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COVID-19-related in-hospital mortality has been reported at 30.7–47.3% in Brazil, however studies assessing exclusively private hospitals are lacking. This is important because of significant differences existing between the Brazilian private and public healthcare systems. We aimed to determine the COVID-19-related in-hospital mortality and associated risk factors in a Brazilian private network from March/2020 to March/2021. Data were extracted from institutional database and analyzed using Cox regression model. Length of hospitalization and death-related factors were modeled based on available independent variables. In total, 38,937 COVID-19 patients were hospitalized of whom 3058 (7.8%) died. Admission to the intensive care unit occurred in 62.5% of cases, and 11.5% and 3.8% required mechanical ventilation (MV) and renal replacement therapy (RRT), respectively. In the adjusted model, age ≥ 61 years-old, comorbidities, and the need for MV and/or RRT were significantly associated with increased mortality (p

The article aims to describe the characteristics of financialization in a set of ten companies and economic groups operating health plans and insurance in Brazil from 2008 to 2016, selected according to their turnover and the size of their client portfolio. The financial/accounting and net worth dimensions were analyzed according to the balance sheets and cash flows, compared to microeconomic indicators of financialization and the records of changes in the shareholding structure filed with commercial boards. The authors analyzed the companies' policy positions based on primary data from semi-structured interviews with qualified representatives and the analysis of shareholder reports and news from the specialized media. In short, financial dominance is expressed in the health plans studied here, but their characterization does not follow a universally reproducible and homogeneous pattern, and empirical research should play a key role in further investigating the phenomenon. Since health and healthcare are defined constitutionally as publicly relevant goods that require support by stable and equitable policies in the distribution of available resources, and given the oligopolistic and concentrating trend in the inherent resources in the process of financialization (in opposition to this guideline) and the strategic place occupied by these companies, the prospects for the system as a whole tend to evolve towards an increase in total health expenditures, with greater concentration of healthcare resources and circulation of resources in the financial accumulation sphere.O objetivo deste artigo é descrever a expressão da financeirização em um conjunto de dez empresas e grupos econômicos atuantes no comércio de planos e seguros de saúde no Brasil entre 2008 e 2016, selecionadas pelo faturamento e pelo tamanho da carteira de clientes. As dimensões contábil/financeira e patrimonial foram analisadas a partir dos balanços patrimoniais e fluxos de caixa cotejados com indicadores microeconômicos de financeirização e dos registros de alteração na composição societária depositados em juntas comerciais. Para analisar o posicionamento político das empresas recorreu-se a dados primários de entrevistas semiestruturadas com representantes qualificados bem como à análise de relatórios aos acionistas e notícias de mídia especializada. Em síntese, a dominância financeira encontra expressão nas empresas de planos de saúde estudadas, mas a sua caracterização não obedece a um padrão homogêneo universalmente reproduzível, devendo a pesquisa empírica ocupar um lugar de destaque na investigação do fenômeno. Sendo a saúde e o seu componente assistencial definidos constitucionalmente como bens de relevância pública que solicitam o amparo de políticas estáveis e equitativas na distribuição dos recursos disponíveis e a tendência oligopolista e concentradora de recursos inerentes ao processo de financeirização contraditória com essa diretriz, e dado o lócus estratégico ocupado por essas empresas, as perspectivas projetadas para o conjunto do sistema tendem a evoluir para aumento dos gastos totais em saúde com maior concentração de recursos assistenciais e puncionamento dos recursos em circulação pela esfera da acumulação financeira.El objetivo de este artículo es describir la expresión de la financiarización en un conjunto de diez empresas y grupos económicos agentes en la comercialización de planes y seguros de salud en Brasil entre 2008 y 2016, seleccionados por su facturación y tamaño de su cartera de clientes. Las dimensiones contable/financiera y patrimonial se analizaron a partir de los balances patrimoniales y flujos de caja cotejados con indicadores microeconómicos de financiarización, así como de los registros de modificación en la composición societaria depositados en juntas comerciales. Para analizar el posicionamiento político de las empresas se recurrió a datos primarios de entrevistas semiestructuradas con representantes cualificados, así como al análisis de informes a los Accionistas y noticias de medios especializados. En resumen, el dominio financiero encuentra expresión en las empresas de planes de salud estudiadas, pero su caracterización no obedece a un patrón homogéneo universalmente reproducible, debiendo ocupar la investigación empírica un lugar de relevancia en la investigación del fenómeno. Siendo la salud y su componente asistencial definidos constitucionalmente como bienes de relevancia pública que solicitan el amparo de políticas estables y equitativas en la distribución de los recursos disponibles, y la tendencia oligopolista y concentradora de recursos inherentes al proceso de financiarización contradictoria con esa directriz, y dado el locus estratégico ocupado por esas empresas, las perspectivas proyectadas para el conjunto del sistema tienden a evolucionar hacia el aumento de los gastos totales en salud con mayor concentración de recursos asistenciales y acaparamiento de los recursos en circulación por parte de la esfera de acumulación financiera.

