Papers by Amanda Fernandes
Journal of the American College of Cardiology
Laboreal
A poda de vegetação no trabalho do eletricista de linha viva sob a ótica da e...
Pesquisa e Extensão: Abordagem Interdisciplinar
Identificar por meio da literatura científica o papel e a importância da utilização da brinquedot... more Identificar por meio da literatura científica o papel e a importância da utilização da brinquedoterapia para crianças hospitalizadas com câncer. Método: Trata-se de uma revisão integrativa realizada a partir das bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Eletrônica Científica Online (SciELO), Base de Dados
SSRN Electronic Journal, 2021
BACKGROUND Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has been associated with impr... more BACKGROUND Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has been associated with improved survival for patients with symptomatic heart failure and reduced ejection fraction (HFrEF). OBJECTIVES We performed a meta-analysis of arrhythmia endpoints from studies comparing ARNI with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with HFrEF to assess for incremental benefit. METHODS We searched PubMed, Embase, and ClinicalTrials.gov. Baseline study characteristics were collected and outcomes were sustained ventricular arrhythmias, atrial arrhythmias, appropriate implantable cardioverter-defibrillator (ICD) therapy, sudden cardiac death (SCD), and biventricular (BiV) pacing rate. RESULTS We included 9 studies, 4 randomized trials, and 5 observational studies (5589 patients on ARNI vs 5615 on ACEIs/ARBs). Follow-up ranged from 2 to 51 months. The mean age was 65.4 6 9.8 years, with 77.3% male patients and a mean ejection fraction of 29.0% 6 7.6%. Ischemic cardiomyopathy was present in 62% of patients. In the ARNI group, there were less SCD (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96; P 5 .02), ventricular arrhythmias (OR 0.45, 95% CI 0.25-0.79; P 5 .005), and appropriate ICD therapy (OR 0.39, 95% CI 0.21-0.74; P 5 .004). Higher rates of BiV pacing were seen (mean difference 3.13, 95% CI 2.58-3.68; P , .00001) when compared with ACEIs/ARBs. No difference in atrial arrhythmias was seen. CONCLUSION ARNI therapy provides incremental benefit with respect to ventricular tachyarrhythmias/SCD, which may, in part, explain improved outcomes in patients with HFrEF compared to ACEIs/ARBs. There was increased BiV pacing and decreased ICD therapy in the ARNI group.
The American Journal of Medicine, 2021
BACKGROUND Patients with atrial fibrillation and bioprosthetic valves are at high risk for thromb... more BACKGROUND Patients with atrial fibrillation and bioprosthetic valves are at high risk for thromboembolic events. The pooled efficacy and safety of NOACs, as a class, relative to warfarin in this population is not well known. We aimed to compare the efficacy and safety of NOACs relative to warfarin in patients with bioprosthetic valves or valve repair. METHODS We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials comparing NOACs to warfarin in patients with atrial fibrillation and bioprosthetic valves or valve repair. We pooled outcomes for stroke or systemic embolism; ischemic stroke; hemorrhagic stroke; and major bleeding. RESULTS We included 4 trials with 1,379 patients, of whom 723 (52.4%) received a NOAC. Mean follow-up ranged from 90 days to 2.8 years. In the pooled analysis, stroke or systemic embolism was significantly lower in patients treated with NOACs (1.9%) compared with warfarin (3.7%) (OR 0.43; 95% CI 0.22-0.85; p=0.02). Ischemic stroke (OR 0.72; 95% CI 0.18-2.93), hemorrhagic stroke (OR 0.18; 95% CI 0.03-1.05), cardiovascular death (OR 0.78; 95% CI 0.38-1.62), and all-cause mortality (OR 0.94; 95% CI 0.55-1.62) were not significantly different between groups. Major bleeding was significantly lower in patients treated with NOAC (2.8%) compared with warfarin (4.7%) (OR 0.49; 95% CI 0.28-0.88; p=0.02). CONCLUSIONS In patients with atrial fibrillation and bioprosthetic valves or valve repair, NOACs are associated with a reduced incidence of thromboembolic events and major bleeding as compared with warfarin. Thus, NOACs may be considered a preferred option for this patient population.
