Reabilitação cardíaca em Portugal. Inquérito 2013‐2014

Silveira, Conceição Eneida dos Santos; Abreu, Ana

doi:10.1016/j.repc.2016.06.006

Cited by 21 publications

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“…In the second 63 , findings indicated that in addition to the healthcare providers shown in Table 1, again physiatrists (75%) and psychologists (62%) were also included as part of the CR team. In the most recent survey 64 , again physiatrists (74%) and psychologists (61%) were also included as part of the CR team. The core components that were also offered in most programs were dietary counseling (96%), and smoking cessation (96%).…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases.Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.Keywords: cardiac rehabilitation, global health, secondary prevention Alphabetical List of Abbreviations: AS= administrative support CABG = coronary artery bypass graft CB = community-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 CR = cardiac rehabilitation CPR= cardiopulmonary resuscitation CVD = cardiovascular disease ECG = electrocardiogram EQ= equipment ET = exercise training FR= financial resources HB = home-based HF = heart failure HR= human resources IA = initial assessment IB = internet-based IHD = ischemic heart disease LMIC = low-and middle-income country MI = myocardial infarction NC = nutrition counseling NZ = New Zealand PAW= patient awareness PCI = percutaneous coronary intervention PE = patient education PR= patient referral RF = risk factor management SC = smoking cessation SM = stress management and/or psychosocial support/counselling TI = transportation issues UAE = United Arab Emirates VAD = ventricular assist device A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 By 2030, it is expected 84 million individuals will be diagnosed with cardiovascular disease (CVD) 1 .Moreover, it is among the leading causes of disability around the world, and contributes to 10% of disabilityadjusted life years lost world-wide 2 . With improved survival (in high-income countries 3 ), clearly there is a great need for secondary prevention, such as is offered in cardiac rehabilitation (CR) programs.Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 . Accordingly, it is a class 1 level A recommendation in clinical practice guidelines for CVD patients 9,10 . 19 , have established guidelines to ensure consistent provision and quality of CR delivery in order to achieve the greatest population health benefits. They all outline the nature of patients indicated for services, and make recommendations regarding the composition of a multi-disciplinary...

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Section: Accepted M Manuscriptmentioning

confidence: 99%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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“…11---13 Only 8% of patients suffering myocardial infarction participate in these programs, 12 in contrast to the European average of over 30% (in many countries it exceeds 50%). 13 The last survey performed by the SPC, in 2013-2014, 12 identified 23 centers in Portugal with CR programs, 12 public and 11 private, which represents an increase compared to 2007, when there were 16 centers.…”

Section: Rationale Definition Of Cardiac Rehabilitationmentioning

confidence: 99%

“…13 The last survey performed by the SPC, in 2013-2014, 12 identified 23 centers in Portugal with CR programs, 12 public and 11 private, which represents an increase compared to 2007, when there were 16 centers. 11 The percentage of patients discharged from hospital after myocardial infarction who participated in a CR program has almost tripled in recent years, increasing from 3% in 2007 11 to 8% in 2014, 8 even though this figure is clearly insufficient to meet the country's needs.…”

Section: Rationale Definition Of Cardiac Rehabilitationmentioning

confidence: 99%

Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology

Abreu

Mendes

Dores³

et al. 2018

Revista Portuguesa de Cardiologia (English Edition)

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Cardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies.In Portugal, only 8% of patients discharged from hospital after myocardial infarction are included in CR programs. In Europe overall, the percentage admitted to CR programs is 30%, while in the USA it is 20-30%.In view of the underuse of CR in Portugal, we call the attention of the health authorities to the need to increase the number and national coverage of CR programs, while maintaining high quality standards. The aim is for all patients resident in Portugal who are eligible for CR programs to have the same opportunities for access and attendance.In order to preserve the benefits and safety of this intervention, CR needs to be performed according to international guidelines. The fact that various initiatives in this field have been developed by different professional groups, some of them non-medical, that do not follow the European guidelines, has prompted us to prepare a series of norms defining mandatory criteria for CR, based on current knowledge and evidence. In this way we aim to ensure that the required * Corresponding author. E-mail address: ananabreu@hotmail.com (A. Abreu). 2174-2049Document downloaded from http://www.elsevier.es, day 07/08/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 07/08/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 364A. Abreu et al.increase in the number of CR programs, linked in a national network of CR centers, does not detract from the need to maintain their efficacy and quality. These criteria should serve as the basis for the future accreditation of CR centers in Portugal. © 2018 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia. Resumo A reabilitação cardíaca é um processo multidisciplinar de recuperação do doente após evento cardiovascular agudo ou com doença cardíaca crónica, que conduz à redução da mortalidade e morbilidade e melhoria da qualidade de vida. Considera-se uma intervenção custo-eficaz com indicação formal expressa em recomendações das mais importantes sociedades científicas internacionais. PALAVRAS-CHAVEEm Portugal, apenas 8% dos doentes com alta hospitalar após enfarte são incluídos em programas de reabilitação cardíaca. Na Europa, a percentagem de admissão nesses programas é em média de 30%, enquanto nos Estados Unidos da América esse percentual se situa entre 20-30%.Pela subutilização franca da reabilitação cardíaca em Portugal, chamamos a atenção das autoridades de saúde para a necessidade de aumentar o número e a distribuição dos programas de reabilitação cardíaca no território n...

