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Congenital Valvular Heart Disease : H ospitalization trends in Portugal

Congenital Valvular Heart Disease : H ospitalization trends in Portugal. Ana Isabel Pereira Gonçalo Ferreira Gustavo Pereira Helena Sousa Isabel Fragoso Joana Nunes Leonor Silva Pedro Miragaia Pedro Pinto Rayanne Pinto. Introdução à Medicina I e II

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Congenital Valvular Heart Disease : H ospitalization trends in Portugal

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  1. Congenital Valvular HeartDisease: Hospitalizationtrends in Portugal Ana Isabel Pereira Gonçalo Ferreira Gustavo Pereira Helena Sousa Isabel Fragoso Joana Nunes Leonor Silva Pedro Miragaia Pedro Pinto Rayanne Pinto Introdução à Medicina I e II 2011/2012 | 1st grade | 9th class

  2. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION Heart: The hollow, muscular organ that maintains the circulation of the blood. AIMS AIMS METHODS METHODS RESULTS RESULTS INTRODUCTION REFERENCES DISCUSSION LIMITATIONS • 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] REFERENCES STRONG POINTS REFERENCES [1] WHO Technical Report, 2004 [2] Nkomo V., et al.. 2006. • [3] Ragavendra R. et al. 2008. • [4] Alpert J. et al. 1999.

  3. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND JUSTIFICATION JUSTIFICATION • STENOSIS • Characterizedby the narrowingof the orificeofthevalves[1,5,6] • REGURGITATION • The valvedoesn’tcloseproperlywhen the heartpumps out bloodandsoitreturns to the auricleor to the ventricle[2,7,8] AIMS AIMS METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES • [5] Quan H, et al. ,2005. • [6] Elixhauser A, et al. , 1998. [7] Valle FH., et al., 2010. [8] FolkmannS., et al., 2010. [1] WHO Technical Report, Series. 2004 [2] Nkomo V., et al.. 2006.

  4. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES [5] Quan H, et al.,2005. [6] Elixhauser A, et al. ,1998.

  5. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION BACKGROUNDMortality rates BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS • -“Most (60%) patients with severe untreated mitral stenosisdie 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 ratesfrom the onset of symptoms are approximately 25% at 1 year and 50% at 2 years. More than 50% ofdeaths 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] • -“When severe symptoms occur, 10-year survival is less than 15% in the patients with untreated mitral stenosis.”[9,10,11] METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES [14] Olsson M., et al., 1992. [15] Mancini M., 2011. [16] Ashikhmina EA., et al., 2011. [17] ValleFH., et al., 2010. [8] Folkmann S., et al., 2010. [9]Dima C., et al., 2010. [10] Pei HJ., et al., 2011. [11] Imamura M., et al., 2010. [12] Xiushui, R., 2011 [13] Wang S., et al., 2010.

  6. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS 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]. METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES [5] Quan H, et al. ,2005. [6] Elixhauser A, et al. , 1998. [18] Lung B., et al., 2003.

  7. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION ICD-9-CMInternationalClassificationofDisease[5,6] BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS 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 RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES • The presentedcodes are from ICD-9-CM (InternationalClassificationofDisease, 9th Revision, Clinical Modification) andtheirselectionhasbeenmadeaccording to thesearticles: [5] Quan H, et al., 2005 ; [6] Elixhauser A, et al. , 1998

  8. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUNDMortality rates BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION -” 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 homeoboxtranscription factor NKX2-5 werefound to cause nonsyndromic, humancongenital heartdisease.” [23,18,2] -“Within a prospectivestudyof 56,109 total births, 457 youngstershavebeenfound to havecongenital heartdisease.” [24,25] LIMITATIONS STRONG POINTS REFERENCES REFERENCES [2] Nkomo V., et al.. 2006. [18] Lung B., et al., 2003. [19]Lopes R., et al., 2011 [20] Tornos P., et al., 2006. [21] Fuster, et al., 2007. [22] Ramakrishna CD., et al., 2009. [23] Schott, J, Et al., 1998 [24] Mitchell, S. Et al., 1971 [25] AroraR., et al., 2002.

  9. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION JUSTIFICATION BACKGROUND BACKGROUND JUSTIFICATION AIMS AIMS • 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. METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES

  10. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION AIMS BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION • 1- To study the prevalence of hospitalizations of congenital valvular heart diseases among the hospitalizations of all valvularheart diseases. 2- To analyze the evolutionof 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 AIMS METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES REFERENCES

  11. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION AIMS BACKGROUND JUSTIFICATION AIMS 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. METHODS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES

  12. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION METHODS BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS The project developed is: • an epidemiological and retrospective study, concerning the frequency of heart valve hospitalizationsamong the Portuguese population between 2000 and 2008; • an observational study, since there was no direct intervention on the populations; • ananalytical study, since we statistically analyzed data from a National Health’s System database. METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES The study is related to the hospitalization numbers about the heart valve diseases of the Portuguese population between 2000 and 2008.

