Papers by Gustavo Oliveira
Arquivos Brasileiros de Cardiologia, 2024
Fundamento: Estudos de coorte internacionais têm consistentemente demonstrado ao longo das última... more Fundamento: Estudos de coorte internacionais têm consistentemente demonstrado ao longo das últimas décadas um prognóstico desfavorável em pacientes do sexo feminino após o primeiro infarto agudo do miocárdio. No entanto, dados nacionais sobre esse tema são limitados. Objetivos: O presente estudo tem como objetivo comparar coortes nacionais de homens e mulheres hospitalizados devido ao primeiro infarto agudo do miocárdio (IAM), examinando os desfechos a longo prazo. Métodos: Estudo retrospectivo, observacional, com dados de mundo real extraídos da plataforma global TriNetX, incluindo pacientes de ambos os sexos com diagnóstico confirmado de IAM por classificação internacional de doenças (CID), versão 11, código I21. O nível de significância estatística adotado na análise foi de 5% (0,05). O desfecho primário avaliado foi composto por óbito, nova hospitalização por IAM, procedimentos de revascularização miocárdica, ou insuficiência cardíaca após fase hospitalar e com seguimento de 5 anos. Resultados: Foram avaliados dados de 29.041 pacientes, dos quais 11.284 (38,4%) eram mulheres. A idade média das populações feminina e masculina foi, respectivamente, 64,4 e 59,8 anos. O grupo de mulheres apresentou maior ocorrência do desfecho combinado de óbito, nova hospitalização por IAM, procedimentos de revascularização miocárdica, ou insuficiência cardíaca após fase hospitalar e com seguimento de 5 anos (OR 1.058; IC 1.005-1.113; p = 0,03). Conclusão: Nesta grande coorte brasileira, o sexo feminino foi associado a maior ocorrência de eventos cardiovasculares em período de 5 anos após a alta hospitalar. Palavras-chave: Infarto Agudo do Miocárdio; Fatores de Risco; Doença Cardiovascular na Mulher.
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Journal of Nuclear Cardiology, 2007
Background: Coronary artery disease (CAD) is the major cause of mortality in developing and devel... more Background: Coronary artery disease (CAD) is the major cause of mortality in developing and developed countries. In Brazil it is responsible for 32,3% of deaths each year. Studies have shown that it is also responsible for high mortality in Asians (A). Myocardial perfusion scintigraphy (MPS) is a very important tool in the investigation of ischaemia. Objective: To compare thepresence of perfusion defects in the MPS between Asians and non-Asians (NA) patients (p). Patients and Methods: In 2005, 284 p were submitted to MPS with MIBI-99m Tc by Gated-SPECT technique and 2-days protocol.Were considered Asians, p who were born in Brazil butare sons of Asians. Of those, 142 p (50%) were Asian. Analyzing clinical characteristics of the 2 groups (A and NA), significant differences (pϽ0,05) between the variables were observed in: age (67a x 72a); male gender (62% x 45.8%); diabetes (39.4% x 28.2%); previous CABG (20.6% x 32.4%) and PTCA (30.3% x 18.3%) and positive familiar hystory (4.9% x 12%). Previous MI, smoke and obesity had not shown significant difference, pϾ0,05. From the 284 p analyzed, 231 (81%) had performed previous angiography (cine), been 116 from the A group. One hundred and fifty-five p had performed MPS with exercise (ETT) and the others with dipyridamole (dipy). Fibrosis and ischaemia were considered in the presence of reversible and fixed perfusion defects, respectively. The statistical analysis were performed through qui-square of Pearson's and Student t tests been significant a pϽ0,05. Variance analysis were also performed through ANOVA test. Results: From 284 p analyzed, 193 p (68%) had presented abnormal perfusion on MPS, where 125 (44%) were suggestive of ischaemia. A higher prevalence of ischaemia were founded in A group (53.3% x 33.1%), pϽ0,001. On the other hand, NA group had presented a higher number of non-ischaemic studies (21.3% x 26.8%), p Ͻ 0,05. Analyzing the severity of the CAD as well as the most frequent artery envolved from the Asian group of patients, it was observed a higher number of total occlusions and LAD stenosis, pϽ0,05. Conclusions: In the studied group, the results suggest that Asian patients had more ischaemia on MPS and more severe coronary artery lesions in angiography in comparison with non-Asian patients.