The concentration and internationalization of health plan companies in Brazil gave them a clearly financial face. Based on the need to understand the health care industry's capital accumulation patterns, the current study examines health plan companies' expansion strategies through the classification of their supply and demand characteristics by recent historical periods and an analysis of recent shareholding trends in one of the leading corporations in the Brazilian health care industry. The 1960s to 2000s witnessed changes in the scale of demands for health plans and adherence by companies to long-term accumulation strategies. Beginning in the early 21st century, changes in the shareholding structures of the largest Brazilian company, consistent with the financialization of its accumulation regime, resulted in the rapid multiplication of its capital. Deepening segmentation of the health care system in a context marked by the downturn in the national economy challenges the preservation of public subsidies for private health plans. Resumen: La concentración e internacionalización de empresas de planes de salud en Brasil les han conferido un carácter financiero. Considerando la necesidad de comprender los padrones de acumulación de ese sector, el trabajo examina estrategias de expansión de las empresas de planes de salud, mediante la periodización de atributos de oferta y demanda y el examen de la trayectoria patrimonial reciente de uno de los grandes grupos del sector. Entre los años 1960 y 2000, se produjeron alteraciones en la escala de las demandas por parte de planes de salud y una adhesión de las empresas a estrategias de acumulación a largo plazo. A partir del siglo XXI, las alteraciones en las estructuras societarias de la mayor empresa brasileña, compatibles con el régimen de acumulación de carácter financiero, resultaron en la multiplicación de su capital en un corto intervalo de tiempo. La profundización de la segmentación del sistema de salud, en un contexto marcado por la desaceleración de la economía, cuestiona la preservación de los subsidios públicos para los planes privados. Resumo: A concentração e internacionalização de empresas de planos de saúde no Brasil conferiram-lhes feição financeira. Considerando a necessidade de compreender os padrões de acumulação desse setor, o trabalho examina estratégias de expansão das empresas de planos de saúde por meio da periodização de atributos da oferta e demanda e exame da trajetória patrimonial recente de um dos grandes grupos do setor. Entre os anos 1960 e 2000, ocorreram alterações na escala das demandas por planos de saúde e adesão das empresas a estratégias de acumulação de longo prazo. A partir do século XXI, as alterações nas estruturas societárias da maior empresa brasileira, compatíveis com o regime de acumulação financeirizada, resultaram na multiplicação de seu capital em um curto intervalo de tempo. O aprofundamento da segmentação do sistema de saúde, em um contexto marcado pela desaceleração da economia, questiona a preservação dos subsídios públicos para os planos privados.

