congenital valvular heart disease : h ospitalization trends in portugal
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Congenital Valvular Heart Disease: Hospitalization trends in Portugal
Introdução à Medicina I e II2011/2012 | 1st grade | 9th class
Ana Isabel PereiraGonçalo FerreiraGustavo PereiraHelena SousaIsabel FragosoJoana NunesLeonor SilvaPedro MiragaiaPedro PintoRayanne Pinto
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INTRODUCTION
These valves are divided in two types:
ATRIOVENTRICULAR VALVES (AV): mitral (or bicuspid) - on the left - and tricuspid, on the right side of the heart. [1,2]
SEMILUNAR (SL): aortic and pulmonary, which are located respectively at the base of the aorta and the pulmonary artery. [2,3,4]
Heart: The hollow, muscular organ that maintains the circulation of the blood.
Introdução à Medicina 2011/2012 | 1st grade | 9th class
[1] WHO Technical Report, 2004
[2] Nkomo V., et al.. 2006.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[3] Ragavendra R. et al. 2008.
[4] Alpert J. et al. 1999.
STRONG POINTS
REFERENCES
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STENOSIS
Characterized by the narrowing of the orifice
of the valves [1,5,6]
REGURGITATION
The valve doesn’t close properly when the
heart pumps out blood and so it returns to
the auricle or to the ventricle [2,7,8]
Introdução à Medicina 2011/2012 | 1st grade | 9th class
[1] WHO Technical Report, Series. 2004
[2] Nkomo V., et al.. 2006.
[5] Quan H, et al. ,2005.
[6] Elixhauser A, et al. , 1998.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
JUSTIFICATION
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[7] Valle FH., et al., 2010.
[8] Folkmann S., et al., 2010.
STRONG POINTS
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Hearth valve diseases
Acquired[5,6]
Rheumatic
Non-rheumatic
Congenital[5,6]
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[5] Quan H, et al. ,2005.
[6] Elixhauser A, et al. , 1998.
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REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
BACKGROUND Mortality rates
5[8] Folkmann S., et al., 2010.[9]Dima C., et al., 2010.[10] Pei HJ., et al., 2011.
Introdução à Medicina 2011/2012 | 1st grade | 9th class
-“Most (60%) patients with severe untreated mitral stenosis die of progressive pulmonary or systemic congestion, but others may suffer systemic embolism (20-30%), pulmonary embolism (10%)”[9]
-“Among symptomatic patients with medically treated, moderate-to-severe aortic stenosis, mortality rates from the onset of symptoms are approximately 25% at 1 year and 50% at 2 years. More than 50% of deaths are sudden.” [8,12,13,14]
-“Tricuspid regurgitation resulting from myocardial dysfunction or dilatation has a mortality of up to 50% at 5 years.” [15,16,17]
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS -“When severe symptoms occur, 10-year survival is less than 15% in the patients with untreated mitral stenosis.”[9,10,11] REFERENCES
JUSTIFICATION
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[11] Imamura M., et al., 2010.[12] Xiushui, R., 2011 [13] Wang S., et al., 2010.
[14] Olsson M., et al., 1992.[15] Mancini M., 2011. [16] Ashikhmina EA., et al., 2011.[17] Valle FH., et al., 2010.
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Hearth valve diseases
Acquired[5,6]
Rheumatic
Non-rheumatic
Congenital[5,6]
Congenital diseases are diseases existing at birth and often before birth, or that develop during the first month of life (infant, newborn, diseases), regardless of cause. Among these diseases, some are characterized by structural deformities [18].
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
JUSTIFICATION
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[5] Quan H, et al. ,2005.
[6] Elixhauser A, et al. , 1998.[18] Lung B., et al., 2003.