The Lancet Regional Health - Americas, 2022
Background Previous Randomised controlled trials (RCT) evaluating chloroquine and hydroxychloroqu... more Background Previous Randomised controlled trials (RCT) evaluating chloroquine and hydroxychloroquine in non-hospitalised COVID-19 patients have found no significant difference in hospitalisation rates. However, low statistical power precluded definitive answers. Methods We conducted a multicenter, double-blind, RCT in 56 Brazilian sites. Adults with suspected or confirmed COVID-19 presenting with mild or moderate symptoms with ≤ 07 days prior to enrollment and at least one risk factor for clinical deterioration were randomised (1:1) to receive hydroxychloroquine 400 mg twice a day (BID) in the first day, 400 mg once daily (OD) thereafter for a total of seven days, or matching placebo. The primary outcome was hospitalisation due to COVID-19 at 30 days, which was assessed by an adjudication committee masked to treatment allocation and following the intention-to-treat (ITT) principle. An additional analysis was performed only in participants with SARS-CoV-2 infection confirmed by molecular or serology testing (modified ITT [mITT] analysis). This trial was registered at ClinicalTrials.gov, NCT04466540. Findings From May 12, 2020 to July 07, 2021, 1372 patients were randomly allocated to hydroxychloroquine or placebo. There was no significant difference in the risk of hospitalisation between hydroxychloroquine and placebo groups (44/689 [6·4%] and 57/683 [8·3%], RR 0·77 [95% CI 0·52–1·12], respectively, p=0·16), and similar results were found in the mITT analysis with 43/478 [9·0%] and 55/471 [11·7%] events, RR 0·77 [95% CI 0·53–1·12)], respectively, p=0·17. To further complement our data, we conducted a meta-analysis which suggested no significant benefit of hydroxychloroquine in reducing hospitalisation among patients with positive testing (69/1222 [5·6%], and 88/1186 [7·4%]; RR 0·77 [95% CI 0·57–1·04]). Interpretation In outpatients with mild or moderate forms of COVID-19, the use of hydroxychloroquine did not reduce the risk of hospitalisation compared to the placebo control. Our findings do not support the routine use of hydroxychloroquine for treatment of COVID-19 in the outpatient setting. Funding COALITION COVID-19 Brazil and EMS.
Arquivos Brasileiros de Cardiologia, 2022
Fundamento: Apesar da necessidade de opções terapêuticas específicas para a doença do coronavírus... more Fundamento: Apesar da necessidade de opções terapêuticas específicas para a doença do coronavírus 2019 (covid-19), ainda não há evidências da eficácia de tratamentos específicos no contexto ambulatorial. Há poucos estudos randomizados que avaliam a hidroxicloroquina (HCQ) em pacientes não hospitalizados. Esses estudos não indicaram benefício com o uso da HCQ; no entanto, avaliaram desfechos primários diferentes e apresentaram vieses importantes na avaliação dos desfechos. Objetivo: Investigar se a HCQ possui o potencial de prevenir hospitalizações por covid-19 quando comparada ao placebo correspondente. Métodos: O estudo COVID-19 Outpatient Prevention Evaluation (COPE) é um ensaio clínico randomizado, pragmático, duplo-cego, multicêntrico e controlado por placebo que avalia o uso da HCQ (800 mg no dia 1 e 400 mg do dia 2 ao dia 7) ou placebo correspondente na prevenção de hospitalizações por covid-19 em casos precoces confirmados ou suspeitos de pacientes não hospitalizados. Os critérios de inclusão são adultos (≥ 18 anos) que procuraram atendimento médico com sintomas leves de covid-19, com randomização ≤ 7 dias após o início dos sintomas, sem indicação de hospitalização na triagem do estudo e com pelo menos um fator de risco para complicações (> 65 anos, hipertensão, diabetes melito, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). Todos os testes de hipótese serão bilaterais. Um valor de p < 0,05 será considerado estatisticamente significativo em todas as análises. Clinicaltrials.gov: NCT04466540. Resultados: Os desfechos clínicos serão avaliados centralmente por um comitê de eventos clínicos independente cegado para a alocação dos grupos de tratamento. O desfecho primário de eficácia será avaliado de acordo com o princípio da intenção de tratar. Conclusão: Este estudo apresenta o potencial de responder de forma confiável a questão científica do uso da HCQ em pacientes ambulatoriais com covid-19. Do nosso conhecimento, este é o maior estudo avaliando o uso de HCQ em indivíduos com covid-19 não hospitalizados.
