Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

Abstract

At the beginning of the 20 th century, cardiovascular diseases accounted for less than 10% of the deaths in the world. At the end of that century, that group of diseases accounted for approximately half of the deaths in the developed countries and 25% of the deaths in developing countries. In 2020, cardiovascular diseases are estimated to ount for 25 million deaths per year, and ischemic heart diseases will surpass infectious diseases as the first cause of death in the world 1 .In Brazil, cardiovascular diseases lead the causes of death and hospitalization, accounting for 32.6% of the deaths with a determined cause. From 1996 to 1999, cardiovascular diseases accounted for 9% of the hospitalizations via SUS (Sistema Único de Saúde -the Brazilian public health system), being the major cause of hospitalization in the population aged 40 to 59 years (17%) and in the population aged 60 or above (29%). Ischemic cardiac diseases accounted for 29.6% of the deaths due to cardiovascular diseases, the mean mortality rate of this group of diseases being 46.4 deaths per 100,000 inhabitants/year in the period 2 .Mortality due to ischemic heart diseases varies widely among countries and among regions in the same country. Recent data from the MONICA Project 3 relative to a 10-year period of study with 37 different populations indicate a reduction in ischemic cardiac events and related mortality rates in most countries. Multiple aspects have contributed to this favorable tendency, including the reduction in the prevalence of risk factors, the improvement in health care and the increase in access to it, and new methods of diagnosis and treatment 4,5 .The number of myocardial revascularization surgeries increased 227% in the United States from 1979States from to 1997States from , and, in 1997,000 patients underwent this surgical procedure. In that country, approximately 1 in every 1,000 individuals undergoes myocardial revascularization surgery per year, which results in costs of $ 50 billion an-

Socioeconomic factors in the prognosis of heart failure in a Brazilian cohort

“…This variable was also identified as a prognostic marker in a study of post-operative morbidity after myocardial revascularization in Brazil. The odds ratio for patients operated under care through the Public Health System was 3.89; for diabetes mellitus 2.25; for renal failure 6.04; and for cardiogenic shock 10.58 [19]. Thus, care under the Public Health System may be a marker of a clinical and socioeconomic conditions associated with less favorable outcomes either in heart failure or post-operative recovery.…”

Cardiovascular Health in Brazil

“…The results are worse among patients whose hospitalization was financed by the SUS. 50,51 This disparity can be attributed both to the lower socioeconomic conditions of SUS patients and the greater difficulty in timely access to health facilities, as in the case of myocardial infarction, and to lesser use of evidence-based therapies, as well. 49 A recently published cluster-randomized clinical trial showed that quality improvements tools for acute coronary syndrome implemented in Brazilian public hospitals resulted in significant improvement of in-hospital cardiovascular event rates and 30-day all-cause mortality.…”

Prevalência de Fatores de Risco para Doença Cardiovascular em Trabalhadores de Empresa Siderúrgica

“…Na população, em cada três indivíduos, um é portador de doença crônica 2 . No Brasil, as DACs são responsáveis por 33% dos óbitos com causas conhecidas, tendo sido a primeira causa de hospitalização no setor público para indivíduos com idade entre 40 e 59 anos 3 e para os com 60 ou mais anos 4 . Diversos fatores contribuem para a quantidade e qualidade de anos que se vive, incluindo fatores genéticos, ambientais e comportamentais, sendo alguns modificáveis e outros não.…”