Primary Health Care – ABC CARDIOL

IJCS

Original Article

Cardiovascular Risk Stratification and Low-Density Lipoprotein Cholesterol Target Achievement in Primary Health Care: A Cross-Sectional Study

Gabriel Olivo Leandro et al. Pedro Henrique Daniel Abreu Samantha Cristiane Lopes Silvia Rozauria Froes Toniazzo

Abstract

Background:

Cardiovascular diseases (CVDs) remain the leading cause of mortality in Brazil. Effective dyslipidemia management is essential for preventing major adverse cardiovascular events (MACE); however, previous studies have reported low rates of lipid target achievement and inadequate statin prescribing in primary health care (PHC) settings.

Objective:

To evaluate low-density lipoprotein cholesterol (LDL-C) target achievement and the appropriateness of statin prescriptions according to cardiovascular risk among patients receiving PHC in a medium-sized Brazilian city.

Methods:

This cross-sectional study was conducted in 18 PHC units in Rio do Sul, Santa Catarina, Brazil, between January 13 and May 30, 2025. The study included 180 adults aged 30-59 years of both sexes who had been followed for at least 6 months and had a lipid profile assessment within the previous year. Cardiovascular risk was estimated using the Framingham Risk Score. Data were analyzed using the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Statistical significance was set at p < 0.05.

Results:

Among the 180 participants, 95 (52.7%) did not achieve LDL-C targets. LDL-C goal attainment was more frequent among low-risk (85.7%) and intermediate-risk (23.9%) individuals and less frequent among high-risk (15.1%) and very high-risk (0.0%) individuals. Cardiovascular risk was significantly associated with lipid control (p < 0.05). Median LDL-C was 106.8 mg/dL (Interquartile Range (IQR), 88.4-136.2), with significant differences across risk categories (p < 0.05). Among the 56 statin prescriptions identified, only 26 (46.4%) were consistent with guideline-recommended statin intensity.

Conclusion:

The low rate of LDL-C target achievement and the high prevalence of inadequate statin therapy highlight the need for more effective lipid management strategies and structured interventions in PHC.

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IJCS

Original Article

Protocol for Improving Hypertension and Diabetes Control Through Lifestyle Intervention in a Cluster Randomized Clinical Trial

Daisy Motta-Santos et al. Thiago Barbabela de Castro Soares Maria Cecília Ramos de Carvalho Regina Márcia Faria de Moura … Sueli Ferreira da Fonseca Larissa Morelli Ferraz Guimarães Reginaldo Gonçalves Clara Rodrigues Alves de Oliveira Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Hypertension and Diabetes Mellitus (DM) are prevalent chronic conditions and major risk factors for cardiovascular diseases. Adequate control of these conditions is challenging, and lifestyle changes are crucial to achieving better management.

Objectives:

To evaluate the effectiveness of a multifaceted and multidisciplinary intervention to improve the control of hypertension and DM in the primary care setting.

Methods:

This cluster randomized clinical trial focuses on lifestyle modifications for managing hypertension and DM, addressing gaps in current non-pharmacological interventions. Primary care professionals are trained to promote health education on physical activity and nutrition. Support is provided through a telementoring program, including messaging app communication, biweekly online meetings (teletutoring), and asynchronous teleconsultations. Primary care professionals conduct twice-weekly group activities with structured intensity adjustments and biweekly health education sessions using interactive methods like conversations, games, and group dynamics. For patients unable to join group activities, brief counseling and guidance on unsupervised physical activity are offered.

Results:

The primary outcomes are blood pressure and glycated hemoglobin values. The innovative intervention program aims to empower primary care professionals and reduce barriers to care through lifestyle changes, improved health education, and support systems for both supervised and unsupervised interventions. Conclusions: Supporting primary care professionals through education and remote assistance can enhance the effectiveness of lifestyle interventions, contributing significantly to the control of hypertension and DM in primary care settings. Trial registration: Previously registered with .

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Editorial

Beyond Translation: Building a Lusophone Alliance for Cardiovascular Care

Flávia Geraldes

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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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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Editorial

Combining Technology with Quality in Medical Care

Luiz Maurino Abreu

First, the X-ray, and then the electrocardiogram, revolutionized the diagnostic approach in cardiology. Medical devices become more sophisticated every day, with the increasing use of diagnostic tools, now offering the possibility of remote transmission of exams, anticipating diagnosis, and allowing the application of care protocols and therapeutic decisions.