Global Heart, 2018
Introduction: The evidence-based recommendations for heart failure (HF) management of care includ... more Introduction: The evidence-based recommendations for heart failure (HF) management of care include use of effective therapies and adoption of healthy lifestyle, behaviour and regular physical activity. Objectives: We aimed to describe the use of proven medications and no-pharmacological recommendations by physicians in patients diagnosed with HF. Methods: Patients with documented HF were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in "real world" clinical practice. Results: Currently, PINNACLE-Brazil has enrolled 6150 patients, with 10.9% diagnosed with HF and, out of these, 82% had a quantitative or qualitative result of a recent or prior left ventricular ejection fraction assessment documented within a 12-month period. Patients who were provided with self-care education on >¼3 elements of education during >¼1 visit within a 12-month period were only 2,4%. Patients with LVEF <40% who were prescribed Betablocker therapy with bisoprolol, carvedilol, or sustained-release metoprolol succinate were 26.5%, and who were prescribed ACE inhibitor or ARB therapy were 8%. Patients with a diagnosis of HF and with quantitative results of an evaluation of both level of activity AND patient symptoms have demonstrated clinically important deterioration since last assessment with a documented plan of care were 33,9%. Conclusion: The preliminary results of PINNACLE-Brazil reveal a large gap between the evidence-based recommendations and the current use of proven medications and self-care education of patients, thus leading to opportunity to adopt strategies to improve management of care and outcomes related to HF.
Global Heart, 2018
randomly selected for training with the mannequin of Litte Anne-Laedal (L) for comparison of trai... more randomly selected for training with the mannequin of Litte Anne-Laedal (L) for comparison of training with the PB mannequin in a 2-minute test to evaluate the following variables: appropriate hand position (HP), frequency of compressions (FC), mean time without compression (TWC), total number of compressions (TNC), and mean compression depth (DFC). Results: 544 subjects were included, 60% aged between 15-16 years old, 58,3% female. The comparison between the two groups did not show statistically significant differences between the two models for the variables under evaluation: HP (p¼0,291), FC (p¼0,589), TWC (p¼0,389) and DFC (p¼0,526). It was not possible to confirm the efficacy of chest compressions in TNC. Conclusion: Mass training is a good strategy to disseminate the importance of the theme to the media and the national press. PB mannequins can be made by students, and allow training of chest compressions without detected difference in the variables evaluated, compared to the marketed mannequin. Randomized studies to evaluate efficacy and effectiveness of the PB mannequin are underway.
Global Heart, 2018
Introduction: The evidence-based recommendations for heart failure (HF) management of care includ... more Introduction: The evidence-based recommendations for heart failure (HF) management of care include use of effective therapies and adoption of healthy lifestyle, behaviour and regular physical activity. Objectives: We aimed to describe the use of proven medications and no-pharmacological recommendations by physicians in patients diagnosed with HF. Methods: Patients with documented HF were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in "real world" clinical practice. Results: Currently, PINNACLE-Brazil has enrolled 6150 patients, with 10.9% diagnosed with HF and, out of these, 82% had a quantitative or qualitative result of a recent or prior left ventricular ejection fraction assessment documented within a 12-month period. Patients who were provided with self-care education on >¼3 elements of education during >¼1 visit within a 12-month period were only 2,4%. Patients with LVEF <40% who were prescribed Betablocker therapy with bisoprolol, carvedilol, or sustained-release metoprolol succinate were 26.5%, and who were prescribed ACE inhibitor or ARB therapy were 8%. Patients with a diagnosis of HF and with quantitative results of an evaluation of both level of activity AND patient symptoms have demonstrated clinically important deterioration since last assessment with a documented plan of care were 33,9%. Conclusion: The preliminary results of PINNACLE-Brazil reveal a large gap between the evidence-based recommendations and the current use of proven medications and self-care education of patients, thus leading to opportunity to adopt strategies to improve management of care and outcomes related to HF.
