Perfil dos pacientes admitidos nos Hospitais de Montes Claros-MG, comInsuficiência Cardíaca, na faixa etária de 0 a 19 anos

Abstract

Introduction: Heart failure (HF) is a large public health problem in the whole world, entailing considerable social security costs, medical attention and absenteeism at work. During 2007 in Brazil it was the major cause of hospitalization for cardiovascular diseases, being responsible for 1.57% of admissions by the SUS for the age range below 20 years.Few studies in Brazil have evaluated the HF in this age range, thus the need to gain knowledge of its main etiology, clinical handling, length of stay and general and hospital mortality, as well as the socio- demographic profile of these patients. Objectives: This study tries to establish the profile of HF patients in the age range 0 to 19 years admitted in hospitals at Montes Claros city (MG), describe its clinical and socio-demographic characteristics, characterize its clinical management, evaluate its HF functional class at admission and discharge and estimating the re-hospitalizations and the survival curve. Casuistic and Methods: 4,757 patients in the age range 0 to 19 years, admitted in fivehospitals during the period April 1, 2008 to March 31, 2009, were interviewed, trying to identify those with cardiopathy diagnostic. 131 patients were identified with cardiopathy; among these 75 showed some HF signals or symptoms or were already being treated for this disease. The only exclusion criterion was when the patient and/or the person responsible for him (her) did not agree to take part in the study. These patients were followed up by phone during up to six months after their hospital discharge for endpoints evaluation. The socio-demographic characteristics, the cardiopathy diagnostics and the comorbidities, themedications used and the examinations performed, as well as the endpoints (discharge from the hospital, transfers, surgeries, re- admissions) and deaths, with estimates of the survival curve, were analyzed. The obtained results were treated by the most adequate statistical methods, considering the value 5% (p < 0.05) as statistical signification threshold. The descriptive results were obtained by using frequencies and percentages for the categorical variables and central trend measures (average and median), and dispersion (standarddeviation) for the quantitative ones. The comparisons between groups and categorical variables were made starting from contingency tables; on which the square test with Yates correction, qui-square and Fisher exact were applied. The t-student and Mann-Whitney tests were used for the comparison between groups and quantitative co-variables. The ProgramEpiInfo (version 3.5.1 dated 2008) and the Software R (version 2.10.1 dated 2009) were used. The MacNemar test was used for evaluating the HF functional class at admission and discharge and the Kaplan-Meier estimator for the survival curve. Results: Seventy-five patients were admitted with HF, thereof 62.7% males, 68% in the age range 0 to 6 yearsand 44% white. The majority (68.7%) was from urban zones and cities other than Montes Claros (60%). The SUS accounted for 97.3% of these hospitalization costs; 58.5% of the patients had income per capita = 1/4 salary. At the admission, 68.7% were congenital cardiopathy carriers, 73.6% were in the HF evolutionary stage C, 50% in the functionalclass IV (NYHA/ROSS) and 37.5% in class III. By comparing the functional class at admission and discharge (MacNemar test) it is seen that there were 28.3% more patients in class IV and 71.4% more in class III at admission than at discharge, thus showing good response to the instituted treatment. The length of stay in the hospital was 13.3 days onaverage, with a re-admission rate of 22.7%. The hospital mortality was 6.7% and the overall mortality 20% during the 19 months follow-up, with the survival curve showing that 80% of the patients were alive after 416 days observation, it also being evidenced by the Kaplan- Meier estimator that the presence of HF diagnostic increased 6.3 times the risk of death in the cardiopathy group. The presence of cardiac murmur was detected on 81,9% of the patients, followed by hepatomegaly (62.7%) and pulmonary rales (40.3%); third sound was not frequent. The Eco- Dopplercardiography was made on 85.3% of the patients and the leftventricular ejection fraction was normal for 81.5% of these patients. Furosemide was the most used medication (72%), with digoxin, ACE inhibitors and spironolactone appearing in less than 40% of the prescriptions. Dobutamine was prescribed for 24% of the patients,prostagladine for 16%, beta-blockers for 5.3%, sildenafil for 4% and indometacine for 1.3%. Laboratory testing such as BUN and electrolyte levels were assessed in less than 50% of the cases. Conclusion: It was possible to establish a profile of patients hospitalized with HF in this age range. The majority of the patients with HF have congenital cardiopathy with preserved ejection fraction and are admitted in the evolutionary stages C and D and HF functional classes III and IV, whose predominant clinical signs and symptoms are tachypnea, tachycardia and sweating, irritability, easy crying, difficult with feeding and poor growth; cardiac murmur is the most frequent signal, functioning as warning for requesting cardiology evaluations and early treatment largely different from those used for adults.