In cardiology, with the transmission of the electrocardiographic tracing to Cardiological Centers in real-time, which at first was done through facsimile devices, and later, with devices with internet transmission, it was possible to adopt treatment protocols, with impact on lethality and function prognosis. Teleconsulting programs in the context of acute myocardial infarction, with transmission of an electrocardiogram performed at the first place of care, for this purpose, were developed in Rio de Janeiro (TIET Project), Salvador, São Paulo and Minas Gerais (Minas Telecardio), all within the public health system (Sistema Único de Saúde – SUS), where the safety and benefit of using Teleconsultation was demonstrated, shortening the time to perform the most appropriate revascularization method.

[…]

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IJCS

Original Article

Association Between Active Commuting and Cardiometabolic Diseases in Primary Health Care Users

Lucas Bressan Pes et al. Gustavo Olszanski Acrani Ivana Loraine Lindemann Shana Ginar da Silva

Abstract

Background

Although active commuting is inversely related to cardiovascular disease risk factors, these associations are unknown among Brazilian primary health care users.

Objective

To investigate the association between active commuting to daily activities and the prevalence of cardiometabolic diseases.

Methods

This cross-sectional study, conducted between May and August 2019, included primary health care users from all 34 primary health care centers in Passo Fundo, a city in southern Brazil. Cardiometabolic diseases (type 2 diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, cardiovascular diseases, and overweight/obesity) were measured by self-reported medical diagnosis using a questionnaire. Active commuting was analyzed dichotomously: daily commuting on foot or by bicycle was considered active, while daily commuting by car, motorcycle, or bus was considered passive. To determine the association between cardiometabolic diseases and active commuting, crude and adjusted prevalence ratios (PR) were estimated using Poisson regression, considering p <0.05 significant.

Results

The sample consisted of 1443 patients. There was an inverse association between active commuting and type 2 diabetes (PR: 0.59; 95% CI [Confidence Interval]: 0.39-0.90) and overweight/obesity (PR: 0.83: 95% CI: 0.71-0.98).

Conclusion

A lower prevalence of type 2 diabetes and obesity/overweight was observed in people who actively commute. These findings indicate that changes in urban infrastructure to enable safe active commuting will positively impact the health of the population.

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IJCS

Original Article

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

Milena Soriano Marcolino et al. Thaís Lorenna Souza Sales João Antônio de Oliveira Danyelle Romana Alves Rios … Thaís Marques Pedroso Laura Caetano de Sá Maria Auxiliadora Martins Antonio Luiz Pinho Ribeiro

Abstract

Background

Warfarin is the only oral anticoagulant available in the Brazilian public health system. Health knowledge and treatment are essential to achieving the desirable therapeutic effect. However, data on these aspects among primary care patients are still lacking.

Objective

To assess health literacy, patient knowledge, and adherence to oral anticoagulation with warfarin, as well as the medication regimen complexity in primary health units in the municipality of Divinópolis, Minas Gerais, Brazil.

Methods

This cross-sectional study included patients using warfarin from primary care settings. Sociodemographic and clinical data were collected from medical records. Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), Oral Anticoagulation Knowledge (OAK), adaptation of the Measure of Adherence to Treatment (MAT-adapted) to oral anticoagulation, and Medication Regimen Complexity Index (MRCI) were applied, and the time in therapeutic range (TTR) was calculated. Patients were stratified in two groups (TTR < 60% and TTR ≥ 60%) and compared using Fisher's exact test at a significance level of p < 0.050.

Results

Analysis included 162 patients (64.8 ± 12.7 years old, 55.6% women). Nonvalvular atrial fibrillation (26.5%) and venous thromboembolism (24.1%) were the main indications for warfarin, and 67.9%, 88.3%, and 16.7% of the patients had inadequate health literacy, insufficient knowledge regarding anticoagulant therapy, and non-adherence to warfarin therapy, respectively. There was no significant association of these parameters in relation to TTR. MRCI showed high pharmacotherapy complexity between the drug prescriptions.

Conclusion

This study showed alarming insufficient knowledge about warfarin therapy and low health literacy in primary care patients.

