Confiabilidad y validez de la escala de depresión geriátrica en adultos mayores con enfermedad arterial coronaria

BACKGROUND: The prevalence of depression in individuals with coronary artery disease (CAD) is high. The Geriatric Depression Scale (GDS) is a broadly used tool to screen for depression in elderly individuals. In Brazil, the psychometric properties of the short version have not been adequately assessed. OBJECTIVE: To evaluate the psychometric properties of the short version of the GDS in patients with CAD treated at a Cardiology Outpatient Clinic. METHODS: The present is a cross-sectional study that assessed 209 elderly individuals (≥ 65 years) with CAD using the GDS-15, the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) and The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The internal consistency of the GDS-15 was calculated through the KR-20. A factorial analysis of this scale was carried out. The GDS-15 scores were compared with the diagnoses of depression (DSM-IV) for the validity of criteria. At the analysis of concurrent validity, the same scores were correlated with those of the CAMDEX, mini-mental state examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and BOMFAQ depression scales. RESULTS: Clinical depression was diagnosed in 35.71% of the sample assessed according to the DSM-IV. For the diagnosis of major depression or dystimia, the cutoff 5/6 presented moderate accuracy (AUROC = 0.84), sensitivity of 79.92% and specificity of 78.29%. The internal consistency was 0.80. At the factorial analysis, three obtained factors explained 52.72% of the total variance that was observed. The GDS-15 scores correlated with those of the CAMDEX depression scale. CONCLUSION: In general, the GDS-15 presented good reliability and validity (concurrent and of criterion). In cardiologic settings, its use, which is simple and fast, can be utilized in the screening for depression.FUNDAMENTO: La prevalencia de depresión en portadores de enfermedad arterial coronaria (EAC) es alta. La escala de depresión geriátrica (EDG) es un instrumento ampliamente utilizado para rastrear la depresión en adultos mayores. En Brasil, las propiedades psicométricas de la versión corta aún no fueron adecuadamente estudiadas. OBJETIVO: Evaluar las propiedades psicométricas de la versión corta de la EDG en portadores de EAC en ambulatorio de cardiología. MÉTODOS: Estudio transversal que evaluó 209 adultos mayores (> 65 años) con EAC utilizando la EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) y The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). La consistencia interna de la EDG-15 fue calculada mediante el KR-20. Se llevó a cabo un análisis factorial de esa escala. Los escores de la EDG-15 fueron comparados con los diagnósticos de depresión (DSM-IV) para la validez de criterios. En el análisis de validez concurrente, los mismos escores fueron correlacionados con los de las escalas de depresión CAMDEX, Miniexamen del Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) y BOMFAQ. RESULTADOS: En un 35,71% de la muestra evaluada se diagnosticó depresión clínica, de acuerdo al DSM-IV. Para el diagnóstico de depresión mayor o distimia, el punto de corte 5/6 presentó precisión moderada (AUROC = 0,84), sensibilidad del 79,92% y especificidad del 78,29%. La consistencia interna fue de 0,80. En el análisis factorial, tres factores obtenidos explicaron el 52,72% de la variancia total observada. Los escores de la EDG-15 se correlacionaron con los de la escala de depresión CAMDEX. CONCLUSIÓN: En general, la EDG-15 presentó buena confiabilidad y validez (concurrente y de criterio). En settings cardiológicos, su uso puede auxiliar en el rastreo de cuadros depresivos de forma simple y rápida.FUNDAMENTO: A prevalência de depressão em portadores de doença arterial coronariana (DAC) é alta. A escala de depressão geriátrica (EDG) é um instrumento amplamente usado para rastrear a depressão em idosos. No Brasil, as propriedades psicométricas da versão curta ainda não foram adequadamente exploradas. OBJETIVO: Avaliar as propriedades psicométricas da versão curta da EDG em portadores de DAC em ambulatório de cardiologia. MÉTODOS: Estudo transversal que avaliou 209 idosos (≥ 65 anos) com DAC utilizando a EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) e The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). A consistência interna da EDG-15 foi calculada pelo KR-20. Uma análise fatorial dessa escala foi conduzida. Escores da EDG-15 foram comparados com os diagnósticos de depressão (DSM-IV) para a validade de critérios. Na análise de validade concorrente, os mesmos escores foram correlacionados com os das escalas de depressão CAMDEX, Miniexame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e BOMFAQ. RESULTADOS: A depressão clínica foi diagnosticada em 35,71% da amostra avaliada de acordo com o DSM-IV. Para o diagnóstico de depressão maior ou distimia, o ponto de corte 5/6 apresentou acurácia moderada (AUROC = 0,84), sensibilidade de 79,92% e especificidade de 78,29%. A consistência interna foi de 0,80. Na análise fatorial, três fatores obtidos explicaram 52,72% da variância total observada. Os escores da EDG-15 correlacionaram-se com os da escala de depressão CAMDEX. CONCLUSÃO: No geral, a EDG-15 apresentou boa confiabilidade e validade (concorrente e de critério). Em settings cardiológicos, seu uso pode auxiliar no rastreamento de quadros depressivos de forma simples e rápida.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