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
The presented codes are from ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification) and their selection has been made according to these articles: [5] Quan H, et al., 2005 ; [6] Elixhauser A, et al. , 1998
ICD-9-CMInternational Classification of Disease [5,6]
746.5 Congenital stenosis of mitral valve
746.3 Congenital stenosis of aortic valve
746.6 Congenital insufficiency of mitral valve
746.4 Congenital insufficiency of aortic valve
INTRODUCTION
BACKGROUND
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RESULTS
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INTRODUCTION
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DISCUSSION
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
BACKGROUND Mortality rates
-” Congenital subaortic stenosis (SAS) has a high recurrence rate after surgical correction. Aortic valve disease frequently coexists with SAS, being its occurrence and progression unpredictable.”[19,20,21,22]
-“Mutations in the gene encoding the homeobox transcription factor NKX2-5 were found to cause nonsyndromic, human congenital heart disease.” [23,18,2]
-“Within a prospective study of 56,109 total births, 457 youngsters have been found to have congenital heart disease.” [24,25]
[2] Nkomo V., et al.. 2006.[18] Lung B., et al., 2003. [19]Lopes R., et al., 2011
INTRODUCTION
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RESULTS
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INTRODUCTION
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METHODS
RESULTS
DISCUSSION
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LIMITATIONS
[23] Schott, J, Et al., 1998[24] Mitchell, S. Et al., 1971[25] Arora R., et al., 2002.
[20] Tornos P., et al., 2006.[21] Fuster, et al., 2007.[22] Ramakrishna CD., et al., 2009.
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JUSTIFICATION
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INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
AIMS
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
Congenital Heart Valve Diseases are the least frequent disease valvular diseases.
There is very few information about this issue in Portugal.
It is important to know the trends of congenital valvular heart diseases in Portugal, since these diseases persist throughout life.
Our work focused specifically on the heart valve diseases with congenital origins, so it was interesting to study the differences in numbers between regions because it would allow us to establish some kind of regional pattern which could eventually lead us to genetic reasons.
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
AIMS
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Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
1- To study the prevalence of hospitalizations of congenital valvular heart
diseases among the hospitalizations of all valvular heart diseases.
2- To analyze the evolution of hospitalizations of congenital heart valve
diseases in Mainland Portuguese public hospitals, between 2000 and 2008.
3- To study which congenital valve heart disease hospitalizations is more
frequent
4- To analyze the frequency of hospitalizations of congenital valvular heart
disease according to:
-Gender
-Age
-Complexity of hospital
- NUTSII and NUTSIII Regions of Mainland Portugal
INTRODUCTION
BACKGROUND
JUSTIFICATION
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
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5- To analyze if the hospitalized patients had to dislocate from their residential
areas to other different NUTSII and NUTSIII regions to be treated.
6- To study hospital fatality rates in patients with heart valve disease and by
each congenital valvular heart disease.
7- To study which is the most diagnosed congenital valve heart disease in the
first year of life, among hospitalized patients.
AIMSAIMS
INTRODUCTION
BACKGROUND
JUSTIFICATION
METHODS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
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The project developed is:
• an epidemiological and retrospective study, concerning the frequency of heart valve hospitalizations among the Portuguese population between 2000 and 2008;
• an observational study, since there was no direct intervention on the populations;
• an analytical study, since we statistically analyzed data from a National Health’s System database.
METHODSINTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
The study is related to the hospitalization numbers about the heart valve diseases of the Portuguese population between 2000 and 2008.
STRONG POINTS
REFERENCES
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In order to gather information about valvular heart diseases we searched for several articles.
Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
Search and Selection of the articles:
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
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KEY WORDSHeart valves;Stenosis;Regurgitation; congenital heart disease;
heart valve diseasesheart valves epidemiology congenitalPortugal
acquired heart disease; epidemiology;Portuguese;Portugal;
Introdução à Medicina 2011/2012 | 1st grade | 9th class
MeSH TERMS
INTRODUCTION
BACKGROUND
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RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
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RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
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"Heart Valve Diseases"[MeSH] AND "heart valves"[MeSH Terms]”
“Congenital Heart Valve Diseases"[MeSH] AND "Portugal"[MeSH]”
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
QUERIES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
REFERENCES
Search using keywords and MeSH terms
selection of abstracts containing keywords and matters of interest
analysis of articles and selection of the most
relevant ones
exclusion of items that were in languages other than English, Portuguese or Spanish
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
Final Articles
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
REFERENCES
Database: provided by the Central Authority for Health Systems, that contained all hospitalization numbers in public hospitals in Mainland Portugal for a period of nine years (2000 - 2008).
Statistical analysis was performed with IBM SPSS software 20th version.