Research, Society and Development, 2021
To validate and analyze the accuracy of the Simonetti adherence score among patients on chronic u... more To validate and analyze the accuracy of the Simonetti adherence score among patients on chronic use of vitamin K antagonists and their time in therapeutic range (TTR) of the international normalized ratio as a measure of quality of anticoagulation. A prospective cohort study with a nonrandomized intervention in patients from an anticoagulation center of a public hospital. Baseline data were collected from May to September 2017, and follow-up data were obtained eight months after a nurse-led educational intervention, which was given to all patients after consent form and after applying the adherence score (N=205). The intervention was undertaken through 30-40 min conversation about relevant factors that had been previously identified in the score derivation study, which comprised drug-drug interactions, inadequate OAC use, comorbidities, effects of food on vitamin K absorption, and invasive procedures. A receiver operating characteristic (ROC) curve was applied to validate the adher...
Arquivos Brasileiros de Cardiologia
Fundamento: O diagnóstico de síndrome coronária aguda (SCA) e a estratificação de risco contempor... more Fundamento: O diagnóstico de síndrome coronária aguda (SCA) e a estratificação de risco contemporâneos são fundamentais para o manejo apropriado e redução da mortalidade e eventos isquêmicos recorrentes, tanto na fase aguda quanto após hospitalização. A Definição Universal de Infarto do Miocárdio recomenda a detecção de curva de troponina acima do limite superior do percentil 99. Objetivos: Avaliar a ocorrência de óbito e infarto agudo do miocárdio (IAM) na fase precoce em pacientes sem elevação de troponina (<0,034 ng/mL), pacientes com mínima elevação [acima do percentil 99 (>0,034 ng/mL e <0,12 ng/mL)], e pacientes com maiores elevações [acima do ponto de corte para IAM pelo kit utilizado (≥0,12 ng/mL)]; e avaliar o impacto dos níveis de troponina na indicação de estratégia invasiva e revascularização miocárdica. Métodos: Estudo de corte transversal de pacientes com SCA com avaliação do pico da troponina I, escores de risco, análise prospectiva de desfechos clínicos até 30 dias e testes bilaterais de significância, com nível de significância adotado sendo < 0,05. Resultados: Foram avaliados 494 pacientes com SCA. Troponina > percentil 99 e abaixo do ponto de corte, assim como valores maiores (acima do ponto de corte), foram associados à maior incidência do desfecho composto (p<0,01) e de revascularização percutânea ou cirúrgica (p<0,01), sem diferença significante em mortalidade até 30 dias. Conclusões: Valores de troponina elevados acima do percentil 99 pela Definição Universal de IAM apresentam papel prognóstico e agregam informação útil ao diagnóstico clínico e escores de risco na identificação de pacientes com maior probabilidade de benefício com estratificação invasiva e procedimentos de revascularização coronária.
Abreviaturas dos títulos dos periódicos de acordo com "List of Journals Indexed in Index medicus".
Arquivos Brasileiros de Cardiologia, 2015
Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim co... more Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim como os conceitos emitidos em artigos assinados são de exclusiva responsabilidade de seus autores, não refletindo necessariamente a opinião da SBC. Material de distribuição exclusiva à classe médica. Os Arquivos Brasileiros de Cardiologia não se responsabilizam pelo acesso indevido a seu conteúdo e que contrarie a determinação em atendimento à Resolução da Diretoria Colegiada (RDC) nº 96/08 da Agência Nacional de Vigilância Sanitária (Anvisa), que atualiza o regulamento técnico sobre Propaganda, Publicidade, Promoção e informação de Medicamentos. Segundo o artigo 27 da insígnia, "a propaganda ou publicidade de medicamentos de venda sob prescrição deve ser restrita, única e exclusivamente, aos profissionais de saúde habilitados a prescrever ou dispensar tais produtos (...)". Garantindo o acesso universal, o conteúdo científico do periódico continua disponível para acesso gratuito e integral a todos os interessados no endereço: www.arquivosonline.com.br.
