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BACKGROUND: Advances in the treatment of heart failure (HF) have resulted in reduced mortality and hospitalization rates. On the other hand, when hospitalized, patients are at high risk of death. OBJECTIVE: As there are few studies in this group of patients in Brazil, we analyzed the numbers of hospitalization and deaths due to HF in the Brazilian Public Health System (SUS) in the city of São Paulo. METHODS: Historical prospective study carried out between 1992 and 2010. The data were obtained from DATASUS. We used Chi-square and t tests for comparison between the periods 1992-1993 and 2008-2009 and logistic regression models when appropriate. The level of significance was set at 5%. RESULTS: There was a 32% decrease in the number of hospitalizations for HF between 1992-1993 and 2008-2009 (p = 0.002). The in-hospital mortality rate for HF was 15%, with a 15% increase in the period (p = 0.004). Between 1992 and 1993, the mean time of hospitalization for HF was 8.8 days. Between 2008 and 2009, it was 11.3 days (p = 0.001). August was the month with the highest incidence of hospitalizations for HF, 20% higher than in February, the month with the lowest incidence (p = 0.041). CONCLUSION: This study showed changes in trends of hospitalization for HF and mortality over the last two decades. We emphasize important implications: 1: 32% decrease in the number of hospitalizations for HF in SUS hospitals in São Paulo; 2: 25% increase in hospitalization time, and 3: seasonal pattern of hospitalization for HF, with a peak in the third quarter.

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FUNDAMENTO: Os avanços no tratamento da insuficiência cardíaca (IC) resultaram em redução da taxa de mortalidade e de hospitalização. Por outro lado, quando hospitalizados, os pacientes apresentam alto risco de óbito. OBJETIVO: Como são poucos os estudos com esse grupo de pacientes no Brasil, analisamos os números de internação e óbito por IC no SUS do município de São Paulo. MÉTODOS: Estudo prospectivo histórico realizado entre 1992 e 2010. Os dados foram obtidos no DATASUS. Utilizamos os testes qui-quadrado e T para a comparação entre os períodos 1992-1993 e 2008-2009 e modelos de regressão logística quando apropriado. O nível de significância considerado foi de 5 por cento. RESULTADOS: Houve redução de 32 por cento no número de internações por IC entre 1992-1993 e 2008-2009 (p = 0,002). A taxa de mortalidade hospitalar por IC foi de 15 por cento, com aumento de 15 por cento no período (p = 0,004). Entre 1992-1993, o tempo médio de hospitalização por IC foi de 8,8 dias. Entre 2008-2009, 11,3 dias (p = 0,001). Agosto foi o mês com maior incidência de internações por IC, 20 por cento maior do que fevereiro, mês de menor incidência (p = 0,041). CONCLUSÃO: Este estudo apresentou as modificações nas tendências de hospitalização e mortalidade hospitalar por IC ao longo das duas últimas décadas. Ressaltamos importantes implicações: 1º: redução em 32 por cento no número de internações por IC em hospitais do SUS no município de São Paulo; 2º: aumento de 25 por cento no tempo de hospitalização; e 3º: padrão sazonal de internação por IC, com pico no terceiro trimestre.

BACKGROUND: Advances in the treatment of heart failure (HF) have resulted in reduced mortality and hospitalization rates. On the other hand, when hospitalized, patients are at high risk of death. OBJECTIVE: As there are few studies in this group of patients in Brazil, we analyzed the numbers of hospitalization and deaths due to HF in the Brazilian Public Health System (SUS) in the city of São Paulo. METHODS: Historical prospective study carried out between 1992 and 2010. The data were obtained from DATASUS. We used Chi-square and t tests for comparison between the periods 1992-1993 and 2008-2009 and logistic regression models when appropriate. The level of significance was set at 5 percent. RESULTS: There was a 32 percent decrease in the number of hospitalizations for HF between 1992-1993 and 2008-2009 (p = 0.002). The in-hospital mortality rate for HF was 15 percent, with a 15 percent increase in the period (p = 0.004). Between 1992 and 1993, the mean time of hospitalization for HF was 8.8 days. Between 2008 and 2009, it was 11.3 days (p = 0.001). August was the month with the highest incidence of hospitalizations for HF, 20 percent higher than in February, the month with the lowest incidence (p = 0.041). CONCLUSION: This study showed changes in trends of hospitalization for HF and mortality over the last two decades. We emphasize important implications: 1: 32 percent decrease in the number of hospitalizations for HF in SUS hospitals in São Paulo; 2: 25 percent increase in hospitalization time, and 3: seasonal pattern of hospitalization for HF, with a peak in the third quarter.

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BACKGROUND: Despite the high incidence of infections after heart transplantation, there is limited information about its epidemiology in patients from countries where Chagas' disease is endemic. METHODS: We analyzed the occurrence of infections in 126 patients aged older than 18 years who underwent transplantation from 1986 through 2007 at a Brazilian University Hospital and who survived at least 48 hours. RESULTS: Heart failure diagnoses before transplantation were idiopathic dilated cardiomyopathy (38.6%), Chagas' disease (34.9%), coronary artery disease (19.8%), and others (6.3%). The respiratory tract was the most common site of infections (40.9%), followed by surgical wound site (18.1%). Trypanosoma cruzi reactivations occurred in 38.8% of Chagas' disease patients: 47.0% had myocarditis, 23.5% had skin lesions, and 29.4% had both. New-onset ventricular dysfunction was observed in 47.0%, with complete response after specific treatment, and 41.0% were asymptomatic cases, diagnosed by routine endomyocardial biopsies. No patient died from such events. No differences in survival were found after 5 years of follow-up between recipients with and without Chagas' disease (p = 0.231). CONCLUSIONS: In a heart transplant population from a developing country, infectious complications occurred at a high rate. Tropical illnesses were uncommon, except for the high rate of Chagas' disease reactivations. Despite that, the overall outcome of these patients was similar to that of recipients with other cardiomyopathies.

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