Heart Rhythm, 2021
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce hospitalizations and death f... more BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce hospitalizations and death from heart failure (HF), but their effect on arrhythmia expression has been poorly investigated. OBJECTIVE To evaluate the association of SGLT2i with arrhythmias in patients with type 2 diabetes mellitus (T2DM) or HF. METHODS We searched Pubmed and ClinicalTrials.gov. Two independent investigators identified randomized, double-blind trials that compared SGLT2i with placebo or active control for adults with T2DM or HF. Primary outcomes were incident atrial arrhythmias, ventricular arrhythmias (VA) and sudden cardiac death (SCD). RESULTS We included 34 randomized (25 placebo-controlled and 9 active-controlled) trials with 63,166 patients (35,883 SGLT2i vs 27,273 control - mean age 53-67 years, 63% male). Medications included canagliflozin, dapagliflozin, empagliflozin or ertugliflozin. Except for one study on HF, all patients had T2DM. Follow-up ranged from 24 weeks to 5.7 years. The cumulative incidence of events was low - 3.6, 1.4 and 2.5 per 1,000 patient-years for atrial arrhythmias, VA and SCD, respectively. SGLT2i therapy was associated with a significant reduction in risk of incident atrial arrhythmias (OR, 0.81, 95% CI 0.69-0.95; P=0.008) and the "SCD" component of the SCD outcome (OR, 0.72, 95% CI 0.54-0.97; P=0.03) compared with control. There was no significant difference in incident VA or the "cardiac arrest" SCD component between groups. CONCLUSIONS SGLT2i are associated with significantly reduced risks of incident atrial arrhythmias and SCD in patients with T2DM. Prospective trials are warranted to confirm the antiarrhythmic effect of SGLT2i and whether this is a class or drug-specific effect.
Journal of Cardiovascular Electrophysiology, 2020
Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for ... more Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for advanced atrioventricular block (AVB) and normal or mildly reduced ejection fraction (EF). We aimed to compare His bundle pacing (HBP), biventricular pacing (BiVP), and RVP for advanced AVB in patients with normal or mildly reduced EF.
The Journal of Heart and Lung Transplantation, 2020
were treated with bivalirudin. Diagnosis and treatment response were based on hemolysis markers a... more were treated with bivalirudin. Diagnosis and treatment response were based on hemolysis markers and LVAD parameters. Results: Overall patients were younger (mean age 48years, 90% males) and heavier (mean BMI 35.2 kg/m 2). 9/10 patients had Heartmate II and 1 had HeartWare device. 6 patients had LVAD implant as a bridge to transplant. All patients were on warfarin with mean INR of 2.8 §0.8 on presentation. Over the course of hospitalization, in general LDH levels showed a biphasic response peaking between day 3-7 and day 21-25 (Figure). With bivalirudin therapy (median duration 28days), 4 patients were successfully discharged from hospital, 2 died and 4 underwent LVAD exchange. Patients who underwent LVAD exchange had recurrent thrombosis requiring urgent transplant (n=2), repeat LVAD exchange (n=1) or died (n=1). Out of the 4 patients who were discharged initially, 1 required urgent transplant, 1 had LVAD exchange with HM III, 1 died and 1 had repeated thrombosis episodes treated conservatively with bivalirudin. 10/21 (47.6%) hospitalizations were treated successfully with bivalirudin. Recurrent thrombotic episodes generally happened after 3 months (mean 100.54 days). Conclusion: Although bivalirudin therapy was partially successful in treatment of LVAD thrombosis, long term outcomes of these patients without transplantation were poor.
Journal of the American College of Cardiology, 2020
Background: Dual antiplatelet therapy (DAPT) after acute coronary syndromes (ACS) is the standard... more Background: Dual antiplatelet therapy (DAPT) after acute coronary syndromes (ACS) is the standard antithrombotic treatment. Strategies including direct oral anticoagulants (DOACs) after ACS have been studies in recent RCTs with the aim of further decreasing thrombotic events. Methods: PubMed, Scopus, and Cochrane Central were searched for randomized controlled trials (RCTs) that included DOACs. The outcomes of interest were trial-defined major adverse cardiac events (MACE), and major bleeding. A network meta-analysis was performed comparing the available antithrombotic regimens in the literature. Results: Six RCTs were included, with a total of 32,261 participants. Mean follow-up was 8.5 months. Antiplatelet strategies were (1) DAPT; (2) DOAC plus DAPT; (3) Low-dose DOAC plus DAPT; and (4) Low-dose DOAC plus single-antiplatelet therapy. Average stenting rates were 62% of the trial population. Low-dose DOAC plus DAPT had the highest probability of being the best, at 61.9% (Figure 1), as well as MI (74.9%). DAPT had the highest probability of being the best in terms of major bleeding (67.6%). Conclusion: A regimen consisting of a low-dose DOAC plus single antiplatelet therapy appears promising, but larger trials are needed to further assess this strategy.
