Implementation of multicenter records in the therapeutic cardiovascular assessment in Brazil

Moreira, Luiz Felipe P.

doi:10.5935/abc.20130245

EDITORIAL

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil

Mailing address

Keywords: Cardiovascular Diseases / therapy; Multicenter Study; Brazil.

Clinical research finds, in controlled clinical trials, its main instrument to establish the therapeutic effectiveness of drug or interventional therapies. On the other hand, the evaluation of demographic, clinical and prognostic characteristics of patients under treatment in the real world depends on comprehensive multicenter observational studies, whose results vary according to countries or regions involved. In the field of cardiology, we have, in our country, few records that represent the national reality. In this vein, recent experiences have been conducted by the Brazilian Society of Cardiology and by specific groups or institutions in recording some specific conditions or therapies.

These studies include the evaluation of epidemiological aspects, prognostic results and the factors involved in the care of patients with acute coronary syndromes^1-3, decompensated heart failure⁴ or disorders at high risk of cardiovascular events⁵. In parallel, the evaluation of the characteristics and outcomes of interventional procedures such as the use of stents in the treatment of heart failure⁶ and cardiac surgeries in the treatment of valvular heart diseases or heart failure⁷ have also been the subject of specific records.

The initial publications of clinical records related to acute coronary syndromes suggest the inclusion of more than six thousand patients treated in centers based in different regions of Brazil. These records have become major documents that show the demography of the disorders involved^{2 3 8}. The initial results of these records demonstrate the diversity of treatments conducted at a national level, including the regional inequality in the employment of reperfusion therapies². The use of these therapies relates, on the other hand, to lower mortality and lower rates of complications in the immediate follow-up of patients^3,8.

Besides this, recent data show lower rates of mortality that are consistent with the international experience in the treatment of unstable angina and acute myocardial infarction with or without ST-segment elevation⁸.

Records focusing on the evolution of patients with heart failure and disorders at high risk of cardiovascular events are still at an initial stage of including patients⁴⁵. However, important issues on the application of confirmedly beneficial therapies can be found in the preliminary data of the REACT study⁹.

As for interventional procedures, publications of the CENIC registry, which includes patients undergoing percutaneous coronary intervention in several Brazilian regions, suggest a progressive improvement of results⁶¹⁰, including the reduction of vascular complications promoted by the technique of access through the radial artery¹⁰. Finally, the constitution of the SP-SCORE-SUS registry to evaluate the results of cardiac surgeries in the State of São Paulo, based on previous publications of a national reference center^11,12, fills an important gap with respect to the employment and results of cardiovascular surgical therapy, expected to be expanded at a national level¹³.

The scenario presented shows the growing concern of researchers and our scientific societies to better characterize the therapeutic profile of cardiovascular disorders in our country. The analysis of the results of a number of multicenter records opens new perspectives for better planning of financial, personal and technological resources used in cardiovascular health, and contributes with insights to deepening scientific knowledge on the events under study.

References

1. Mattos LA. Rationality and methods of ACCEPT registry - Brazilian registry of clinical practice in acute coronary syndromes of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2011;97(2):94-9.
2. Nicolau JC, Franken M, Lotufo PA, Carvalho AC, Marin Neto JA, Lima FG, et al. Use of demonstrably effective therapies in the treatment of acute coronary syndromes: comparison between different Brazilian regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE). Arq Bras Cardiol. 2012;98(4):282-9.
3. Piegas LS, Avezum A, Guimarães HP, Muniz AJ, Reis HJ, dos Santos ES, et al. Acute coronary syndrome behavior: results of a Brazilian registry. Arq Bras Cardiol. 2013 Jun;100(6):502-10
4. BREATHE investigators. Rationale and design: BREATHE registry-I Brazilian Registry of Heart Failure. Arq Bras Cardiol. 2013;100(5):390-4.
5. Mattos LA. Rationality and methods: registry of clinical practice in high-risk cardiovascular patients. Arq Bras Cardiol. 2011;97(1):3-7.
6. Cardoso CO, de Quadros AS, Mattos LA, Gottschall CA, Sarmento-Leite RE, Marin-Neto JA. Use of drug-eluting stents in Brazil: the CENIC (National Registry of Cardiovascular Interventions) registry. Arq Bras Cardiol. 2007;89(6):356-61.
7. Mejía OA, Lisboa LA, Dallan LA, Pomerantzeff PM, Trindade EM, Jatene FB, Kalil Filho R. Heart surgery programs innovation using surgical risk stratification at the São Paulo State Public Healthcare System: SP-SCORE-SUS study. Rev Bras Cir Cardiovasc. 2013;28(2):263-9.
8. Mattos LA, Berwanger O, dos Santos ES, Reis HJ, Romano ER, Petriz JL, et al. Clinical outcomes at 30 days in the Brazilian Registry of Acute Coronary Syndromes (ACCEPT). Arq Bras Cardiol. 2013;100(1):6-13.
9. Berwanger O, Piva e Mattos LA, Martin JF, Lopes RD, Figueiredo EL, Magnoni D, et al. Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study. Arq Bras Cardiol. 2013;100(3):212-20.
10. Andrade PB, Tebet MA, Andrade MV, Labrunie A, Mattos LA. Radial approach in percutaneous coronary interventions: current status in Brazil. Arq Bras Cardiol. 2011;96(4):312-6.
11. Lisboa LA, Mejia OA, Dallan LA, Moreira LF, Puig LB, Jatene FB, Stolf NA. Previous percutaneous coronary intervention as risk factor for coronary artery bypass grafting. Arq Bras Cardiol. 2012;99(1):586-95.
12. Mejía OA, Lisboa LA, Puig LB, Moreira LF, Dallan LA, Pomerantzeff PM, et al. InsCor: a simple and accurate method for risk assessment in heart surgery. Arq Bras Cardiol. 2013;100(3):246-54.
13. Mejía OA, Lisboa LA. The risk of risk scores and the dream of BraSCORE. Rev Bras Cir Cardiovasc. 2012;27(2):xii-xiii.