  13. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND SearchandSelectionof the articles: JUSTIFICATION JUSTIFICATION AIMS AIMS In order to gather information about valvular heart diseases we searched for several articles. METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES REFERENCES

  14. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND KEY WORDS JUSTIFICATION JUSTIFICATION • Heart valves; • Stenosis; • Regurgitation; • congenital heart disease; • acquired heart disease; • epidemiology; • Portuguese; • Portugal; AIMS AIMS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES MeSH TERMS REFERENCES • heart valve diseases • heart valves • epidemiology • congenital • Portugal

  15. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND QUERIES JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS • "Heart Valve Diseases"[MeSH] AND "heart valves"[MeSH Terms]” • “Congenital Heart Valve Diseases"[MeSH] AND "Portugal"[MeSH]” RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES REFERENCES

  16. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES REFERENCES exclusion of items that were in languages ​​other than English, Portuguese or Spanish • Final • Articles

  17. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND StatisticalAnalysis: JUSTIFICATION JUSTIFICATION • 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). AIMS AIMS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS Statistical analysis was performed with IBM SPSS software 20th version. STRONG POINTS REFERENCES PHASES REFERENCES Data separationacording to thedifferenttypesof valvular heartdiseases – theacquired (rheumaticand non-rheumatic) andthe congenital ones; FrequencyStudy (occurenceof the diseasesamong the Portuguese population in differentregions (criteriaof NUTSII) Studyof congenital heartvalvediseases.

  18. Introdução à Medicina 2011/2012 | 1st grade | 9th class INTRODUCTION INTRODUCTION The least frequent BACKGROUND BACKGROUND Congenital valvular heartdiseases JUSTIFICATION JUSTIFICATION The least studied AIMS AIMS VARIABLES OF THE STUDY METHODS RESULTS RESULTS • 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 REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Discrete Variables Chi-square Test [26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups

  19. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To study the prevalence of hospitalizations congenital valvular heart diseases among the valvular heart diseases, in Mainland Portugal, between 2000 and 2008 BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES Graphic 1- Frequency of hospitalizations by different valve hear diseases types 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).

  20. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To analyze the evolution of hospitalizations of congenital heart valve diseases in Mainland Portuguese public hospitals, between 2000 and 2008. BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS Number of Hospitalizations REFERENCES STRONG POINTS REFERENCES Graphic 2(a)- Frequencies of each congenital heart valvediseasesbyyearsince 2000 to 2008

  21. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION AIM: To analyze the evolution of hospitalizations of congenital heart valve diseases in Mainland Portuguese public hospitals, between 2000 and 2008. BACKGROUND JUSTIFICATION AIMS METHODS RESULTS DISCUSSION LIMITATIONS Number of Hospitalizations REFERENCES STRONG POINTS REFERENCES Graphic 2(b)- Frequencies ofhospitalzationsofeach congenital heart valvediseasesbyyearsince 2000 to 2008

  22. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To study which hospitalizations of congenital valve heart diseases are more frequent in Mainland Portugal, between 2000 and 2008. BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION Number of Hospitalizations LIMITATIONS REFERENCES STRONG POINTS REFERENCES Types of congenital valvular heartdisease 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.

  23. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal, between 2000 and 2008, according to age [26] JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES -The age group ‘0 through 2 years’ has the highest percent of hospitalizations. (p<0,001) Graphic 3(a)- Frequencies of congenital HVD by age groups (%). [26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups

  24. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION BACKGROUND AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal between 2000 and 2008, according to age. [26] JUSTIFICATION AIMS METHODS RESULTS DISCUSSION Number ofHospitalizations (hpm) LIMITATIONS STRONG POINTS REFERENCES Graphic 3(b)- Frequencies of congenital HVD by age groups in hpm. (hospitalizations per millionofadmissions) [26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups

  25. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease in Mainland Portugal between 2000 and 2008, according to gender. BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION hpm AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS Number ofHospitalizations (hpm) STRONG POINTS REFERENCES hpm REFERENCES Hpm – hospitalization per millionofresidents 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) • [30]http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=6790&tipoSeleccao=0&contexto=pq&selTab=tab1&submitLoad=true

  26. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION 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 BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Graphic 5- Frequencies of VHD by types of hospitals -Central hospitals have the highest percent of hospitalizations (80%) [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

  27. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To analyze the frequency of hospitalizations of congenital valvular heart disease according to NUTS II Regions of Mainland Portugal., between 2000 and 2008[28] BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS • 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) METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Hpm – hospitalization per millionofresidents Graphic 6- Frequency ofHospitalizationsof Congenital Heart Valve Diseases by NUTSII regions of Mainland Portugal between 2000 and 2008 [30] [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

  28. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION 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] BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS • 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. RESULTS REFERENCES DISCUSSION LIMITATIONS Number of Patients REFERENCES STRONG POINTS REFERENCES Dislocation 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 [28]The presented division of Mainland Portugal was adopted by NUTSII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf

