Auditoria sobre o acompanhamento cardiológico em pacientes com Duchenne que necessitam de suporte ventilatório no Canadá
Canadá – mesmo em países de primeiro mundo os protocolos de axompanhamento cardíológico em Duchenne não sao seguidos; recomenda-se pelo uma avaliação cardiológica anual. Numa avaliação no Canadá estudando 32 pacientes com Duchenne apenas 19 haviam passado por esta avaliação e somente 22 haviam feito o ecocardiograma. Provavelmente no Brasil o número de pessoas sem estas avaliações seria maior.
O texto em inglës do trabalho pode ser lido abaixo:
(B47 INTENSIVE CARE UNIT PHYSIOTHERAPY AND WEANING: MIND OVER MUSCLE?) Audit Of The Cardiac Management Of Patients With Duchenne Muscular Dystrophy On Ventilatory Support
L. O’Brien , M. Avendano , R. Goldstein , R. A. Evans – Canada
Introduction. The life expectancy of patients with Duchenne Muscular Dystrophy (DMD) has increased, from the 2 decade to the 5 decade, in part due to improved ventilatory support. However, cardiomyopathy is common and is projected to increase as a cause of death. Current international guidelines recommend an annual assessment of cardiac function in adult patients with DMD and initiation of appropriate pharmacological treatment (1). We conducted an audit of the current cardiac management of patients with DMD with respiratory failure under the care of West Park Healthcare Centre, Toronto, Canada.
Methods: We reviewed the medical charts of patients with DMD requiring ventilatory support. Patients were included if they had respiratory follow up within the last three years and were alive at the time of the audit. Patient demographics and ventilatory status were recorded. Cardiac management was recorded including date of the last documented electrocardiogram (ECG), echocardiogram (ECHO), cardiology review and pharmacological management. The ECG and ECHO reports were reviewed.
Results: 32 patients with DMD (31 male, mean [SD] age 31 [7] yrs) met the inclusion criteria and their medical notes were retrieved. 7/32 patients were living in a chronic assisted ventilation unit and 25/32 were cared for at home. 18/32 required continuous ventilation and 14/32 required nocturnal ventilation only. 17/32 patients were ventilated via a tracheostomy. 10/32 and 6/32 patients had a documented ECG and ECHO respectively, within the last year. 26/32, 22/32, and19/32 patients had previous documentation of an ECG, ECHO, and had been assessed by a cardiologist, respectively. Out of the available results, 21/25 patients had an abnormal ECG and 15/20 patients had demonstrable left ventricular dysfunction (Grade II: 6, Grade III: 7, Grade IV: 2). 16/32 were prescribed either an Angiotensin Converting Enzyme inhibitor or an Angiotensin Receptor Blocker, 11/32 were prescribed Beta-Blockers, 4/32 were prescribed digoxin and 1/32 was prescribed spironolactone.
Conclusions: Although cardiac function had been assessed in over two thirds of patients with DMD, few were undergoing annual cardiac assessments. A new policy of closer monitoring is suggested with a repeat audit in two years. This audit highlights the need for respiratory physicians to refer these patients for annual cardiology review in line with current guidance.
(1) Bushby K et al. Lancet Neurol 2010; 9(1):77-93
