Insuficiência cardíaca em grande hospital terciário de São Paulo Heart failure in a large tertiary hospital of São Paulo

OBJETIVO: Verificar a incidência, principais causas, fatores desencadeantes ou de piora da insuficiência cardíaca (IC) no ano de 1995, no Instituto do Coração de São Paulo. MÉTODOS: Foram analisados os registros referentes a pacientes internados, obtidos do banco de dados da PRODESP. Analisaram-se nos pacientes com IC os dados: idade, sexo, diagnóstico principal e secundários, procedimentos executados e óbitos. Para fim de análise, construíram-se tabelas de distribuição conforme o sexo, idade e diagnóstico principal. Análise de variância e teste do qui-quadrado foram empregados para verificar diferença entre os grupos estudados. RESULTADOS: Dos pacientes internados (903 de 9620) 9,38% apresentaram IC. As idades variaram de 2 dias a 98 (média 52,6) anos e a maioria era do sexo masculino (60,4%). Miocardiopatia isquêmica (32,6%), miocardiopatia dilatada (25,8%) e valvopatias (22,0%) foram as principais causas de IC. Foram submetidos à cirurgia, angioplastia, ou implante de marcapasso, 32,1% dos pacientes, sendo os valvopatas na maioria submetidos à correção de sua cardiopatia de base (63,3%). Houve maior incidência de múltiplos diagnósticos secundários com o aumento da idade. A mortalidade foi maior nos com idade <20 anos e nos >80 anos. CONCLUSÃO: A incidência de IC foi de 9,38%, sendo miocardiopatia isquêmica a causa mais freqüente. Foi possível corrigir a causa da IC em 32,1%. A mortalidade foi maior nas crianças provavelmente pela maior complexidade de sua cardiopatia e nos mais idosos devido à maior associação de diagnósticos secundários ou fatores agravantes.<br>PURPOSE: To study the incidence, main causes, aggravating factors and secondary diagnoses of heart failure (HF) during 1995 at the Instituto do Coração of São Paulo. METHODS: Data from hospitalized patients according to the PRODESP data base were analyzed. The following data were studied: age, sex, principal and secondary diagnoses, surgical procedures and mortality. To analyze the data, tables according to sex, age and main cause were built. Analysis of variance and t test were employed to verify differences between groups. RESULTS: In 1995, 903 out of 9620 patients were hospitalized due to HF. The majority were male (60.4%) and the patients' age was between two days and 98 years old (mean 52.6). Ischemic (32.6), dilated (25.8%) and valvar heart disease (22%) were the main causes of HF. 32.1% were submitted to correction of the HF main cause, specially those with valvar heart disease (62.3%). There was greater incidence of multiple diagnoses in aged patients. The mortality was greater in patients younger than 20 and in those older than 80 years old. CONCLUSION: The incidence of HF at INCOR during 1995 was 9.38%. Ischemic myocardiopathy was the most frequent HF cause. The mortality was greater among children, probably because of heart disease complexity and, in the above-80 group due to the greater comorbidity

Validating the SIR: a better prognostic score index for patients with brain metastases treated with stereotactic radiosurgery

Objective: The aim of this paper is to validate the score index forsurvival in patients treated with stereotactic radiosurgery, using aclassification prepared to better evaluate the prognosis of patientswith brain metastasis submitted to stereotactic surgery, re-evaluatingsurvival of patients and reviewing the medical literature. Methods:Data from 100 patients with brain metastases treated with stereotacticradiosurgery at a single institution, between July 1993 and February2000, were retrospectively analyzed. The prognostic factors andscores studied were age, Karnofsky performance status, extracranialdisease status, number of brain lesions, volume of the largest lesion,primary tumor type, treated or not with whole brain radiation therapy,SIR, and RPA. Kaplan-Meier actuarial survival curves for subsets werecalculated and compared by log-rank test. Complete and backwardelimination Cox models were utilized to identify the prognostic factorsand scores independently associated with survival. Results: Karnofskyperformance status, extracranial disease status, volume of the largestbrain lesion, RPA, and SIR were significantly correlated with prognosisin Kaplan-Meier survival analysis. Applying Cox models, significancewas observed for KPS and volume of the largest lesion (p < 0.0001and p = 0.0182, respectively), as well as for SIR and RPA when testedindividually (p < 0.0001 and p = 0.0002, respectively). However, whentesting SIR and RPA together, only SIR reached independent statisticalsignificance (p < 0.0001). Conclusion: SIR classification demonstrateda better accuracy in predicting survival time than RPA. SIR was testedin other centers, showing superior accuracy and applicability than theRPA, thus validating this score