Health Education – ABC CARDIOL

IJCS

Editorial

Education and Training in Pediatric Cardiac Critical Care: An Essential Tool to Improve Outcomes

Klebia Castello Branco et al. Jorge Yussef Afiune

In an article published in the International Journal of Cardiovascular Sciences, Campos and Carvalho examine the challenges of educating and training teams in pediatric cardiac critical care in developing countries. They also highlight emerging opportunities for improvement and growth.

In recent decades, substantial advances have been made in the field of pediatric cardiology, including progress in pediatric cardiac surgery, catheter-based interventions, anesthesia, cardiac imaging and monitoring, neonatal and pediatric critical care, mechanical circulatory support, and the expansion of multidisciplinary teams. These advances have led to significant improvements in outcomes for children with congenital and acquired heart disease. However, congenital heart disease still places a significant burden on health care systems, especially in low- and middle-income countries.

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IJCS

Original Article

Innovative Health Education Strategies: Training Professionals in Hypertension and Diabetes Care in Primary Health Care

Thiago Barbabela de Castro Soares et al. Priscila Lenita Candida dos Santos Regina Márcia Faria de Moura Daisy Motta-Santos … Reginaldo Gonçalves Polianna Delfino Pereira Daniella Nunes Pereira Clara Rodrigues Alves de Oliveira Lilian Cristina Rezende Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and behavioral changes are a cornerstone of their prevention and treatment. However, implementing such changes can be challenging, and the use of validated protocols may support this process.

Objectives:

To develop, implement, and evaluate a continuing education protocol for primary care professionals focused on creating and monitoring action plans for the care of patients with arterial hypertension (AH) and diabetes mellitus (DM).

Methods:

The strategy involved 20 hours of in-person workshops and 15 hours of online training, based on Ministry of Health guidelines and covering topics such as physical activity, nutrition, and lifestyle. Evaluation was conducted through the development of team-based action plans and the administration of a satisfaction questionnaire.

Results:

The model was implemented in five municipalities, with 166 healthcare professionals participating in the in-person workshops. All teams developed action plans to implement the covered topics within their local contexts. The workshops on physical activity, nutrition, and lifestyle change were mostly rated as “good,” “very good,” or “excellent.” The most frequently mentioned terms in the qualitative assessments were “content,” “knowledge,” and “practices.” The strategy proved feasible, and partnerships with local public institutions enabled the active involvement of health professionals in proposing solutions to identified issues ().

Conclusion:

The action plans were tailored to local realities and reflected a high level of satisfaction with both the content and the hands-on approach of the sessions.

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IJCS

Editorial

Challenging Health Literacy, Patient Knowledge, and Adherence to Oral Anticoagulation in Primary Care Units

Alfredo José Mansur

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.

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Original Article

Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin

Hannah Cardoso Barbosa et al. Heloisa de Carvalho Torres João Antônio de Queiroz Oliveira Rebeca Priscila de Melo Santos … Josiane Moreira da Costa Leonardo Gonçalves Miranda Adriana Silvina Pagano Marcus Fernando da Silva Praxedes Maria Auxiliadora Parreiras Martins

Abstract

Background

Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy.

Objective

The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients.

Methods

The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population.

Results

Relevance, adequacy, clarity, and internal reliability of the instrument’s items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96.

Conclusion

EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.

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Editorial

Use of Warfarin in Oral Anticoagulation Therapy: Challenges and EmpoderACO Strategy for Promoting Patient Empowerment in Self-Care

Carina Carvalho Silvestre et al. Sabrina Cerqueira-Santos

Warfarin is an oral anticoagulant widely used for primary and secondary prevention of thromboembolism that belongs to the class of vitamin K antagonists.^, In Brazil, warfarin is still the main oral anticoagulant distributed free of charge by the Unified Health System. According to the Institute for Safe Practices in the Use of Medicines (ISMP – Brazil), warfarin is classified as a high-alert or potentially dangerous drug since it has a low therapeutic index and its use requires constant attention for the drug to act in the prevention of thromboembolic events without increasing the risk of hemorrhages.^, Furthermore, it appears as one of the drugs that should be the target of priority actions for the prevention of damage, according to the Third Global Patient Safety Challenge of the World Health Organization Health.

Management of anticoagulant therapy with warfarin is a challenge for many patients. It requires procedures that are considered complex, such as the regular measurement of the international normalized ratio (INR), the interpretation of the results to adjust the drug dose by the responsible team, as well as the adequate understanding of the factors that may influence its effectiveness and safety, such as adverse reactions and interactions with other drugs and foods.^, Thus, strategies are needed to help in the proper and safe use of the medication and contribute to understanding its use process and consequent adherence to treatment.

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IJCS

Original Article

Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community?

Rafaella Zulianello dos Santos et al. Andrea Schaefer Korbes Eliara Ten Caten Martins Mateus De Lucca … Leonardo De Lucca Marlus Karsten Magnus Benetti

Abstract

Background:

Increased level of physical activity (PA) and health education are known as non-pharmacological treatments of hypertension (HP). There is a lack of studies investigating the influence of HP knowledge on the level of PA among hypertensive patients.

