Avaliação de lesão cardíaca e aspectos da assistência farmacêutica em pacientes hospitalizados com COVID-19

Abstract

Background: Troponin levels are commonly abnormal in hospitalized patients with COVID‐19 and they are associated with poorer prognosis. The COVID-19 pandemic has caused several health services to adapt their activities, in this context, pharmaceutical services had to promote pharmaceutical care activities, while adapting actions necessary to provide high quality care. This study aimed to: i) evaluate myocardial injury as an independent predictor of in-hospital mortality and mechanical ventilation requirement in COVID-19 hospitalized Brazilian patients. (Article 1) and ii) evaluate the actions of hospital pharmacists in the COVID-19 pandemic and impacts on patient care (Article 2). Methods: Article 1 describes cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals in 17 cities. Consecutive patients admitted with confirmed diagnosis of COVID-19 between March and September 2020 were included. Medical records were reviewed to collect patient demographic and clinical data. Models for the primary outcomes: mortality and mechanical ventilation were estimated by Poisson regression with robust variance. For the multivariate analyses, two predictive models were estimated to assess the role of elevated troponin on outcomes. Article 2 presents a scoping review with research conducted in January 2023, registered in the Open Science Framework, without restriction of date or language of publication and with different databases. We used Scopus, Medline, Virtual Health Library, Web of Science and Cochrane databases. Search strategies included combinations of indexed keywords related to "SARS-CoV-2", "Patient safety" and "Hospital pharmacy services". Results: Article 1: A total of 2,925 patients were included in this analysis with median age of 60 [interquartile range (IQR) 48-71] years old. Patients with myocardial injury represented by elevated troponin levels, presented a higher risk of death relative risk (2.03 [1.60-2.58]) and mechanical ventilation requirement relative risk (1.87 [1.57-2.23]) when compared to controls. Article 2: Of the 314 studies identified, nine were eligible for this review. Hospital pharmacists played important role in activities that promoted: ensuring the supply of drugs and supplies in 89% of the studies; analyzing prescriptions and disseminating drug information to the care team and patients in 67% of the studies; developing treatment guidelines and remote pharmaceutical care services in 56% of the studies; searching for new suppliers, new pharmaceutical alternatives and working with the multiprofessional team in 44% of the studies. Conclusion: Cardiac injury showed to be an independent predictor of in-hospital mortality and need of mechanical ventilation in hospitalized COVID-19 patients. The design of strategies involving the monitoring of troponin levels as risk biomarkers helps to identify patients at greater risk of clinical complications and death, improving care for these patients. The scoping review showed that the actions provided by the hospital pharmacy in care units have positive effects in terms of quality and safety of care provided during the pandemic. The evaluation and recording of the pharmaceutical activities observed can serve as a starting point for planning to address future health crises.