Epidemiologia II. 2016-1.

Exercício aula 2: Descrevendo a ocorrência das doenças

O texto abaixo, retirado das publicações Epidemiology and risk profile of heart failure.
doi:10.1038/nrcardio.2010.165 e Epidemiology of Heart Failure. doi: 10.1161/CIRCRESAHA.113.300268,
conforme indicado com f e r, respectivamente, discutem a epidemiologia da insuficiência cardíaca. Com
base nessa leitura, responda as perguntas enunciadas ao final.

Definition. Heart failure (HF) is a shared chronic phase of a multitude of cardiac diseases.f HF is
defined as “a complex clinical syndrome that can result from any structural or functional cardiac disorder
that impairs the ability of the ventricle to fill or eject blood.” The guidelines underscore that “it is largely a
clinical diagnosis that is based on a careful history and physical examination.” As HF is a syndrome and not
a disease, its diagnosis relies on a clinical examination and can be challenging.2,3 r
Burden of disease. Heart failure (HF) is a major public health issue, with a prevalence of over 5.8
million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in
five. HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many
cancers.f HF remains a rising global epidemic with an estimated prevalence of >37.7 million individuals
globally.1,2f As of 2011, within the USA alone, an estimated 5.7 million individuals live with HF and
870,000 new cases are diagnosed every year.3f Many developing nations are in the midst of an
epidemiological transition as the disease burden rapidly shifts from diseases related to nutritional
deficiencies and infections to degenerative chronic diseases observed in the older population.4f
Aetiologies. A wide range of cardiac conditions, hereditary defects, and systemic diseases can result
in HF. Patients with HF can have mixed aetiologies, which are not mutually exclusive, and HF aetiologies
vary considerably between high-income and developing countries.41,83f More than two-thirds of all cases of
HF can be attributed to four underlying conditions: ischaemic heart disease, chronic obstructive pulmonary
disease, hypertensive heart disease, and rheumatic heart disease.f
Epidemiology. An epidemic can reflect increased incidence, increased survival leading to increased
prevalence, or both factors combined. Delineating the respective responsibility of each of these factors is
essential to understand the determinants of the HF epidemic. The progress in the primary prevention of HF
would lead to decreasing incidence of the disease while improvement in medical care would result in
improved survival, in turn increasing the prevalence of HF. Both incidence and survival in turn play a major
role in the genesis of the burden of hospitalization among patients living with HF.r
Investigating the HF epidemic: conceptual
framework. The increase in cardiovascular
disease burden is primarily due to
demographic shifts, namely an
expanding and ageing global
population.6 The ever-increasing
incidence of HF in the USA since the
1970s has been described as an
epidemic.7,8f

Incidence
In general, the global incidence of HF ranges from 100 to 900 cases per 100,000 person-years
depending on the diagnostic criteria used and population studied.8f
Prevalence
An estimated 37.7 million people are living with HF globally.2f The estimates of HF prevalence in
developed countries generally range from 1–2% of the adult population.43f
A tabela abaixo retrata parte do resultado da revisão de estudos com critérios padronizados para o
diagnóstico de IC .r
Perguntas:
1) Na tabela acima, as informações são oriundas de estudos que examinaram diferentes populações,
em pelo menos 2 momentos, com intervalos de tempo variados, tanto entre os estudos, quanto
entre os indivíduos em cada estudo (é impossível examinar muitas pessoas no mesmo dia..., quiçá
no mesmo ano). Os estudos descritos têm a vantagem de ter utilizados critérios padronizados para
afastar o diagnóstico no primeiro momento e para estabelece-lo no segundo momento,
aumentando a precisão das estimativas. Como foi calculada a medida de incidência acumulada
(1º estudo citado) e de taxa de incidência (4º estudo citado)?
2) Um estudo realizado entre 2010 e 2011 com amostra aleatória de indivíduos cadastrados no
Programa Médico de Família de Niterói, de 45 a 99 anos, examinou 633 indivíduos, 393
mulheres e 240 homens. Entre as mulheres, 38 tiveram diagnóstico de IC e entre os homens, 26.
Que indicador pode ser calculado com esses dados? Calcule-o para homens e para mulheres.
3) Na continuidade do Estudo acima mencionado, programada para 2016, todos os participantes da
primeira etapa serão reexaminados. Espera-se encontrar cerca de 6 casos novos entre as mulheres
e 4 entre os homens. Diga que indicador pode ser calculado com esses dados? Calcule-o para
homens e para mulheres, utilizando as informações do enunciado da questão 5.
4) Sabe-se que o tratamento, tanto da hipertensão, quanto da insuficiência cardíaca vem se
aprimorando. Escreva sobre a incidência e prevalência da insuficiência cardíaca levando isso em
consideração.