Objective:

To examine the influence of patient’s knowledge about HP on PA level and the relationship between these variables.

Methods:

A cross-sectional study was conducted in in a primary care center located in a city in the southern Brazil. A total of 199 hypertensive patients (median 61.2 [13] years; body mass index (BMI) 21.9 (7.5) kg/m2; 72.4% women) were included. The level of PA was assessed by measuring the number of steps taken daily. The knowledge about HP was assessed by a standardized questionnaire (HIPER-Q). The Kruskall-Wallis test was used to compare age, BMI and PA level between HP knowledge categories, and the Spearman test was used to assess correlations (p <0.05).

Results:

The median score of knowledge about HP for patients categorized as insufficient (n=6, 3%), poor (n=24; 12.1%), acceptable (n=101; 50.8%) and good (n=68; 34.2%) was 11.0 (8.0), 20.0 (4.0), 26.0 (5.0) and 38.0 (2.0), respectively. No patient has achieved an “excellent” level of knowledge. There was no significant difference in PA level (p = 0.341), BMI (p = 0.510) or age (p = 0.073) between these categories. Age was negatively correlated with knowledge about HP (p <0.05 and rho = 0.02).

Conclusions:

Patient’s knowledge about HP did not influence the level of PA in hypertensive patients. Age, number of steps per day and BMI were not significantly different between the categories of knowledge. Public policies and organizational strategy should be addressed to improve health education and avoid sedentary behavior in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Editorial

Lifestyle and Medication Costs May Be Associated with Consequences for Adult Patient Health

Abrahão Afiune Neto

The increase in health costs can be explained by several factors, such as the aging of the population, changes in the morbidity and mortality structures of the population and the introduction of new medical technologies in the diagnosis and treatment of diseases.

Moreover, the guarantee of the appropriate and safe use of the medications also covers clinical, economic, legal, regulatory, and cultural aspects that must be taken into account in the decision-making process in the health sector. The first study on the economic analysis of medications was published in 1979 by Bootman et al.

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Editorial

CADE-Q SV: Practical and Relevant in the Assessment of Patients with Cardiovascular Diseases regarding their Health Condition

Juliana Beust de Lima

Cardiovascular diseases (CVD) remain the leading cause of death worldwide. According to estimates by the World Health Organization (WHO), approximately 17.9 million individuals die per year due to this clinical condition. In Brazil, a registry of the Brazilian Society of Cardiology shows an increase in mortality over the years, affecting 383,961 individuals in 2017.

Considering the strong association of CVD with morbidity and mortality, as well as the impairment of functional capacity and quality of life shown by these patients, strategies aimed at minimizing these impairments and that can be shown to be cost-effective should be implemented. In this scenario, cardiovascular rehabilitation (CVR) is crucial and should be part of the overall treatment of CVD.

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IJCS

Original Article

Adherence score for Users of Oral Anticoagulants

Sérgio Henrique Simonetti et al. Ana Cristina Mancussi e Faro Estela Regina Ferraz Bianchi

Abstract

Background:

The score is an effective instrument for the assessment of treatment adherence in users of oral anticoagulants and maintenance of INR (international normalized ratio) within the therapeutic range.

Objective:

To develop an adherence score for oral anticoagulant users for the maintenance of INR within the therapeutic range.

Methods:

This was an analytical, observational, cross-sectional study, with a quantitative approach, conducted in a public cardiology hospital. A total of 607 patients who met the inclusion criteria were evaluated. Variables with a significance level of 5% in the exploratory analysis and considered clinically relevant were included and subjected to a multiple logistic regression model. Predictive accuracy of the model was determined using the C statistic.

Results:

The variables with a significance level of 5% in the multivariate analysis were: education, family income, inadequate use of medications, drug-drug interactions, invasive procedures, food-drug interactions, physical activity, medical conditions, other factors, and complications related to oral anticoagulant therapy. The following prognostic variables were identified: family income, inadequate use of medications, invasive procedures, drug-drug interactions, dietary habits, medical conditions, other factors (stress, thinness, weight loss). C-statistic for adherence score was 0.94.

Conclusion:

The Simonetti adherence score proved to be easily applicable and feasible, with high predictive value for influencing factors, promoting the improvement of adherence and maintenance of INR in the ideal range. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

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Original Article

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

Rafaella Zulianello dos Santos et al. Christiani Decker Batista Bonin Eliara Ten Caten Martins Moacir Pereira Junior … Gabriela Lima de Melo Ghisi Kassia Rosangela Paz de Macedo Magnus Benetti

Abstract

Background:

The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients.

Objective:

To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease.

Methods:

A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis.

Results:

The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension.

Conclusion:

The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

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IJCS

Original Article

Matricial Support and Arterial Hypertension Control

Clóvis Hoepfner et al. Morgana Longo Andressa de Oliveira Coiradas Laíssa Mara Rodrigues Teixeira

Abstract

Background:

A continuing education program for health professionals improves their performance and increases hypertension control rates.