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Editorial

Human Development Index and Chronic Diseases in Brazil between 1980 and 2019

Alfredo José Mansur et al. Lucia Pereira Barroso

The human development index synthesizes dimensions of human societies taking into consideration life expectancy at birth, education, and standard of living. Life expectancy is an expression of the health conditions of a particular population. Education is expressed as years of schooling. The standard of living is indicated by gross national income per capita. It is recognized that the human development index does not encompass every social determinant of the experience of citizens of a specific human society. Nonetheless, it is useful and a recognized methodological approach for measurements and comparisons; however, inequalities, poverty, human security, empowerment, and other characteristics may be missed.^, That said, it is always opportune for the medical-scientific community to bear in mind the dimensions examined in the human development index and to develop recurrent studies and updates over time, as the conditions in which human societies live are dynamic.

In the current study, the authors evaluated the human development index in Brazil over four decades (1980-2019). The data (the underlying cause of death) were retrieved from death certificates in a Unified Health System (SUS) public database relative to chronic non-infectious diseases with time series analyses. Mortality was corrected for 100.000 inhabitants distributed in quartiles in each Brazilian state.

[…]

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IJCS

Editorial

Exercise-induced Bronchoconstriction and its Relevance in Public Health

Tales de Carvalho

The case report from Castro et al., entitles Exercise-Induced Bronchoconstriction: A Frequent, but Neglected Cause of Chest Pain, opportunely sheds light on a highly relevant question in terms of public health, as it treats important aspects that encompass from the diagnosis to the pharmacological treatment of Exercise-Induced Bronchoconstriction (EIB).^–

EIB often leads to an isolated cough, as well as thoracic and abdominal pain, which should always be contemplated after having discarded other causes of dyspnea and exercise-induced chest pain.^– It is an acute airway obstruction that is transitory and spontaneously reversible, and occurs during and after exercise and physical effort, regardless of the previous diagnosis of bronchial asthma. EIB normally arises 2 to 5 min after exercise, reaching a peak at 10 min and disappearing in up to 60 min.^,,

[…]

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Letter to the Editor

Previous Chronic Diseases and their Relationship with COVID-19 Infection

Bruna Redivo de Souza et al. Eliane Mazzuco Layse Wiggers Kemper

Dear editor,

Due to the current global pandemic, the subject addressed is of great relevance. It is known that there is a certain urgency in the production and dissemination of scientific and epidemiological data about the new Coronavirus. Therefore, research that helps profile the population most vulnerable to this disease contributes to preventing an even greater number of deaths and sequelae resulting from COVID-19.

[…]

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Original Article

Characteristics and Temporal Trends in the Mortality of Different Heart Failure Phenotypes in Primary Care

Antonio José Lagoeiro Jorge et al. Leticia Mara dos Santos Barbetta Eduardo Thadeu de Oliveira Correia Wolney de Andrade Martins … Adson Renato Leite Maria Auxiliadora Nogueira Saad Márcia Maria Sales dos Santos Dayse Mary Correia Maria Luiza Garcia Rosa Sérgio Chermont Cárita Cunha dos Santos Evandro Tinoco Mesquita

Abstract

Background:

The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice.

Objective:

The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting.

Methods:

This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease.

Results:

Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001).

Conclusion:

The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.

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IJCS

Original Article

Optimal Cutoff of the TG/HDL-c ratio for Cardiovascular Risk in Hypertensive and Diabetic Patients Monitored by Primary Health Care in a city in Minas Gerais

Eunice Ferreira da Silva et al. Rosângela Minardi Mitre Cotta Érica Toledo Mendonça Deíse Moura de Oliveira … Silvia Almeida Cardoso Renata Maria Colodette Tiago Ricardo Moreira

Abstract

Background

The analysis of the atherogenic potential of the lipid profile for biomarkers, such as the TG/HDL-c ratio, predicts cardiovascular risk better than isolated lipids.

Objective

To identify the TG/HDL-c cutoff points for multiple risks (hypertension, Diabetes Mellitus, obesity) and to evaluate the association between sociodemographic, clinical, laboratory, anthropometric, and life habit variables and the TG/HDL-c ratio in hypertensive and/or diabetic individuals in the context of Primary Health Care.

Methods

This was a cross-sectional study with 833 hypertensive and/or diabetic patients, conducted between August 2017 and April 2018. The cutoff point of the TG/HDL-c were obtained by the ROC curve. Cardiovascular risk was discriminated by TG/HDL-c, categorized by the cutoff and evaluated in relation to multiple risks. The magnitude of the association between TG/HDL-c and independent variables was estimated by logistic regression. The significance level of p<0.05 was adopted for all tests.

