Cardiovascular disease is the leading cause of death around the world. According to a study from the World Economic Forum, the economic burden of this disease to society reached US$ 863 billion in 2010, with an estimation to rise by 22% to US$ 1,044 in 2030. Likewise, recent studies have shown that in Brazil ischemic heart disease and stroke have been the main cause of death since the end of the 1960s, costing a total of R$ 56.2 billion just in 2015[2,3]. Due to Brazil’s large size, its 27 states have developed unevenly, so states located in the south and southeast regions of the country are more developed and have the best infrastructure. Hence, such differences ought to be considered when allocating resources efficiently to improve healthcare among the population. It is imperative to seek knowledge through locally-based research as its outcomes may be used as a tool to instruct policy makers, regional-level physicians, health professionals and the general population.
To establish the Brazilian contribution to cardiovascular disease research, the Scival platform (www.scival.com) was used, which analyzes data from several sources such as Scopus and ScienceDirect. In the case of patent article citations, data emanate from European Patent Office, Intellectual Property Office, Japan Patent Office, United States Patent and Trademark Office and the World Intellectual Property Organization. A query was made to retrieve data from Brazil which had been published within the most recent 5-year period (2014-2018) in the field of “Cardiology and Cardiovascular Medicine”. One of the key features of Scival is that it disaggregates each field into specific research topics. As approximately 96,000 specific research topics have been defined, topic clusters are formed by aggregating topics with similar research interest, creating a broader area of research. It is important to note that a publication can belong to only one topic, consequently, to one topic cluster.
The indicators used for this analysis were the following:
Scholarly output: The number of documents published within the 5-year period
in the topic cluster.
Growth (%): This indicator represents the increase or decrease of published
documents within the specific topic cluster in the 5-year period.
International collaboration (%): The proportion of published documents
authored by researchers from Brazil and another countries.
Field-Weighted Citation Impact (FWCI): Indicator that refers to citations
received in the year of publication plus the following 3 years. FWCI of 1.00
means that the publications have been cited at world average for similar
publications. Thus, a score of 1.17 indicates that the outputs have been
cited 17% more than expected. Contrarily, a FWCI of 0.77 means 23% less
cited than the world average.
Patent-cited scholarly output: The count of scholarly outputs published by
the country that have been cited in patents.
Scholarly output: The number of documents published within the 5-year period in the topic cluster.
Growth (%): This indicator represents the increase or decrease of published documents within the specific topic cluster in the 5-year period.
International collaboration (%): The proportion of published documents authored by researchers from Brazil and another countries.
Field-Weighted Citation Impact (FWCI): Indicator that refers to citations received in the year of publication plus the following 3 years. FWCI of 1.00 means that the publications have been cited at world average for similar publications. Thus, a score of 1.17 indicates that the outputs have been cited 17% more than expected. Contrarily, a FWCI of 0.77 means 23% less cited than the world average.
Patent-cited scholarly output: The count of scholarly outputs published by the country that have been cited in patents.
As Table 1 reveals, the field of “Cardiology and Cardiovascular Medicine” in Brazil is constituted by 47 topic clusters, ordered according to the number of papers published within the 5-year period. The most prolific topic was “Percutaneous coronary intervention; Patients; Myocardial infarction”, with 584 papers, of which 49.3% were the product of an international collaboration. While its growth has diminished slightly over the 5-year period, its FWCI score denotes that these papers have been cited 99% more than expected. In fact, the six most prolific topic cluster exhibits an FWCI >1, revealing the quality of the work published.
|Topic cluster||Scholarly output||Growth (%)||International collaboration (%)||Field-Weighted Citation Impact|
|Percutaneous Coronary Intervention; Patients; Myocardial Infarction||584||-1.7||49.3||2|
|Atrial Fibrillation; Patients; Catheter Ablation||570||54.3||48.8||1.42|
|Cholesterol; Lipids; Atherosclerosis||492||15.8||35.8||2.71|
|Sepsis; Acute Kidney Injury; Patients||483||0.3||32.7||2|
|Anticoagulants; Patients; Venous Thromboembolism||472||28.1||31.4||1.25|
|Heart Rate; Blood Pressure; Patients||412||27.6||40.3||0.9|
|Wounds and Injuries; Pressure Ulcer; Bandages||385||60.6||12.7||0.56|
|Renin-Angiotensin System; Peptidyl-Dipeptidase A; Angiotensins||348||-7.4||36.8||0.91|
|Hypertension; Blood Pressure; Patients||337||6.2||35.6||2.41|
