RESUMO
BACKGROUND: Congestive heart failure (CHF) is a well-recognized risk factor for venous thromboembolism (VTE) and is associated with higher mortality in patients with an acute pulmonary embolism (PE). There are very few data on how acute PE affects the clinical course of patients with heart failure. The purpose of this study was to determine the impact of an acute PE on the short-term prognosis of patients hospitalized for decompensated CHF. METHODS: This was a prospective cohort study of 198 patients admitted to a coronary care unit between July 2001 and March 2003 with severe decompensated CHF. The primary outcome measure was death or rehospitalization at 3 months. RESULTS: PE was confirmed in 18 of 198 patients enrolled (9.1%). The groups with and without PE were comparable with regards to demographics, the prevalence of comorbid conditions, and severity of CHF (p > 0.05). The prevalence of cancer (p = 0.0001), previous VTE (p = 0.003), and right ventricular overload (p = 0.006) was higher in the PE group. The presence of PE was also associated with a longer hospital stay (37.5 +/- 71.6 days vs 15.4 +/- 15.0 days, p = 0.001) [mean +/- SD] and a higher incidence of death or rehospitalization at 3 months (72.2% vs 43.9%, p = 0.02). In a multiple logistic regression analysis, PE remained an independent predictor of death or rehospitalization at 3 months (odds ratio, 4.0; 95% confidence interval, 1.1 to 15.1; p = 0.038). CONCLUSIONS: Acute PE commonly complicates the hospital course of patients with severe CHF, increasing the length of hospital stay and the chance of death or rehospitalization at 3 months.
Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Embolia Pulmonar/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To assess mortality trend due to heart failure (HF) in Salvador--Bahia, from 1979 to 1995. METHODS: HF was defined by notations from the 9th Review of International Disease Code (IDC9) 428.0, 428.1 and 428.9. HF death and population data (metropolitan area of Salvador) were obtained by means of Secretaria de Saúde da Bahia (Bahia State Health Secretariat) and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality rates (/100,000) were total or per gender and age, and gross or adapted per age (straight standardization). RESULTS: Mortality rates due to HF had a progressive reduction in the period of time assessed, for both genders, especially up to 1992. From then and up to 1995, there was an apparent stabilization of the curves. Gross mortality rate went from 25.0/10(5), in 1979, to 16.4/10(5) inhabitants, in 1995 (a decrease of 34.4%). The reduction was 34.0% (23.3/10(5), in 1979, to 15.4/10(5) inhabitants, in 1995) for male sex and 35.2% (26.7/10(5), in 1979, to 17.3/10(5) inhabitants, in 1995), for female sex. The same trend took place in several age ranges, including the population > or = 40 years old, which has a greater risk for HF. After adaptation per age (standard population of 1979), it is observed that relative reductions in the rates were even greater. CONCLUSION: Mortality due to HF, in Salvador-Bahia, decreased from 1979 to 1992, becoming stable from then to 1995.
Assuntos
Insuficiência Cardíaca/mortalidade , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Brasil/epidemiologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida , População UrbanaRESUMO
OBJETIVO: Avaliar a tendência da mortalidade por insuficiência cardíaca (IC) em Salvador - Bahia, no período de 1979-1995. MÉTODOS: A IC foi definida pelas notacões da 9ª Revisão do Código Internacional de Doencas (CID9) 428.0, 428.1 e 428.9. Dados de óbitos por IC e populacionais (região metropolitana de Salvador) foram obtidos por meio da Secretaria de Saúde da Bahia e do Instituto Brasileiro de Geografia e Estatística. As taxas de mortalidade (/100.000) foram totais ou por gênero e idade, e brutas ou ajustadas por idade (padronizacão direta). RESULTADOS: As taxas de mortalidade por IC sofreram reducão progressiva no período de tempo avaliado, para ambos os gêneros, especialmente até o ano de 1992. A partir daí e até 1995, ocorreu uma aparente estabilizacão das curvas. A taxa de mortalidade bruta passou de 25,0/10(5), em 1979, para 16,4/10(5) habitantes, em 1995 (queda de 34,4 por cento). A reducão foi de 34,0 por cento (23,3/10(5), em 1979, para 15,4/10(5) habitantes, em 1995) para o sexo masculino e de 35,2 por cento (26,7/10(5), em 1979, para 17,3/10(5) habitantes, em 1995), para o sexo feminino. A mesma tendência ocorreu nas diversas faixas etárias, inclusive para a populacão > 40 anos, de maior risco para IC. Após o ajuste por idade (populacão padrão de 1979), observa-se que as reducões relativas nas taxas foram ainda maiores. CONCLUSAO: A mortalidade por IC, em Salvador-Bahia, declinou de 1979 a 1992, estabilizando-se a partir de então até 1995.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Insuficiência Cardíaca , Distribuição por Idade , Fatores Etários , Brasil/epidemiologia , Modelos Lineares , Mortalidade/tendências , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida , População UrbanaRESUMO
OBJECTIVES: To determine the incidence of clinical pulmonary embolism (PE) in a population with severe congestive heart failure (CHF) admitted to a coronary care unit (CCU), and to identify clinical predictors of PE in this population. DESIGN AND SETTING: Prospective, observational study performed in a CCU of a tertiary care hospital between July 2001 and March 2003. PATIENTS: One hundred ninety-eight patients with severe decompensated CHF. MEASUREMENTS AND RESULTS: Of 198 patients recruited, 18 patients (9.1%) received a diagnosis of PE during their hospitalization. Deep vein thrombosis was demonstrated in 8 of 18 patients (44.4%) with PE. Thromboprophylaxis was used by 12 of 18 patients (66.7%) with PE and 126 of 180 patients (70%) without PE (p = 0.77). Both groups were similar with respect to mean age (68.2 +/- 14.1 years vs 69.6 +/- 13.4 years [+/- SD]), proportion of male patients (61.1% vs 55.1%), markers of CHF severity (New York Heart Association functional class > II, ejection fraction < 30%, Na < 136 mEq/L, ischemic etiology), and comorbid conditions (diabetes mellitus, atrial fibrillation, chronic renal failure, hypertension) [p = not significant]. The presence of PE was significantly associated with cancer (relative risk [RR], 8.4; 95% confidence interval [CI], 3.9 to 18.1), immobilization (RR, 5.4; 95% CI, 2.0 to 14.4), previous venous thromboembolism (VTE) [RR, 4.4; 95% CI, 1.7 to 11.3], COPD (RR, 3.1; 95% CI, 1.03 to 9.2), and right ventricle (RV) abnormality (RR, 3.3; 95% CI, 1.3 to 8.0). In a multiple logistic regression analysis, only cancer (odds ratio [OR], 26.9; 95% CI, 4.9 to 146.8), RV abnormality (OR, 9.7; 95% CI, 2.2 to 42.6), and previous VTE (OR, 9.1; 95% CI, 1.28 to 64.7) remained independently associated with PE. CONCLUSIONS: In patients with severe decompensated CHF admitted to a CCU, the incidence of clinical PE is very high despite adequate prophylaxis. Traditional risk factors seemed to play an important role in determining the risk of PE in this population.