Health Systems – ABC CARDIOL

ABC

Editorial

Beyond Translation: Building a Lusophone Alliance for Cardiovascular Care

The science of cardiovascular prevention has reached a plateau of implementation. Despite an extensive arsenal of effective interventions, including antihypertensive pharmacotherapy, lipid-lowering agents, tobacco control, and population-level risk reduction, the global burden of non-communicable diseases (NCDs) continues to rise, particularly in low-income and middle-income countries. But the failure is not one of discovery; it is of delivery. The prevailing model of cardiovascular evidence generation—largely produced, debated, and disseminated within high-income, research-intensive systems—has struggled to gain traction in other health-system contexts where NCDs account for the greatest share of morbidity and mortality.

Interventions validated in well-resourced, highly specialised environments will often be implemented, if at all, within systems challenged by workforce shortages, fragmented care pathways, constrained financing, and with different epidemiological profiles. As a result, evidence that is robust in principle may prove fragile in practice. Bridging this gap requires not just translation of language, but also of systems.

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ABC

Editorial

Post-COVID Syndrome or Long COVID: A New Challenge for the Healthcare System

José Geraldo Mill et al. Jéssica Polese

COVID-19 posed an unprecedented challenge to public health around the world. According to the ‘WHO Coronavirus (Covid-19) Dashboard’ (updated on 10/18/23), the disease affected 770 million people and caused 6.9 million deaths. In terms of the number of cases, Brazil occupies the 8 ^th position (38 million), rising to 2 ^nd in the number of deaths (more than 700 thousand) and, unfortunately, reaches 1 ^st in fatality rate with approximately 368 deaths/100 thousand inhabitants. These data indicate that if the pandemic was devastating for the world, it was even more drastic for the Brazilian population. The lethality of the disease worldwide was around 1%, and, also in this indicator, Brazil stands out negatively, with lethality close to 1.9%. As the disease affected a huge number of individuals, the number of survivors of the disease is also large.

Most individuals affected by SARS-CoV-2 fully recover after illness. An important portion, however, remains symptomatic for a variable period of time. The persistence of symptoms is more frequent and varied in more severe forms of the disease. In a cohort of 41 patients who required hospitalization for, on average, 9 days, 80% had reduced lung function 30 days after discharge, which persisted for up to 6 months in around 10% of patients, some of them with clear signs of restrictive pulmonary syndrome, limiting factor for physical effort. ^,

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IJCS

Original Article

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Gabriela de Oliveira Salazar et al. Glessiane de Oliveira Almeida José Augusto Soares Barreto-Filho Marcos Antônio Almeida-Santos … Enaldo Vieira de Melo Felipe J. Aidar José Ícaro Nunes Cruz Joselina Luzia Menezes Oliveira Leonardo Baumworcel Antônio Carlos Sobral Sousa

Abstract

Background:

It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool.

Objective:

To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN).

Methods:

This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level.

Results:

Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474).

Conclusion:

Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

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ABC

Research Letter

Impact of COVID-19 on the Life of Brazilian Cardiologists and Cardiovascular Surgeons

Andre Luiz Cerqueira Almeida et al. Marcelo Melo Rodrigo Elton Ferreira Rodrigues Luis Fábio Botelho … Paulo André Abreu Almeida Silvio Henrique Barberato

Introduction

The COVID-19 (from the English coronavirus disease) pandemic has had a strong impact on cardiology services. The number of visits and cardiac interventions has decreased in many parts of the world in recent months.^, However, despite increasing pressure and burden on the healthcare system, the provision of care has continued, particularly because patients with pre-existing cardiovascular disease are at high risk of COVID-19 infection, complications, and primary cardiac manifestations.

In addition, effects of the COVID-19 have affected the society and in particularly healthcare professionals in terms of physical and mental health consequences, financial disturbances, and changes in quality of life.^– Therefore, the COVID-19 pandemic has affected many aspects of the work and life of health care providers.^,,

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ABC

Artigo Original

Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control

Alfredo Dias Oliveira-Filho et al. José Augusto Barreto-Filho Sabrina Joany Felizardo Neves Divaldo Pereira de Lyra Junior

BACKGROUND: Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood pressure (BP). OBJECTIVE: To determine the association between treatment adherence measured by a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8) and BP control in hypertensive outpatients. METHODS: A cross-sectional study was carried out with hypertensive patients older than 18 years, treated at six of the Family Health Strategy Units in Maceió (AL), through interviews and home blood pressure measurements, between January and April 2011. Adherence was determined by MMAS-8 version translated for this study. The patients were considered adherent when they had a score equal to 8 at the MMAS-8. RESULTS: The prevalence of adherence among the 223 patients studied was 19.7%, while 34% had controlled BP (> 140/90 mmHg). The average adherence value according to the MMAS-8 was 5.8 (± 1.8). Adherent patients showed to be more prone (OR = 6.1, CI [95%] = 3.0 to 12.0) to have blood pressure control than those who reached mean (6 to <8) or low values (<6) at the adherence score. The Portuguese version of MMAS-8 was showed a significant association with BP control (p = 0.000). CONCLUSION: The diagnosis of non-adherent behavior through the application of MMAS-8 in patients using of antihypertensive medications was predictive of elevated systolic and diastolic BP.

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Beyond Translation: Building a Lusophone Alliance for Cardiovascular Care

Post-COVID Syndrome or Long COVID: A New Challenge for the Healthcare System

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Impact of COVID-19 on the Life of Brazilian Cardiologists and Cardiovascular Surgeons

Introduction

Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control

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