SARA MICHELLY GONCALVES BRANDAO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Cost-effectiveness of long-term disease management program in heart failure: results from the REMADHE trial(2013) BOCCHI, E. A.; CRUZ, F.; BRANDAO, S.; GUIMARAES, G.; BACAL, F.; ISSA, V. S.; CHIZZOLA, P.; SOUZA, G.; FERREIRA, S. M. A.conferenceObject CARVEDILOL FOR PREVENTION OF CHEMOTHERAPY-INDUCED CARDIOTOXICITY: FINAL RESULTS OF THE PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED CECCY TRIAL(2020) AYUB-FERREIRA, Silvia M.; AVILA, Monica; BRANDAO, Sara; CRUZ, Fatima D.; WANDERLEY JR., Mauro; RIGAUD, Vagner O. C.; HAJJAR, Ludhmila; KALIL-FILHO, Roberto; CRUZ, Cecilia B. V.; ALVES, Marco Stephan; GUIMARAES, Guilherme V.; ABDUCH, Maria; ISSA, Victor S.; SANTOS, Marilia; BITTENCOURT, Marcio; BOCCHI, Edimar Alcides- Cost-Effectiveness Benefits of a Disease Management Program: The REMADHE Trial Results(2018) BOCCHI, Edimar Alcides; CRUZ, Fatima das Dores da; BRANDAO, Sara Michelly; ISSA, Victor; AYUB-FERREIRA, Silvia Moreira; ROCCA, Hans-Peter Brunner la; WIJK, Sandra Sanders vanBackground: Published studies have generated mixed, controversial results regarding the Cost-effectiveness of heart failure disease management programs (HF-DMPs). This study assessed the cost-effectiveness of an HF-DMP in ambulatory patients compared with usual care (UC). Methods: In the prospective randomized REMADHE trial, we evaluated incremental costs per quality adjusted life-year (QALY) and life-year (LY) gained as effectiveness ratios (ICERs) over a study period of 2.47 +/- 1.75 years. Results: The REMADHE HF-DMP was more effective and less costly than UC in terms of both QALYs and LYs (95% and 55% chance of dominance, respectively). Average saving was US$7345 (2.5%-97.5% bootstrapped confidence interval similar to 16,573 to +921). The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY or LY was 99% and 96%, respectively. Cost-effectiveness of HF-DMP was highest in subgroups with left ventricular ejection fraction <35%, age >50 years, male sex, New York Heart Association (NYHA) functional class >= III, and ischemic etiology. The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY was >= 90% in all subgroups apart from NYHA functional class I-II, where it was 70%. Even when the intervention costs increased by 500% or when excluding outliers in costs, DMP had a high chance of being cost-effective (87%-99%). Conclusions: The HF-DMP of the REMADHE trial, which encompasses long-term repeated education alongside telephone monitoring, has a high probability of being cost-effective in ambulatory patients with HF.
- Circulating miR-1 as a potential biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients(2017) RIGAUD, Vagner Oliveira-Carvalho; FERREIRA, Ludmila R. P.; AYUB-FERREIRA, Silvia M.; AVILA, Monica S.; BRANDAO, Sara M. G.; CRUZ, Fatima D.; SANTOS, Marilia H. H.; CRUZ, Cecilia B. B. V.; ALVES, Marco S. L.; ISSA, Victor S.; GUIMARAES, Guilherme V.; CUNHA-NETO, Edecio; BOCCHI, Edimar A.Cardiotoxicity is associated with the chronic use of doxorubicin leading to cardiomyopathy and heart failure. Identification of cardiotoxicity-specific miRNA biomarkers could provide clinicians with a valuable prognostic tool. The aim of the study was to evaluate circulating levels of miRNAs in breast cancer patients receiving doxorubicin treatment and to correlate with cardiac function. This is an ancillary study from ""Carvedilol Effect on Chemotherapy-induced Cardiotoxicity"" (CECCY trial), which included 56 female patients (49.9 +/- 3.3 years of age) from the placebo arm. Enrolled patients were treated with doxorubicin followed by taxanes. cTnI, LVEF, and miRNAs were measured periodically. Circulating levels of miR-1,-133b,-146a, and -423-5p increased during the treatment whereas miR-208a and -208b were undetectable. cTnI increased from 6.6 +/- 0.3 to 46.7 +/- 5.5 pg/mL (p<0.001), while overall LVEF tended to decrease from 65.3 +/- 0.5 to 63.8 +/- 0.9 (p=0.053) over 12 months. Ten patients (17.9%) developed cardiotoxicity showing a decrease in LVEF from 67.2 +/- 1.0 to 58.8 +/- 2.7 (p=0.005). miR-1 was associated with changes in LVEF (r=-0.531, p<0.001). In a ROC curve analysis miR-1 showed an AUC greater than cTnI to discriminate between patients who did and did not develop cardiotoxicity (AUC = 0.851 and 0.544, p = 0.0016). Our data suggest that circulating miR-1 might be a potential new biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients.