Arquivos Brasileiros de Cardiologia, 2019
Fundamento: Dados sobre a epidemiologia da insuficiência cardíaca (IC) em áreas pouco desenvolvid... more Fundamento: Dados sobre a epidemiologia da insuficiência cardíaca (IC) em áreas pouco desenvolvidas são escassos. Objetivos: Nosso objetivo foi determinar a morbidade e a mortalidade por IC na Paraíba e no Brasil, e sua tendência em dez anos. Métodos: Realizou-se uma busca retrospectiva de 2008 a 2017 utilizando-se o banco de dados do DATASUS incluindo pacientes com idade ≥ 15 anos, com diagnóstico primário de IC. Os dados da morbimortalidade por IC foram coletados e estratificados por ano, sexo e idade. Foram realizados correlação de Pearson e teste para tendências de Mantel-Haenzsel. Um nível de 5% foi definido como estatisticamente significativo. Resultados: De 2008 a 2017, as internações por IC diminuíram 62% (p = 0,004) na Paraíba, e 34% (p = 0,004) no Brasil. A taxa de mortalidade hospitalar aumentou na Paraíba e no Brasil [65,1% (p = 0,006) e 30,1% (p = 0,003), respectivamente], mas a mortalidade hospitalar em números absolutos apresentou uma diminuição significativa somente na Paraíba [37,5% (p = 0,013)], o que foi mantido após a estratificação por idade, exceto para os grupos 15-19, 60-69 e > 80 anos. Observou-se um aumento no período de internação [44% (p = 0,004) na Paraíba e 12,3% (p = 0,004) no Brasil]. De 2008 a 2015, a taxa de mortalidade por IC na população diminuiu 10,7% na Paraíba (p = 0,047) e 7,7% (p = 0,017) no Brasil. Conclusões: Apesar de a taxa de mortalidade por IC estar diminuindo na Paraíba e no Brasil, observou-se um aumento na taxa de mortalidade hospitalar e na duração da internação por IC. Devem ser realizados estudos clínicos em hospitais para serem identificadas as causas dessa tendência de aumento.
Journal of the American College of Cardiology, 2018
Background: There is limited data evaluating the use of endovascular aortic valve replacement for... more Background: There is limited data evaluating the use of endovascular aortic valve replacement for bicuspid aortic stenosis (AS). We therefore decided to conduct a real world analysis assessing the utility of TAVR for this patient population. Methods: Data from the 2012 to 2014 nationwide inpatient sample database was analyzed. Stata/IC 14.2 was used to estimate trends and outcomes of endovascular aortic valve replacement in patients with bicuspid aortic stenosis. ICD-9-CM diagnostic (746.4: bicuspid aortic valve) and procedure codes (35.05, 35.06: for aortic valve replacement) were used to identify this patient subpopulation. Results: An estimated total of 41,050 patients underwent TAVR during the specified study period. An increasing trend of TAVR for bicuspid AS was identified (p=0.004). A total of 405 TAVR for bicuspid AS were performed. When compared to tricuspid AS, this subpopulation was younger (mean age 65.6 vs. 81.2 p<0.001), consisted mainly of male patients (64.2% vs. 52.2%, p=0.026), and had less comorbidities per Charlson comorbidity index (<0.001). Regression analysis showed no difference for paravalvular leaks (OR 1.3, 95%CI 0.3-5.4), permanent pacemaker implantation (OR 0.98, 95%CI 0.5-1.9), mean length of stay (p=0.558) or in-hospital mortality (OR 1.5, 95%CI 0.6-3.6). Conclusion: The use of TAVR for the management of bicuspid AS has increased in recent years. Our study did not reveal major differences with regards to complications when comparing TAVR for bicuspid or tricuspid AS.
