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PD38 Telehealth Use To Fight The COVID-19 Pandemic In A Brazilian Private Healthcare System
- Geraldo Jose Coelho Ribeiro, Maria da Glória Cruvinel Horta, Ricardo Mesquita Camelo, Nelson Otávio Beltrão Campos, Douglas Ribeiro de Oliveira, Lélia Maria de Almeida Carvalho, Karina de Castro Zocrato, Daniel Pitchon dos Reis, Mariana Ribeiro Fernandes, Patrícia Liz Terenzi Cunha, Annemarie Dusanek, Fernando Martín Biscione, Silvana Kelles
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, p. S104
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Introduction
The outbreak of the COVID-19 pandemic generated the need to adapt patients’ access to health services, given the rapid and exponential increase in demand at all levels of care, making social distancing one of the few weapons available in this fight. In this scenario, telehealth proved to be a fundamental tool in tracking and guiding patients with suspected or confirmed disease. This work presents the demographic profile of the people attended, the most prevalent clinical situations in care and the clinical outcomes of the remote care.
MethodsThis was an observational, descriptive, cross-sectional, retrospective study carried out at Unimed Belo Horizonte, a medical work cooperative, from March 2020 to May 2021. We analyzed anonymized data on remote care from electronic medical records provided by the operator, with the remote contacts of these patients being spontaneous.
ResultsIn the period evaluated, 380,663 remote calls were made, with a monthly average of 36,888 calls. Of these visits, 59.5% were carried out by women and 40.5% by men. There were, 13,211 (3.5%) consultations with patients aged 0 to 9 years, 19,933 (5.2%) 10 to 19 years, 319,882 (84%) in people aged 20 to 59 years, and 27,633 (7.3%) aged 60 years or older. There were 64,348 (17%) consultations in patients with confirmed COVID-19 and 40,997 (11%) with suspected COVID-19. There were 194,746 (51.2%) consultations due to respiratory complaints and 14% of consultations due to other causes, but whose initial care was due to signs and symptoms suggestive of COVID-19. Of people assisted remotely, 29,734 (7.8%) attended the emergency room within 3 days, while 38,685 (10.2%) sought the emergency room within 14 days. There were 2,846 (0.7%) consultations in the emergency room that resulted in the hospitalization of patients.
ConclusionsTelehealth proved to be resolute and an important tool for accessing health services during the pandemic.
PD35 Mortality And Risk Factors Associated With Dialysis Patients With COVID-19 In A Brazilian Supplementary Health Service
- Karina de Castro Zocrato, Maria da Glória Cruvinel Horta, Ricardo Mesquita Camelo, Geraldo Jose Coelho Ribeiro, Nelson Otávio Beltrão Campos, Douglas Ribeiro de Oliveira, Daniel Pitchon dos Reis, Mariana Ribeiro Fernandes, Patrícia Liz Terenzi Cunha, Lélia Maria de Almeida Carvalho Annemarie Dusanek, Fernando Martín Biscione, Silvana Kelles
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, pp. S102-S103
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Introduction
Patients with chronic kidney disease (CKD) and COVID-19 are at high risk of adverse outcomes due to the presence of comorbidities. However, it is still unclear whether dialysis therapy is associated with a worse prognosis in patients infected with SARS-CoV-2. The objectives were to assess mortality and risk factors associated with a worse prognosis of these patients (e.g., age, sex, comorbidities, Intensive Care Admission [ICU] admission, and need for invasive mechanical ventilation [IMV]).
MethodsAn observational, descriptive, retrospective study was conducted in the private healthcare maintenance organization (Unimed-BH) of Belo Horizonte and 33 surrounding cities in Brazil. We used data collected from the organization’s database. We included adult inpatients with CKD on previous dialysis therapy who tested positive for COVID-19, from February 2020 to June 2021.
ResultsDuring the period, 16182 patients were admitted to Unimed-BH with a diagnosis of COVID-19. Of these, 333 (2%) had dialysis CKD. Male patients were 180 (54%), age ranged from 22.85 to 95.75 years and the mean was 60.91 years. Of the 333 patients, 109 (32.7%) were admitted to the ICU, and 56 (16.8%) required IMV. Among the 14 comorbidities analysed, the mean number of comorbidities was 6, with 93 (27.9%) dyslipidaemia, 74 (22%) diabetic, 270 (81%) hypertensive, 25 (7.5%) asthmatic, 42 (12.6%) with chronic pulmonary disease (CPD) and 122 (36.6%) with congestive heart failure (CHF). There were 66 (19.8%) deaths, 29 (43.9%) were male, the mean age was 60.8 years, and 23 patients (34.8%) were elderly (>60 years). Among the patients who died, 55 (83.3%) were in the ICU and 46 (69.7%) on IMV. The mean number of comorbidities was 9.27 being 16 (24.2%) dyslipidaemia, 44 (66.6%) diabetic, 60 (90.9%) hypertensive, 5 (7%) asthmatic, 10 (15%) with CPD and 32 (48.5%) with CHF.
