alegre, RS – Brazil Hospital do Coração (HCor), São Paulo, SP – Brazil
João Vicente Vitola – Quanta Diagnóstico e Terapia (QDT), Curitiba, PR – Brazil Walter José Gomes – Departamento de Cirurgia, Universidade Federal de São
José Geraldo de Castro Amino – Sessão Clínica, Instituto Nacional de Paulo (UFESP), São Paulo, SP – Brazil
Cardiologia (INC), Rio de Janeiro, RJ – Brazil Washington Andrade Maciel – Serviço de Arritmias Cardíacas, Instituto
José Márcio Ribeiro – Clínica Médica (Ambulatório), União Educacional Vale Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro,
do Aço (UNIVAÇO), Ipatinga, MG - Brazil RJ – Brazil
Leonardo Silva Roever Borges – Departamento de Pesquisa Clínica, Wolney de Andrade Martins – Centro de Ciências Médicas, Universidade
Universidade Federal de Uberlândia (UFU), MG – Brazil Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil
Exterior Horacio José Faella - Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P.
Amalia Peix - Instituto de Cardiología y Cirugía Cardiovascular, Havana – Cuba Garrahan”, Caba – Argentina
James A. Lang - Des Moines University, Des Moines – USA
Amelia Jiménez-Heffernan - Hospital Juan Ramón Jiménez, Huelva – Spain
James P. Fisher - University of Birmingham, Birmingham – England
Ana Isabel Venâncio Oliveira Galrinho - Hospital Santa Marta, Lisboa – Portugal
João Augusto Costa Lima - Johns Hopkins Medicine, Baltimore – USA
Ana Maria Ferreira Neves Abreu - Hospital Santa Marta, Lisboa – Portugal
Jorge Ferreira - Hospital de Santa Cruz, Carnaxide, Portugal
Ana Teresa Timóteo - Hospital Santa Marta, Lisboa – Portugal
Manuel de Jesus Antunes - Centro Hospitalar de Coimbra, Coimbra – Portugal
Charalampos Tsoumpas - University of Leeds, Leeds – England
Marco Alves da Costa - Centro Hospitalar de Coimbra, Coimbra – Portugal
Chetal Patel - All India Institute of Medical Sciences, Delhi – Indian
Maria João Soares Vidigal Teixeira Ferreira - Universidade de Coimbra,
Edgardo Escobar - Universidad de Chile, Santiago – Chile Coimbra – Portugal
Enrique Estrada-Lobato - International Atomic Energy Agency, Vienna – Austria Massimo Francesco Piepoli - Ospedale “Guglielmo da Saliceto”, Piacenza – Italy
Erick Alexanderson - Instituto Nacional de Cardiología - Ignacio Chávez, Ciudad Nuno Bettencourt - Universidade do Porto, Porto – Portugal
de México – México Raffaele Giubbini - Università degli Studi di Brescia, Brescia – Italy
Fausto Pinto - Universidade de Lisboa, Lisboa - Portugal Ravi Kashyap - International Atomic Energy Agency, Vienna – Austria
Ganesan Karthikeyan - All India Institute of Medical Sciences, Delhi – Indian Roberto José Palma dos Reis - Hospital Polido Valente, Lisboa – Portugal
Guilherme Vianna e Silva - Texas Heart Institute, Texas – USA Shekhar H. Deo - University of Missouri, Columbia – USA
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International Journal of Cardiovascular Sciences. 2018;31(2)87-89
87
EDITORIAL
Relationship between Social Factors and Cardiovascular Diseases
Claudio Tinoco Mesquita
Universidade Federal Fluminense, Niterói, RJ – Brazil
“It’s a recession when your neighbor loses his job; and innovative data in cardiology: the relationship
it’s a depression when you lose your own.”
of cardiovascular mortality with macroeconomics
– Harry Truman
indicators. Correlating gross domestic product per
capita (GDPpc) data from several municipalities of the
For decades, western countries have witnessed
Rio de Janeiro state in recent decades with the reduction
cardiovascular diseases leading the statistics for cause of
in mortality due to DCS, those authors have reported
death. In Brazil, diseases of the circulatory system (DCS)
that the decline in mortality has been preceded by a
represent a major cause of death, accounting, in 2011, for
GDPpc elevation, with a strong correlation between
28.6% of all mortality causes.1
that indicator and the mortality rates. Those authors
In a multinational endeavor, the reduction in the risk of have concluded that the GDPpc variation associated
premature death due to cardiovascular diseases has been strongly with the decline in mortality due to DCS.4
defined as a United Nations Organization sustainable
Although relevant, the association between social
development goal for 2030.2 Although DCS are the major
factors and cardiovascular diseases has been little
cause of death worldwide, industrialized countries have
studied. In 2015, the American Heart Association
shown a decline in death due to DCS. This reduction
published a document aimed at raising awareness about
in cardiovascular mortality has also occurred in Brazil.
