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Silva-Cardoso J, Santos J, Araújo I, Andrade A, Morais Sarmento P, Santos P, Moura B, Marques I, Peres M, Ferreira JP, Agostinho J, Pimenta J. conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT). Rev Port Cardiol 2024; 43:225-235. [PMID: 37689388 DOI: 10.1016/j.repc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
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Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal.
| | - Jonathan Santos
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ARS Norte, ACES Vale Sousa Norte, USF Torrão, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Morais Sarmento
- Departamento de Medicina Interna e Hospital de Dia de Insuficiência Cardíaca do Hospital da Luz de Lisboa, Lisboa, Portugal
| | - Paulo Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal; MEDCIDS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Brenda Moura
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica - Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - João Pedro Ferreira
- Unic@RISE, Serviço de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Joao Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Pimenta
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; UnIC@RISE, Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Moita CF, Marau G, Corte-Real S, Dantas A. Adherence to European guidelines for the use of acetylsalicylic acid in primary health care. Rev Port Cardiol 2023; 42:307-313. [PMID: 36634762 DOI: 10.1016/j.repc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease remains a leading cause of global morbidity and mortality. The administration of low doses of acetylsalicylic acid (ASA) in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been clearly established. However, the most recent guidelines do not recommend aspirin in primary prevention, reserving it for high-risk patients and after a risk/benefit assessment. The aim of this study was to assess the adherence to European guidelines for the use of ASA in primary and secondary prevention of ASCVD in primary health care. METHODS The study population corresponded to individuals >50 years registered at two primary health care units without (primary prevention) and with previous ASCVD events (secondary prevention). RESULTS Reporting the population size: e.g. "we studied a total of 1262 individuals, 720 in primary prevention and 542 in secondary prevention". A total of 61 individuals (8.5%) were under aspirin therapy in primary prevention, most of them taking 150 mg/day (57%). In secondary prevention, 195 patients (27%) were receiving ASA only, most taking 150 mg/day (52%), and 166 patients (31%) were not under any antithrombotic or anticoagulant therapy. The 100 mg dosage was predominant in patients with ischemic heart disease with (64%) and without (64%) angina, as well as those with myocardial infarction (61.5%) and peripheral vascular disease (62%). CONCLUSIONS In this study, the prevalence of aspirin use in primary prevention was 8.5%. We found that 30% of patients were not taking either antithrombotic or anticoagulation therapy in secondary prevention. In both primary and secondary prevention, the 150 mg dosage was predominant.
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Affiliation(s)
| | - Gonçalo Marau
- USF S. Julião, ACES Lisboa Ocidental e Oeiras, Oeiras, Portugal
| | | | - Ana Dantas
- USF S. Martinho de Alcabideche, ACES Cascais, Cascais, Portugal
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Bettencourt N, Mendes L, Fontes JP, Matos P, Ferreira C, Botelho A, Carvalho S, Durazzo A, Faustino A, Ladeiras Lopes R, Vasconcelos M, Vieira C, Correia M, Ferreira AM, Ferreira N, Pires-Morais G, G Almeida A, Ferreira MJV, Teixeira M. Consensus document on chronic coronary syndrome assessment and risk stratification in Portugal: A position paper statement from the [Portuguese Society of Cardiology's] Working Groups on Nuclear Cardiology, Magnetic Resonance and Cardiac Computed Tomography, Echocardiography, and Exercise Physiology and Cardiac Rehabilitation. Rev Port Cardiol 2020; 41:241-251. [PMID: 33342714 DOI: 10.1016/j.repc.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 01/19/2023] Open
Abstract
Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.
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Affiliation(s)
| | | | - José Paulo Fontes
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Catarina Ferreira
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Vila Real, Portugal
| | - Ana Botelho
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Sofia Carvalho
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Anaí Durazzo
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Ana Faustino
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Ricardo Ladeiras Lopes
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Faculdade de Medicina do Porto, Porto, Portugal
| | - Mariana Vasconcelos
- Faculdade de Medicina do Porto, Porto, Portugal; Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Miguel Correia
- Centro Hospitalar Tondela/Viseu e Hospital CUF-Viseu, Viseu, Portugal
| | - António M Ferreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal; Hospital da Luz, Lisboa, Portugal
| | - Nuno Ferreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Ana G Almeida
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria e Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Maria João Vidigal Ferreira
- Centro Hospitalar Universitário de Coimbra e Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Madalena Teixeira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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