Myocardial revascularization: prevalence of arterial hypertension and smoking
PREVALENCE OF ARTERIAL HYPERTENSION AND SMOKING AMONG PATIENTS SUBMITTED TO MYOCARDIAL REVASCULARIZATION
PREVALÊNCIA DE HIPERTENSÃO ARTERIAL E TABAGISMO ENTRE PACIENTES SUBMETIDOS A REVASCULARIZAÇÃO DO MIOCÁRDIO
PREVALENCIA DE HIPERTENSIÓN ARTERIAL Y HÁBITO DE FUMAR ENTRE PACIENTES SOMETIDOS A REVASCULARIZACIÓN MIOCÁRDICA
Claudia Franco Guimarães1; Antônio Acácio Guimarães2; Keila Alves Teixeira3
ABSTRACT
Objective: to identify the prevalence of arterial hypertension and smoking among patients undergoing myocardial revascularization. Methods: descriptive, cross-sectional study. From a convenience sample, 72 medical records of patients undergoing percutaneous transluminal coronary angioplasty and myocardial revascularization surgery were analyzed in a public hospital located in the interior of Bahia. A questionnaire was applied to identify the sociodemographic data and health-disease profile of these patients. For data analysis, descriptive and inferential statistics were used, using the Sperman's Chi-square test. Results: it was identified that 38% of the patients underwent angioplasty and 62% to cardiac surgery. Most of the patients were male (58%) and their age ranged from 40 to 79 years. The prevalence of arterial hypertension was 97% and smoking 7%. Conclusion: these results have the potential to direct intervention strategies with hypertensive people, especially in the context of Primary Care, for health promotion, seeking to reduce the possibility of myocardial revascularization.
Descriptors: Hipertension; Tabacco Use Disorder; Cardiovascular Disease; Thoracic Surgery. RESUMO
Objetivo: identificar a prevalência de hipertensão arterial e tabagismo entre pacientes submetidos a revascularização do miocárdio. Métodos: estudo descritivo, de corte transversal. A partir de uma amostra de conveniência foram analisados 72 prontuários de pacientes submetidos a angioplastia coronária percutânea transluminar e a cirurgia de revascularização miocárdica em um hospital público localizado no interior da Bahia. Aplicou-se um questionário para identificar os dados sociodemográficos e perfil saúde-doença destes pacientes. Para a análise dos dados empregou-se a estatística descritiva e inferencial, por meio do teste de Qui-quadrado de Sperman. Resultados: identificou-se que 38% dos pacientes foram submetidos a angioplastia e 62% à cirurgia cardíaca. A maioria dos pacientes era do sexo masculino (58%) e a idade variou de 40 a 79 anos. A prevalência de hipertensão arterial foi de 97% e de tabagismo 7%. Conclusão: esses resultados tem potencial para direcionar estratégias de intervenções com pessoas hipertensas, sobretudo no âmbito da Atenção Básica, para a promoção da saúde, buscando-se reduzir a possibilidade da ocorrência de revascularização do miocárdio.
Descritores: Hipertensão; Tabagismo; Doenças Cardiovasculares; Cirurgia Torácica. RESUMEN
Objetivo: identificar la prevalencia de hipertensión arterial y tabaquismo en pacientes sometidos a revascularización miocárdica. Métodos: estudio descriptivo, transversal. A partir de una muestra de conveniencia, se analizaron 72 registros médicos de pacientes sometidos a angioplastia coronaria transluminal percutánea y cirugía de revascularización miocárdica en un hospital público ubicado en el interior de Bahía. Se aplicó un cuestionario para identificar los datos sociodemográficos y el perfil salud-enfermedad de los pacientes. Para el análisis de datos, se utilizaron estadísticas descriptivas e inferenciales, aplicando la prueba de Chi-cuadrado de Sperman. Resultados: se identificó que el 38% de los pacientes se sometieron a angioplastia y el 62% a cirugía cardíaca. La mayoría de los pacientes eran hombres (58%) y su edad oscilaba entre 40 y 79 años. La prevalencia de hipertensión arterial fue del 97% y el tabaquismo del 7%. Conclusión: estos resultados tienen el potencial de dirigir estrategias de intervención con personas hipertensas, especialmente en el contexto de Atención Primaria, para la promoción de la salud, buscando reducir la posibilidad de revascularización miocárdica.