OBJETIVO: Descrever custo direto e indireto do tratamento ambulatorial e hospitalar da insuficiência cardíaca, durante 2002, no Hospital Universitário Antônio Pedro, Niterói. MÉTODOS: Estudo transversal, retrospectivo sobre utilização e valoração de recursos em 70 pacientes, selecionados de forma consecutiva, em tratamento ambulatorial e hospitalar. Foram utilizados questionários e prontuários dos pacientes para coleta dos dados. Os recursos utilizados foram valorados em reais (ano 2002). O ponto de vista do estudo foi a perspectiva da sociedade. Os dados foram analisados no programa EPINFO, versão 2002. RESULTADOS: A população estudada constou de 70 pacientes (39 mulheres), idade média de 60,3 anos. Ocorreram 465 diárias hospitalares (28,5% dos pacientes). Houve 386 internações em enfermaria e 79 em unidade de tratamento intensivo. O custo com consulta ambulatorial foi de R$ 14,40. O gasto com medicamentos ambulatoriais totalizou R$ 83.430,00 (custo por paciente/ano de R$ 1.191,86). O custo por paciente internado foi de R$ 4.033,62. O custo com exames complementares totalizou R$ 39.009,50 (custo por paciente/ ano de R$ 557,28). Foram aposentados pela insuficiência cardíaca 20 pacientes, representando perda de produtividade de R$ 182.000,00. O custo total foi de R$ 444.445,20. Hospitalização representou 39,7% e a utilização de medicamentos 38,3% do custo direto. CONCLUSÃO: O custo com hospitalização e os gastos com medicamentos representaram os principais componentes do custo direto. Os custos indiretos representaram impactos econômicos semelhantes aos custos diretos. OBJECTIVE: To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antônio Pedro, Niterói. METHODS: A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were valuated in Brazilian Reais (2002). The study's point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version. RESULTS: The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R$ 14.40. The expenses with ambulatory medications amounted R$ 83,430.00 (R$ 1,191.86/patient/year). The cost per hospitalized patient was R$ 4,033.62. The cost with complementary examinations totaled R$ 39,009.50 (R$ 557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R$ 182,000.00. The total cost was R$ 444,445.20. Hospitalization represented 39.7% and the use of medications 38.3% from direct costs. CONCLUSION: The hospitalization cost and the expenses with medications represented the main components of direct costs. Indirect costs represented economic impacts similar to direct costs. Escola Paulista de Medicina Universidade Federal Fluminense UNIFESP, EPM SciELO

OBJETIVO: Comparar entre os hospitais públicos e privados de Niterói o perfil epidemiológico, sócio-econômico, aspectos clínicos, etiologia, tempo de internação e a mortalidade dos pacientes internados por insuficiência cardíaca descompensada. MÉTODOS: Estudo transversal prospectivo e multicêntrico (julho a setembro/ 2001), incluindo todos os pacientes internados com diagnóstico primário de insuficiência cardíaca, maiores de 18 anos, e com pontuação 8 ou superior pelos critérios de Boston. RESULTADOS: Incluídos 203 pacientes: 98 públicos, 50% eram homens, média de idade de 61,1± 11,3 anos, 65% negros, 57% recebiam até 1 salário mínimo, 56% eram analfabetos, 66% tinham cardiopatia isquêmica; tempo médio de internação de 12,6 dias e a taxa de mortalidade ajustada para a idade de 5,23; 105 privados, 49% eram homens, média de idade de 72 ± 12,7 anos, 20% negros, 58% recebiam mais de 6 salários mínimos, 11% eram analfabetos, 62% eram isquêmicos; o tempo médio de internação hospitalar de 8 dias e a taxa de mortalidade ajustada para idade de 2,94. A distribuição das co-morbidades e fatores de risco similar entre os pacientes, à exceção do tabagismo, mais freqüente no serviço público. CONCLUSÃO: Além de assimetrias sócio-econômicas, o tempo de internação hospitalar e a taxa mortalidade ajustada para idade foram maiores no serviço público de saúde. OBJECTIVE: To compare the epidemiological and socioeconomic profiles, clinical features, etiology, length of hospitalization, and mortality of patients with decompensated heart failure admitted to public and private hospitals in the city of Niterói. METHODS: We carried out a prospective, multicenter study (from July to September 2001) comprising all patients older than 18 years with the primary diagnosis of heart failure and admitted to hospitals in the city of Niterói, whose scores according to the Boston criteria were 8 or above. Proportions were compared using the chi-square and Fisher exact tests. RESULTS: The sample comprised 203 patients as follows: 1) 98 patients from public hospitals: 50% were men, their mean age was 61.1±11.3 years, 65% were black, 57% had an income of 1 minimum wage or less, 56% were illiterate, 66% had ischemic heart disease, their mean length of hospitalization was 12.6 days, and the mortality rate adjusted for age was 5.23; 2) 105 patients from private hospitals: 49% were men, their mean age was 72±12.7 years, 20% were black, 58% had an income greater than 6 minimum wages, 11% were illiterate, 62% had ischemic heart disease, their mean length of hospitalization was 8 days, and the mortality rate adjusted for age was 2.94. The distribution of comorbidities and risk factors was similar among the patients of the 2 hospital systems, except for the smoking habit, which was more frequent among patients from public hospitals. CONCLUSION: In addition to the socioeconomic asymmetries, the hospitalization length and the mortality rate adjusted for age were greater in patients in the public health system.

