Luis Eduardo Rohde

Sumário […] Diretriz Brasileira de Insuficiência Cardíaca – 2026 Sumário […] Diretriz Brasileira de Insuficiência Cardíaca – 2026

A Estatística Cardiovascular – Brasil foi estabelecida para fornecer avaliação da saúde cardiovascular no Brasil de maneira periódica, abrangente e baseada em evidência, assim como para apoiar a prática clínica, a pesquisa, o planejamento em saúde pública e a elaboração de políticas.1-3 Desenvolvida sob os auspícios da Sociedade Brasileira de Cardiologia, a iniciativa reúne uma rede multidisciplinar de investigadores de instituições acadêmicas em todo o país, que são responsáveis pela revisão, análise e interpretação dos dados de múltiplas fontes complementares. [...] A Estatística Cardiovascular – Brasil foi estabelecida para fornecer avaliação da saúde cardiovascular no Brasil de maneira periódica, abrangente e baseada em evidência, assim como para apoiar a prática clínica, a pesquisa, o planejamento em saúde pública e a elaboração de políticas.1-3 Desenvolvida sob os auspícios da Sociedade Brasileira de Cardiologia, a iniciativa reúne uma rede multidisciplinar de investigadores de instituições acadêmicas em todo o país, que são responsáveis pela revisão, análise e interpretação dos dados de múltiplas fontes complementares.

Objectives: Point‐of‐care ultrasound (POCUS) emerged as a promising tool to evaluate acute decompensated heart failure (ADHF). We propose a POCUS score combining lung and systemic congestion for ADHF assessment. Methods: Patients admitted to the cardiac intensive care unit (CICU) with a diagnosis of ADHF and left ventricular ejection fraction (LVEF) n = 109) were mostly male (67.8%), with a mean age of 64.5 years and mean LVEF of 25%. Delta DUCS (∆DUCS) from CICU admission up to 72 hours was an independent predictor of in‐hospital mortality (odds ratio [OR] = 0.66, p = .009; ROC AUC = 0.76). DUCS at CICU discharge was an independent predictor of 30‐day mortality and readmission (OR = 1.61, p = .001; ROC AUC = 0.77). Both ∆DUCS in 72 hours and DUCS at CICU discharge had good accuracy, in addition to adequate calibration metrics based on observed to expected ratio and performance. DUCS also improved NRI compared to a multivariate predictive model for in‐hospital mortality (5.4%) and 30‐day mortality and readmission (22.5%). Conclusions: DUCS was an independent predictor of in‐hospital mortality and of 30‐day mortality and hospital readmission, representing a potentially useful tool to assess ADHF and treatment response.

Resumo Fundamento O escore Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) é uma ferramenta de estratificação de risco utilizada para prever mortalidade na insuficiência cardíaca (IC). Entretanto, possíveis diferenças relacionadas ao sexo em seu desempenho e sua aplicabilidade à população brasileira permanecem incertas. Objetivos Avaliar diferenças baseadas no sexo no desempenho do escore MAGGIC e validar o escore em uma coorte brasileira de IC. Métodos Este estudo de coorte retrospectivo incluiu 866 pacientes acompanhados em um ambulatório de IC. O desfecho primário foi mortalidade por todas as causas em 3 anos. O escore MAGGIC foi calculado para cada paciente. A discriminação foi avaliada por meio da área sob a curva característica de operação do receptor, e a calibração foi avaliada pelo teste de Hosmer-Lemeshow. As análises foram realizadas para a coorte total e estratificadas por sexo. Considerou-se valor de p < 0,05 como estatisticamente significativo. Resultados A taxa global de mortalidade em 3 anos foi de 33,4% (36,4% em homens e 27,8% em mulheres; p = 0,010). A mortalidade predita foi de 20,9% (escore médio de 18,3 ± 7), sendo 22,7% em homens e 19,1% em mulheres. O escore demonstrou boa discriminação (área sob a curva = 0,72; intervalo de confiança de 95%: 0,686-0,754), com desempenho semelhante em homens (0,704 [0,661-0,747]) e mulheres (0,733 [0,674-0,792]). A calibração mostrou boa concordância: qui-quadrado (χ2) global = 1,1 (p = 0,998), χ2 para homens = 0,9 (p = 0,999) e χ2 para mulheres = 1,3 (p = 0,995). A mortalidade observada foi maior nos grupos de risco moderado, sem diferença significativa entre os grupos de risco moderado e alto (p = 0,236). Conclusão O escore MAGGIC apresentou bom desempenho em uma coorte brasileira de IC, sem diferenças significativas relacionadas ao sexo, embora tenha sido identificada maior mortalidade observada entre pacientes de risco moderado.