Results

The cutoff values of TG/HDL-c (3.26 for men and 2.72 for women) were more sensitive and less specific than those in the literature. Women (OR=1.90 and 95% CI 1.13-3.20) and men (OR=4.58 and 95% CI 1.78-11.76) with multiple risks, and white men, alcohol users, with a history of stroke, had a higher chance of altered GT/HDL-c. Increases in glycosylated hemoglobin, glycemia, and phosphorus in women, and cholesterol, glycemia, and microalbuminuria in men increased the chances of altered TG/HDL-c. Being a former smoker and black reduced the chance of altered TG/HDL-c in women.

Conclusions

TG/HDL-c proved to be a good indicator for habitual use in Primary Care.

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IJCS

Original Article

Cardiovascular Risk Profile of a Young Adult Women Population Assisted in Primary Care

Tomás de Souza Mello et al. Mariana Stutz Klen Rafael Bellotti Azevedo Fernanda Costa Barradas … Luiza Araújo Nogueira Natália Rossilho Moyses Ushijima Rafael Barbosa da Silva Bica Elizabeth Silaid Muxfeldt

Abstract

Background

Although cardiovascular disease is a major cause of death among women, cardiovascular risk assessment in young women is frequently postponed due to a number of factors.

Objectives

To assess cardiovascular risk of young adult women living in one of Rio de Janeiro’s Family Health Strategy geographical units in the city’s central area.

Materials and Methods

populational, cross-sectional study with adults between 20 and 50 years old. Sociodemographic characteristics such as educational level and employment status were recorded. Anthropometric measurements, traditional cardiovascular risk factors, gynecological and gestational history, and selected laboratory exams were assessed. The bivariate analysis compared the baseline characteristics of the population between genders and the prevalence of cardiovascular risk factors in women according to educational level and occupation status, using non-paired Student’s t-test for normal continuous variables, Mann-Whitney test for asymmetrical continuous variables, and chi-square test for categorical variables. A significance level of 5% (p < 0.05) was adopted.

Results

A total of 710 individuals were enrolled. In women, who comprised 59.7% of our sample, central obesity and a sedentary lifestyle were more prevalent, whereas smoking and hypertension were less observed. However, women with lower educational status had a higher prevalence of smoking and hypertension. In hypertensive women, factors such as early menopause, higher prevalence of hypertensive disorders of pregnancy and higher number of pregnancies were noticed.

Conclusion

An adverse cardiovascular risk profile in our population of young women was particularly influenced by central obesity, sedentary lifestyle, hypertensive disorders of pregnancy and lower educational status.

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IJCS

Original Article

Potential Impact of the New American High Blood Pressure Guidelines on Hypertension Prevalence in a Primary Health Care Unit in Rio de Janeiro – the LapARC Study

Marcelle Guimarães de Oliveira et al. Angélica Furriel de Almeida da Silva Taissa Lorena dos Santos Mariana Loureiro Cunha … Bruna Rosenbrock Ferreira Taveira Elizabeth Silaid Muxfeldt

Abstract

Background

The new American Heart Association guidelines for hypertension (HT) proposed a reduction of the diagnostic cut-off point, leading to a substantial increase in the prevalence of HT.

Objectives

To assess the prevalence of HT determined by the traditional criteria, the AHA criteria, and home blood pressure monitoring (HBPM) in a population of young adults attending a primary healthcare unit, and its association with cardiovascular risk.

Methods

A cross-sectional population study on adults aged from 20 to 50 years attending a primary healthcare unit, in Rio de Janeiro, Brazil. Sociodemographic and anthropometric data, cardiovascular risk factors, office blood pressure and HBPM were registered. The diagnosis of HT was defined by traditional criteria (office BP ≥ 140 x 90 mmHg) and by the new (AHA) criteria (office BP ≥ 130 x 80 mmHg). Bivariate analysis was used for comparisons between the two diagnostic criteria, and Kappa coefficient was used to assess the agreement in diagnosis between office BP and HBPM. The level of significance adopted was 5% (p<0.05).

