RESUMO

Background: Residual risk management in patients with previous cardiovascular disease (CVD) is a relevant issue. Objectives: 1) to assess the residual risk of patients with CVD using the new scores developed to predict recurrent CVD events (SMART score/SMART-REACH model); 2) to determine the use of therapies with cardiovascular benefit and the achievement of therapeutic goals in patients with very high residual risk. Methods: A multicenter, descriptive, cross-sectional study was performed. Individuals over 18 years of age with CVD were included consecutively. The 10-year risk of recurrent events was estimated using the SMART score and the SMART-REACH model. A value ≥ 30% was considered "very high risk". Results: In total, 296 patients (mean age 68.2 ± 9.4 years, 75.7% men) were included. Globally, 32.43% and 64.53% of the population was classified as very high risk by the SMART score and the SMART-REACH model, respectively. Among patients classified as very high risk by the SMART score, 45.7% and 33.3% were treated with high-intensity statins and reached the goal of LDL-C <55 mg/dL, respectively. The results were similar when evaluating very high patients according to the SMART-REACH model (high-intensity statins: 59.7%; LDL-C <55 mg/dL: 43.9%). Few very high-risk patients with diabetes were receiving glucose-lowering drugs with demonstrated cardiovascular benefit. Conclusion: In this secondary prevention population, the residual risk was considerable. Underutilization of standard care treatments and failure to achieve therapeutic goals were evident even in subjects with very high residual risk.

RESUMO

Discrepancies between clinical suspicion and pathological findings in pulmonary embolism (PE) appear to be frequent. The aim of this study was to analyze the prevalence of PE in a necropsy series of patients who have died in an acute care hospital between 1998-2017, its relationship with previous clinical suspicion, and its importance as a cause of death. It is a retrospective observational study of 350 autopsies done at the Department of Pathology. We analyzed the demographic characteristics, main clinical diagnoses stated in the autopsy request form, incidence of PE diagnosed, main autopsy findings related with the cause of death, as well as the concordance between clinical suspicion and autopsy diagnosis. In only 8% of the cases (n = 28) the clinical diagnosis of autopsy request was PE. An autopsy diagnosis of PE was done in 127 cases (36.3%); in 33 cases (25.9%) affected large pulmonary vessels; medium caliber vessels were affected in 75 cases (59.1%), and in 19 cases small vessels. The PE was considered as a contributor or cause of death in 30.9% (n = 108). However, only 15.7% of the confirmed PE cases had previous clinical suspicion. This series of necropsies shows that PE is a high prevalence finding in autopsies at an acute care hospital, and an important cause of death in a 20 years period. The finding of a low concordance with clinical diagnosis should alert the medical community on the importance of clinical suspicion in order to achieve an early diagnosis and treatment of this disease.

Las discrepancias entre la sospecha clínica y los hallazgos patológicos en el tromboembolismo pulmonar (TEP) son frecuentes. El objetivo de este estudio fue analizar la prevalencia de TEP en una serie de necropsias de fallecidos en un hospital general de agudos entre 1998 y 2017, su relación con la sospecha clínica y su importancia como causa de muerte. Es un estudio retrospectivo y observacional de 350 autopsias realizadas en el Servicio de Patología; analiza características demográficas, principales diagnósticos clínicos informados en la solicitud de autopsia (sospecha clínica de muerte), incidencia anatomopatológica de TEP, diagnósticos primarios de autopsia relacionados con la muerte y concordancia entre sospecha clínica y diagnósticos de autopsia. En solo el 8% de las autopsias (n = 28), el TEP fue el diagnóstico clínico informado. En las autopsias, se encontró TEP en 127 casos (36.3%). Afectó arterias pulmonares grandes en 33 casos (25.9%), vasos medianos en 75 (59.1%) y vasos pequeños en 19 casos. El TEP se consideró el principal contribuyente o la causa principal de muerte en un 30.9% (n = 108) de los casos. Sin embargo, solo en el 15.7% de los casos confirmados había una sospecha clínica previa de TEP. Esta serie muestra que el TEP es un hallazgo de alta prevalencia y una causa importante de muerte en autopsias realizadas en un hospital de agudos. La evidencia de la baja concordancia entre los diagnósticos anatomopatológicos y clínicos del TEP alerta sobre la importancia de la sospecha clínica para lograr un tratamiento temprano de la enfermedad.

Assuntos

RESUMO

Las discrepancias entre la sospecha clínica y los hallazgos patológicos en el tromboembolismo pulmonar (TEP) son frecuentes. El objetivo de este estudio fue analizar la prevalencia de TEP en una serie de necropsias de fallecidos en un hospital general de agudos entre 1998 y 2017, su relación con la sospecha clínica y su importancia como causa de muerte. Es un estudio retrospectivo y observacional de 350 autopsias realizadas en el Servicio de Patología; analiza características demográficas, principales diagnósticos clínicos informados en la solicitud de autopsia (sospecha clínica de muerte), incidencia anatomopatológica de TEP, diagnósticos primarios de autopsia relacionados con la muerte y concordancia entre sospecha clínica y diagnósticos de autopsia. En solo el 8% de las autopsias (n = 28), el TEP fue el diagnóstico clínico informado. En las autopsias, se encontró TEP en 127 casos (36.3%). Afectó arterias pulmonares grandes en 33 casos (25.9%), vasos medianos en 75 (59.1%) y vasos pequeños en 19 casos. El TEP se consideró el principal contribuyente o la causa principal de muerte en un 30.9% (n = 108) de los casos. Sin embargo, solo en el 15.7% de los casos confirmados había una sospecha clínica previa de TEP. Esta serie muestra que el TEP es un hallazgo de alta prevalencia y una causa importante de muerte en autopsias realizadas en un hospital de agudos. La evidencia de la baja concordancia entre los diagnósticos anatomopatológicos y clínicos del TEP alerta sobre la importancia de la sospecha clínica para lograr un tratamiento temprano de la enfermedad.

Discrepancies between clinical suspicion and pathological findings in pulmonary embolism (PE) appear to be frequent. The aim of this study was to analyze the prevalence of PE in a necropsy series of patients who have died in an acute care hospital between 1998-2017, its relationship with previous clinical suspicion, and its importance as a cause of death. It is a retrospective observational study of 350 autopsies done at the Department of Pathology. We analyzed the demographic characteristics, main clinical diagnoses stated in the autopsy request form, incidence of PE diagnosed, main autopsy findings related with the cause of death, as well as the concordance between clinical suspicion and autopsy diagnosis. In only 8% of the cases (n = 28) the clinical diagnosis of autopsy request was PE. An autopsy diagnosis of PE was done in 127 cases (36.3%); in 33 cases (25.9%) affected large pulmonary vessels; medium caliber vessels were affected in 75 cases (59.1%), and in 19 cases small vessels. The PE was considered as a contributor or cause of death in 30.9% (n = 108). However, only 15.7% of the confirmed PE cases had previous clinical suspicion. This series of necropsies shows that PE is a high prevalence finding in autopsies at an acute care hospital, and an important cause of death in a 20 years period. The finding of a low concordance with clinical diagnosis should alert the medical community on the importance of clinical suspicion in order to achieve an early diagnosis and treatment of this disease.

Assuntos