2020 Top 10 Original Articles in the Arquivos Brasileiros de Cardiologia and the Revista Portuguesa de Cardiologia

publishersversionpublishe

The Top 10 Original Articles Published in the Arquivos Brasileiros de Cardiologia and in the Revista Portuguesa de Cardiologia in 2019

publishersversionpublishe

Original Article Proportional Mortality due to Heart Failure and Ischemic Heart Diseases in the Brazilian Regions from 2004 to 2011

Abstract Background: Heart failure (HF) and ischemic heart diseases (IHD) are important causes of death in Brazil

In-hospital outcomes of Infective Endocarditis from 1978 to 2015: analysis through machine-learning techniques

© 2021 The Authors. Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. This is an open access article under the CC BY-NC- ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Background: Early identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. Methods: A retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. Results: This study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. Conclusions: The use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning-based analysis.info:eu-repo/semantics/publishedVersio

Como cuidar do seu coração na pandemia do COVID-19: recomendações para a prática do exercício físico e respiratórios

The first cases of Coronavirus (COVID-19) were reported in December 2019 in Wuhan Province (China) and the infection quickly spread throughout the world, despite the strategies adopted by the Chinese Government to stop this epidemiological phenomenon. Four months later, on April 14, 2020, COVID-19 became a worldwide pandemic with more than 1 million confirmed cases and almost 107,000 deaths worldwide (1). In Brazil, until April 14, 2020, 25,263 cases and 1,532 deaths were confirmed with a lethality rate of 4.6% (1). Most experts in epidemiology and infectology agree that much of the success in containing the virus in China is due to the rapid measures taken by authorities in imposing quarantine on the majority of the population. In this sense, weeks later, other countries that were also so seriously affected - such as Italy, Spain and the United States of America - adopted the most severe social quarantine strategies. Additionally, based on world information and as the pandemic progressed, some characteristics of the population at greatest risk for COVID-19 were identified. In this sense, epidemiological data showed that elderly individuals, those with pre-existing heart diseases, diabetics, with risk factors for cardiovascular diseases (CVD), and patients with respiratory diseases were more susceptible to more serious outcomes caused by COVID- 19 (1). In this context, the quarantine period establishing itself as the most appropriate strategy to slow the rapid spread of COVID-19, especially in Brazil - where the possibility of testing suspected cases, geographically identifying and isolating patients is small - this can have side effects about other health dimensions of patients and isolated individuals and, mainly, in those mentioned being in the risk group. Starting a sudden state of quarantine implies a radical change in the lifestyle of the population. In many cases, they can impact the level of physical activity (PA) and physical exercise to maintain an adequate state of health (2), with a negative impact on the control of certain diseases (3), such as diabetes, hypertension, CVD, respiratory diseases or simply to guarantee active aging, reduce the risk of frailty, sarcopenia and dementia, such as diseases associated with the elderly (4,5). In addition, the negative psychological impact of quarantine has recently been described (6). In this context, individuals are subjugated to post-traumatic stress, symptoms of confusion and anger. In addition, stressors that have become more prevalent with the longest quarantine duration have been identified, among which were identified: (i) fear of infection; (ii) frustration; (iii) boredom; (iv) lack of supplies; (v) inadequate information; (vi) financial losses; and, (vii) stigmas. On the other hand, PA and physical exercise have been shown to be an effective therapy for most chronic diseases with direct effects on mental and physical health (2-10). Considering biological mediators, physical exercise has been considered an effective approach to preventive and / or therapeutic benefits on human biological processes (2,8,10). The elderly person deserves special attention, because in this group of individuals, PA and physical exercise induce positive biological responses with additional effects on the characteristics of aging and associated diseases (11). In this sense, exercise in the elderly is able to prevent frailty, sarcopenia / dinapenia, risk of falls, self-esteem and cognitive impairment or decline (11,12). Therefore, in order not to interrupt or totally change people's lifestyle during quarantine and maintain an active lifestyle at home, it is important to consider the feasibility of maintaining the practice of physical exercise, even in small physical spaces, for the health of the population. in general, but mainly for those with risk factors for COVID-19 and the elderly.Os primeiros casos de Coronavírus (COVID-19) foram relatados em dezembro de 2019 na Província de Wuhan (China) e a infecção rapidamente se espalhou por todo o mundo, apesar das estratégias adotadas pelo Governo Chinês para parar este fenômeno epidemiológico. Quatro meses mais tarde, em 14 de abril de 2020, o COVID-19 se tornou uma pandemia mundial com mais de 1 milhão de casos confirmados e quase 107.000 mortes no mundo (1). No Brasil, até o dia 14 de abril de 2020, foram confirmados 25.263 casos e 1.532 óbitos com uma taxa de letalidade de 4,6% (1). A maioria dos especialistas em epidemiologia e infectologia concordam que grande parte do sucesso em conter o vírus na China se deve a medidas rápidas adotadas pelas autoridades ao impor a quarentena para a maioria da população. Neste sentido, semanas depois, outros países que também foram tão seriamente afetados - como Itália, Espanha e Estados Unidos da América - adotaram as estratégias mais severas de quarentena social. Adicionalmente, com base nas informações mundiais e à medida que a pandemia avançava, algumas características da população de maior risco para COVID-19 foram identificadas. Neste sentido, os dados epidemiológicos davam conta de que os indivíduos idosos, os com cardiopatias pré-existentes, diabéticos, com fatores de risco para doenças cardiovasculares (DCV), e pacientes com doenças respiratórias estavam mais susceptíveis a desfechos mais graves provocados pelo COVID-19 (1). Neste contexto, o período de quarentena se estabelecendo como estratégia mais adequada para desacelerar a propagação rápida do COVID-19, sobretudo no Brasil - onde a possibilidade de testar os casos suspeitos, identificar geograficamente e isolar os doentes é pequena - isso pode ter efeitos colaterais sobre outras dimensões da saúde dos pacientes e indivíduos isolados e, principalmente, nos mencionados estar no grupo de risco. Iniciar um estado repentino de quarentena implica em uma mudança radical no estilo de vida da população. Em muitos casos, podem impactar no nível de atividade física (AF) e exercício físico para manter um estado de saúde adequado (2), com impacto negativo no controle de certas doenças (3), como diabetes, hipertensão, DCV, doenças respiratórias ou simplesmente para garantir um envelhecimento ativo, reduzir o risco de fragilidade, sarcopenia e demência, como doenças associadas a pessoa idosa (4,5). Além disso, o impacto psicológico negativo da quarentena foi recentemente descrito (6). Neste contexto, os indivíduos estão subjugados ao estresse pós-traumático, sintomas de confusão e raiva. Além disso, foram identificados fatores estressores que podem se tornarem mais prevalentes com a maior duração da quarentena, entre eles foram identificados: (i) medo de infecção; (ii) frustração; (iii) tédio; (iv) falta de suprimentos; (v) informações inadequadas; (vi) perdas financeiras; e, (vii) estigmas. Por outro lado, AF e exercício físico têm se mostrado uma terapia eficaz para a maioria das doenças crônicas com efeitos diretos na saúde mental e física (2-10). Considerando os mediadores biológicos, o exercício físico tem sido considerado uma abordagem eficaz para os benefícios preventivos e/ou terapêuticos sobre os processos biológicos humano (2,8,10). Merece atenção especial a pessoa idosa, porque nesse grupo de indivíduos, a AF e o exercício físico induzem resposta biológicas positivas com efeitos adicionais sobre as características do envelhecimento e doenças associadas (11). Nesse sentido, o exercício em pessoas idosas é capaz de prevenir a fragilidade, sarcopenia / dinapenia, risco de quedas, auto-estima e comprometimento ou declínio cognitivo (11,12). Portanto, para não interromper ou mudar totalmente o estilo de vida das pessoas durante quarentena e manter um estilo de vida ativo em casa é importante considerar a viabilidade de manutenção da prática de exercício físico, mesmo que em espaços físicos pequenos, para a saúde da população em geral, mas principalmente para aqueles com fatores de risco para COVID-19 e idosos