Results

A total of 472 individuals were evaluated (male: 39%; mean age: 38.5 ± 8.7 years). The prevalence of HT was 23.5% and raised to 41.1% with the new AHA criteria. The prevalence of HT using HBPM was 25.5%, but the diagnostic agreement was low (kappa=0.028) with changes in diagnosis in 18% of the cases.

Conclusion

The prevalence of HT almost doubled with the new AHA diagnostic criteria for HT. HBPM seemed to be an important instrument in HT diagnosis in this population. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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Letter to the Editor

Response to “Readmission of Patients with Acute Coronary Syndrome and its Determinants”: An Overview of PHC

Laís Cruz Lima et al. Eliane Mazzuco André Luís Prudêncio

Reply

We are thankful to the comments and for the interest in our study, which is about a relevant topic, i.e., readmission of patients with acute coronary syndrome (ACS) and its determinants to both public hospitals (Brazil’s public health system — SUS) and private hospitals. A better understanding of the findings we reached, which certainly reflect what happens in the country, will result in benefits for the therapeutic approach of those who have this major disease.

The expressive rate of readmissions observed, which certainly has a significant impact on health costs, results not only from clinical factors, but also from the type of assistance received by the patient, both during hospitalization and after discharge. It is worth noting that about 72% of the Brazilian population depends exclusively on the public health system. Therefore, as we said, Primary Health Care (PHC) can play a pivotal role in the adoption and reinforcement of secondary prevention measures that will surely be successful for those particularly affected by ACS. According to Ordinance No. 2436 of the Ministry of Health, published on 21/9/2017, Brazil’s Policy on Primary Health Care provides for the longitudinality of care, with monitoring of the effects of health interventions and coordination of care. Therefore, person-centered care, also advocated in this ordinance, places PHC in a fundamental role of helping patients to develop knowledge, skills and competence to better take care of their own health. Health education actions are essential to stress self-care and the prevention of subsequent readmissions. Finally, co-responsibility between health professionals and patients in the implementation of actions to prevent complications of the disease, health promotion and proper therapeutic adherence can positively influence the reduction of readmission rates.

[…]

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IJCS

Original Article

Increased Left Atrial Volume and Its Relationship to Vitamin D in Primary Care

Erica de Abreu Macedo et al. Maria Luiza Garcia Rosa Antônio José Lagoeiro Jorge Adson Renato Leite … Leivys Henrique Silva Santos Juliana Salge Vieira

Abstract

Background:

The study is based on the fact that left atrial (LA) volume measurement is a marker of the presence of diastolic dysfunction and that Vitamin D deficiency may be associated with ventricular remodeling, worsening of left ventricular (LV) diastolic and systolic function, and activation of the renin-angiotensin-aldosterone system.

Objective:

To evaluate whether LAV changes are related to vitamin D deficiency.

Method:

A cross-sectional, population-based, unicentric study in which 640 patients over 45 years of age enrolled in the Niterói’s Médico de Família program, RJ, were evaluated. Patients were submitted to tissue Doppler echocardiography to evaluate the parameters of diastolic and systolic function and vitamin D dosage. The presence or absence of hypovitaminosis D associated with structural and functional cardiac changes was compared between each group. A p < 0.05 value was considered as an indicator of statistical significance.

Results:

Of the 640 individuals analyzed, hypovitaminosis D was confirmed in 39.2% of the patients, of whom 34.8% had diastolic dysfunction. The most relevant echocardiographic parameters that were statistically significant were non-indexed AEDs and LAV, E’/A’ and E wave deceleration time, which were associated with the presence of hypovitaminosis D (P < 0.01).

Conclusion:

The study of the association of hypovitaminosis D and the appearance of structural and functional cardiac abnormalities may contribute to the discussion of the adoption of one more criterion to select individuals at risk of developing clinical cardiac insufficiency in primary care since, with the use of echocardiography, the subclinical condition of cardiac involvement, with prognostic and treatment implications for the referred patients with hypovitaminosis D, can be identified early.

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Editorial

The Freedom of Clinicians and the Art of the Impossible

Systemic arterial hypertension – or simply hypertension, in casual language – is considered the major and most common risk factor for death and disability of non-communicable diseases.^, Its prevalence in Europe ranges from 30% to 45%. In the United States, two thirds of the adults older than 60 years are hypertensive. In South Asia and Sub-Saharan Africa, hypertension has increased rapidly. Recently, the world prevalence of hypertension was estimated at 31%.

