congenital valvular heart disease : h ospitalization trends in portugal

1

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

2

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

3

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]


[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

REFERENCES

http://en.wikipedia.org/wiki/File:Mitral_stenosis,_gross_pathology_20G0015_lores.jpg

4

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.

STRONG POINTS

REFERENCES


BACKGROUND Mortality rates

5[8] Folkmann S., et al., 2010.[9]Dima C., et al., 2010.[10] Pei HJ., et al., 2011.


-“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.

STRONG POINTS

REFERENCES

6

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.

STRONG POINTS

REFERENCES


7


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

JUSTIFICATION

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METHODS

RESULTS

REFERENCES

INTRODUCTION

JUSTIFICATION

AIMS

METHODS

RESULTS

DISCUSSION

REFERENCES

LIMITATIONS

STRONG POINTS

REFERENCES

8


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

BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

REFERENCES

INTRODUCTION

JUSTIFICATION

AIMS

METHODS

RESULTS

DISCUSSION

REFERENCES

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.

STRONG POINTS

REFERENCES

JUSTIFICATION

9

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


AIMS

10

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

STRONG POINTS

REFERENCES

11

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


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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.


BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

Search and Selection of the articles:

REFERENCES

INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

RESULTS

DISCUSSION

REFERENCES

LIMITATIONS

STRONG POINTS

REFERENCES

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KEY WORDSHeart valves;Stenosis;Regurgitation; congenital heart disease;

heart valve diseasesheart valves epidemiology congenitalPortugal

acquired heart disease; epidemiology;Portuguese;Portugal;


MeSH TERMS

INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

REFERENCES

INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

RESULTS

DISCUSSION

REFERENCES

LIMITATIONS

STRONG POINTS

REFERENCES

"Heart Valve Diseases"[MeSH] AND "heart valves"[MeSH Terms]”

“Congenital Heart Valve Diseases"[MeSH] AND "Portugal"[MeSH]”

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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

16


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.

17


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

REFERENCES

18

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


19

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


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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


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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


22

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.


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


23

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]


BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

REFERENCES

INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

METHODS

DISCUSSION

REFERENCES

LIMITATIONS


STRONG POINTS

REFERENCES


24

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


STRONG POINTS

REFERENCES


Age group6600tan28a56606600tan10a56606600tan21a5660

6610tan3a56616610tan14a56616610tan25a5661

6610tan7a56616620tan19a5662

6620tan1a56626620tan13a56626620tan24a5662

6610tan8a5661

6620tan22a5662

6620tan13a5662

6620tan13a5662

6600tan2a5660

6600tan10a5660

6600tan19a5660

6600tan4a5660

0-23-5_6-12_13-1819-2425-6465-79>80

Num

ber o

f Hos

pita

lizati

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.


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

REFERENCES


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]


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


27

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


STRONG POINTS

REFERENCES


28


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

REFERENCES


29


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


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


30


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

6600tan21a5660

6610tan14a5661

6610tan7a5661

6620tan1a5662

6620tan24a5662

6630tan17a5663

6640tan10a5664

6640tan4a5664

Num

ber o

f Pati

ents

Dislocation

STRONG POINTS

REFERENCES


31

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

REFERENCES


32

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

6600tan10a5660

6600tan21a5660

6610tan3a5661

6610tan14a5661

6610tan25a5661

6610tan7a5661

DeathsSurvive

Num

ber o

f dea

ths a

nd su

rviv

als


STRONG POINTS

REFERENCES


33

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

REFERENCES

LIMITATIONS

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


Num

ber o

f Hos

pita

lizati

ons

STRONG POINTS

REFERENCES


34

DISCUSSION INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

LIMITATIONS

REFERENCES

DISCUSSION

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.

STRONG POINTS

REFERENCES


35

DISCUSSION INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

LIMITATIONS

REFERENCES

DISCUSSION

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.

STRONG POINTS

REFERENCES


36

LIMITATIONS INTRODUCTION

BACKGROUND

JUSTIFICATION

AIMS

METHODS

RESULTS

DISCUSSION

REFERENCES

LIMITATIONS

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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JUSTIFICATION

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METHODS

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INTRODUCTION

JUSTIFICATION

AIMS

METHODS

RESULTS

DISCUSSION

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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.

REFERENCES

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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

INTRODUCTION

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INTRODUCTION

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REFERENCESIntrodução à Medicina

2011/2012 | 1st grade | 9th class

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INTRODUCTION

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RESULTS

DISCUSSION

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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

INTRODUCTION

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INTRODUCTION

BACKGROUND

JUSTIFICATION

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METHODS

EXPECTED RESULTS

RESULTS

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INTRODUCTION

BACKGROUND

JUSTIFICATION

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METHODS

RESULTS

DISCUSSION

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LIMITATIONS

[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


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REFERENCES

[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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congenital valvular heart disease : h ospitalization trends in portugal

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