|Stroke; Patients; Cerebral Hemorrhage||303||4.6||30.7||1.09|
|Heart Failure; Patients; Brain Natriuretic Peptide||301||-6.5||36.2||1.76|
|Coronary Artery Disease; Patients; Echocardiography||264||19.3||45.8||1.07|
|Aortic Valve; Mitral Valve; Aortic Valve Stenosis||253||7.3||37.2||1.12|
|Ischemic Preconditioning; Reperfusion Injury; Ischemic Postconditioning||221||6.5||13.6||1.01|
|Heart Diseases; Patients; Congenital Heart Defects||211||-30.4||21.8||0.56|
|Abdominal Aortic Aneurysm; Aneurysm; Dissection||191||-2.6||22.0||0.47|
|Vasodilation; Endothelium; Dilatation||171||51.2||16.4||0.62|
|Catheters; Renal Dialysis; Central Venous Catheters||160||96.3||13.1||0.47|
|Pneumothorax; Lung; Pleural Effusion||142||11.6||22.5||0.59|
|Pulmonary Hypertension; Pulmonary Artery; Patients||136||61.2||47.4||1.11|
|Rehabilitation; Depression; Patients||135||63.2||38.5||0.83|
|Heart Arrest; Cardiopulmonary Resuscitation; Out-Of-Hospital Cardiac Arrest||115||23.6||41.2||1.01|
|Peripheral Arterial Disease; Ischemia; Extremities||113||-28.9||21.2||1.42|
|Vascular Stiffness; Pulse Wave Analysis; Blood Pressure||109||11.4||33.0||0.93|
|Matrix Metalloproteinases; Matrix Metalloproteinase 9; Metalloproteases||109||-22.8||33.0||0.7|
|Calcium; Calcium Signaling; Ion Channels||97||-6.1||53.6||0.83|
|Uric Acid; Gout; Hyperuricemia||95||20.7||33.7||1.26|
|Lymphedema; Breast Neoplasms; Chylothorax||90||4.2||15.6||0.51|
|Enterovirus; Poliomyelitis; Myocarditis||81||30.5||43.2||1.5|
|Endocarditis; Aneurysm; Patients||81||22.2||18.5||1.13|
|Heart-Assist Devices; Extracorporeal Membrane Oxygenation; Patients||78||-10.8||20.5||0.56|
|Erythrocyte Indices; Neutrophils; Lymphocytes||65||-25.8||10.8||0.52|
|Hypertrophic Cardiomyopathy; Myosins; Cardiomyopathies||61||21.2||32.8||0.7|
|Anthracyclines; Doxorubicin; Neoplasms||57||30.7||28.1||1.08|
|Sarcoidosis; Granuloma; Patients||52||119.4||23.1||0.6|
|Trachea; Thoracic Aorta; Bronchoscopy||50||47.7||16.0||0.92|
|Ischemia; Patients; Superior Mesenteric Artery||46||-0.4||17.4||0.68|
|Coronary Vessels; Pulmonary Artery; Fistula||39||-1.5||7.7||0.14|
|Heart Neoplasms; Myxoma; Echocardiography||38||131.2||26.3||1.27|
|Erythrocytes; Contrast Media; Blood||37||-24||21.6||0.81|
|Renal Artery; Renal Artery Obstruction; Hypertension||36||25.7||5.6||0.5|
|Hyponatremia; Sodium; Hyperkalemia||32||132.7||34.4||0.94|
|Inferior Vena Cava; Renal Veins; Syndrome||32||177.5||9.4||0.56|
|Heart; Acoustic Waves; Cardiology||30||-13.4||26.7||0.4|
|Pregnancy; Dissection; Coronary Vessels||27||-72.4||14.8||0.33|
|Pericarditis; Pericardial Effusion; Constrictive Pericarditis||22||76.1||9.1||0.32|
|Takotsubo Cardiomyopathy; Patients; Electrocardiography||17||-7.5||35.3||0.66|
Another important aspect to consider is the impact of the Brazilian papers in patent generation. As Collins and Wyatt stated, the main characteristic of papers cited by patents must be in a rapidly developing field with a high scientific content. To understand the real value of these papers, 509 US patents issued from 1987 to 2003 cited 273 Chilean papers from several disciplines. In this regard, Table 2 summarizes the Brazilian papers cited in 16 patents issued from 2014 to 2018.
|Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: A randomized controlled trial||2014||Brazilian Journal of Cardiovascular Surgery||29||588-594|
|Butyrate impairs atherogenesis by reducing plaque inflammation and vulnerability and decreasing NFκB activation||2014||Nutrition, Metabolism and Cardiovascular Diseases||24||606-613|
|Vorapaxar in acute coronary syndrome patients undergoing coronary artery bypass graft surgery: Subgroup analysis from the TRACER trial (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome)||2014||Journal of the American College of Cardiology||63||1048-1057|
|Statin-associated muscle symptoms: impact on statin therapy - European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management||2015||European Heart Journal||36||1012-1022|
|Management of pulmonary arterial hypertension||2015||Journal of the American College of Cardiology||65||1976-1997|
|Simplified Method for Vagal Effect Evaluation in Cardiac Ablation and Electrophysiological Procedures||2015||JACC: Clinical Electrophysiology||1||451-460|
|2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary||2017||Heart Rhythm||14||e445-e494|
|Targeting PCSK9 for therapeutic gains: Have we addressed all the concerns?||2016||Atherosclerosis||248||62-75|
|Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients with Peripheral Artery Disease||2016||Journal of the American College of Cardiology||67||2719-2728|
|Association of endothelial dysfunction with cardiovascular risk factors and new-onset diabetes mellitus in patients with hypertension||2018||Journal of Clinical Hypertension||20||935-941|
Undoubtedly, research developed by Brazilian investigators in topics related to cardiovascular disease has proven valuable, not only for the academic community, but also for the industry. I believe now is the time to make this research useful for policy makers to influence their assessments.
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