The last three decades have witnessed the development of several effective and safe drugs to treat hypertensives. However, although a blood pressure reduction by only 10 mm Hg in those patients is known to reduce the risk of cardiovascular death and stroke by 25-40% throughout life, the threshold value or target value to be achieved in hypertensive adults in general, and in the elderly in particular, is controversial. In addition, several patients remain poorly controlled despite treatment, without reaching the target values of the ESC/ESH Recommendations or those suggested as a result of the SPRINT study.

[…]

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Original Article

Evaluation of Quality of Life in Patients with and without Heart Failure in Primary Care

Antonio José Lagoeiro Jorge et al. Maria Luiza Garcia Rosa Dayse Mary da Silva Correia Wolney de Andrade Martins … Diana Maria Martinez Ceron Leonardo Chaves Ferreira Coelho William Shinji Nobre Soussume Hye Chung Kang Samuel Datum Moscavitch Evandro Tinoco Mesquita

Abstract

Background:

Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL).

Objective:

To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community.

Methods:

Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF – n = 35) and HF with reduced ejection fraction (HFrEF – n = 24).

Results:

Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity – ability and difficulty to perform common activities of everyday life – was significantly worse (p < 0.0001) in patients with HF independently of sex and age. There was no difference between HFpEF and HFrEF.

Conclusion:

Patients with HF had low quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

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Original Article

Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

Guilherme Brasil Grezzana et al. David William Moraes Airton Tetelbon Stein Lucia Campos Pellanda

Abstract

Background:

Hypertension is an important risk factor for cardiovascular outcomes. Primary health care (PHC) physicians should be prepared to act appropriately in the prevention of cardiovascular risk factors. However, the rates of patients with control of blood pressure (BP) remain low. The impact of the reclassification of high BP by 24-hour ambulatory BP monitoring (ABPM) can lead to different medical decisions in PHC.

Objective:

To evaluate the agreement between the BP measured by a conventional method by PHC physicians and by 24-hour ABPM, considering different BP normal thresholds for the 24-hour ABPM according to the V Brazilian ABPM Guidelines and the European Society of Hypertension Guidelines.

Methods:

A cross-sectional study including 569 hypertensive patients. The BP was initially measured by the PHC physicians and, later, by 24-hour ABPM. The BP measurements were obtained independently between the two methods. The therapeutic targets for the conventional BP followed the guidelines by the Eighth Joint National Committee (JNC 8), the V ABPM Brazilian Guidelines, and the 2013 European Hypertension Guidelines.

Results:

There was an accuracy of 54.8% (95% confidence interval [95%CI] 0.51 – 0.58%) for the BP measured with the conventional method when compared with the 24-hour ABPM, with a sensitivity of 85% (95%CI 80.8 – 88.6%), specificity of 31.9% (95%CI 28.7 – 34.7%), and kappa value of 0.155, when considering the European Hypertension Guidelines. When using more stringent thresholds to characterize the BP as “normal” by ABPM, the accuracy was 45% (95%CI 0.41 – 0.47%) for conventional measurement when compared with 24-hour ABPM, with a sensitivity of 86.7% (95%CI 0.81 – 0.91%), specificity of 29% (95%CI 0.26 – 0.30%), and kappa value of 0.103.

Conclusion:

The BP measurements obtained by PHC physicians showed low accuracy when compared with those obtained by 24-hour ABPM, regardless of the threshold set by the different guidelines.

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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

Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study

Rafael Caire de Oliveira dos Santos et al. Alessandra Carvalho Goulart Alan Loureiro Xavier Kisukuri Rodrigo Martins Brandão … Debora Sitnik Henrique Lane Staniak Marcio Sommer Bittencourt Paulo Andrade Lotufo Isabela Martins Bensenor Itamar de Souza Santos

Abstract

Background:

To the best of our knowledge, there are no studies evaluating the influence of the unit of the first contact on the frequency and time of pharmacological treatment during an acute coronary syndrome (ACS) event.

Objectives:

The main objective was to investigate if the unit of first contact influenced the frequency and time of aspirin treatment in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.

Methods:

We analyzed the pharmacological treatment time in 830 ERICO participants – 700 individuals for whom the hospital was the unit of first contact and 130 who initially sought primary care units. We built logistic regression models to study whether the unit of first contact was associated with a treatment time of less than three hours.