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
Statistical Analysis:
1. Data separation acording to the different types of valvular heart diseases – the acquired (rheumatic and non-rheumatic) and the congenital ones;
2. Frequency Study (occurence of the diseases among the Portuguese population in different regions (criteria of NUTSII)
3. Study of congenital heart valve diseases.
PHASES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
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Gender (male, female) Age Groups (according to a scale adapted from MeSH: [0,2] – Infant;
[3,5] – Child Pre-school; [6,12] – Child; [13,18] – Adolescent; [19,24] – Young adult; [25,64] – Adult; [65,79] – Aged; [>80] - Elderly) [26]
Different Portugal regions (international criteria of NUTSII and NUTS III) Complexity of the hospitals (Type C: 1- Central hospitals; 2- Peripheral
hospitals; 3- Peripheral hospitals, level 1) Area of residence
The least frequent
The least studied
Congenital valvular heart diseases
VARIABLES OF THE STUDY
Discrete Variables Chi-square Test
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
RESULTS
DISCUSSION
REFERENCES
LIMITATIONS
[26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
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RESULTSAIM: To study the prevalence of hospitalizations congenital valvular heart diseases among the valvular heart diseases, in Mainland Portugal, between 2000 and 2008
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
We found that congenital valvular diseases account for only 1,2% of all valvular disease hospitalizations, what corresponds to 1803 hospitalizations. On the other hand, non-rheumatic valvular diseases account for most of valvular diseases hospitalizations (graphic 1).
Graphic 1- Frequency of hospitalizations by different valve hear diseases types
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
LIMITATIONS
Congenital1.209%
Rheumatic32.853%
Non-Rheumatic65.938%
Frequency
CongenitalRheumaticNon-Rheumatic STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
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RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
AIM: To analyze the evolution of hospitalizations of congenital heart valve diseases in Mainland Portuguese public hospitals, between 2000 and 2008.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
Graphic 2(a)- Frequencies of each congenital heart valve diseases by year since 2000 to 2008
Num
ber o
f Hos
pita
lizati
ons
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
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RESULTS
RESULTSAIM: To analyze the evolution of hospitalizations of congenital heart valve diseases in Mainland Portuguese public hospitals, between 2000 and 2008.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
Graphic 2(b)- Frequencies of hospitalzations ofeach congenital heart valve diseases by year since 2000 to 2008
Num
ber o
f Hos
pita
lizati
ons
STRONG POINTS
REFERENCES
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INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
AIM: To study which hospitalizations of congenital valve heart diseases are more frequent in Mainland Portugal, between 2000 and 2008.
RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
0
100
200
300
400
500
600
449547
258
549
Congenital Valve Heart Diseases Frequencies
Graphic 2(c)- Frequencies of each congenital heart valve diseases
-Among the analysed Hospitalizations of Congenital Valvular Heart Diseases, the hospitalizations by congenital mitral valve stenosis are the least frequent one.
Num
ber o
f Hos
pita
lizati
ons
Types of congenital valvular heart disease
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
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32%
8%
14%11%
5%
21%
8%2%
0 thru 2 yrs3 thru 56 thru 1213 thru 1819 thru 2425 thru 6465 thru 7980 or more
Graphic 3(a)- Frequencies of congenital HVD by age groups (%).
-The age group ‘0 through 2 years’ has the highest percent of hospitalizations. (p<0,001)
AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal, between 2000 and 2008, according to age [26]
RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
[26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups
STRONG POINTS
REFERENCES
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Graphic 3(b)- Frequencies of congenital HVD by age groups in hpm. (hospitalizations per million of admissions)
AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal between 2000 and 2008, according to age. [26]
RESULTS
RESULTS
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
LIMITATIONS
[26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups
STRONG POINTS
REFERENCES
Introdução à Medicina 2011/2012 | 1st grade | 9th class
Age group6600tan28a56606600tan10a56606600tan21a5660
6610tan3a56616610tan14a56616610tan25a5661
6610tan7a56616620tan19a5662
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6610tan8a5661
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0-23-5_6-12_13-1819-2425-6465-79>80
Num
ber o
f Hos
pita
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ons (
hpm
)
25
Gender6600tan20a56606600tan25a5660
6600tan1a56606600tan6a5660
6600tan11a56606600tan16a56606600tan21a56606600tan26a5660
6600tan1a56606600tan6a5660
6600tan11a56606600tan7a566
0
6600tan7a5660
MaleFemale
Graphic 4- Frequencies of each congenital VHD by gender [30]
-The frequency of hospitalizations of congenital valve heart diseases is approximately the same in men and women. (p=0,053)
AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal between 2000 and 2008, according to gender.
RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
Hpm – hospitalization per million of residents
[30]http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=6790&tipoSeleccao=0&contexto=pq&selTab=tab1&submitLoad=true
STRONG POINTS
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Introdução à Medicina 2011/2012 | 1st grade | 9th class
hpm
hpm
Num
ber o
f Hos
pita
lizati
ons (
hpm
)
26
Graphic 5- Frequencies of VHD by types of hospitals
-Central hospitals have the highest percent of hospitalizations (80%)
1440
347
16
Central HospitalsDistrictal HospitalLevel 1 Districtal Hospitals
AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal between 2000 and 2008, according to the complexity of the hospital. [27]
RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
[27]The presented division of types of hospitals was based on the division adopted by the Portuguese National Health System: http://www.dre.pt/pdf1s/2005/03/054B00/24302431.pdf
STRONG POINTS
REFERENCES
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INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
• Centre and the city of Lisbon have the highest frequency of hospitalizations congenital valve heart disease – 212,1hpm and 210,2hpm (p<0,001; therefore p<0,05)
Graphic 6- Frequency of Hospitalizations of Congenital Heart Valve Diseases by NUTSII regions of Mainland Portugal between 2000 and 2008 [30]
RESULTSAIM: To analyze the frequency of hospitalizations of congenital valvular heart disease according to NUTS II Regions of Mainland Portugal., between 2000 and 2008[28]
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
[28]The presented division of Mainland Portugal was adopted by NUTSII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf[30]http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=6790&tipoSeleccao=0&contexto=pq&selTab=tab1&submitLoad=true
Hpm – hospitalization per million of residents
STRONG POINTS
REFERENCES
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RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
AIM: To analyze the dislocation of hospitalized patients moved from their residential areas to other different NUTSII region to be treated, between 2000 and 2008[28]
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
[28]The presented division of Mainland Portugal was adopted by NUTSII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf
Graphic 7- Frequency of hospitalizations of congenital valvular heart diseases according to dislocation or not from their residence area, according to NUTSII regions of Mainland Portugal
Moved Did not move0
200
400
600
800
1000
1200
1400
1600
1800• In what concerns
to dislocation, we found that 9,5% of hospitalizaed patients moved from their residential areas to other different NUTS II region to be treated.
Num
ber o
f Pati
ents
Dislocation
STRONG POINTS
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RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease according to NUTS III Regions of Mainland Portugal, between 2000 and 2008 [29]
• We found that Grande Lisboa (47,0 hpm) and Grande Porto (21,7 hpm) have the highest numbers of Hospitalizations of congenital hearth valve diseases. (p<0,001)
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
Hpm – hospitalization per million of residents
Graphic 8- Frequency of Hospitalizations of Congenital Heart Valve Diseases by NUTSIII regions of Mainland Portugal [30]
[29]The presented division of Mainland Portugal was adopted by NUTSIII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf[30]http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=6790&tipoSeleccao=0&contexto=pq&selTab=tab1&submitLoad=true
STRONG POINTS
REFERENCES
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RESULTS INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
AIM: To analyze the dislocation of hospitalized patients moved from their residential areas to other different NUTSIII region to be treated. [29]
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
[29]The presented division of Mainland Portugal was adopted by NUTSIII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf
Graphic 9- Frequency of hospitalizations of congenital valvular heart diseases according to dislocation or not from their residence area, according to NUTSIII regions of Mainland Portugal
• In what concerns to dislocation, we found that 23,4% of hospitalized patients moved from their residential areas to other different NUTSIII region to be treated. Moved Did not move
6600tan28a5660
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Num
ber o
f Pati
ents
Dislocation
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75 4.2%
172895,8%
DiedSurvived
Graphic 10- Frequency of hospital deaths among patients with congenital heart valve diseases
-The number of deaths among the studied hospitalizations is 4,2%.