ConclusionsDialysis patients appear more susceptible to unfavourable outcomes than the general population. Our findings are similar to those reported in the world literature which is still scarce. It is important to conduct more studies on this population.
PD36 Outcomes Of Centenaries Hospitalized Due To COVID-19 In A Private Healthcare System
- Ricardo Mesquita Camelo, Maria da Glória Cruvinel Horta, Geraldo Jose Coelho Ribeiro, Nelson Otávio Beltrão Campos, Douglas Ribeiro de Oliveira, Lélia Maria de Almeida Carvalho, Karina de Castro Zocrato, Daniel Pitchon dos Reis, Mariana Ribeiro Fernandes, Patrícia Liz Terenzi Cunha, Annemarie Dusanek, Fernando Martín Biscione, Silvana Kelles
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 38 / Issue S1 / December 2022
- Published online by Cambridge University Press:
- 23 December 2022, p. S103
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Introduction
Life expectancy is increasing worldwide. However, during the COVID-19 pandemic, people 100 years or more (centenaries) were challenged by a potentially fatal disease. We evaluated the outcome of centenaries hospitalized due to COVID-19 in a private healthcare system of Belo Horizonte/Brazil (Unimed-BH).
MethodsAdministrative data were collected from the hospital database. Patients were included if they had a severe adult respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) ribonucleic acid identified by quantitative real-time reverse transcriptase polymerase chain reaction (RT-qPCR) or by the International Code of Disease-10th review (ICD-10) hospitalization codes U07.1, B34.2, or B97.2.
ResultsFrom March 1 2020 to October 31 2021, 316.4 ± 12.9 centenaries/month were registered. Eighteen hospitalizations due to COVID-19 were identified. Median age was 101.8 years (inter-quartile range [IQR]:100.7,103.0). Most patients were female (83%). There was a median of 6.0 morbidities per patient (IQR:5.3,7.8), range 2-12 morbidities, among 71 possible morbidities. The most described morbidities were systemic arterial hypertension (94%), dementia (61%), and congestive heart failure (61%). Median length of hospitalization was 6.5 days (IQR:3.3,8.0). No patient was dialyzed. Seven (39%) patients died during hospitalization, of whom 3 (17%) were admitted to the Intensive Care Unit and 2 (11%) were oxygenated by invasive mechanical ventilation. No other patients were admitted to the Intensive Care Unit or invasively mechanically ventilated.
ConclusionsAlthough the hospitalization rate was low, the mortality rate during hospitalization was high among centenaries. Further research is required to evaluate the actual risks of centenaries to be infected by SARS-CoV-2 and the subsequent outcomes.
PP57 Outcomes On Transcatheter Aortic Valve Implantation
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Lélia Maria de Almeida Carvalho, Luíza Rodrigues, Sandra de Oliveira Sapori Avelar, Mariana Fernandes, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, pp. 47-48
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Introduction
Severe aortic stenosis with symptoms or left ventricular dysfunction has commonly a poor prognosis and therefore, aortic valve replacement is usually performed for patients aiming at improving their functional class and survival rate.
MethodsThis retrospective study evaluated a convenience sample of patients at high risk for open surgery for the correction of aortic valve dysfunction treated with TAVI from 2013 to 2018. Data from a private healthcare organization in Belo Horizonte, Brazil were used to assess all-cause mortality. Continuous variables were expressed as mean and standard deviation. Cox proportional regression model and Log-Rank test were used to adjust the survival curve.
ResultsFifty-two patients were included in the study (mean 83 ± 5.7 years of age, range 67 to 93 years; female 55.8 percent). Patients were characterized by: left ventricular ejection fraction (n = 30; mean 52.9 percent, range 26 to 81 percent); aortic valve area (n = 36; mean 0.68 cm2, range 0.4 to 1.2 cm2); left atrium size (n = 14; range 30 to 61 ml/m2); pulmonary artery pressure (n = 20; mean 53 mmHg, range 31 to 70 mmHg). Death occurred in 19 patients during the follow-up period (mean 8.4 months, range 0 to 60 months). Nine deaths occurred within the first 30 days of follow-up (17.3 percent) and 14 (26.9 percent) in the first year. Stroke occurred in three patients (5.8 percent) in the post-implant period. A pacemaker device was required for nine patients (17.3 percent).
ConclusionsTranscatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients at high risk for surgery. Real-world studies might result in a better understanding of the local team expertise on TAVI utilization.
PP55 The Effectiveness Of Viabahn In Peripheral Artery Aneurysms
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Lélia Maria de Almeida Carvalho, Mariana Fernandes, Luíza Rodrigues, Sandra de Oliveira Sapori Avelar, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 47
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Introduction
Open repair was considered for several years the gold standard therapy for the treatment of peripheral artery aneurysms (PAAs). However, with advancements in endovascular technology increasing attention has been directed toward repairing PAAs using an endovascular stent graft.
MethodsThis retrospective study evaluated a cohort of patients after the correction of PAAs with Viabahn. Patients treated from January 2011 to January 2018 were assessed for all-cause mortality, amputation and the need for re-intervention. Data were extracted from an administrative database from a healthcare organization in Belo Horizonte, Brazil.
ResultsFifty-two patients were included in the study (median age 69.1 years, range 15 to 90 years; male 63.5 percent), three of whom also received Viabahn for contralateral PAAs. In total, 84 devices were used (average 1.5 per PAA); distribution: popliteal and tibial arteries (n = 30; 57 percent), femoral and iliac arteries (n = 19; 37 percent), axillary artery (n = 1; 2 percent), splenic artery (n = 1; 2 percent), abdominal aorta (n = 1; 2 percent). After a mean follow up time of 1.98 ± 1.68 years, we observed death (n = 3; 5.8 percent), amputation (n = 3; 5.8 percent) and the need for re-intervention (n = 17; 32.6 percent) in 23 patients (44.2 percent). The combined overall survival for the first, second and third year of follow up was 70.2 percent (Confidence Interval [95% CI]: 58.9 - 83.6); 63 percent (95% CI: 51.0 - 78.0) and 57.3 percent (95% CI 44.6 - 73.6).
ConclusionsThere are still several unanswered questions regarding the best approach for patients with PAAs. In the absence of well-designed clinical studies, the assessment of databanks on real-world patients may contribute to improve our understanding of treatment alternatives and provide guidance to improve current clinical results.
PP54 A Cohort Case Study On Implantable Cardioverter Defibrillators
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Mariana Fernandes, Luíza Rodrigues, Lélia Maria de Almeida Carvalho, Sandra de Oliveira Sapori Avelar, Elen Cristina Pinto, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 47
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Introduction
Many patients presenting with arrhythmias are treated with antiarrhythmic drug therapy. However, for some patients, usually survivors of previous serious ventricular arrhythmias, treatment implies the use of implantable cardioverter defibrillators (ICDs) and/or Cardiac Resynchronization Therapy (CRT) devices.
MethodsThis retrospective study evaluated a cohort of patients with arrhythmia requiring the use of ICDs, CRT or ICDs + CRT from January 2004 to March 2018. Data from a private healthcare organization in Belo Horizonte, Brazil were used to assess all-cause mortality and the need for replacement of the device. Continuous variables were expressed as mean and standard deviation. Cox proportional regression model and Log-Rank test were used to adjust the survival curve.
ResultsFive hundred and ninety-three patients were included in the study (median age 67.6 years, range 23 to 89 years; male 62 percent). According to the type of device used to treat these patients, the distribution was 338 (57.0 percent), 169 (28.5 percent), 86 (14.5 percent), for ICDs, ICDs + CRT, CRT, respectively. After a mean follow-up time of 3.12 years (range 0 to 13.6 years), 283 devices were replaced (ICDs n = 140; ICDs + CRT n = 90; CRT n = 53) and 284 deaths occurred (median survival of 6.9 years). The median survival was 7.3, 5.8, 4.8, 5.5 years for ICDs single-chamber, ICDs dual-chamber, ICDs + CRT, CRT, respectively.
ConclusionsRandomized trials are often criticized for their enrollment of highly selected patients. Studies on real-word data can provide reliable information regarding the use of ICDs and/or CRT devices in the treatment of patients with serious ventricular arrhythmias.