Results:

Individuals who went to primary care units received the first aspirin dose in those units in 75.6% of the cases. The remaining 24.4% received aspirin at the hospital. Despite this finding, individuals from primary care still had aspirin administered within three hours more frequently than those who went to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for non ST-elevation ACS and ST-elevation myocardial infarction, respectively). In adjusted models, individuals coming from primary care were more likely to receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval: 2.06-6.51).

Conclusions:

In our setting, individuals from primary care were more likely to receive aspirin earlier. Enhancing the ability of primary care units to provide early treatment and safe transportation may be beneficial in similar settings.

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Prevalence of cardiovascular risk factors in elderly individuals treated in the Brazilian Public Health System in Goiânia

Carla Cristina da Conceição Ferreira et al. Maria do Rosário Gondim Peixoto Maria Alves Barbosa Érika Aparecida Silveira

BACKGROUND: Cardiovascular risk factors (CVRF) present a high prevalence and have an impact on the morbimortality of the elderly; however, this question is still unknown by the elderly treated in the Brazilian Public Health System (SUS). OBJECTIVE: To investigate the prevalence of CVRF among the elderly treated by SUS in the city of Goiânia, state of Goiás, Brazil. METHODS: Cross-sectional study using a multiple-stage sampling method, carried out through a home-based interview with 418 elderly individuals aged > 60 years treated by SUS in the city of Goiânia, state of Goiás, Brazil. Socioeconomic and demographic data, as well as data on lifestyle, weight, height, waist circumference, blood pressure and medications used were collected. The studied CVRF were: arterial hypertension, diabetes mellitus, total obesity, central obesity, dyslipidemias, smoking, sedentary lifestyle and alcohol consumption. The Chi-square test was used for the analyses of the associations, with significance being set at 5%. RESULTS: The prevalences of the CVRF were: 80.4% of arterial hypertension; 83.3% of central obesity; 59.8% of sedentary lifestyle; 32.2% of total obesity; 23.4% of dyslipidemias; 19.1% of diabetes mellitus; 10.0% of smoking and 5.9% of alcohol consumption. As for the simultaneity, 2.4% of the elderly did not present CVRF. The simultaneity of two or more CVRF occurred in 87.3% of the elderly and was more frequent among women. CONCLUSION: The CVRF occur simultaneously in more than half of the elderly individuals, and the most prevalent ones were: arterial hypertension, central obesity and sedentary lifestyle. It is necessary to foster the strategies of health promotion and prevention of cardiovascular injury in elderly individuals treated by SUS in the city of Goiânia, especially among those with simultaneous CVRF.

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The association between metabolic syndrome and its components and heart failure in patients referred to a primary care facility

Flávio Augusto Colucci Coelho et al. Marco Aurélio Espósito Moutinho Verônica Alcooforado de Miranda Leandro Reis Tavares … Maurício Rachid Maria Luiza Garcia Rosa Evandro Tinoco Mesquita

BACKGROUND: Metabolic syndrome (MS) is characterized by a collection of risk factors that are associated with elevated rates of cardiovascular events and the risk of developing heart failure (HF). In our field, the association of MS in stable chronic HF patients has not been established. OBJECTIVE: To determine the prevalence of MS in relation to gender and HF type in patients treated at a Primary Care Facility. METHODS: Between January 2005 and August 2006, 144 patients were included in a cross sectional study. An echocardiogram, using the modified criteria of the EPICA study, was performed to determine whether or not the patient had HF, and of which type. Statistical analysis was conducted using the software SAS™ System, version 6.04, and statistical significance was established as 5%. RESULTS: MS was observed in 111 patients (77%), of which 73 (66%) were females: odds ratio (OR) 0.195 – (confidence interval – CI = 0.08 – 0.46) and p< 0.0001. HF was identified in 102 patients (71%) with a great correlation between females and the presence of MS: 51 patients (65%); OR 0.116 (CI = 0.36- 0.37) and p < 0.0001. Among the HF patients, 61 (42%) presented HF with preserved systolic function and 41 (29%) with systolic dysfunction; p = ns. HF with preserved systolic function was associated with the presence of MS in 53 (87%) of the 61 patients, p = 0.022. CONCLUSION: In our community, MS is closely related to HF with preserved systolic function and to the female gender.

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