Cardiology in Brazil: a country in development.

Sugarloaf mtn sunset Rio Brazil is a country of continental proportions. It takes the same amount of time to fly between the UK and France as it does to fly across just one state in Brazil. With a population of around 185 million, Brazil is the sixth most populous country in the world after China, India, the USA, Indonesia, and Russia. Brazil is one of the BRIC countries—Brazil, Russia, India, and China—which have fast growing developing economies. In the last 8–10 years, the country’s economic profile has improved and become more stable, partly due to its production of oil. Like all other countries in development, there is the problem of big differences in class. There are many poor people and there are also very wealthy people. But in the last 10 years, there has been a transformation in the middle class, which has grown and begun to make purchases of things like soap and other personal hygiene products. In such a big country, there are also regional differences. The southeast of the country is very well developed, whereas the north is still developing and has more areas with very poor people. One of the big challenges for the future of Brazil is health. Cardiovascular disease represents the most important cause of death in Brazil, at 32%. ‘Our figure is very similar to the figure of several countries in Europe and also the USA’, says Prof. Antonio C.P. Chagas, MD, FESC, FACC, Professor of Medicine at the Heart Institute, University of São Paulo, Brazil, and past president of the Brazilian Society of Cardiology. There is a high prevalence of cerebral vascular incidents because of the poor control of hypertension, many people are obese, there is poor control of dyslipidaemia, and diabetes is a common problem. Coronary heart disease is the principal disease but Brazil still has some kinds of valvular heart disease. In poor areas, for example, there is rheumatic fever, and still several people have mitral regurgitation or mitral insufficiency developed through rheumatic disease. In the past 2 years, the Brazilin Society of Cardiology has made a plan to prevent rheumatic disease. Another important problem in cardiovascular disease is Chagas’ disease, a heart disease caused by the protozoan Trypanosoma cruzi. Chagas says: ‘We are doing a lot to prevent and also to treat patients with Chagas’ disease’. Although Brazil is a country in development, Chagas says that the standards of interventional procedures like angioplasty, and of cardiac surgery, are comparable to the USA and the UK. Cardiac surgery and angioplasty are available in the large majority of the Brazilian states, from the south to the extreme north, but there are a few areas where they are not available. Chagas estimates that all facilities are available in around 80% of the country. The most important hospitals are in the southeast but very good hospitals also exist in the north, and new hospitals are being developed in the interior of the country. About 25–30% of the Brazilian population is covered by private money or private insurance. The remaining majority have their healthcare funded by the government. This includes, for example, cardiac revascularization, bypass, angioplasty, electrophysiology, pacemakers, cardiac defibrillators, and paediatric cardiology procedures.