OBJECTIVE: To compare blood pressure response to dynamic exercise in hypertensive patients taking trandolapril or captopril. METHODS: We carried out a prospective, randomized, blinded study with 40 patients with primary hypertension and no other associated disease. The patients were divided into 2 groups (n=20), paired by age, sex, race, and body mass index, and underwent 2 symptom-limited exercise tests on a treadmill before and after 30 days of treatment with captopril (75 to 150 mg/day) or trandolapril (2 to 4 mg/day). RESULTS: The groups were similar prior to treatment (p

In developed countries, heart failure with preserved ejection fraction (HFpEF) is more prevalent than heart failure with reduced ejection fraction (HFrEF) in the community. However, it has not been completely established if this fact is also observed within our community.To determine the most prevalent form of heart failure (HFpEF or HFrEF) and whether the prevalence of HFpEF is higher in the community.This is a cross-sectional study conducted with patients clinically diagnosed with HF who were seen in community-based health care centers from January to December 2005. Echodopplercardiograms were performed for all patients. The form of HF was stratified according to the presence of abnormalities and the shortening fraction observed on the echodopplercardiogram.The study evaluated 170 patients (61.0 +/- 13.3 years of age), most of them women and elderly. HFpEF was the more prevalent form of HF (64.2%, p0.001), affecting mostly elderly women (62%, p = 0.07), whereas the opposite condition, HFrEF, was observed mostly in elderly men (63.6%, p = 0.07). Patients with no HF represented one-third of the cases (27.6%). HFrEF patients had more lower-limb edema, coronary disease, diabetes, chronic renal failure, higher Boston scores and hospital readmissions. Use of alcoholic beverages and smoking were also more common among HFrEF patients.HFpEF is the most prevalent form of HF in the community especially among elderly women, whereas HFrEF affects mostly elderly men and is associated with greater clinical severity, main risk factors and no changes in lifestyle. Despite the signs and symptoms of HF, this condition was not confirmed for one-third of the cases.

Metabolic syndrome (MS) is characterized by a collection of risk factors that are associated with elevated rates of cardiovascular events and the risk of developing heart failure (HF). In our field, the association of MS in stable chronic HF patients has not been established.To determine the prevalence of MS in relation to gender and HF type in patients treated at a Primary Care Facility.Between January 2005 and August 2006, 144 patients were included in a cross sectional study. An echocardiogram, using the modified criteria of the EPICA study, was performed to determine whether or not the patient had HF, and of which type. Statistical analysis was conducted using the software SAS System, version 6.04, and statistical significance was established as 5%.MS was observed in 111 patients (77%), of which 73 (66%) were females: odds ratio (OR) 0.195--(confidence interval--CI = 0.08 - 0.46) and p0.0001. HF was identified in 102 patients (71%) with a great correlation between females and the presence of MS: 51 patients (65%); OR 0.116 (CI = 0.36- 0.37) and p0.0001. Among the HF patients, 61 (42%) presented HF with preserved systolic function and 41 (29%) with systolic dysfunction; p = ns. HF with preserved systolic function was associated with the presence of MS in 53 (87%) of the 61 patients, p = 0.022.In our community, MS is closely related to HF with preserved systolic function and to the female gender.