Descriptores: Hipertensión; Tabaquismo; Enfermedades Cardiovasculares; Cirúrgia Torácica.
1 Nurse. Master's student in Health Sciences at the Universidade Federal da Bahia (UFBA, Federal University of Bahia). Professor at the UNIFTC University Center campus Vitoria da Conquista - BA. Professor at the Universidade do Estado da Bahia (UNEB, State University of Bahia), campus Guanambi-BA. Email: franconurse@gmail.com
2 Nurse. Master in Sports Science. Professor of the nursing department of the Centro Universitário UNIFTC campus Vitoria da Conquista- BA. Email: baxoenfermeiro@gmail.com
3 Graduation student in nursing at Centro Universitário UNIFTC, campus Vitoria da Conquista-BA. Email: keila.enfa.2020@hotmail.com
Corresponding Author: Keila Alves Teixeira. Address: Avenida Claudia Botelho, nº 1065, Residencial Alfa Park, Vitoria da Conquista- BA,
Brazil.
INTRODUCTION
Smoking is considered a relevant risk factor for the occurrence of several diseases that cause death worldwide. Among them are ischemic heart disease, Chronic Obstructive Pulmonary Disease (COPD), lung cancer and stroke(1). It is worth mentioning that 7.4 million deaths occur annually due to cardiovascular diseases (CVD)(2). This group of pathologies is characterized by damaging the heart pump and blood vessels and by being able to be avoided, through improvements in lifestyle, with a reduction in smoking and alcohol abuse, with regular physical exercise. and maintaining a balanced and healthy diet, which tends to reduce excess body weight(3).
The Systemic Arterial Hypertension (SAH) due to the fact it is an insidious disease, with multifactorial genesis and, in most cases, oligo-asymptomatic is characterized as an important epidemiological problem to be faced by public health in Brazil(4) and from many countries in the world, mainly because it is one of the most frequent risk factors for cardiovascular disease(2). In addition, SAH is responsible for several complications that cause permanent or temporary disabilities, raising the costs of public coffers and the private sector, due to health expenses and those resulting from early retirements and absenteeism at work(5).
So, in an associated way, smoking and SAH are important risk factors for CVD, especially with regard to coronary artery obstructions(5). This means that many patients with cardiac complications require invasive and surgical procedures for treatment. Cardiac catheterization (CAT) is the most used diagnostic test to identify the type of obstruction or the number of lesions in the cardiac muscle, being indicated for both the adult population and the elderly population and cardiac angioplasty can also be used for the treatment(2).
From the current diagnostic and therapeutic possibilities available, it is perceivable that scientific health has been improved. This technological advance brings several benefits to people with CVD, with increasingly skillful, resolute and minimally invasive procedures in interventional cardiology(6), which collaborate to reduce damage and, consequently, mortality. There are studies that indicate a high quality of life in people after procedures for the treatment of CVD, with recovery of various functions and activities of daily living(7,8).
In this sense, it is important to carry out studies that seek to reaffirm the existing
correlation between risk factors with the outcome of CVD among patients undergoing invasive treatment. This is so that it is possible to identify the populations at greatest risk for CVD, allowing health systems to prepare themselves to intervene in a more assertive manner and directed to the demands of this population. Given the above, the present investigation aimed to identify the prevalence of SAH and smoking among patients undergoing myocardial revascularization.
METHODS
Descriptive cross-sectional study, carried out in a hospital unit located in the interior of Bahia. This unit is a reference in cardiology and aims to serve the entire population of southwest Bahia. It has approximately 200 beds, providing 24-hour assistance, both in the private network, as well as through the
Sistema Único de Saúde (SUS, Unified Health
System). There are an average of 15 thousand consultations, 900 hospitalizations and 550 surgeries per month distributed between general and cardiac surgery.