conferenceObject Characteristics and prognostic marker in obese heart failure patients in clinical practice in a heart failure clinic(2014) BOCCHI, E. AEdimar Alcides; OLIVEIRA, B.; ISSA, V.; CRUZ, F.; BRANDAO, S.; AYUB-FERREIRA, S.; CHIZZOLA, P.; SOUZA, G.; GUIMARAES, G.- Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity(2018) AVILA, Monica Samuel; AYUB-FERREIRA, Silvia Moreira; WANDERLEY JR., Mauro Rogerio de Barros; CRUZ, Fatima das Dores; BRANDAO, Sara Michelly Goncalves; RIGAUD, Vagner Oliveira Carvalho; HIGUCHI-DOS-SANTOS, Marilia Harumi; HAJJAR, Ludhmila Abrahao; KALIL FILHO, Roberto; HOFF, Paulo Marcelo; SAHADE, Marina; FERRARI, Marcela S. M.; COSTA, Romulo Leopoldo de Paula; MANO, Max Senna; CRUZ, Cecilia Beatriz Bittencourt Viana; ABDUCH, Maria Cristina; ALVES, Marco Stephan Lofrano; GUIMARAES, Guilherme Veiga; ISSA, Victor Sarli; BITTENCOURT, Marcio Sommer; BOCCHI, Edimar AlcidesBACKGROUND Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with beta-blockers remains controversial. OBJECTIVES This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m(2)) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a >= 10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 +/- 3.64 mm to 45.2 +/- 3.2 mm vs. 44.9 +/- 3.6 mm to 46.4 +/- 4.0 mm; p = 0.057). CONCLUSIONS In this largest clinical trial of beta-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction.(Carvedilol Effect in Preventing Chemotherap-Induced Cardiotoxicity [CECCy] NCTO1724450)(C) 2018 by the American College of Cardiology Foundation.
conferenceObject Cost of pharmacological therapy in heart failure and heart transplantation outpatients: effects of age, etiology and functional class(2013) BRANDAO, S. M. G.; ISSA, V. S.; FERREIRA, S. M. A.; STORER, S.; SANTOS, V. G.; CHIZZOLA, P. R.; SOUZA, G. E. C.; FERNANDO, B. A. C. A. L.; VEIGA, G. G.; BOCCHI, E. A.- Reverse Auction: A Potential Strategy for Reduction of Pharmacological Therapy Cost(2015) BRANDAO, Sara Michelly Goncalves; ISSA, Victor Sarli; AYUB-FERREIRA, Silvia Moreira; STORER, Samantha; GONCALVES, Bianca Gigliotti; SANTOS, Valter Garcia; CARVAS JUNIOR, Nelson; GUIMARAES, Guilherme Veiga; BOCCHI, Edimar AlcidesBackground: Polypharmacy is a significant economic burden. Objective: We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients. Methods: We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost. Results: The monthly cost per patient for HF drugs acquired via RA was $ 10.15 (IQ 3.51-40.22) versus $ 161.76 (IQ 86.05-340.15) via CP; for HT, those costs were $ 393.08 (IQ 124.74-774.76) and $ 1,207.70 (IQ 604.48-2,499.97), respectively. Conclusions: RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.
conferenceObject Immunohistochemical Counting of Mononuclear Infiltrates in Endomyocardial Biopsy Fragments: A New Method To Improve the Diagnosis of Rejection after Heart Transplantation(2013) BOCCHI, E. A.; BENVENUTTI, L. A.; TANIGAWA, R.; BRANDAO, S.; ISSA, V. S.; AYUB-FERREIRA, S.; CRUZ, F.; POMERANTZEFF, P.; HONORATO, R.; LOURENCO-FILHO, D. D.; FIORELLI, A. I.; CHIZZOLA, P.; SOUZA, G.; BACAL, F.