Burden of cardiovascular diseases attributable to risk factors in Brazil : data from the "Global Burden of Disease 2019" study

Introduction: To better understand trends in the main cause of death in Brazil, we sought to analyze the burden of cardiovascular risk factors (RF) and cardiovascular diseases (CVD) attributable to specifi c RFs in Brazil from 1990 to 2019, using the estimates from the GBD 2019 study. Methods: To estimate RF exposure, the Summary Exposure Value (SEV) was used, whereas for disease burden attributed to RF, mortality and disability-adjusted life-years (DALY) due to CVD were used. For comparisons over time and between states, we compared age-standardized rates. The sociodemographic index (SDI) was used as a marker of socioeconomic conditions. Results: In 2019, 83% of CVD mortality in Brazil was attributable to RF. For SEV, there was a reduction in smoking and environmental RF, but an increase in metabolic RF. High systolic blood pressure and dietary risks continue to be the main RF for CVD mortality and DALY. While there was a decline in age-standardized mortality rates attributable to the evaluated RF, there was also a stability or increase in crude mortality rates, with the exception of smoking. It is important to highlight the increase in the risk of death attributable to a high body mass index. Regarding the analysis per state, SEVs and mortality attributable to RF were higher in those states with lower SDIs. Conclusions: Despite the reduction in CVD mortality and DALY rates attributable to RF, the stability or increase in crude rates attributable to metabolic RFs is worrisome, requiring investments and a renewal of health policies

Trends in prevalence, mortality, and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017 : estimates from the “Global Burden of Disease 2017” (GBD 2017) study

Background: Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. Methods: We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110–115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). Results: In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5–19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5–209.2) deaths to 104.8 (95%UI 94.9–114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. Conclusions: While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging