Care of patients and therapeutics in clinical practice has evolved based on scientific and technological advances, mainly in patients living in societies with appropriate social, educational, and economic conditions, as well as supported facilities that are able to be elicited when needed. However social disparities, whether in social and economic background or in education can vary among population subsets in a way that may hinder the proper care necessary to fulfill expected results. These disparities influence adherence that may be less than optimal. Health literacy is a public concern recognized by different agencies, including the World Health Organization (WHO). Moreover, the healthcare network in different countries may vary.

In Brazil, reports of experiences in primary care facilities, which present interesting opportunities to add to the clinical experience, were evaluated in the city of Divinópolis, in the southeastern region of Brazil, with estimated population of 242,505 inhabitants. Primary care facilities in Divinópolis are organized in 43 primary care units. In the current study, the authors evaluated 162 participants (mean age 64.8±12.7 years-old, 55.6% women) concerning chronic treatments with warfarin, 50% of which were identified due to nonvalvular atrial fibrillation or venous thromboembolism. Participants were evaluated with tests devised to check for oral anticoagulation knowledge, adherence to treatment, health literacy, and the medication complexity index. The relationship of the studied variables with the therapeutic range of INR was unclear; the sample size may well have been a key limitation to estimating associations. The mean follow-up time was 16.5 months after recruitment in March 2020. There were 16 deaths, two of which may have been related to hemorrhage and two possibly related to thromboembolism. The study revealed insufficient knowledge about warfarin therapy and low health literacy in primary care facilities.

[…]

The infarct size reduction in acute myocardial infarction (AMI) has been studied for more than 50 years. Animal experiments were conducted in the 1970s, followed by the first clinical studies to reduce infarct size (IS), with fibrinolytic agents or with mechanical coronary angioplasty (PTCA). The clinical experience of coronary reperfusion indicated that left ventricle function was not normalized in 30% of the patients, and despite unblocking the epicardial vessel, demonstrated hemodynamically, there was no equivalent in myocardial perfusion. New concepts emerged such as reperfusion injury, microvascular dysfunction, “no-reflow” phenomenon, and stunned and hibernating myocardium, which became the focus of basic research and clinical investigation. To improve characterization, different technologies were used, such as contrast echocardiography, isotopic studies, including positron emission tomography, and magnetic resonance.

Cardioprotection (CP) aims to reduce IS and improve clinical outcomes. The translation of CP from preclinical and promising proof-of-concept studies to clinical benefit (CB) for patients has been quite unsatisfactory. Almost all these studies that did not translate into CB had infarct size reduction as the primary endpoint and used protocols selected to achieve IS reduction.

[…]