A risk score for predicting peripheral arterial disease in individuals 75 years or older

BACKGROUND: The prevalence of peripheral arterial disease (PAD) in the elderly is high. Most are asymptomatic and the sensitivity of the physical exam is low. In Brazil, little is known in regard to PAD risk factors in the elderly. OBJECTIVES: To identify risk factors for PAD among elderly individuals (> 75 years) in the community and to develop a prediction score. METHODS: Cross-sectional, prospective, community-based study nested within a cohort study (Epidoso). A total of 176 individuals were assessed. PAD was defined as an ankle-brachial index 18 points defined the high risk individuals and yielded sensitivity, specificity, positive predictive value and negative predictive value of 85.9%, 71.4%, 63.2% and 89.9%, respectively. Receiver-operator characteristic analysis yielded area under curve of 85%, indicating excellent discrimination and goodness-of-fit statistics indicated excellent calibration (p=0.639). CONCLUSION: Because of its good performance, the proposed score can become a simple and useful tool to identify elderly community residents at higher risk of PAD who should be considered for further investigation.FUNDAMENTO: A prevalência de doença arterial periférica (DAP) é elevada entre os idosos. A maioria é assintomática e o exame físico pouco sensível. No Brasil, os fatores associados à DAP em idosos são pouco conhecidos. OBEJETIVOS: Identificar os fatores associados à presença de doença arterial periférica (DAP) em idosos (> 75 anos) da comunidade e desenvolver um escore de predição da doença. MÉTODOS: Estudo transversal, aninhado em uma coorte prospectiva (Epidoso). Foram avaliados 176 idosos (> 75 anos) da comunidade. A presença de DAP foi definida por meio do índice tornozelo-braquial 75 anos) da comunidade com alto risco para DAP e que mereceriam investigação mais detalhada.Universidade Federal de São Paulo (UNIFESP)Hospital Israelita Albert EinsteinUNIFESPSciEL

Medical Students’ Awareness About Value-Based Health Care in Brazil: A Cross Sectional Study

Background: Rising healthcare costs demand a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. This requires that all future doctors to understand the VBHC Model. We aimed to evaluate the VBHC awareness among Brazilian medical students and to identify it’s associated intrinsic/extrinsic factors through a survey-based, cross-sectional study. Methods: An online survey was sent to students from Brazilian medical schools. A descriptive analysis based on participants' level of awareness about VBHC was performed. The categorical variables included were absolute and relative frequencies using chi-square tests. A multivariate binary logistic regression analysis was performed by calculating the odds ratio (OR) and 95% confidence intervals (95%CI) to compare each response according to VBHC awareness. Results: We collected 3030 responses from 148 Medical Schools across all Brazilian states. Medical students were compared into 2 groups; 1 was familiar with VBHC (14%; 426); 2 were not (86%; 2575). The univariate analysis showed that group 1 was more willing to share clinical outcomes/costs data related to their practice (57.04%) compared to 2 (48.12%), p<0.01. The multivariate analysis showed that internship experience was the most relevant factor associated with VBHC exposure (OR 4.32 [CI 95% 1.82 - 10.24]). Conclusion: We found that few medical students understand VBHC concepts, and that exposure was due to self-education efforts. Our results suggest that medical schools have the potential to reinforce both intrinsic and extrinsic factors related to students with regards to VBHC knowledge in order to prepare future doctors to practice in a value-driven context

Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography

OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortalityand the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lowerlimb peripheral arterial disease.METHODS: We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease,as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronaryartery. We measured the ankle-brachial index immediately after coronary angiography, and a value of ,0.9was used to diagnose peripheral arterial disease.RESULTS: The patients’ average age was 77.4 years. The most prevalent risk factor was hypertension (96%), andthe median late follow-up appointment was 28.9 months. The ankle-brachial index was ,0.9 in 47% of thepatients, and a low index was more prevalent in patients with multiarterial coronary disease compared topatients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of,0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal andnon-fatal acute myocardial infarctions two- to three-fold.CONCLUSION: In elderly patients with documented coronary disease, a low ankle-brachial index (,0.9) wasassociated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a lowindex was correlated with an increase in the occurrence of major cardiovascular events

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Patients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV

Validation of the Edinburgh Claudication Questionnaire in 1st generation Black African-Caribbean and South Asian UK migrants: A sub-study to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study

<p>Abstract</p> <p>Background</p> <p>We determined the diagnostic accuracy of the Edinburgh Claudication Questionnaire (ECQ) in 1^stgeneration Black African-Caribbean UK migrants as previous diagnostic questionnaires have been found to be less accurate in this population. We also determined the diagnostic accuracy of translated versions of the ECQ in 1^stgeneration South Asian UK migrants, as this has not been investigated before.</p> <p>Methods</p> <p>Subjects were recruited from the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study, a community based screening survey for heart failure in minority ethnic groups. Translated versions of the ECQ were prepared following a recognised protocol. All participants attending screening between October 2007 and February 2009 were asked to complete the ECQ in the language of their choice (English, Punjabi, Bengali, Urdu, Hindi or Gujarati). Subjects answering positively to experiencing leg pain or discomfort on walking were asked to return to have Ankle Brachial Pressure Index (ABPI) measured.</p> <p>Results</p> <p>154 out of 2831 subjects participating in E-ECHOES (5.4%) were eligible to participate in this sub-study, for which 74.3% returned for ABPI assessment. Non-responders were younger than participants (59[9] vs. 65[11] years; p = 0.015). Punjabi, English and Bengali questionnaires identified participants with Intermittent Claudication, so these questionnaires were assessed. The sensitivities (SN), specificities (SP), positive (PPV) and negative (NPV) predictive values were calculated. English: SN: 50%; SP: 68%; PPV: 43%; NPV: 74%. Punjabi: SN: 50%; SP: 87%; PPV: 43%; NPV: 90%. Bengali: SN: 33%; SP: 50%; PPV: 13%; NPV: 73%. There were significant differences in diagnostic accuracy between the 3 versions (Punjabi: 83.8%; Bengali: 45%; English: 62.2%; p < 0.0001). No significant differences were found in sensitivity and specificity between illiterate and literate participants in any of the questionnaires and there was no significant different difference between those under and over 60 years of age.</p> <p>Conclusions</p> <p>Our findings suggest that the ECQ is not as sensitive or specific a diagnostic tool in 1^stgeneration Black African-Caribbean and South Asian UK migrants than in the Edinburgh Artery Study, reflecting the findings of other diagnostic questionnaires in these minority ethnic groups. However this study is limited by sample size so conclusions should be interpreted with caution.</p