OP129 Healthcare Utilization After Bariatric Surgery
- Silvana Marcia Bruschi Kelles, Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Mariana Ribeiro Fernandes, Luíza de Oliveira Rodrigues, Sandra de Oliveira Sapori Avelar, Lélia Maria de Almeida Carvalho, Nelson Otavio Beltrao Campos, Luciano Rios Scherrer, Fernando Martin Biscione
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 29
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Introduction
Bariatric surgery has become one of the fastest growing operative procedures due to its sustained results and the increasing prevalence of obesity worldwide. Despite this fact, bariatric surgery carries the usual risks and threats of surgical interventions and therefore its benefits might be undermined by its mid and long-term complications.
MethodsThis retrospective study included obese patients requiring bariatric surgery from January 2004 to December 2017 provided by a private healthcare organization in Belo Horizonte, Brazil. Data regarding healthcare utilization were extracted from an administrative database (software Oracle Business Intelligence). Continuous variables were expressed as mean and standard deviation. Log-Rank test was used to adjust the survival curve (software STATA 13.1, Stata Corp, USA). This historical cohort resulted in no interventions, neither during the instituted treatment nor after the observed outcome. Privacy of subjects and the confidentiality of their personal information were handled in accordance with the ethical principles of the Declaration of Helsinki.
ResultsIn total, 16,786 patients were included in the study (mean age 37.2 ± 10.2 years; female 79.2 percent; mean body mass index 42.4 ± 5.5 kg/m2). Patients were followed for up to seven years before and after surgery (total of 78,113 patients/year). For this group, the hospitalization rate was 0.099 / patients-year before versus 0.151 / patients-year after the bariatric surgery (p < 0.001). There were 224 deaths (1.33 percent) identified during the follow-up period, 0.4 percent in the first 30 postoperative days. The average costs for hospitalization were USD 3,339.36 and USD 4,305.04 for open and laparoscopic surgery, respectively.
ConclusionsBariatric surgery has been an increasingly popular choice in the management of obesity. In our sample, it did not reduce the overall mid-term healthcare utilization rate.
PP091 A Follow Up Study On Transcatheter Aortic Valve Implantation (TAVI)
- Silvana Marcia Kelles, Augusto Cesar Soares dos Santos, Junior, Daniela Azevedo, Lélia Maria de Almeida Carvalho, Luíza de Oliveira Rodrigues, Mariana Ribeiro Fernandes, Maria da Glória Cruvinel Horta, Sandra de Oliveira Sapori Avelar
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 113-114
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INTRODUCTION:
Severe aortic stenosis with symptoms or left ventricular dysfunction has commonly a poor prognosis. Aortic valve replacement is usually performed for these patients aiming at improving their functional class and survival rate. Transcatheter aortic valve implantation (TAVI) is often presented as an option in patients with high surgical risk for conventional surgical valve replacement.(1) Nonetheless, in this group of patients, the literature has yielded conflicting evidence suggesting that benefits of TAVI for patients of high or intermediate surgical risk is not consistent.(2,3)
METHODOLOGY:This retrospective study aimed to evaluate the mortality rate from a cohort of patients after the correction of aortic valve dysfunction with TAVI. It consisted of a convenience sample of patients at high risk for open surgery for the correction of aortic valve dysfunction treated with TAVI from 2013 to 2016. All included patients were being provided healthcare assistance by a private nonprofit health maintenance organization (HMO) operating in Belo Horizonte, Brazil. Since TAVI is not currently covered by the Brazilian supplementary healthcare system, reimbursements were enforced by lawsuits. Data was extracted from an administrative database, using the software Oracle Business Intelligence®. Continuous variables were expressed as mean and standard deviation. The Kaplan-Meier method was used to adjust the 1-year survival curve using the software STATA 13.1 (Stata Corp, College Station, TX, USA). This historical cohort resulted in no interventions, neither during the course of the instituted treatment nor after the observed outcome. Privacy of subjects and the confidentiality of their personal information were handled in accordance to the ethical principles of the Declaration of Helsinki.
RESULTS:Overall, seventeen patients with a mean age of 80.5 years (68-91) underwent TAVI; 59 percent were women. Peri-operative mortality rate was 23.5 percent (n = 4) and accumulated overall one-year mortality was 35.3 percent (n = 6). Mean length of hospital stay was 26.9 ± 16.6 days. Prolonged hospital stay (≥ 7 days) occurred in 14/17 cases (82.3 percent), with a maximum of 51 days.
CONCLUSIONS:In similarity to our findings, other authors described a high early and late mortality rate in patients undergoing TAVI. The strategy to use TAVI as an alternative in patients at high risk for open surgery is still under debate and should be carefully discussed taking into consideration the local team expertise as well as local healthcare available recourses.