OBJETIVO: Comparar as percepcoes sobre diagnostico e manuseio da insuficiencia cardiaca (IC) entre cardiologistas clinicos (CC) e medicos de familia (MF) de Niteroi. METODOS: Utilizacao de questionario qualitativo validado no estudo EURO-HF, que foi submetido a 54 MF e 62 CC. Esses profissionais forneceram informacoes sobre a forma de diagnostico da IC, acesso aos exames complementares e quais sao mais utilizados; nome dos medicamentos utilizados, doses, efeitos adversos e quais farmacos reduzem mortalidade. RESULTADOS: MF e CC relataram como os sinais e sintomas mais frequentemente identificados nos pacientes com IC dispneia, edema e cansaco (96,3% vs 100%, 74% vs 58% e 22,2% vs 67,7%). A classificacao de severidade de IC mais utilizada pelos MF foi leve/moderada/grave (53,8%) e pelos CC foi da NYHA (72,7%). CC solicitam ecocardiograma com maior frequencia que os MF (p < 0,001). CC diferenciam IC com funcao sistolica preservada da IC com disfuncao sistolica mais frequentemente que os MF (p < 0,001). CC usam mais frequentemente betabloqueadores (p < 0,001), IECA (p < 0,001) e espironolactona (p < 0,001) que MF. As doses de IECA utilizadas pelos CC sao maiores que as usadas pelos MF (p < 0,001) e as doses de espironolactona mais proximas as recomendadas na literatura. CONCLUSAO: CC utilizam uma investigacao diagnostica mais intensa, bem como utilizam os farmacos que reduzem a morbidade e mortalidade dos pacientes com IC com maior propriedade.

To compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói.A qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality.FD and CC reported that the most common signs and symptoms identified by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classification method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p0.001). CC use beta-blockers (p0.001), angiotensin-converting enzyme inhibitors (p0.001) and spironolactone (p0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature.CC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients.

To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antonio Pedro, Niterói.A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were evaluated in Brazilian Reais (2002). The study's point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version.The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R$ 14.40. The expenses with ambulatory medications amounted R$ 83,430.00 (R$ 1,191.86/patient/year). The cost per hospitalized patient was R$ 4,033.62. The cost with complementary examinations totaled R$ 39,009.50 (R$ 557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R$ 182,000.00. The total cost was R$ 444,445.20. Hospitalization represented 39.7% and the use of medications 38.3% from direct costs.The hospitalization cost and the expenses with medications represented the main components of direct costs. Indirect costs represented economic impacts similar to direct costs.

To compare the epidemiological and socioeconomic profiles, clinical features, etiology, length of hospitalization, and mortality of patients with decompensated heart failure admitted to public and private hospitals in the city of Niterói.We carried out a prospective, multicenter study (from July to September 2001) comprising all patients older than 18 years with the primary diagnosis of heart failure and admitted to hospitals in the city of Niterói, whose scores according to the Boston criteria were 8 or above. Proportions were compared using the chi-square and Fisher exact tests.The sample comprised 203 patients as follows: 1) 98 patients from public hospitals: 50% were men, their mean age was 61.1+/-11.3 years, 65% were black, 57% had an income of 1 minimum wage or less, 56% were illiterate, 66% had ischemic heart disease, their mean length of hospitalization was 12.6 days, and the mortality rate adjusted for age was 5.23; 2) 105 patients from private hospitals: 49% were men, their mean age was 72+/-12.7 years, 20% were black, 58% had an income greater than 6 minimum wages, 11% were illiterate, 62% had ischemic heart disease, their mean length of hospitalization was 8 days, and the mortality rate adjusted for age was 2.94. The distribution of comorbidities and risk factors was similar among the patients of the 2 hospital systems, except for the smoking habit, which was more frequent among patients from public hospitals.In addition to the socioeconomic asymmetries, the hospitalization length and the mortality rate adjusted for age were greater in patients in the public health system.

OBJECTIVE: To evaluate the behavior of blood pressure during exercise in patients with hypertension controlled by frontline antihypertension drugs. METHODS: From 979ergometric tests we retrospectively selected 49 hipertensive patients (19 males). The age was 53±12 years old and normal range rest arterial pressure ( or = 10 mmHg/MET; or increase of diastolic pressure greater than 15 mmHg. RESULTS: Physiologic response of arterial blood pressure occurred in 50% of patients on beta blockers, the best one (p