RESULTSAIM: To study hospital fatality rates in patients with congenital heart valve disease in
Mainland Portugal between 2000 and 2008
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
STRONG POINTS
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RESULTSAIM: To study the fatality rates in hospitalizations in Mainland Portugal between 2000
and 2008 by each congenital valvular heart disease.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
REFERENCES
LIMITATIONS
Graphic 11- Analysis of hospital fatality rates by each congenital valve heart disease
• We found that Mitral Insufficiency had the highest hospital fatality rate among the hospitalizations of congenital heart valve diseases. Hospitalizations of Congenital Valve Heart Diseases had, between 2000 and 2008, a fatality rate of 7,05 per million.
6600tan28a5660
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DeathsSurvive
Num
ber o
f dea
ths a
nd su
rviv
als
Types of congenital valvular heart disease
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RESULTSAIM: To study the most diagnosed congenital valve heart disease in the first year of life
among hospitalizations in Mainland Portugal between 2000 and 2008.
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
RESULTS
REFERENCES
INTRODUCTION
BACKGROUND
JUSTIFICATION
AIMS
METHODS
DISCUSSION
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Graphic 12- Frequencies of each hospitalizations of heart valve diseases in the first year of life and after first year of life
• We found that in first year of live the most diagnosed congenital heart valve disease is Mitral Insufficiency. After first year of life is aortic insufficiency.
Aortic Stenosis Aortic Insufficiency Mitral Stenosis Mitral Insufficiency6600tan28a5660
6600tan19a5660
6600tan10a5660
6600tan1a5660
6600tan21a5660
6600tan12a5660
6610tan3a5661
6610tan23a5661
6610tan14a5661
6610tan5a5661
6610tan25a5661
After First Year of LifeFirst Year of life
Types of congenital valvular heart disease
Num
ber o
f Hos
pita
lizati
ons
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1. Our statistical study showed that hospitalizations of congenital valve heart diseases are, in fact, the least frequent.
2. In the evolution of hospitalizations of congenital valvular heart diseases, there are no statistically significant differences between the values throughout the years, showing that the tendency is the stabilization of these numbers.
3. According to gender, the frequency of this kind of hospitalizations are approximately the same.
4. Younger age groups have higher percent of hospitalizations than older groups, probably because this kind of diseases are diagnosed and treated preferably in early ages.
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5. Centre and Lisbon have the highest numbers of hospitalizations of congenital valve heart disease, probably because these regions include the biggest cities of the country, where there is more population, better access to health care and younger people.
6. Relating to NUTS III division, Grande Porto and Grande Lisboa, the biggest cities of Portugal, have the biggest numbers of hospitalizations.
7. We realized that over 23% of the hospitalized patients had to move from their residence area to reach the hospital where they are treated and almost 10% had to move larger distances to a different NUTS II region. This fact is probably due to the small number of central hospitals, which made people to go to other NUTS II regions.
8. Central hospitals had much more hospitalizations than district hospitals. This is probably related not only to the higher population around central hospitals, but also to the higher number of specialists and better conditions this kind of hospitals have to offer.
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LIMITATIONS INTRODUCTION
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One person can have different crisis and as they are assisted in different hospitals they are given different numbers and so they are considered different people in our study.
The only information we have is where people live, which is not necessarily the place where the roots of the family were established, so this regional pattern doesn’t necessarily reflects genetic variations.
We cannot assume that one patient was only diagnosed with one congenital valvular heart disease based on his hospitalization between 2000 and 2008. He could have been first diagnosed earlier, but, as we only have information of this period of time, we considered him as a new case of the disease.
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Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION
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BACKGROUND
We were able to study a kind of disease that is the least common among the heart valve diseases, which is something rare and, in Portugal, unique.
We analyzed all hospitalizations in Portugal related to heart valve diseases from Mainland Portugal from 2000 to 2008, and not just a sample of them.
Our study referred several variables (age, gender, area of residence, complexity of hospital) that allowed us to study the trends of hospitalization which, hopefully, can be used to direct the resources better in order to improve the quality of the interventions.
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[1] WHO Technical Report, Series. Rheumatic fever and rheumatic heart disease. 2004
[2] Nkomo V., Gardin J., Skelton T., Gottdiener J., Scott C., Enriquez-Sarano M., Burden of valvular heart diseases: a population-based study. The Lancet. 2006, 368(9540):1005-1011.
[3] Ragavendra R., Kim A., WilliamF., David S., Eric R., Practical Cardiology, Lippincott Williams & Wilkins, 2008, 452.