The unit provides specific beds in the two intensive care sectors to receive patients undergoing cardiological procedures performed in the hemodynamics sectors (cardiac catheterization and angioplasty) and in the operating room (in which different types of heart
surgery are performed, including
revascularization of the myocardium, valve replacement and closure of intra-aortic communication) with full support of physical structure and multiprofessional team trained for admission in the cardiac postoperative period.
Data were collected through the analysis of 72 medical records of hospitalized patients, via SUS, in a cardiac intensive care unit, during the months of May to July of the year
2019, after performing myocardial
revascularization procedures and angioplasty. coronary. The medical records of all patients who underwent cardiac procedures mentioned above were included. In turn, medical records that lacked relevant information for the analysis, such as the diagnosis of SAH and/or smoking, were excluded.
The data collection itself took place in November 2019, after release from the hospital's medical records archiving sector. For the collection, a questionnaire elaborated by the researchers was used, based on the literature on the topic and considering the objectives proposed for the research, which contained 16 objective questions, which evaluated the socio-demographic data and the health-disease profile of the patients.
For the tabulation of data, the statistical program Statistical Package for the Social
Myocardial revascularization: prevalence of arterial hypertension and smoking
Sciences (IBM SPSS) version 22.0 was used, and a descriptive analysis of the data was performed according to the calculations of two variables x and y. To verify the correlation between SAH, smoking and myocardial revascularization, Spearman's chi-square test was performed, in which the results: close to -1 indicated negative correlation, close to 0 indicated non-linear correlation and close to 1 indicated correlation positive. A 95% significance level was adopted with the p value considered significant when <0.05.
The research was carried out according to the Resolution of the Conselho Nacional de
Saúde/MS (National Health Council/Ministry of
Health) nº. 466/2012 and 512/2016 that provide for research involving human beings. Thus, the research only started after a favorable opinion from the Comitê de Ética em
Pesquisa (CEP, Research Ethics Committee) of
the Instituto Mantenedor de Ensino Superior
da Bahia (IMES, Institute of Superior Teaching
of Bahia), under CAAE 24042619.5.0000. 5032 and opinion number 3.722.272. As these are secondary data, the signing of the Free and Informed Consent Form was not applied.
RESULTS
The results showed that, regarding age, the sample presented an important variation, with patients who were between 40 and 79 years old. More specifically, between 40 and 49 years were 04 cases (5.0%), between 50 and 59 years were 26 cases (36.0%), between 60 and 69 years were 25 cases (35.0%) and between 70 at 79 years, there were 17 cases (24.0%). Regarding sex, 58.0% were men and, regarding work activity, 83.0% of medical records did not present this information (Table 1).
Table 1: Distribution of number and proportion of patients with cardiovascular diseases, according to age group, sex and profession. Vitória da Conquista (BA), Brazil, 2019.
VARIABLE N % Age Group (in years)
40 to 49 04 5,0 50 to 59 26 36,0 60 to 69 25 35,0 70 to 79 17 24,0 Sex Male 42 58,0 Female 30 42,0 Profession Home 02 3,0 Retired No data 10 60 14,0 83,0 Source: research data, 2019.
According to the data in the medical records, it was possible to identify that the diagnosis of SAH was present in 97.2% of individuals undergoing cardiac procedures (96.4% among those undergoing cardiac angioplasty and 97.7% among those
undergoing revascularization of the
myocardium). In turn, smoking was present in 7.0% of patients. However, it is highlighted that 36.1% of patients undergoing cardiac procedures were ex-smokers (Table 2).
Table 2: Prevalence of SAH and smoking among patients undergoing cardiac revascularization. Vitória da Conquista (BA), Brazil, 2019.
VARIABLES N %
Patients undergoing PTCA* (n=28)
SAH 27 96,4 Smoker 03 10,7 Former smoker 09 32,1 Never smoked 16 57,2 Pacientes submetidos a RM** (n=44) HAS 43 97,7 Smoker 02 4,5 Former smoker 17 38,6 Others 01 2,3 Never smoked 25 56,8
Legend: *Coronary angioplasty; **Revascularization of the myocardium.
Source: research data, 2019.
