Febre reumática e suas complicações no Brasil: aspectos epidemiológicos entre os anos de 2008 e 2017
Febre reumática e suas complicações no Brasil: aspectos epidemiológicos entre os anos de 2008 e 2017
Data
2023-05
Autores
Bellot, Camila Polis
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: a Febre Reumática (FR) é uma doença inflamatória desencadeada em pessoas
suscetíveis após infecção com o estreptococo beta hemolítico do grupo A, bactéria que
inicialmente causa amigdalite e piodermite. A FR permanece como importante causa de
internação hospitalar no Brasil e no mundo, mesmo que passível de prevenção e erradicação.
Sua maior sequela é a Cardiopatia Reumática (CR), manifestada através das lesões valvares
e outras complicações como endocardite infecciosa, arritmias, e acidente vascular encefálico.
Acomete indivíduos jovens em idade economicamente ativa e adultos. É estimada perda de
anos potenciais de vida ajustados por doença (DALY) de 26 anos por brasileiro por ano (23)
,
tempo este maior que as neoplasias malignas (13,1 anos).
Objetivo: o objetivo desta pesquisa é realizar um diagnóstico situacional da FR, atualizando
dados epidemiológicos do Brasil. Método: trata-se de um estudo ecológico utilizando dados
públicos. As buscas foram baseadas nos principais registros de FR por Código Internacional
da Doença (CID) relacionados à FR e CR, referentes à internação e mortalidade entre os anos
de 2008 e 2017. Na avaliação da mortalidade agrupamos os resultados por CIDs, comparados
por sexo, idade, raça. Para avaliação das internações, comparamos o número de internações
(AIH) por CID, ano, o tempo de internação, a causa e o desfecho da internação, e tipo de leito
utilizado. As análises estatísticas foram realizadas no Software SAS. Não foi possível mapear
a rede de atendimento ambulatorial e profilaxia secundária da FR por ausência de registros
específicos à doença na atenção básica, portanto a doença aguda e fora de surto sem
necessidade de hospitalização não foi contemplada. Resultados: em relação aos óbitos
vimos que o Brasil tem 12,3 mortes/100 mil habitantes, com pico aos 50 anos e predomínio
do sexo feminino. Observamos que 6,3% das internações evoluíram com óbito. Sobre as
internações, valvopatia foi maior causa e 54,4% dos pacientes necessitaram de unidade de
terapia intensiva (UTI). Na população pediátrica, 89% das internações por valvopatia
utilizaram UTI. A taxa nacional foi de 4,3 internações/100 mil habitantes. Na distribuição das
internações por cor há predomínio de brancos (49,63%) e pardos (44,1%). Prevalecem
hospitalizações em mulheres, e pico aos 50 anos.
Não temos, no momento, informações da atenção básica suficientes para montar o panorama
nacional dos atendimentos ambulatoriais.
Apesar de haver lacunas no conhecimento, há evidências suficientes para realizar ações
locais voltadas à CR.. Conclusão: Os dados mostram que a FR segue contribuindo
substancialmente para hospitalizações e morte no Brasil.Com estes dados visamos,
portanto, contribuir para o manejo e controle da doença e suas complicações, bem como
planejar políticas públicas direcionadas à FR. Palavras-chave: Febre Reumática, Cardiopatia
Reumática, Doença Valvar Cardíaca, Epidemiologia, Brasil
Introduction: Rheumatic Fever (RF) is an autoimmune disease, triggered in susceptible people following infection with group A beta hemolytic streptococcus, which causes tonsillitis and piodermitis. RF remains an important cause of hospital admission in Brazil and worldwide. Rheumatic Heart Disease (RHD) is the major sequel, manifested as valvular lesions and other complications such as infective endocarditis, arrhythmia, and stroke. It affects young individuals of economically active age and adults. Disability- adjusted life years (DALY) is estimated at 26 years per Brazilian per year, which is more than malignant neoplasms (13.1 years). Objective: the objective of this study is to carry out a situational diagnosis of RF, updating epidemiological data from Brazil. Method: this is an ecological study using public data. The searches were based on the main RF records by International Disease Code (ICD) related to RF and RHD, regarding hospitalization and mortality between the years 2008 and 2017. In the evaluation of mortality, we grouped the results by ICDs, compared by sex, age, and color. To assess hospitalizations, we compared the number of hospitalizations (AIH) by ICD, by year, length of stay, cause and outcome of hospitalization, and the type of hospital bed utilized. Statistical analyzes were performed using the SAS Software. It was not possible to map the network of outpatient care and secondary