Frecuencia cardiaca como factor de riesgo para letalidad en pacientes con síndrome coronario agudo en el Hospital Belén de Trujillo
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Date
2022-07-04
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Universidad Nacional de Trujillo
Abstract
A nivel mundial, la prevalencia de enfermedad coronaria está aumentando, aunque hay variaciones regionales debido a la influencia de las economías, la industrialización y el avance en los sistemas de salud. Los datos de Norteamérica sugieren que aproximadamente el 25% de las muertes están asociadas con enfermedades cardíacas cada año. La incidencia en el mundo occidental está disminuyendo a pesar de que los factores de riesgo como la hipertensión, la diabetes mellitus y la obesidad están aumentando. La disminución se debe al fortalecimiento de los sistemas de salud debido al avance relativo en las intervenciones terapéuticas e invasivas. Como Asia comprende más de un tercio de la población mundial, su experiencia en la prevalencia de enfermedad coronaria es significativa. La medicina cardiovascular china se centra principalmente en la prevención al cambiar su enfoque de la terapia basada en los síntomas a la mejora guiada por el estilo de vida. Las tendencias en la mortalidad por enfermedad coronaria fueron favorables en los países de la Unión Europea, mientras que en los países de Europa del Este, la mortalidad sigue siendo excepcionalmente alta. Las tasas de mortalidad han disminuido significativamente en la mayoría de los países de América Latina a pesar de las disparidades en las tendencias actuales. Justificación: La creciente evidencia ha demostrado que el uso de biomarcadores refleja diferentes entidades patológicas, como la inflamación, estrés oxidativo, necrosis tisular y activación plaquetaria. Sin embargo, ningún biomarcador disponible ofrece un diagnóstico ideal propiedades como detección temprana, alta sensibilidad y especificidad, fácil disponibilidad y rentabilidad. Por lo tanto, el despliegue de nuevas estrategias es esencial para satisfacer las necesidades de diagnóstico, pronóstico y terapéutico. En este sentido la identificación de factores de riesgo para valorar el riesgo de letalidad en este contexto patológico específico puede ser relevante, en este sentido el empleo de elementos básicos de semiología como la frecuencia cardiaca al ingreso puede ofrecer información importante que conduzca a afinar el pronóstico en pacientes con síndrome coronario agudo. Enunciado del problema : ¿Es la frecuencia cardiaca factor de riesgo par letalidad en pacientes con síndrome coronario agudo en el Hospital Belén de Trujillo?. Hipótesis alterna (Ha): La frecuencia cardiaca es factor de riesgo para letalidad en pacientes con síndrome coronario agudo en el Hospital Belén de Trujillo. Hipótesis nula (Ho): La frecuencia cardiaca no es factor de riesgo para letalidad en pacientes con síndrome coronario agudo en el Hospital Belén de Trujillo.
Objetivos generales: Determinar si la frecuencia cardiaca es factor de riesgo para letalidad en pacientes con síndrome coronario agudo en el Hospital Belén de Trujillo. Objetivos específicos: Determinar la frecuencia de bradicardia en pacientes con síndrome coronario agudo con o sin letalidad. Comparar la frecuencia de bradicardia en pacientes con síndrome coronario agudo con o sin letalidad. Determinar la frecuencia de taquicardia en pacientes con síndrome coronario agudo con o sin letalidad. Comparar la frecuencia de taquicardia en pacientes con síndrome coronario agudo con o sin letalidad. Diseño de Estudio : Estudio analítico, observacional, retrospectivo, de casos y controles. Unidad de análisis : Estará constituido por cada paciente con síndrome coronario agudo atendidos en el Departamento de Emergencias del Hospital Belén de Trujillo durante el período 2021- 2022 y que cumplan con los criterios de selección. Unidad de Muestreo : Estará constituido por la historia clínica de cada paciente con síndrome coronario agudo atendidos en el Departamento de Emergencias del Hospital Belén de Trujillo durante el período 2021 - 2022 y que cumplan con los siguientes criterios de selección. Criterios de selección: Criterios de Inclusión (casos): Pacientes de ambos sexos; fallecidos; mayores de 15 años; en cuyas historias clínicas se encuentren los estudios necesarios para precisar las variables en estudio. Criterios de Inclusión (controles): Pacientes de ambos sexos; sobrevivientes; mayores de 15 años; en cuyas historias clínicas se encuentren los estudios necesarios para precisar las variables en estudio. Procedimientos y Técnicas : Ingresarán al estudio los pacientes con síndrome coronario agudo atendidos en el Departamento de Emergencias del Hospital Belén de Trujillo durante el período 2021- 2022 y que cumplan con los criterios de selección. Estadígrafo de estudio: Dado que es un estudio que evaluará la asociación entre variables a través de un diseño de casos y controles, se realizara la determinacion del odds ratio (OR); de las categorias de frecuencia cardiaca respecto al desenlace mortalidad intrahospitalaria. Se realizará el cálculo del intervalo de confianza al 95% del estadígrafo correspondiente.
