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Predictors of hospital mortality in hemodynamically stable patients with pulmonary embolism.

Arq Bras Cardiol. 2009 Aug;93(2):135-40

Authors: Volschan A, Albuquerque D, Tura BR, Knibel M, Esteves JP, Bodanese LC, Silveira F, Pantoja J, Souza PC, Mansur J, Mesquita ET,

BACKGROUND: Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients. OBJECTIVES: To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism. METHODS: This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model. RESULTS: Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve. CONCLUSION: In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice.

PMID: 19838490 [PubMed - indexed for MEDLINE]

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Efficacy of atorvastatin when not administered daily.

Arq Bras Cardiol. 2007 Nov;89(5):294-300, 325-32

Authors: Ghattas AE, Pimenta J

BACKGROUND: Statins are widely used because they reduce cardiac events. Although they are indicated for daily use, some doctorsgive prescriptions for every other day, mainly with the purpose of reducing costs. OBJECTIVE: To evaluate the efficacy of atorvastatin, when not administered everyday, on LDL-cholesterol (LDL-C) levels, and also to evaluate cost reduction. METHODS: A total of 100 patients with hypercholesterolemia in primary (PP) and secondary prevention (SP) were assessed. After a 12-week diet period, atorvastatin was initiated at a dose of 10 mg per day. After six weeks, LDL-C was determined, and if the levels were <80 or <104 mg/dL for SP and PP, respectively, two atorvastatin doses were subtracted per week. If LDL-C remained <80 or <104 mg/dL, a further reduction to three times a week was allowed, and the last determination was performed after six more weeks. The percentage variation in costs was the parameter to evaluate the saving. RESULTS: In 47 out of the 52 patients of this group, a reduction by 32% in LDL-C was observed, and daily atorvastatin was maintained. Forty one patients remained throughout the study and had their weekly dosage reduced. In 25 patients the medication was administered three times a week, and in 16, five times a week, with reductions of 42.4% and 46.1% in LDL-C, respectively. As regards costs, one of the groups had their monthly expense reduced from R$ 106.65 to R$ 74.65, and the other group from R$ 106.65 to R$ 53.33. CONCLUSION: The results suggest that atorvastatin may be administered on a non-daily basis. A cost reduction between 30% and 50% was also observed.

PMID: 18066453 [PubMed - indexed for MEDLINE]

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Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure.

Arq Bras Cardiol. 2007 Oct;89(4):251-5

Authors: Issa VS, Bacal F, Mangini S, Carneiro RM, Azevedo CH, Chizzola PR, Ferreira SM, Bocchi EA

BACKGROUND: Hyponatremia and congestive phenomena indicate a bad prognosis in decompensated heart failure. The occurrence of renal failure is associated to an increased death risk. OBJECTIVE: To evaluate the safety and efficacy of the hypertonic saline solution in patients with decompensated heart failure for renal failure prevention. METHODS: Patients with decompensated heart failure, congestion and hyponatremia participated in the study. In addition to the standard treatment, the patients received hypertonic saline solution and were submitted to clinical as well as laboratory assessment. RESULTS: Nine patients were enrolled in the study. Mean age was 55 + 14.2 years, being 5 male (55.5%) and 4 (44.5%) female patients. All of them presented functional class III-IV of the New York Heart Association (NYHA), and 5 (55.5%) received dobutamine. All of them presented initial creatinine > 1.4 mg/dl. The mean tonicity of the solution was 4.39% + 0.018% (2.5% to 7.5%) and the duration of treatment was 4.9 days + 4.1 days (1-15 days). There were no severe adverse effects; none of the patients presented clinical worsening or neurologic disorders; hypokalemia occurred in 4 cases (44.5%). The comparison of the variables before and after treatment showed a decrease in urea (105 mg/dl + 74.8 mg/dl vs. 88 mg/dl + 79.4 mg/dl; p = 0.03) and increase in the urinary volume (1,183 ml/day vs. 1,778 ml/day; p = 0.03); there was no tendency to creatinine decrease (2.0 mg/dl + 0.8 mg/dl vs. 1.7 mg/dl + 1.0 mg/dl; p = 0.08). Despite the elevation in sodium levels (131 mEq/l + 2.8 mEq/l vs. 134 mEq/l + 4.9 mEq/l) and weight decrease (69.5 kg + 18.6 kg vs. 68.2 kg + 17.1 kg), there was no statistically significant difference. CONCLUSION: The use of hypertonic saline solution in patients with decompensated heart failure can be a safe therapeutic method and potentially related to clinical improvement and renal failure prevention.

PMID: 17992382 [PubMed - indexed for MEDLINE]

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