Risco nutricional de pacientes com insuficiência cardíaca assistidos pelo SUS e pela rede de saúde suplementar: um estudo comparativo

• Ano de defesa: 2020
• Autor(a) principal: Alves, Luciana Vieira Sousa
• Orientador(a): Sousa, Antônio Carlos Sobral
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Ciências da Saúde
• Palavras-chave em Português: Ciências da saúde; Doenças Cardiovasculares; Insuficiência Cardíaca; Desnutrição; Avaliação Nutricional; Sistema Único de Saúde; Saúde suplementar
• Palavras-chave em Inglês: Health Sciences; Cardiovascular Diseases; Cardiac insufficiency; Malnutrition; Nutritional Assessment; Health Unic System; Supplementary health
• Área do conhecimento CNPq: CIENCIAS DA SAUDE
• Link de acesso: http://ri.ufs.br/jspui/handle/riufs/17162

Introduction: Heart failure (HF) is one of the main causes of hospitalization both in the Brazilian Unified Health Service (SUS) and in the Supplementary Health Network (RSS). Malnutrition, common in patients with HF, influences the evolution of the disease prognosis. There is a lack of studies comparing the nutritional status of patients with HF in these two health systems. Objective: To compare the nutritional status of patients with HF treated by SUS and RSS. Methodology: This is a population-based, cross-sectional, observational study, with sample selection by spontaneous demand, with data from the VICTIM-CHF (Congestive Heart Failure) Registry in SUS hospitals and RSS in Aracaju / SE. The following were collected: demographic data; etiological factors and HF functional capacity, anthropometric data and nutritional screening for the diagnosis of malnutrition and low muscle mass. Numerical variables were described as medians and interquartile ranges and categorical variables in absolute numbers and percentages. Student's t-test was used for normal distribution and, in other cases, the Mann-Whitney non-parametric test was used. Fisher's exact test was applied to estimate measures of association between categorical variables. Odds ratios and 95% confidence intervals for malnutrition were calculated according to the Hospital model. Two-tailed p <0.05 was adopted as the significance criterion. The estimates were calculated in Stata version 16 (College Station, Texas, USA) and the graphs were developed in Python (version 3.9.0). Results: The sample consisted of 370 volunteers, 53% male, 58% elderly and the majority (69%) assisted by SUS. The most prevalent etiology was hypertensive heart disease (26%) and 90% were classified with NYHA 3 and 4. The Body Mass Index (BMI) was increased by 49% of the sample, being overweight and reduced and reduced by 50% of the volunteers. Nutritional screening showed that 44% of individuals were malnourished. SUS beneficiaries were younger (p <0.001), had longer hospital stays (p = 0.013) and lower values of arm muscle area (p = 0.036) and arm circumference (p = 0.02), compared to from RSS. A higher rate of malnutrition was also observed through subjective evaluations (MAN + SGA) in SUS patients (p <0.001). Conclusion: There was a high frequency of malnutrition among patients hospitalized with HF, with a greater chance of affecting SUS users. However, the high nutritional risk may not be related to social class, but to the lack of assistance offered by the public service, making it easier for RSS users to access.