Abstract Worldwide, the prevalence of coronary heart disease is increasing, although there are regional variations due to the influence of economies, industrialization and advances in health systems. Data from North America suggest that approximately 25% of deaths are associated with heart disease each year. The incidence in the western world is declining even though risk factors such as hypertension, diabetes mellitus and obesity are increasing. The decrease is due to the strengthening of health systems due to the relative progress in therapeutic and invasive interventions. As Asia comprises more than a third of the world's population, its experience in the prevalence of coronary heart disease is significant. Chinese cardiovascular medicine focuses primarily on prevention by shifting its focus from symptom-based therapy to lifestyle-guided improvement. Trends in coronary heart disease mortality were favorable in European Union countries, while in Eastern European countries, mortality remains exceptionally high. Mortality rates have decreased significantly in most Latin American countries despite disparities in current trends. Justification: Increasing evidence has shown that the use of biomarkers reflects different pathological entities, such as inflammation, oxidative stress, tissue necrosis and platelet activation. However, no available biomarker offers diagnostic ideal properties such as early detection, high sensitivity and specificity, easy availability, and cost-effectiveness. Therefore, the use of new strategies is essential to meet diagnostic, prognostic and therapeutic needs. In this sense, the identification of risk factors to assess the risk of lethality in this specific pathological context may be relevant; in this sense, the use of basic elements of semiology such as heart rate on admission may offer important information that leads to fine-tuning the prognosis in patients with acute coronary syndrome. Problem statement: Is heart rate a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo?. Alternate hypothesis (Ha): Heart rate is a risk factor for lethality in patients with acute coronary syndrome at Hospital Belén de Trujillo. Null hypothesis (Ho): Heart rate is not a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo. General objectives: To determine if heart rate is a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo. Specific objectives: To determine the frequency of bradycardia in patients with acute coronary syndrome with or without lethality. To compare the frequency of bradycardia in patients with acute coronary syndrome with or without lethality. To determine the rate of tachycardia in patients with acute coronary syndrome with or without lethality. To compare the rate of tachycardia in patients with acute coronary syndrome with or without lethality. Study Design: Analytical, observational, retrospective, case-control study. Analysis unit: It will be made up of each patient with acute coronary syndrome treated in the Emergency Department of Hospital Belén de Trujillo during the period 2021-2022 and who meet the selection criteria. Sampling Unit: It will be made up of the clinical history of each patient with acute coronary syndrome treated in the Emergency Department of Hospital Belén de Trujillo during the period 2021 - 2022 and who meet the following selection criteria. Selection criteria: Inclusion Criteria (cases): Patients of both sexes; deceased; Over 15 years old; in whose medical records the necessary studies are found to specify the variables under study. Inclusion Criteria (controls): Patients of both sexes; survivors; Over 15 years old; in whose medical records the necessary studies are found to specify the variables under study. Procedures and Techniques: Patients with acute coronary syndrome treated at the Emergency Department of Hospital Belén de Trujillo during the period 2021-2022 and who meet the selection criteria will be admitted to the study. Study statistician: Since it is a study that will evaluate the association between variables through a case-control design, the odds ratio (OR) will be determined; of heart rate categories with respect to the in-hospital mortality outcome. The calculation of the 95% confidence interval of the corresponding statistician will be made. Keywords: Tachycardia, acute coronary syndrome, electrocardiogram.