Implementation of multicenter records in the therapeutic cardiovascular assessment in Brazil

Luiz Felipe P. Moreira

Publication Dates

Publication in this collection
11 Feb 2014
Date of issue
Dec 2013

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Mattos LA. Rationality and methods of ACCEPT registry - Brazilian registry of clinical practice in acute coronary syndromes of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2011;97(2):94-9.

[2] 2. Nicolau JC, Franken M, Lotufo PA, Carvalho AC, Marin Neto JA, Lima FG, et al. Use of demonstrably effective therapies in the treatment of acute coronary syndromes: comparison between different Brazilian regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE). Arq Bras Cardiol. 2012;98(4):282-9.

[3] 3. Piegas LS, Avezum A, Guimarães HP, Muniz AJ, Reis HJ, dos Santos ES, et al. Acute coronary syndrome behavior: results of a Brazilian registry. Arq Bras Cardiol. 2013 Jun;100(6):502-10

[4] 4. BREATHE investigators. Rationale and design: BREATHE registry-I Brazilian Registry of Heart Failure. Arq Bras Cardiol. 2013;100(5):390-4.

[5] 5. Mattos LA. Rationality and methods: registry of clinical practice in high-risk cardiovascular patients. Arq Bras Cardiol. 2011;97(1):3-7.

[6] 6. Cardoso CO, de Quadros AS, Mattos LA, Gottschall CA, Sarmento-Leite RE, Marin-Neto JA. Use of drug-eluting stents in Brazil: the CENIC (National Registry of Cardiovascular Interventions) registry. Arq Bras Cardiol. 2007;89(6):356-61.

[7] 7. Mejía OA, Lisboa LA, Dallan LA, Pomerantzeff PM, Trindade EM, Jatene FB, Kalil Filho R. Heart surgery programs innovation using surgical risk stratification at the São Paulo State Public Healthcare System: SP-SCORE-SUS study. Rev Bras Cir Cardiovasc. 2013;28(2):263-9.

[8] 8. Mattos LA, Berwanger O, dos Santos ES, Reis HJ, Romano ER, Petriz JL, et al. Clinical outcomes at 30 days in the Brazilian Registry of Acute Coronary Syndromes (ACCEPT). Arq Bras Cardiol. 2013;100(1):6-13.

[9] 9. Berwanger O, Piva e Mattos LA, Martin JF, Lopes RD, Figueiredo EL, Magnoni D, et al. Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study. Arq Bras Cardiol. 2013;100(3):212-20.

[10] 10. Andrade PB, Tebet MA, Andrade MV, Labrunie A, Mattos LA. Radial approach in percutaneous coronary interventions: current status in Brazil. Arq Bras Cardiol. 2011;96(4):312-6.

[11] 11. Lisboa LA, Mejia OA, Dallan LA, Moreira LF, Puig LB, Jatene FB, Stolf NA. Previous percutaneous coronary intervention as risk factor for coronary artery bypass grafting. Arq Bras Cardiol. 2012;99(1):586-95.

[12] 12. Mejía OA, Lisboa LA, Puig LB, Moreira LF, Dallan LA, Pomerantzeff PM, et al. InsCor: a simple and accurate method for risk assessment in heart surgery. Arq Bras Cardiol. 2013;100(3):246-54.

[13] 13. Mejía OA, Lisboa LA. The risk of risk scores and the dream of BraSCORE. Rev Bras Cir Cardiovasc. 2012;27(2):xii-xiii.