Background The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain. Objectives To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort. Methods This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant. Results The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236). Conclusion The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.

Introduction: Cardiovascular diseases (CVD) are the leading cause of death worldwide, with oxidative stress playing a significant role in their progression. The use of N-acetylcysteine (NAC), a well-known antioxidant and a precursor to glutathione (GSH), has shown potential in preventing different types of CVD. Yet, there are limited data assessing NAC’s impact on GSH levels in animal models of CVD. Objective: To estimate the effects of NAC supplementation on reduced glutathione (GSH) and total glutathione levels in cardiac tissue or serum/plasma from animals with established heart disease. Methods: We searched PubMed, Embase, Web of Science, Scielo, Lilacs/BINACIS, MedRxiv, and BioRxiv databases (the search was completed in February 2025). We included studies in animal models (of any species) of CVD receiving NAC (via any route or dose) and performed a random-effects meta-analysis and Risk of Bias assessment (PROSPERO register: CRD42023382024). Results: We identified 738 articles, fully reviewed 48, and included 8 in the meta-analysis. Meta-analysis showed that NAC supplementation resulted in a statistically significant increase in GSH (SMD = 1.54, CI 95% = 0.13–2.94; p = 0.03), with high heterogeneity (I² = 88%) and in total glutathione (SMD = 1.22, CI 95% = 0.41–2.02; p = 0.003) with moderate heterogeneity (I² = 49%). Subgroup analyses suggested a dose-dependent effect, while sensitivity analyses indicated that species- and model-related differences influenced the magnitude of the GSH response. Conclusion: NAC supplementation increases glutathione levels in animal models of heart disease, although the magnitude of the effect appears dose- and model-dependent.

Conduction system pacing (CSP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT), with potential clinical benefits and lower costs. PhysioSync-HF is a multicenter, randomized trial comparing these strategies from both clinical and economic perspectives in patients with heart failure with reduced ejection fraction (HFrEF). To describe the rationale and design of the trial-based economic evaluation embedded within the PhysioSync-HF trial. The PhysioSync-HF trial enrolled 179 patients with 1-year follow-up. Procedural cost data will be collected using a time-driven activity-based costing approach. Costs associated with the device, adverse clinical events, and ambulatory care during follow-up will be estimated using resource-based accounting methods. Appropriate methods will address missing data, and statistical analyses will account for the skewed distribution of cost variables. The primary economic outcome is the between-group difference in total direct medical costs per patient over the 1-year follow-up (CSP vs BVP). Secondary outcomes include component-level cost breakdowns of direct medical expenses and a budget impact analysis estimating the annual effect on Brazil's health care system if all eligible patients received CSP instead of BVP. By leveraging a multicenter cardiovascular trial to measure costs of CSP versus BVP, this economic evaluation aims to identify cost-saving opportunities that could expand equitable access to CRT for individuals with HFrEF in Brazil, while providing insights relevant to other health care settings worldwide. NCT05572736.