In addition to SAH, patients undergoing cardiac procedures had other comorbidities, such as Diabetes mellitus (DM) (25 cases - 35.0%) and genetic or acquired heart disease (60 cases - 83.0%). It is noteworthy that 18 patients (25.0%) had concomitant SAH, DM and heart disease. For all situations, the correlation was negative (Table 3).
Table 3: Diagnostic analysis regarding the patient's clinical condition. Vitória da Conquista (BA), Brazil, 2019.
DIAGNOSIS N %
SAH 70 97,0
Genetic/acquired heart disease 60 83,0
DM Type 1 or 2 25 35,0
SAH + DM + heart diseases 18 25,0 Source: research data, 2019.
Most cardiac catheterizations performed were elective (54 cases - 75.0%); and as a result, mainly tri-arterial lesions were identified - in which there is damage to three vessels of the heart - (27 cases - 37.5%). After diagnosis, the most used form of treatment was myocardial revascularization (44 cases - 61.1%) (Table 4).
Table 4 - Analysis of data on cardiac catheterization and treatment. Vitória da Conquista (BA), Brazil, 2019.
VARIABLE N % Did CAT* Yes 72 100,0 No 0 0 Type: Urgency 18 25,0 Elective 54 75,0 Result of CAT Arterial injury 24 33,3 Bi-arterial injury 21 29,1 Tri-arterial injury 27 37,5 Treatment Medicated 0 0 PTCA** 28 38,8 RM*** 44 61,1 Others 0 0
Legend: *Cardiac catheterization; **Coronary angioplasty; ***Revascularization of the myocardium. Source: research data, 2019.
Finally, it was observed that the rate of complications recorded in the medical records related to cardiac procedures was low. For patients who underwent angioplasty, there was 01 case (3.5%) of atrial fibrillation and for those who underwent myocardial revascularization, there were 03 cases (6.8%) of atrial fibrillation; 02 cases of renal dysfunction (4.5%); 02 cases of death (4.5%) and 01 case of respiratory infection (2.3%) (Table 5).
Table 5: Analysis of the patient's complications after cardiac revascularization. Vitória da Conquista (BA), Brazil, 2019.
Variables N %
Patients undergoing PTCA* 28 100,0
Atrial fibrillation 01 3,5 Pacientes submetidos a RM** 44 100,0 Atrial fibrillation 03 6,8 Renal dysfunction 02 4,5 Death 02 4,5 Respiratory infection 01 2,3 *Coronary angioplasty; **Revascularization of the myocardium. Source: research data, 2019.
DISCUSSION
According to the results of this study, it was possible to observe that the age profile of patients undergoing cardiac procedures was marked by the most prevalent presence of people between 60 and 79 years old. It is known that, as age progresses, CVD has a higher prevalence. This is because, several factors can contribute to this result, such as long-term non-adherence to lifestyle changes, including healthy eating habits, physical exercise, among others(9).
As for sex, it was noticed that men were the most prevalent. In this sense, the
differences between men and women identified in the medical records point to a risk of more frequent cardiovascular complications in men. On the other hand, a study carried out in Belém (PA) with 90 people diagnosed with coronary artery disease identified that 70.0% were female(10). This is due to the fact that the interviews in this study cited were carried out with patients with a stable clinical condition, and men are generally those who most need invasive interventions to treat heart disease. In this sense, authors reveal that there is a higher percentage of CVD mortality among men, which may be associated with the fact that SAH also occurs mainly among men(11). This is mainly due to the fact that the rate of adherence to pharmacological and non-pharmacological treatment for SAH and heart disease is lower in males(12).
It is known that women have a longer life expectancy than men, when it comes to heart disease it is known that female hormones protect them during their lives. Such protection decreases during the onset of menopause and ceases completely after menopause. In addition, women are also more careful with their health, practicing healthy lifestyle habits, adequate nutrition and preventive search for health services more frequently(13).