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“…The latest surveys of CR in Portugal 41,42 show that in 2009, only 3% 41 and in 2014 only 8% 42 of ACS patients participated in phase I, II or III CR programs. Phase I was available in only 31% 41 and 40% 42 of centers in 2009 and 2014, respectively, while a psychological component was included in 43% of programs in the first survey, 41 rising to 61% in the second.…”

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confidence: 99%

“…Phase I was available in only 31% 41 and 40% 42 of centers in 2009 and 2014, respectively, while a psychological component was included in 43% of programs in the first survey, 41 rising to 61% in the second. 42 Despite improvements in recent years, access to psychological assessment and interventions during hospital stay as part of a CR program is still restricted to a few centers (no more than 40%). The ability to offer such interventions soon after ACS requires the availability of sufficient numbers of psychologists in hospitals and on CR teams to be able to provide this service.…”

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confidence: 99%

Brief psychological intervention in patients admitted after acute coronary syndrome: Essential or secondary?

Abreu

2017

Revista Portuguesa de Cardiologia (English Edition)

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Psychosocial factors have a significant effect on cardiovascular risk, to an extent that is comparable to that of hypertension or abdominal obesity.1 Acute coronary syndromes (ACS) also trigger emotional reactions that can be severe, 2,3 and an acute cardiac event or unexpected admission to an intensive care unit can be frightening and stressful.4 Studies on individuals who have suffered myocardial infarction (MI) reveal high levels of depression and anxiety (31% and 26%, respectively, before discharge, 2 as well as one and two years afterwards 2,3 ). These figures are important because depression and anxiety are independent predictors of reinfarction, 5 due to a variety of pathophysiological mechanisms including hyperactivity of the sympathetic nervous system and of the hypothalamushypophysis-adrenal axis, alterations in platelet function, inflammation, and endothelial dysfunction. 6 ---8 Studies have shown a strong association between a major stressful event and the occurrence of MI and cardiac mortality. Cardiovascular mortality increases in the weeks following the death of a loved one 9,10 and immediately after ଝ Please cite this article as: Abreu A. Breve intervenção psicológ-ica em doentes internados após síndrome coronária aguda: essencial ou acessória? Rev Port Cardiol. 2017;36:651---654.E-mail address: ananabreu@hotmail.com a terrorist attack, 11 natural disaster 12 or an important football match. 13,14 In Hospital de Santa Marta, psychological assessments have revealed that in over 50% of MI cases there was an acute stress trigger: divorce, death of a close relative, moving home, retirement, or change of employment (Abreu et al., unpublished data, presented at the 2010 Portuguese Congress of Cardiology). These patients already have causal factors related to anxiety and depression that do not disappear with the MI. It can be speculated that these predisposing factors may worsen the patient's emotional state, beyond the acute stress caused by the MI itself.Patients with depression or anxiety are hospitalized more often in the year following MI 15 and those with depression are less likely to return to work, both full time and at reduced working hours. 16This negative impact on prognosis shows the importance of identification and prompt and appropriate treatment of the emotional problems arising from ACS.A brief psychological intervention following ACS has both benefits and limitations. Nowadays, the psychological dimension should be central to any cardiac rehabilitation (CR) program, unlike in the past when such programs were mainly exercise-based. 17 CR is a structured, wide-ranging, multidisciplinary intervention that includes functional, nutritional and psychosocial components and a variety of

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Reabilitação cardíaca em Portugal. Inquérito 2013‐2014

Abstract: The number of patients admitted to CR programs, as well as the number of centers, increased considerably between 2007 and 2014 in Portugal. Despite these favorable developments, further improvements are still needed.

Cited by 21 publications

References 16 publications

A Review of Cardiac Rehabilitation Delivery Around the World

A Review of Cardiac Rehabilitation Delivery Around the World

Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology

Brief psychological intervention in patients admitted after acute coronary syndrome: Essential or secondary?

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