[4] Alpert J., Dalen J., Valvular heart disease, Lippincott Williams and Wilkins, 1999.
[5] Quan H, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005 Nov;43(11):1130-9
[6] Elixhauser A, et al. Comorbidity measures for use with administrative data. Med Care. 1998 Jan;36(1):8-27
[7] Valle FH, Costa AR, Pereira EM, Santos EZ. Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement. Arq Bras Cardiol. 2010 Jun;94(6):720-5. Epub 2010 May 21
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REFERENCES[8] Folkmann S, Gorlitzer M. Quality-of-life in octogenarians one year after aortic valve replacement with or without coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):750-3. Epub 2010 Sep 16
[9] Dima C., 2010, Mitral Stenosis [Internet], Available from: http://emedicine.medscape.com/article/155724-overview
[10] Pei HJ, Wu YJ, Yang YJ. Current treatment status in patients with severe aortic valve stenosis and outcome of long term follow-up at advanced age: a Chinese single center study. Chin Med J (Engl). 2011 Sep;124(18):2879-82
[11] Imamura M, Prodhan P, Dossey AM, Jaquiss RD. Reoperation after supravalvular aortic stenosis repair. Ann Thorac Surg. 2010 Dec;90(6):2016-22
[12] Xiushui, R., 2011, Aortic Stenosis [Internet]. Available from: http://emedicine.medscape.com/article/150638-overview
[13] Wang S.S., 2010, Aortic regurgitation [Internet]. Available from: http://emedicine.medscape.com/article/150490-overview
[14] Olsson M, Granström L, Lindblom D. Aortic valve replacement in octogenarians with aortic stenosis: a case-control study. J Am Coll Cardiol. 1992 Dec;20(7):1512-6
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[15] Mancini M., 2011, Tricuspid regurgitation [Internet]. Available from: http://emedicine.medscape.com/article/158484-overview
[16] Ashikhmina EA, Schaff HV, Dearani JA. Aortic valve replacement in the elderly: determinants of late outcome. Circulation. 2011 Aug 30;124(9):1070-8. Epub 2011 Aug 8
[17] Valle FH, Costa AR, Pereira EM, Santos EZ. Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement. Arq Bras Cardiol. 2010 Jun;94(6):720-5. Epub 2010 May 21
[18] Iung B, Baron G, Butchart EG, Delahaye F, A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heartdisease. Eur Heart J, 2003:13:1231–1243
[19] Lopes R, Lourenço P, Gonçalves A, Cruz C, Maciel MJ., The natural history of congenital subaortic stenosis., 2011
[20] Tornos P., Valvular Disease in Woman. Revista Española de Cardiología. 2006: 59(8):831-36
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[21] Fuster, O’Rourke, Walsh, Poole-Wilson, Hurt´s 12 th Ed. 2007 – The Heart
[22] Ramakrishna CD, Khadar SA, George R. The age-specific clinical and anatomical profile of mitral stenosis. Singapore Med J. 2009 Jul;50(7):680-5.
[23] Schott, J.; Benson, D. W.; Basson, C.; Pease, W; Silberbach, G.; Moak, J.; Maron, B.; Seidman, C.; Seidman, J. Congenital Heart Disease Caused by Mutations in the Transcription Factor NKX2-5, 1998
[24] Mitchell, S.; Korones, S.; Berendes, H. W. “Congenital Heart Disease in 56,109 Births Incidence and Natural History”, 1971
[25] Arora R, Kalra GS, Singh S, Mukhopadhyay S, Kumar A , Mohan JC , Nigam M, Percutaneous transvenous mitral commissurotomy: immediate and long-term follow-up results. Catheter Cardiovasc Interv, 2002:55:450–456
[26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups
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[27] The presented division of types of hospitals was based on the division adopted by the Portuguese National Health System: http://www.dre.pt/pdf1s/2005/03/054B00/24302431.pdf
[28] The presented division of Mainland Portugal was adopted by NUTSII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdfhttp://www.dre.pt/pdf1s/2005/03/054B00/24302431.pdf
[29] The presented division of Mainland Portugal was adopted by NUTSIII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf
[30]http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=6790&tipoSeleccao=0&contexto=pq&selTab=tab1&submitLoad=true
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