In the medical records analyzed, it was noted that smoking was not a risk factor contributing to coronary worsening and referral to cardiac revascularization of the patients analyzed, given that 41 of them had never smoked, 26 were ex-smokers and only five smoked. However, it should be noted that according to PAHO/WHO(6) approximately 25% of deaths from coronary heart disease (angina and myocardial infarction) are related to smoking.
Also according to PAHO/WHO(6) 47% of the world population adhered to anti-smoking programs after the disclosure of images of pathologies caused by tobacco; bans on smoking in public places, such as bars and restaurants; sale prohibited to minors; public health policies, which aim to reduce or inhibit the use of cigarettes among the entire world population and especially among young people, thus protecting other people from being passive smokers.
The data also revealed that many patients had SAH (70 cases); heart diseases (60 cases) and DM (25 cases). In this sense, authors point out that people with DM are 3 to 4 times more likely to suffer a cardiovascular event and twice the risk of dying from this event when compared to the general population(14).
In addition, it is noteworthy the fact that 18 patients had simultaneously presented the three diseases, increasing the risk for CVDs due to the overlap of risk factors. In this sense, the literature points out that the incidence of
Myocardial revascularization: prevalence of arterial hypertension and smoking
concomitant chronic comorbidities increases the chances of the person having cardiac complications, including influencing the type, duration and number of procedures performed for the treatment of CVD(15).
It was also identified in this research that
all patients who underwent cardiac
revascularization underwent a diagnostic examination of cardiac catheterization. This is because, it is through the result of the CAT that the type of treatment to be conducted according to the degrees of obstruction of the arteries is stipulated and the MRI is indicated from two lesions. However, in the present study, cases of MR with only one lesion were evidenced due to the degree of obstruction and the arterial lesions, the treatment of choice was PTCA(16,17).
According to the data collected, there was a small rate of post-surgical complications of cardiac revascularization, evidencing the occurrence of four cases of Arterial Fibrillation, two cases of renal dysfunction, two deaths and one case of respiratory tract infection. The low incidence of complications suggests that the procedure has shown good results. And according to a similar investigation, Atrial Fibrillation occurred in 10% of the patients investigated(18), a data compatible with those identified in this study.
Regarding deaths, it was found that a similar study found a rate close to 60%, which was associated with risk factors such as SAH and smoking(19). It is interesting to highlight that the lower death rate in the present study is due to the fact that the investigated population is considerably less smoker than the study used for comparison, reinforcing that the smoking habit may represent a greater chance of dying after a cardiovascular event.
CONCLUSION
From the results of this study, it was possible to verify the profile of patients who underwent coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty, and it was identified that SAH is a major risk factor for cardiac revascularization and smoking despite being a risk factor for cardiovascular disease had a low prevalence in the sample studied.
As a limitation, it was identified that the filling of printed medical records in many cases was incomplete. This may be due to the fact that in many cases the patient may omit important data or be unable to answer many questions, for example about lifestyle, consumption of illicit drugs, at the time the initial form is filled out, leading to this gaps in medical records. Furthermore, it is considered that a small population was analyzed in this study, as the time for data collection and
research development was reduced.
Therefore, the data presented here refer to a circumscribed reality and generalizations of the identified information are not allowed.
It is recommended that, in future research, data be collected by means of medical records and interviews with patients in order to have more complete and reliable data, so that important information is not lost when filling out forms. In addition, expanding the sample may allow identifying other realities, which will provide greater generalizations of the results.
Individual contribution of the authors: Teixeira KA: Participated in the design and writing of the project; data collection, analysis and interpretation; writing of the article and final approval of the version to be published. Guimarães CF and Guimarães AA V: Participated in the relevant critical review of the intellectual content and final approval of the version to be published. All authors declare to be responsible for all aspects of the work, ensuring its accuracy and integrity.
Submitted: 20/04/2020 Accepted in: 01/06/2020
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This work is licensed under a Creative Commons license Attribution - Noncommercial - Share the same 4.0 International How to cite this article Guimarães CF, Guimarães AA, Teixeira KA. Prevalence of arterial hypertension and smoking among patients submitted to myocardial revascularization. Rev Parana Enferm. 2020; 3(1):4-10. [Acess: month/day/year]; Available in:_____URL________.