Background: Heart failure (HF) has a major impact on public health. HF staging helps capture preclinical disease and its progression to advanced stages. There are scarce data on HF staging from longitudinal studies in Latin America. This study aimed to determine the prevalence and mortality of HF stages in a Brazilian adult cohort of participants 60 years old and over. Methods: The ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health) multicentric cohort comprises 15 105 adults. From 2008 to 2010, ELSA carried out interviews and clinical, laboratory, and cardiovascular tests. In this analysis, we included participants 60 years old and over who had an echocardiogram performed at baseline visit and additional information regarding risk factors and functional capacity. Results: There were 2356 participants (65±4 years; 53% women) with baseline echocardiogram. Of these, 504 (21%) participants were considered at low risk for developing HF (stage 0). Prevalence of HF was 1026 (44%) for stage A (at risk for HF), 557 (24%) for stage B (pre‐HF), and 269 (11%) for stage C (symptomatic HF), with different distribution between sexes ( P <0.001). Multivariable risk‐adjusted model for all‐cause mortality over a median follow‐up of 12 years, found 6%, 12%, 18%, and 27% for stages 0, A, B, and C, respectively, with hazard ratios of 1.82 [95% CI, 1.2–2.7], 2.52 [95% CI, 1.7–3.8], and 4.29 [95% CI, 2.8–6.6], using as reference stage 0. Conclusions: The high prevalence of symptomatic, and preclinical HF in older adults and the increased mortality with disease progression may be responsible for an elevated public health burden. This information is critical for understanding and planning health policies for older adults in middle‐income countries.

Background Conduction system pacing (CSP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT), with potential clinical benefits and lower costs. PhysioSync-HF is a multicenter, randomized trial comparing these strategies from both clinical and economic perspectives in patients with heart failure with reduced ejection fraction (HFrEF). Objective To describe the rationale and design of the trial-based economic evaluation embedded within the PhysioSync-HF trial. Methods The PhysioSync-HF trial enrolled 179 patients with 1-year follow-up. Procedural cost data will be collected using a time-driven activity-based costing approach. Costs associated with the device, adverse clinical events, and ambulatory care during follow-up will be estimated using resource-based accounting methods. Appropriate methods will address missing data, and statistical analyses will account for the skewed distribution of cost variables. Results The primary economic outcome is the between-group difference in total direct medical costs per patient over the 1-year follow-up (CSP vs BVP). Secondary outcomes include component-level cost breakdowns of direct medical expenses and a budget impact analysis estimating the annual effect on Brazil’s health care system if all eligible patients received CSP instead of BVP. Conclusion By leveraging a multicenter cardiovascular trial to measure costs of CSP versus BVP, this economic evaluation aims to identify cost-saving opportunities that could expand equitable access to CRT for individuals with HFrEF in Brazil, while providing insights relevant to other health care settings worldwide. Trial Registration NCT05572736.

Resumo Fundamento A estimulação do sistema de condução (ESC) surgiu como uma alternativa à estimulação biventricular (EBV) para terapia de ressincronização cardíaca (TRC), com potenciais benefícios clínicos e menores custos. O PhysioSync-HF é um estudo multicêntrico e randomizado que compara essas estratégias sob as perspectivas clínica e econômica em pacientes com insuficiência cardíaca e fração de ejeção reduzida (ICFER). Objetivo Descrever a justificativa e o desenho da avaliação econômica baseada em ensaio clínico incorporada ao estudo PhysioSync-HF. Métodos O estudo PhysioSync-HF incluiu 179 pacientes com seguimento de 1 ano. Os dados de custo do procedimento serão coletados utilizando a abordagem de custeio baseado em atividades e tempo. Os custos associados ao dispositivo, eventos clínicos adversos e cuidados ambulatoriais durante o seguimento serão estimados por meio de métodos de contabilidade baseados em recursos consumidos. Métodos apropriados serão empregados para tratar dados ausentes, e as análises estatísticas considerarão a distribuição assimétrica das variáveis de custo. Resultados O desfecho econômico primário é a diferença entre os grupos no custo médico direto total por paciente ao longo de 1 ano de seguimento (ESC vs. EBV). Os desfechos secundários incluem a decomposição dos custos diretos em componentes e uma análise de impacto orçamentário que estima o efeito anual no sistema de saúde brasileiro se todos os pacientes elegíveis recebessem ESC em vez de EBV. Conclusão Aproveitando um ensaio cardiovascular multicêntrico para mensurar os custos da ESC em comparação à EBV, esta avaliação econômica busca identificar oportunidades de redução de custos que possam ampliar o acesso com equidade à TRC para indivíduos com ICFER no Brasil, além de fornecer informações relevantes para outros sistemas de saúde no mundo. Registro do Ensaio NCT05572736.