Implementation of a Dedicated Cardiovascular and Stroke Unit in a Crowded Emergency Department of a Tertiary Public Hospital in Brazil: Effect on Mortality Rates

Nasi, Luiz Antônio; Ferreira-Da-Silva, Andre L; Martins, Sheila Cristina Ouriques; Furtado, Mariana Vargas; Almeida, Alexandre Oliveira; Brondani, Rosane; Wirth, Letícia Fleck; Kluck, M.; Polanczyk, Carísi Anne

doi:10.1111/acem.12291

Cited by 13 publications

(13 citation statements)

References 30 publications

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“…• De acordo com um estudo de base comunitária realizado na cidade de Matão em 2003-2004 e 2015-2016, a incidência de AVC ajustada por idade diminuiu em 39% (IRR 0,61; IC 95%, 0,46-0,79) e a mortalidade, em 50% (IRR 0,50; IC 95%, 0, 94). A idade média de pacientes com AVC aumentou em 9%, passando de 65,2 (IC 95%,62,8) para 71,0 (IC 95%,68,8) anos. A taxa de letalidade de 1 ano foi 26%.…”

Section: Avcunclassified

“…46 • No segundo estudo do registro de AVC de Matão, todos os eventos de AVC incidente (81 casos) que ocorreram entre 1 de agosto de 2015 e 31 de julho de 2016 foram registrados. A idade média aumentou em 9%, passando de 65,2 (IC 95%,62,8) para 71,0 (IC 95%,68,8) anos. Entre os períodos 2003-2004 e 2015-2016, a incidência ajustada por idade diminuiu em 39% (IRR 0,61; IC 95%, 0,46-0,79) e a mortalidade, em 50% (IRR 0,50; IC 95%, 0, 94).…”

Section: Subtipos De Avcunclassified

“…Entretanto, a taxa de letalidade por AVC não diminuiu a despeito das melhorias nos indicadores de qualidade do cuidado para AVC. 68 • Um ensaio clínico randomizado por cluster avaliou o efeito de uma intervenção multifacetada de melhoria da qualidade referente à adesão às terapias baseadas em evidência para o cuidado de pacientes com AVCI agudo e AIT (incluindo manejo de caso, lembretes, roadmap e checklist para o plano terapêutico, materiais educativos, auditorias periódicas e relatórios de feedback para cada cluster da intervenção). O estudo avaliou 1.624 pacientes de 36 hospitais, cobrindo todas as regiões brasileiras.…”

Section: Admissões Hospitalaresunclassified

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Estatística Cardiovascular – Brasil 2021

Oliveira¹,

Brant²,

Polanczyk³

et al. 2022

Arquivos Brasileiros De Cardiologia

131

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Section: Avcunclassified

Section: Subtipos De Avcunclassified

Section: Admissões Hospitalaresunclassified

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Estatística Cardiovascular – Brasil 2021

Oliveira¹,

Brant²,

Polanczyk³

et al. 2022

Arquivos Brasileiros De Cardiologia

131

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“…Este hallazgo es similar a estudios previos con una metodología similar a la nuestra. 18,19 Sin embargo, existen reportes sobre la reducción de la mortalidad en la UCN. 20 Un metaanálisis reportó que el beneficio en la mortalidad y el grado de dependencia funcional puede verse a 1 año, 4 sugiriendo que el principal impacto de la UCN es a largo plazo.…”

Section: Discussionunclassified

Impacto en el desenlace funcional en pacientes con ictus: experiencia de una unidad de cuidados neurovasculares

Góngora‐Rivera

Treviño-Herrera

González-Aquines

et al. 2018

GMM

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Antecedentes y objetivo: Las unidades de cuidados neurovasculares (UCN) impactan favorablemente en el pronóstico funcional del paciente con ictus en comparación con las salas de internamiento general. La efectividad de las UCN en México no ha sido evaluada. Nuestro objetivo fue determinar el impacto que tiene una UCN en un hospital académico de tercer nivel del noreste de México. Método: Estudio de cohorte prospectivo, observacional y analítico. La población fue dividida en dos periodos: el primero consistió en aquellos pacientes ingresados antes de la implementación de la UCN (2008UCN ( -2010, y el segundo consistió en pacientes ingresados posterior a la implementación de la UCN (2010UCN ( -2014. Se evaluó el estado funcional al egreso y a los 3 meses. Resultados y conclusiones: Se incluyeron 598 pacientes (periodo 1: 246; periodo 2: 352). En el periodo 2 se incrementó la profilaxis de trombosis venosa profunda (razón de momios [RM]: 3.235; intervalo de confianza del 95 % [IC 95 %]: 2.18-4.80; p = 0.01) y se redujeron la estancia hospitalaria (RM: 0.42; IC 95 %: 0.29-0.62; p = 0.01) y la discapacidad funcional grave (Rankin ≥ 3) a los 3 meses de seguimiento (RM: 0.42; IC 95 %: 0.29-0.62; p = 0.01). La implementación de una UCN mejoró el desenlace funcional a 3 meses y disminuyó los días de estancia intrahospitalaria de pacientes con ictus.

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“…15 Other subsequent studies have also shown positive results with the hospitalization of patients in coronary units. [16][17][18][19] The coronary intensive care unit (CICU) was implemented at our service in 2004. However, assessments have not yet been made to determine if the creation of this unit specialized in the treatment of acute coronary syndromes was associated with a decrease in mortality or greater adherence to modern treatments recommended by the latest guidelines.…”

Section: Introductionmentioning

confidence: 99%

Impact of coronary intensive care unit in treatment of myocardial infarction

Todo

Bergamasco

Azevedo

et al. 2017

Rev. Assoc. Med. Bras.

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Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

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Implementation of a Dedicated Cardiovascular and Stroke Unit in a Crowded Emergency Department of a Tertiary Public Hospital in Brazil: Effect on Mortality Rates

Cited by 13 publications

References 30 publications

Estatística Cardiovascular – Brasil 2021

Estatística Cardiovascular – Brasil 2021

Impacto en el desenlace funcional en pacientes con ictus: experiencia de una unidad de cuidados neurovasculares

Impact of coronary intensive care unit in treatment of myocardial infarction

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