the influence of social factors on the incidence, treatment
Mansur & Favarato3 have shown that significant and
and outcomes of cardiovascular diseases.5 The World
constant reduction from 1980 to 2012, probably secondary
Health Organization defines the social components of
to the easier diagnosis and treatment of systemic arterial
health as “the circumstances under which individuals
hypertension, the main cardiovascular risk factor. Of the
are born, grow, live, work and age, in addition to the
several actions that contributed to decrease cardiovascular
systems used to cope with diseases”. Of the several social
mortality, the following stand out: cardiovascular
factors related to cardiovascular diseases, education
prevention with better control of risk factors; access to new
stands out, and studies have shown that individuals
drugs to manage dyslipidemia and prevent myocardial
with lower educational levels have greater prevalence
infarction, such as aspirin; fighting smoking and sedentary
of cardiovascular risk factors, higher incidence of
lifestyle; and the most effective treatment of cardiovascular
cardiovascular events and higher cardiovascular
diseases already established, cardiovascular surgeries and
mortality rate regardless of other demographic factors.5
percutaneous procedures.2
A lower educational level is associated with several
In this issue of the International Journal of risk factors, such as higher sedentary lifestyle rates.6
Cardiovascular Sciences, Soares et al.4 report on relevant Other studies have pointed to the combination of
emotional stress and low socioeconomic status in patients
experiencing an episode of acute coronary syndrome
Keywords
as a determinant of greater vulnerability to subsequent
Cardiovascular Diseases / mortality; Cardiovascular anxiety and depression, factors associated with worse
Diseases / epidemiology; Cardiovascular Diseases / prognosis.7 Andrade et al.8 have reported that certain
prevention and control; Myocardial Ischemia; Risk Factors; social factors, such as the number of elderly people,
Socioeconomic Factors. the illiteracy rate and the human development index,
Mailing Address: Claudio Tinoco Mesquita
Professor da Universidade Federal Fluminense. Programa de Pós-Graduação em Ciências Cardiovasculares. Hospital Universitário Antonio Pedro.
Av. Marquês do Paraná 303, Centro, Niterói, RJ – Brazil
E-mail: [email protected]
DOI: 10.5935/2359-4802.20180007
Claudio Tinoco Int J Cardiovasc Sci. 2018;31(2)87-89
88 Relationship Between Social Factors and Cardiovascular Diseases Editorial
contribute to mortality due to ischemic heart disease in viewpoint, with regression in several social development
Brazil. Those authors have found an inverse relationship indicators, consequent to the significant crisis in the oil
between GDP and cardiovascular mortality, as well as a sector. Such data added to the increase in obesity and in
lower cardiovascular mortality rate in the most populous the prevalence of diabetes in Brazil might have accounted
cities, which might have more resources to cope with for the interruption in the decline in cardiovascular
acute complications of ischemic heart disease. It is worth mortality reported by Mansur & Favarato3 since 2010
noting that those authors have found a relationship of in Brazil, contributing to the unprecedented increase
cardiovascular mortality with the distance between the in cardiovascular mortality after years of progressive
patients’ household and the healthcare centers, indicating drops. In the United States, a similar phenomenon
that patients living on the periphery of larger cities have has been recently observed and has raised adverse
higher cardiovascular complication rates.8 expectations regarding the cardiovascular mortality
Figure 1 shows worrisome data by illustrating decline trajectory.9 We congratulate the authors on their
the behavior of GDP in Brazil in recent decades. study that evidences the importance of improving the
After a variable period of GDP growth, Brazil faced population’s life conditions to reduce cardiovascular
two consecutive years of GDP reduction, and the Rio mortality. Public health managers should strive not to
de Janeiro state was particularly affected from the social miss any opportunity in that area.
Annual percentage variation of the GDP in Brazil between 1979 and 2016
10.0
8.0
6.0
4.0
2.0
0.0
–2.0
–4.0
–6.0
1977 1982 1987 1992 1997 2002 2007 2012 2017
Figure 1 – Annual percentage variation of the gross domestic product (GDP) in Brazil between 1979 and 2016. Source: Fundação Getúlio Vargas
- National Account Center - several publications from 1947 to 1989; IBGE. Research Executive Board. National Account Coordination. https://
agenciadenoticias.ibge.gov.br (accessed on February 19, 2018).
Int J Cardiovasc Sci. 2018;31(2)87-89 Claudio Tinoco
Editorial Relationship Between Social Factors and Cardiovascular Diseases 89
References
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Rio de Janeiro State Municipalities. Int J Cardiovasc Sci. 2018. [in press]. 8. de Andrade L, Zanini V, Batilana AP, de Carvalho EC, Pietrobon R, Nihei
OK, et al. Regional Disparities in Mortality after Ischemic Heart Disease
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International Journal of Cardiovascular Sciences. 2018;31(2)90-96
90
ORIGINAL ARTICLE
Impact of Risk Factors for Coronary Artery Disease on Hospital Costs of Patients Undergoing
Myocardial Revascularization Surgery in the Brazilian Unified Health System (SUS)
João Luis Barbosa,1 Clarissa Antunes Thiers,1 Carlos Felipe dos Santos Cunha,2 Juliana Moutella,2 Bernardo Rangel
Tura,1 Giulia Principe Orsi,2 Karen Feldman,2 Nathália Rodrigues da Silva,2 Luiz Felipe Faria3
Instituto Nacional de Cardiologia (INC);1 Universidade Estácio de Sá;2 Universidade Federal Fluminense (UFF),3 Rio de Janeiro, RJ – Brazil
Abstract
Background: Cardiovascular diseases are a major cause of mortality and morbidity. Myocardial revascularization
surgery may be indicated for the relief of symptoms and to reduce mortality. However, surgery is a costly procedure
and the impact of the number of cardiovascular risk factors on the cost of the procedure has not been established.
Objectives: To identify the impact of risk factors for coronary artery disease on myocardial revascularization surgery cost.
Methods: We selected 239 patients undergoing myocardial revascularization surgery at the National Institute of
Cardiology in the period from 01 January to 31 December 2013. We included patients aged over 30 years, with
indication for the procedure. Patients undergoing combined procedures were excluded.
Results: Seven patients had only one risk factor, 32 patients had two risk factors, 75 patients had 3 risk factors,
78 patients had four risk factors, 36 patients had 5 risk factors and 11 patients presented 6 risk factors. The total
costs, on average, was R$ 14,143.22 in the group with 1 risk factor, R$ 18,380.40 in the group with 2 risk factors,
R$ 21,229.51 in the group with 3 risk factors, R$ 24,620.86 in the group with 4 risk factors, R$ 21,337.92 in the group
with 5 risk factors and R$ 36,098,35 in the group with 6 risk factors (p = 0.441).
Conclusion: This study demonstrates that, in a public referral center for highly complex cardiology procedures,
there was no significant correlation between the number of cardiovascular risk factors and hospitalization costs.
(Int J Cardiovasc Sci. 2018;31(2)90-96)
Keywords: Coronary Artery Disease; Myocardial Revascularization / economics; Risk Factors; Hospital Costs;
Unified Health System.
Introduction MRS costs at a national level. The aim of this study was to
investigate the impact of risk factors on MRS costs in the
Cardiovascular diseases are a major cause of mortality Brazilian Unified Health System (SUS).
and morbidity.1 In a national context, the prevalence of
ischemic heart disease has increased in the past years, Methods
leading to an increase in hospitalizations and health costs.2
Myocardial revascularization surgery (MRS) is an expensive This was an observational, prospective, unicenter
therapy, indicated to selected patients. Clinical conditions study. A total of 239 consecutive patients who had
of patients prior to MRS can have an important influence undergone MRS at the National Institute of Cardiology
on the procedure costs. However, there is little information were selected. This is a public tertiary hospital that
regarding the impact of cardiovascular risk factors related serves SUS users referred for high complexity cardiology
to the development of coronary artery disease (CAD) on procedures from 01 January 2013 to 31 December 2013.
Mailing Address: João Luis Barbosa
Av: Embaixador Abelardo Bueno, 3250/BL 2/603. Postal Code: 22775040, Barra da Tijuca, Rio de Janeiro, RJ – Brazil.
E-mail: [email protected], [email protected]
DOI: 10.5935/2359-4802.20170098 Manuscript received May 31, 2016, revised manuscript July 22, 2017, accepted July 31, 2017