Arquivos Brasileiros de Cardiologia, 2013
Fundamento: O tecido adiposo representa não somente uma fonte de energia estocável, mas principal... more Fundamento: O tecido adiposo representa não somente uma fonte de energia estocável, mas principalmente um órgão endócrino que secreta várias citoquinas. A adiponectina, uma nova proteína semelhante ao colágeno, foi descoberta como uma citoquina específica do adipócito e um promissor marcador de risco cardiovascular. Objetivos: Avaliar a associação entre os níveis séricos da adiponectina e o risco para a ocorrência de eventos cardiovasculares, em pacientes com síndromes coronarianas agudas (SCA), e as correlações entre adiponectina e os biomarcadores metabólicos, inflamatórios e miocárdicos. Métodos: Foram recrutados 114 pacientes com SCA, com seguimento médio de 1,13 ano para avaliação de desfechos clínicos. Modelos de regressão de risco proporcional de Cox com penalização de Firth foram construídos para determinar a associação independente entre adiponectina e o risco subsequente dos desfechos primário (composto de óbito cardiovascular/IAM não fatal/AVE não fatal) e coprimário (composto de óbito cardiovascular/ IAM não fatal/AVE não fatal/re-hospitalização requerendo revascularização). Resultados: Houve correlações diretas e significantes entre adiponectina e idade, HDL-colesterol e BNP, e inversas e significantes entre adiponectina e circunferência abdominal, peso corporal, índice de massa corporal, índice HOMA, triglicerídeos e insulina. A adiponectina foi associada a maior risco para os desfechos primário e coprimário (HR ajustado 1,08 e 1,07/incremento de 1.000, respectivamente, p = 0,01 e p = 0,02). Conclusão: Em pacientes com SCA, a adiponectina sérica foi preditor de risco independente para eventos cardiovasculares. De modo adicional às correlações antropométricas e metabólicas, a adiponectina mostrou correlação significante com BNP.
Prognostic significance of the change in glucose level in the first 24 h after acute myocardial i... more Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study
Neurology and Neuroscience Reports, 2018
Introduction: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes ... more Introduction: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Despite recent advances in understanding of plaque biology, diagnosis, and treatment, atherosclerosis remains a leading cause of morbidity and mortality. The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. HDL-C is believed to retard the formation of atherosclerotic lesions by removing excess cholesterol from cells and preventing endothelial dysfunction. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between very low HDL-Candcarotid artery disease (CD). The aim of this study is to examine this association of very low HDL-Cwith CD in different ages and sex. Methods and analysis: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that examined the association between very low HDL-Cand CD, focus on cohort, case-control and cross-sectional studies, wereconducted among in adults aged 40 to 70 years, provided sufficient data for calculating ORs or relative risk with a 95% CI, were published as original articles written in English or other languages, and have been published until January 2018 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. Ethics and dissemination : Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal.
The Lancet, 2019
Background To our knowledge, no previous study has prospectively documented the incidence of comm... more Background To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. Methods The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the agestandardised and sex-standardised incidence of these events per 1000 person-years. Findings This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9•5 years (IQR 8•5-10•9). During follow-up, 11 307 (7•0%) participants died, 9329 (5•7%) participants had cardiovascular disease, 5151 (3•2%) participants had a cancer, 4386 (2•7%) participants had injuries requiring hospital admission, 2911 (1•8%) participants had pneumonia, and 1830 (1•1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7•1 cases per 1000 person-years) and in MICs (6•8 cases per 1000 person-years) than in HICs (4•3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13•3 deaths per 1000 person-years) were double those in MICs (6•9 deaths per 1000 person-years) and four times higher than in HICs (3•4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0•4 in HICs, 1•3 in MICs, and 3•0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. Interpretation Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).
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Papers by Gustavo Oliveira