Cardiovascular prevention in coronary heart disease patients: guidelines implementation in clinical practice

Abstract

238Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):238-47 Brasil CKOI, et al. -Cardiovascular prevention Abstract Objective: To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling.Methods: Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3). Conclusion: There was no significant change on the evidencebased pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy.Comprehensive programs for clinical practice should be pursued for longer follow-up period.

Application of MAT Methodology in the Evaluation of Prescribing Adherence to Clinical Practice Guidelines for Secondary Prevention of Coronary Heart Disease in Post-Acute Coronary Syndrome Patients in Kuwait

“…This is alarming and increases the risk for recurrent cardiovascular events. It has to be emphasized that successful management of CVDs involves not only the treatment of a specific disease but also treating and preventing the risk factors for CVD, including diabetes, dyslipidemia, and hypertension ( Indio do Brasil et al, 2013 ). Limitations to patients achieving target goals reported in the literature include inappropriate prescribing practices, poor patient adherence to medication, and unawareness of the importance of therapeutic goal attainment ( Whitley et al, 2006 ).…”

Prevenção secundária farmacológica de doenças cardiovasculares em população rural assistida por unidades básicas de saúde do município de Embu-Guaçu/SP

“…8,9 Medidas preventivas, incluindo farmacoterapia, são importantes não apenas para diminuir a morbidade e mortalidade das DCV, mas também porque tem impacto na qualidade de vida. 10,11 Segundo diretrizes internacionais de prevenção secundária das DCV, recomenda-se tratamento medicamentoso ao longo da vida com antiagregantes plaquetários, betabloqueadores, estatinas e inibidores da enzima conversora de angiotensina (IECA). [11][12][13][14] Com o aumento do uso desse tratamento para prevenção secundária, a cada 10.000 pacientes, mais de 104 vidas poderiam ser salvas e 191 eventos isquêmicos recorrentes poderiam ser evitados se a maioria desses pacientes com doenças crônicas fossem tratados na Atenção Primária.…”

“…10,11 Segundo diretrizes internacionais de prevenção secundária das DCV, recomenda-se tratamento medicamentoso ao longo da vida com antiagregantes plaquetários, betabloqueadores, estatinas e inibidores da enzima conversora de angiotensina (IECA). [11][12][13][14] Com o aumento do uso desse tratamento para prevenção secundária, a cada 10.000 pacientes, mais de 104 vidas poderiam ser salvas e 191 eventos isquêmicos recorrentes poderiam ser evitados se a maioria desses pacientes com doenças crônicas fossem tratados na Atenção Primária. A dinâmica proposta pela Estratégia Saúde da Família (ESF), centrada na promoção da qualidade de vida e intervenção dos fatores que a colocam em risco, permite a identificação mais acurada e um melhor acompanhamento dos indivíduos com vistas à prevenção de doenças, principalmente as cardiovasculares, tendo um impacto sobre as taxas de incidência das mesmas.…”