Journal of the American College of Cardiology, 2019
Background: Recent studies provide evidence that PCSK9 inhibitors are effective lipid-lowering, b... more Background: Recent studies provide evidence that PCSK9 inhibitors are effective lipid-lowering, but definitive evidence regarding clinical cardiovascular endpoints is still lacking. Methods: MEDLINE, Scopus, and Cochrane library were searched through August 2018 to identify randomized clinical trials of PCSK9 inhibitors that are currently available for clinical use. Two investigators extracted data and appraised risks of bias. The study endpoints were major cardiovascular events, all-cause mortality, myocardial infarction, and stroke. Results: Twenty-one PCSK9 inhibitor trials were identified, but only 11 reported the outcomes of interest, amounting to 52,171 participants. Major adverse cardiovascular events was lower with PCSK9i (10.4% vs 12.5%; RR 0.86; 95% CI 0.81-0.90; I²=0%). Myocardial infarction was also lower with PCSK9i (4.25% vs 5.57; RR 0.80; 95% CI 0.74-0.86; I²=32%), as well as stroke (1.32% vs 1.77%; RR 0.77; 95% CI 0.67-0.89; I²=0%). All-cause mortality was not significant different between PCSK9 inhibitors and placebo (2.93% vs 3.32%; RR 0.87; 95% CI, 0.67-1.13; I²=55%). Conclusion: PCSK9 monoclonal antibodies decrease major cardiovascular events, including myocardial infarction and stroke. New guidelines will likely adopt PCSK9 inhibitors as standard of care.
Heart rhythm, Jan 20, 2018
Ablation approaches have been described for the management of symptomatic ventricular arrhythmias... more Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180), endocardial-only mapping with substrate modification (n = 17), ventricular fibrillation (VF)-triggering premature ventricular complex ablation (n = 5), and mixed approaches (n = 31). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and triggering pr...
Journal of the American College of Cardiology, 2017
Background: Vagus nerve stimulation (VNS) acts by providing augmentation of parasympathetic tone ... more Background: Vagus nerve stimulation (VNS) acts by providing augmentation of parasympathetic tone with the theoretical effect of inhibiting progression of heart failure. We aimed to perform a meta-analysis comparing VNS with medical therapy for the management of heart failure with reduced ejection
International Archives of Medicine, 2016
Objective: To analyze the effect of an individualized education using a short leaflet on the prev... more Objective: To analyze the effect of an individualized education using a short leaflet on the prevention of falls in adults and elderly hospitalized. Method: Prospective study consists of three steps: application checklist on knowledge of falls, presentation of a leaflet on falls and repetition of questions about knowledge of falls after the intervention. Results: The study included 49 patients with a mean age 47.06; 34 the majority (69.4%) were women, 31 (63.3%) was married, they had an average of 9.06 studies. most prevalent medical diagnostics, and the gastro-intestinal endocrine system, both with 8 (16.3%), followed by cardiovascular 7 (14.3%). It was observed that the arrangements of responses prior to the application of the intervention were lower than the arrangements of the responses after the intervention. The same happened to the errors and the responses considered in part. Conclusion: Educational intervention on prevention of falls had a positive effect on learning of hospitalized patients.
Journal of the American College of Cardiology, 2021
CONGRESSO BRASILEIRO CIÊNCIA E SOCIEDADE, 2019
Uma frequente causa de danos em estruturas de madeira é a introdução de esforços inadequados devi... more Uma frequente causa de danos em estruturas de madeira é a introdução de esforços inadequados devidos a algumas alterações intencionais como, por exemplo, adaptações e mudanças de áreas, ou podem ser alterações acidentais como cedência de apoios. Assim, este trabalho tem por intuito realizar uma análise de um telhado de madeira de um edifício residencial localizado em Teresina-PI que apresenta patologias de origem estrutural de modo a servir como embasamento para pesquisas futuras e ser referência ao tema. Baseando-se em literaturas e com registro de imagens feitas in loco, foi realizado um levantamento de dados que puderam auxiliar-nos a entender as possíveis causas dos problemas detectados e formular sugestões que possam resolvê-los. Constatou-se que a estrutura mostrou-se instável com deslocamentos e flechas observáveis e apresentando algumas manchas que modificaram a coloração da madeira. Assim, é proposto que haja no desenvolvimento da obra ou de reabilitação um planejamento de concepção que deve ser seguido de modo a conferir durabilidade para, isto posto, vir a ter manutenção e reparo das estruturas à base de madeira, já que este material possui especificações muito próprias. Palavras-Chave: Patologia. Edifício. Telhado. Estruturas de madeira. INTRODUÇÃO Como a madeira é um material anisotrópico, ou seja, com propriedades mecânicas que dependem da disposição de suas fibras, é preciso conhecer as variabilidades naturais que este material possui que está diretamente ligado ao tipo de árvore na qual a madeira é extraída e ao seu desempenho em contato com o ambiente. Quanto a isso e sabendo que ela é de origem natural, as
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Papers by Amanda Fernandes