prophylaxis of RF due to the lack of specific records for the disease in primary care, therefore the acute disease and that occurring out of outbreaks, without the need for hospitalization, was not contemplated. Results: Brazil has 12.3 deaths/100.000 inhabitants, with a peak at age 50 and a predominance of females; 6.3% of hospitalizations resulted in death. Regarding hospitalizations, the national rate was 4.3 hospitalizations/100,000 inhabitants. Valvular heart disease was the main cause for hospitalization and 54.4% of the patients were treated in the intensive care unit (ICU). In the pediatric population, 89% of hospitalizations due to valvular heart needed ICU treatment. In the distribution of hospitalizations by color, there is a predominance of whites (49.63%) and browns (44.1%). Hospitalizations were prevalent in women and peaked at age 50. At the moment, we do not have enough information on primary care to depict the national panorama of outpatient care. Although there are gaps in knowledge, there is sufficient evidence to carry out local actions aimed at RHD. Conclusion: Data show that RF still contributes significantly to hospitalizations and death in Brazil. We aim, therefore, to contribute to the management and control of the disease and its complications, as well as to plan public policies aimed at RF. Keywords: Rheumatic Fever, Rheumatic Heart Disease, Heart Valve Diseases, Epidemiology, Brazi
Introduction: Rheumatic Fever (RF) is an autoimmune disease, triggered in susceptible people following infection with group A beta hemolytic streptococcus, which causes tonsillitis and piodermitis. RF remains an important cause of hospital admission in Brazil and worldwide. Rheumatic Heart Disease (RHD) is the major sequel, manifested as valvular lesions and other complications such as infective endocarditis, arrhythmia, and stroke. It affects young individuals of economically active age and adults. Disability- adjusted life years (DALY) is estimated at 26 years per Brazilian per year, which is more than malignant neoplasms (13.1 years). Objective: the objective of this study is to carry out a situational diagnosis of RF, updating epidemiological data from Brazil. Method: this is an ecological study using public data. The searches were based on the main RF records by International Disease Code (ICD) related to RF and RHD, regarding hospitalization and mortality between the years 2008 and 2017. In the evaluation of mortality, we grouped the results by ICDs, compared by sex, age, and color. To assess hospitalizations, we compared the number of hospitalizations (AIH) by ICD, by year, length of stay, cause and outcome of hospitalization, and the type of hospital bed utilized. Statistical analyzes were performed using the SAS Software. It was not possible to map the network of outpatient care and secondary prophylaxis of RF due to the lack of specific records for the disease in primary care, therefore the acute disease and that occurring out of outbreaks, without the need for hospitalization, was not contemplated. Results: Brazil has 12.3 deaths/100.000 inhabitants, with a peak at age 50 and a predominance of females; 6.3% of hospitalizations resulted in death. Regarding hospitalizations, the national rate was 4.3 hospitalizations/100,000 inhabitants. Valvular heart disease was the main cause for hospitalization and 54.4% of the patients were treated in the intensive care unit (ICU). In the pediatric population, 89% of hospitalizations due to valvular heart needed ICU treatment. In the distribution of hospitalizations by color, there is a predominance of whites (49.63%) and browns (44.1%). Hospitalizations were prevalent in women and peaked at age 50. At the moment, we do not have enough information on primary care to depict the national panorama of outpatient care. Although there are gaps in knowledge, there is sufficient evidence to carry out local actions aimed at RHD. Conclusion: Data show that RF still contributes significantly to hospitalizations and death in Brazil. We aim, therefore, to contribute to the management and control of the disease and its complications, as well as to plan public policies aimed at RF. Keywords: Rheumatic Fever, Rheumatic Heart Disease, Heart Valve Diseases, Epidemiology, Brazi
Description
Palavras-chave
Febre Reumática, Cardiopatia
Reumática, Doença Valvar Cardíaca, Epidemiologia, Brasil, Rheumatic Fever, Rheumatic Heart Disease, Heart Valve Diseases, Epidemiology, Brazil
Citação
Polis CP. Febre reumática e suas complicações no Brasil: aspectos epidemiológicos entre os anos de 2008 e 2017. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2023.