“Estudo EMMA: estudo coorte brasileiro baseado na comunidade sobre mortalidade e morbidade por acidente vascular cerebral”
Palavras-chave:
Acidente vascular cerebral, Vigilância em saúde pública, Estudos coortes, Fatores de risco, MortalidadeResumo
CONTEXTO E OBJETIVO: O acidente vascular cerebral (AVC) tem alta carga de incapacidade e mortalidade. Objetivou-se avaliar a epidemiologia, fatores de risco e prognóstico do AVC no Estudo EMMA (Estudo da Mortalidade e Morbidade do AVC). TIPO DE ESTUDO E LOCAL: Estudo longitudinal prospectivo de base comunitária conduzido em hospital universitário. MÉTODOS: Dados sobre AVC baseados em eventos fatais e não fatais foram avaliados, incluindo dados sociodemográficos, mortalidade e preditores, por meio de regressão logística e análises de sobrevida. RESULTADOS: O subtipo de AVC foi melhor definido no ambiente hospitalar do que na comunidade local. Na fase hospitalar, cerca de 70% eram eventos primários e do subtipo isquêmico. Entre os fatores de risco cerebrovascular, a frequência de ingestão de álcool foi mais alta no AVC hemorrágico comparado com o isquêmico (35,4% versus 12,3%, P < 0,001). O risco de morte depois de AVC hemorrágico foi maior que o do AVC isquêmico e este gradiente foi máximo aos 10 dias após o evento (razão das chances, 3,31; intervalo de confiança (IC) de 95%: 1,55-7,05). Análise de sobrevivência em 4 anos com 665 casos de AVC primário (82,6% AVC isquêmico e 17,4% AVC hemorrágico) demonstrou taxa de sobrevida global de 48%. Aos 4 anos, maiores riscos de morte foram para casos de AVC isquêmico e pacientes analfabetos (hazard ratio, HR: 1,83; 95% IC: 1,26-2,68) ou com diabetes (HR:1,45; IC 95%: 1,07-1,97). Casos com depressão maior apresentaram pior sobrevida de 1 ano (HR: 4,60; IC 95%: 1,36-15,55). CONCLUSÃO: Em longo prazo, dados do EMMA fornecerão informações adicionais para planejamento de recursos destinados ao sistema de saúde público.
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Referências
Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015;45(3):161-76.
Barker-Collo S, Bennett DA, Krishnamurthi RV, et al. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013. Neuroepidemiology. 2015;45(3):203-14.
Ribeiro AL, Duncan BB, Brant LC, et al. Cardiovascular Health in Brazil: Trends and perspectives. Circulation. 2016;133(4):422-33.
Lotufo PA. Stroke is still a neglected disease in Brazil. Sao Paulo Med J. 2015;133(6):457-9.
Lotufo PA, Goulart AC, Fernandes TG, Benseñor IM. A reappraisal of stroke mortality trends in Brazil (1979-2009). Int J Stroke. 2013;8(3):155-63.
Lotufo PA, Benseñor IM. Stroke mortality in Brazil: one example of delayed epidemiological cardiovascular transition. Int J Stroke. 2009;4(1):40-1.
Lotufo PA, Benseñor IJ. Raça e mortalidade cerebrovascular no Brasil [Race and stroke mortality in Brazil]. Rev Saúde Pública. 2013;47(6):1201-4.
Lotufo PA, Fernandes TG, Bando DH, Alencar AP, Benseñor IM. Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010. Int J Cardiol. 2013;167(6):2820-3.
Benseñor IM, Goulart AC, Szwarcwald CL, et al. Prevalência de acidente vascular cerebral e de incapacidade associada no Brasil: Pesquisa Nacional de Saúde - 2013 [Prevalence of stroke and associated disability in Brazil: National Health Survey – 2013]. Arq Neuropsiquiatr. 2015;73(9):746-50.
Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818-27.
Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009;40(6):2068-72.
Anderson CS, Jamrozik KD, Broadhurst RJ, Stewart-Wynne EG. Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study. Stroke. 1994;25(10):1935-44.
Pham TM, Fujino Y, Tokui N, et al. Mortality and risk factors for stroke and its subtypes in a cohort study in Japan. Prev Med. 2007;44(6):526-30.
Minelli C, Fen LF, Minelli DP. Stroke incidence, prognosis, 30-day, and 1-year case fatality rates in Matão, Brazil: a population-based prospective study. Stroke. 2007;38(11):2906-11.
Lavados PM, Sacks C, Prina L, et al. Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic- Mestizo population in Iquique, Chile (PISCIS project): a community- based incidence study. Lancet Neurol. 2007;6(2):140-8.