  29. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION 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] BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS • 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) METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Hpm – hospitalization per millionofresidents Graphic 8- Frequency ofHospitalizationsof 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

  30. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION AIM: To analyze the dislocation of hospitalized patients moved from their residential areas to other different NUTSIII region to be treated. [29] BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS • 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. METHODS METHODS RESULTS Number of Patients REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Dislocation 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 [29]The presented division of Mainland Portugal was adopted by NUTSIII division: http://dre.pt/pdf1sdip/2002/11/255A00/71017103.pdf

  31. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION • AIM: To study hospital fatality rates in patients with congenital heart valve disease in Mainland Portugal between 2000 and 2008 BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Graphic 10- Frequency of hospital deaths among patients with congenital heart valve diseases -Thenumberofdeaths among the studied hospitalizations is 4,2%.

  32. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION • AIM: To study the fatality rates in hospitalizations in Mainland Portugal between 2000 and 2008 by each congenital valvular heart disease. BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS Number of deaths and survivals REFERENCES DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES Types of congenital valvular heartdisease 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.

  33. Introdução à Medicina 2011/2012 | 1st grade | 9th class • RESULTS INTRODUCTION INTRODUCTION • AIM: To study the most diagnosed congenital valve heart disease in the first year of life among hospitalizations in Mainland Portugal between 2000 and 2008. BACKGROUND BACKGROUND JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS REFERENCES DISCUSSION Number ofHospitalizations LIMITATIONS REFERENCES STRONG POINTS REFERENCES Types of congenital valvular heartdisease Graphic 12- Frequencies of each hospitalizations ofheart 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.

  34. Introdução à Medicina 2011/2012 | 1st grade | 9th class • DISCUSSION INTRODUCTION BACKGROUND JUSTIFICATION Our statistical study showed that hospitalizations of congenital valve heart diseases are, in fact, the least frequent. 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. According to gender, the frequency of this kind of hospitalizations are approximately the same. 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. AIMS METHODS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES

  35. Introdução à Medicina 2011/2012 | 1st grade | 9th class • DISCUSSION INTRODUCTION BACKGROUND 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. Relating to NUTS III division, Grande Porto and Grande Lisboa, the biggest cities of Portugal, have the biggest numbers of hospitalizations. 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. 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. JUSTIFICATION AIMS METHODS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES

  36. Introdução à Medicina 2011/2012 | 1st grade | 9th class • LIMITATIONS INTRODUCTION BACKGROUND JUSTIFICATION • 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. AIMS METHODS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES

  37. Introdução à Medicina 2011/2012 | 1st grade | 9th class • STRONG POINTS INTRODUCTION INTRODUCTION BACKGROUND JUSTIFICATION JUSTIFICATION • 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. AIMS AIMS METHODS METHODS RESULTS RESULTS REFERENCES DISCUSSION LIMITATIONS STRONG POINTS REFERENCES

  38. Introdução à Medicina 2011/2012 | 1st grade | 9th class • REFERENCES INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND • [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 JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS EXPECTED RESULTS RESULTS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES REFERENCES

  39. Introdução à Medicina 2011/2012 | 1st grade | 9th class • REFERENCES INTRODUCTION • [8] Folkmann S, Gorlitzer M. Quality-of-life in octogenarians one year after aortic valve replacement with or without coronary artery bypass surgery. Interact CardiovascThorac 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 CollCardiol. 1992 Dec;20(7):1512-6 BACKGROUND JUSTIFICATION AIMS METHODS RESULTS DISCUSSION LIMITATIONS STRONG POINTS REFERENCES

  40. Introdução à Medicina 2011/2012 | 1st grade | 9th class • REFERENCES INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND [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 historyof congenital subaortic stenosis., 2011 [20] Tornos P., Valvular Disease in Woman. RevistaEspañola de Cardiología. 2006: 59(8):831-36 JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS EXPECTED RESULTS RESULTS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES REFERENCES

  41. Introdução à Medicina 2011/2012 | 1st grade | 9th class • REFERENCES INTRODUCTION INTRODUCTION BACKGROUND BACKGROUND [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, Percutaneoustransvenous mitral commissurotomy: immediate and long-term follow-up results. Catheter CardiovascInterv, 2002:55:450–456 [26]The presented age groups division were based on a scale from MeSH: http://www.ncbi.nlm.nih.gov/mesh?term=age%20groups JUSTIFICATION JUSTIFICATION AIMS AIMS METHODS METHODS RESULTS EXPECTED RESULTS RESULTS DISCUSSION LIMITATIONS REFERENCES STRONG POINTS REFERENCES REFERENCES

  42. Introdução à Medicina 2011/2012 | 1st grade | 9th class • REFERENCES INTRODUCTION BACKGROUND JUSTIFICATION [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.pdf http://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 AIMS METHODS RESULTS DISCUSSION LIMITATIONS STRONG POINTS REFERENCES

  43. Introdução à Medicina 2011/2012 | 1st grade | 9th class THANK YOU FOR YOUR ATENTION!

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