Percepções sobre diagnóstico e manuseio da insuficiência cardíaca: comparação entre cardiologistas clínicos e médicos de família

Abstract

Original Article M a i l i n g A d d r e s s : L e a n d r o R e i s T a v a r e s• R u a O t á v i o C a r n e i r o , 1 1 0 / 2 0 1 -2 4 2 3 0 -1 9 1 -N i t e r ó i , R J -B r a z i l E-mail: lreistavares@uol.com. OBJECTIVETo compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói. METHODSA qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality. RESULTSFD and CC reported that the most common signs and symptoms identifi ed by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classifi cation method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p < 0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p < 0.001). CC use beta-blockers (p < 0.001), angiotensin-converting enzyme inhibitors (p < 0.001) and spironolactone (p < 0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p < 0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature. CONCLUSIONCC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients. KEY WORDSHeart failure, diagnosis, management.

Instruments to assess quality of life in patients with heart failure

“…Another specific instrument used to assess QoL in patients with HF is the Euro Heart Failure Quality of Life Questionnaire. Unlike the CHQ-C, this instrument, which incorporates the assessment of functional status, evaluates a number of issues related to health and QoL, focusing more on perceived health and overall QoL (16,30,31).…”

Lessons Learned from Community Studies of HFpEF – The Digitalis Study

“…1,2 Inspired by the importance of primary health care (PHC) in the Alma-Ata Declaration, which was adopted in 1978, projects aimed at improving health quality and access to health were planned and established with methods that included the entire community. 3 From this point onward, we were able to observe the development and implementation of the PHC model in Brazil and, especially, in the city of Niterói, which pioneered the implementation of the Family Health Program (FHP). 4 The FHP, which is based on the family medicine model from Cuba, consists of a team of general practitioners, led by a family doctor, that is responsible for the health of family groups in a given territory.…”

“…4 The FHP, which is based on the family medicine model from Cuba, consists of a team of general practitioners, led by a family doctor, that is responsible for the health of family groups in a given territory. 3,4 The UFF has been participating in the reconstruction of PHC since its collaboration with the city of Niterói in the 1970s. 5,6 This collaboration began with the implementation of the program through changes in the medical curriculum, bringing new professionals, professors, and the UFF closer to PHC.…”

“…Establishing a relationship between doctors and PHC as early as medical education promotes better perception of the social role of the doctor, general practitioner, or specialist in the health of an entire community. 3,6…”

Impact of a Supervised Twelve-Week Combined Physical Training Program in Heart Failure Patients: A Randomized Trial

“…Despite advances in the treatment of HF, its mortality and morbidity are still alarming [2]. In addition, both intolerance to exercise and recurrent hospitalizations of patients with HF compromise their working life and quality of life (QOL) [3].…”