Cabral NL, Longo A, Moro C, et al. Education level explains differences in stroke incidence among city districts in Joinville, Brazil: a three-year population-based study. Neuroepidemiology. 2011;36(4):258-64.
Goulart AC, Fernandes TG, Santos IS, et al. Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort. BMC Neurol. 2013;13:51.
Cabral NL, Muller M, Franco SC, et al. Three-year survival and recurrence after first-ever stroke: the Joinville stroke registry. BMC Neurol. 2015;15:70.
Goulart AC, Bustos IR, Abe IM, et al. A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study. Int J Stroke. 2010;5(4):284-9.
Goulart AC, Fernandes TG, Alencar AP, et al. Low education as a predictor of poor one-year stroke survival in the EMMA Study (Study of Stroke Mortality and Morbidity in Adults), Brazil. Int J Stroke. 2012;7(7):E4.
Fernandes TG, Goulart AC, Santos-Junior WR, et al. Nível de escolaridade e dependência funcional em sobreviventes de acidente vascular cerebral isquêmico [Educational levels and the functional dependence of ischemic stroke survivors]. Cad Saúde Pública. 2012;28(8):1581-90.
World Health Organization. WHO STEPS Stroke Manual: the WHO STEPwise approach to stroke surveillance/Noncommunicable Diseases and Mental Health, World Health Organization. Geneva: World Health Organization; 2005. Available from: http://www. who.int/chp/steps/stroke/manual/en/index.html. Accessed in 2016 (Oct 11).
Abe IM, Lotufo PA, Goulart AC, Benseñor IM. Stroke prevalence in a poor neighbourhood of São Paulo, Brazil: applying a stroke symptom questionnaire. Int J Stroke. 2011;6(1):33-9.
Abe IM, Goulart AC, Santos Júnior WR, Lotufo PA, Benseñor IM. Validation of a stroke symptom questionnaire for epidemiological surveys. Sao Paulo Med J. 2010;128(4):225-31.
Goulart AC, Bensenor IM, Fernandes TG, et al. Early and one-year stroke case fatality in Sao Paulo, Brazil: applying the World Health Organization’s stroke STEPS. J Stroke Cerebrovasc Dis. 2012;21(8):832-8.
Fernandes TG, Goulart AC, Campos TF, et al. Taxas de letalidade precoce por acidente vascular cerebral em três registros hospitalares no nordeste e sudeste do Brasil [Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil]. Arq Neuropsiquiatr. 2012;70(11):869-73.
Barros JB, Goulart AC, Alencar AP, Lotufo PA, Bensenor IM. The influence of the day of the week of hospital admission on the prognosis of stroke patients. Cad Saude Publica. 2013;29(4):769-77.
Baccaro A, Segre A, Wang YP, et al. Validation of the Brazilian-Portuguese version of the Modified Telephone Interview for cognitive status among stroke patients. Geriatr Gerontol Int. 2015;15(9):1118-26.
de Mello RF, Santos Ide S, Alencar AP, et al. Major Depression as a Predictor of Poor Long-Term Survival in a Brazilian Stroke Cohort (Study of Stroke Mortality and Morbidity in Adults) EMMA study. J Stroke Cerebrovasc Dis. 2016;25(3):618-25.
Valiengo L, Casati R, Bolognini N, et al. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series. Neurocase. 2016;22(2):225-8.
Fernandes TG, Benseñor IM, Goulart AC, et al. Stroke in the rain forest: prevalence in a ribeirinha community and an urban population in the Brazilian Amazon. Neuroepidemiology. 2014;42(4):235-42.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.
Cabral NL, Goncalves AR, Longo AL, et al. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. J Neurol Neurosurg Psychiatry. 2009;80(7):755-61.
Damasceno A, Gomes J, Azevedo A, et al. An epidemiological study of stroke hospitalizations in Maputo, Mozambique: a high burden of disease in a resource-poor country. Stroke. 2010;41(11):2463-9.
Lavados PM, Sacks C, Prina L, et al. Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS Project). Lancet. 2005;365(9478):2206-15.
Truelsen T, Heuschmann PU, Bonita R, et al. Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol. 2007;6(2):134-9.
Dalal PM, Bhattacharjee M, Vairale J, Bhat P. Mumbai stroke registry (2005-2006)--surveillance using WHO steps stroke instrument--challenges and opportunities. J Assoc Physicians India. 2008;56:675-80.
Sridharan SE, Unnikrishnan JP, Sukumaran S, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke. 2009;40(4):1212-8.
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