Objective:

To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals.

Methods:

A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007.

Results:

There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensin-converting-enzyme inhibitors.

Conclusion:

There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective.

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Original Article

Education to a Healthy Lifestyle Improves Symptoms and Cardiovascular Risk Factors – AsuRiesgo Study

Graciela Chaves et al. Nidia Britez Judith Munzinger Lorenz Uhlmann … Graciela Gonzalez Guillermo Oviedo Victoria Chaparro Oscar Achon Thomas Bruckner Meinhard Kieser Hugo A. Katus Derliz Mereles

Background:

Cardiovascular diseases are the current leading causes of death and disability globally.

Objective:

To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population.

Methods:

All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association’s 2020 parameters of cardiovascular health were assessed.

Results:

A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments.

Conclusion:

A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence.

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Artigo Original

Therapeutic inertia and control of high blood pressure in primary health care units

Clóvis Hoepfner et al. Selma Cristina Franco

BACKGROUND: The importance of adequate management and control of high blood pressure (HBP). OBJECTIVE: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at primary health care units (PHCU) in the city of Joinville, as well as the associated factors. METHODS: A cross-sectional study, which included cluster sampling and analysis of medical records, with the evaluation of 415 patients with high blood pressure. We evaluated the blood pressure (BP), increments of therapy, risk factors and comorbidities. RESULTS: There was prevalence of females and nursing appointments. The age ranged between 28 and 90 years (mean of 61.5 years). There was a reduction in the mean BP (155.8 ± 20.8/95.7 ± 10.6 mmHg to 140.3 ± 22/84.1 ± 12.4 mmHg) between the first and last record and the final normal BP in 36.6% of patients, with similar results for men and women. Over the past 12 months, the BP was high on 1,295 occasions, and there was a therapeutic increment on only 156 occasions (12.0%). 1.85 drugs were used per patient, mainly diuretics and ACE inhibitors. There was high prevalence of obesity (40%), diabetes (41%), high LDL (46%) and left ventricular hypertrophy (25.5%). CONCLUSION: The high therapeutic inertia, low control of high blood pressure and the large number of comorbidities suggest the need for continuing education programs for health professionals and other measures to improve the disease control in primary health care units.

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Artigo Original

Influence of financial subsidy and venue on advanced cardiac life support courses, in the learning of cardiovascular emergency

Heberth C. Miotto et al. Eugênio M. A. Goulart Carlos Faria Santos Amaral Maria da Consolação V. Moreira

BACKGROUND: The success in learning of emergency depends on many factors that can be summarized as: student, instructors and course. OBJECTIVE: To evaluate the influence of financial subsidy and venue of course in learning cardiovascular emergency. METHODS: Data were analyzed regarding the courses of Advanced Cardiac Life Support (ACLS) in the period from December 2005 to December 2006. In agreement with the financial subsidy, they were divided in: group 1 – integral subsidy; group 2 – subsidy of 50%; and group 3 – without subsidy. As for the venue of the course, they were divided in: locality A – study in city with> 1 million inhabitants; and locality B – study in city with <1 million inhabitants. The practical and theoretical approval and the theoretical average were compared. RESULTS: 819 students participated in ACLS: 199 (24%) in group 1, 122 (15%) in 2 and 498 (61%) in 3. The practical and theoretical approval and the average in the theoretical exam were greater in group 3 than in other groups (p <0.05). Four hundred and eighty two (482) took the course in venue A (59%) and 337 (41%) in venue B. The practical approval was similar for both groups (p = 0.33), however the theoretical approval was greater in venue A (73% vs. 65% – p = 0.021 – OR = 1.44 and IC: 1.05 – 1.97). The theoretical average was greater in venue A (87.1 ± 10.4 and 86 ± 11, respectively p <0.05). CONCLUSION: The financial subsidy and venue of the course had influence in the theoretical and practical approval.

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Artigo Original

Guide of internet sites for the study of cardiology

Luciana Aikawa et al. Denise Cássia Moreira Zornoff Beatriz Bojikian Matsubara

OBJECTIVE: To increase the offer of didactic resources for medical students, physicians, and health care professionals, stimulating the use of the Internet for academic purposes or cardiological updating. METHOD: Electronic addresses with academic content in the areas of anatomy, biophysics, physiology, semiology, electrocardiography, and image diagnosis were researched and selected. The selection criteria included the following: relevance of the content, neatness of presentation, and richness of animation resources. The sites obtained were classified in regard to their contents and academic level. RESULTS: The sites obtained were as follows: 5 sites of anatomy and anatomical pathology, one of biophysics, 3 of physiology, 8 of semiology, 7 of image diagnosis, and 2 of electrocardiography. The sites were also organized according to academic level to provide an alternative access. The set of addresses resulted in a simplified and hierarchic guide of contents for the study of cardiac morphology and image diagnosis in cardiology. CONCLUSION: The resulting list of sites is an example of the potential of the Internet as a learning instrument to be used in association with other conventional pedagogical methods.

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