Análise do diagnóstico da insuficiência cardíaca com fração de ejeção preservada em pacientes dos serviços de urgência pública e privado

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common presentation of heart failure (HF), with a prevalence of over 50% and a prognosis similar to that of heart failure with reduced ejection fraction (HFrEF). At the end of the last century, there has been an increase in the number of studies addressing patients with HFpEF, however, few studies have evaluated the diagnosis of this syndrome. In order to analyze how the diagnosis of preserved heart failure with ejection fraction is made in patients with clinical signs compatible with the signs and symptoms of HF and treated at emergency services of public or private health services, we analyzed the following: information collected from medical records and personal interview of patients admitted to 5 cardiology referral hospital units in the city of Aracaju-SE after clinical suspicion of heart failure was established. We evaluated 156 patients between may 2018 and february 2019, of which 73 (46.77%) were female and 83 (53.21%) male with a mean age of 63.17 ± 16.76 years. Regarding the type of care, 63 (40.38%) were attended in the private health system while 93 (59.62%) were attended in the public health system. Of the personal history, 104 (66.66%) were hypertensive, 64 (41.02%) had dyslipidemia, 56 (36%) were diabetic and 75 (48.07%) claimed to have some type of cardiac arrhythmia diagnosed. Clinical diagnosis by the Framingham Criteria was confirmed in 98 (62.82%) patients and in 97 (62.17%) patients by the Boston Score. Echocardiography was performed in 57 (90.47%) patients in the private health system and in 70 (75.23%) patients in the public system. Measurement of left ventricular ejection fraction was assessed by the Teicholz method in 55 (78.57%) of examinations performed in the public system and 29 (50.87%) of those performed in the private system. Simpson's formula was used in 15 (21.42%) exams in the public system and 28 (49.12%) those performed in the private system. Of the patients who underwent echocardiography 46 (36.22%) had LVEF = 50%, and of these in 15 (32.6%) the E/e’ ratio was evaluated. Among patients with LVEF = 50% and the E/e’ ratio was evaluated, in 8 (53.33%) a value less than or equal to 15 was found, and in 4 (50%) the incidence of LV mass, the NT-proBNP values were evaluated in 2 (25%), the left atrial index volume in 6 (75%), and the BNP values in no patient in this subgroup. It was concluded that the steps for the diagnosis of heart failure with preserved ejection fraction are not performed properly in the reference hospitals of the city of Aracaju, especially in the public system units and regarding the evaluation of diastolic dysfunction through E/e’ ratio