Abstract Worldwide, the prevalence of coronary heart disease is increasing, although there are regional variations due to the influence of economies, industrialization and advances in health systems. Data from North America suggest that approximately 25% of deaths are associated with heart disease each year. The incidence in the western world is declining even though risk factors such as hypertension, diabetes mellitus and obesity are increasing. The decrease is due to the strengthening of health systems due to the relative progress in therapeutic and invasive interventions. As Asia comprises more than a third of the world's population, its experience in the prevalence of coronary heart disease is significant. Chinese cardiovascular medicine focuses primarily on prevention by shifting its focus from symptom-based therapy to lifestyle-guided improvement. Trends in coronary heart disease mortality were favorable in European Union countries, while in Eastern European countries, mortality remains exceptionally high. Mortality rates have decreased significantly in most Latin American countries despite disparities in current trends. Justification: Increasing evidence has shown that the use of biomarkers reflects different pathological entities, such as inflammation, oxidative stress, tissue necrosis and platelet activation. However, no available biomarker offers diagnostic ideal properties such as early detection, high sensitivity and specificity, easy availability, and cost-effectiveness. Therefore, the use of new strategies is essential to meet diagnostic, prognostic and therapeutic needs. In this sense, the identification of risk factors to assess the risk of lethality in this specific pathological context may be relevant; in this sense, the use of basic elements of semiology such as heart rate on admission may offer important information that leads to fine-tuning the prognosis in patients with acute coronary syndrome. Problem statement: Is heart rate a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo?. Alternate hypothesis (Ha): Heart rate is a risk factor for lethality in patients with acute coronary syndrome at Hospital Belén de Trujillo. Null hypothesis (Ho): Heart rate is not a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo. General objectives: To determine if heart rate is a risk factor for lethality in patients with acute coronary syndrome at the Hospital Belén de Trujillo. Specific objectives: To determine the frequency of bradycardia in patients with acute coronary syndrome with or without lethality. To compare the frequency of bradycardia in patients with acute coronary syndrome with or without lethality. To determine the rate of tachycardia in patients with acute coronary syndrome with or without lethality. To compare the rate of tachycardia in patients with acute coronary syndrome with or without lethality. Study Design: Analytical, observational, retrospective, case-control study. Analysis unit: It will be made up of each patient with acute coronary syndrome treated in the Emergency Department of Hospital Belén de Trujillo during the period 2021-2022 and who meet the selection criteria. Sampling Unit: It will be made up of the clinical history of each patient with acute coronary syndrome treated in the Emergency Department of Hospital Belén de Trujillo during the period 2021 - 2022 and who meet the following selection criteria. Selection criteria: Inclusion Criteria (cases): Patients of both sexes; deceased; Over 15 years old; in whose medical records the necessary studies are found to specify the variables under study. Inclusion Criteria (controls): Patients of both sexes; survivors; Over 15 years old; in whose medical records the necessary studies are found to specify the variables under study. Procedures and Techniques: Patients with acute coronary syndrome treated at the Emergency Department of Hospital Belén de Trujillo during the period 2021-2022 and who meet the selection criteria will be admitted to the study. Study statistician: Since it is a study that will evaluate the association between variables through a case-control design, the odds ratio (OR) will be determined; of heart rate categories with respect to the in-hospital mortality outcome. The calculation of the 95% confidence interval of the corresponding statistician will be made. Keywords: Tachycardia, acute coronary syndrome, electrocardiogram.
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Keywords
Taquicardia, Síndrome coronario agudo, Electrocardiograma