ABSTRACT
RESUMEN: El tratamiento del Infarto Agudo del Miocardio con supradesnivel del segmento ST debe iniciarse en el escenario prehospitalario, en el sitio del primer contacto médico. El diagnóstico electrocardiográfico precoz debe ser realizado, idealmente, dentro de los primeros 10 min después de la consulta y confirmado por un especialista. A este respecto, la teletransmisión del electrocardiograma a un centro de llamados atendido por especialistas en horario 24/7 es un modelo muy eficiente, idealmente como parte de una red de tratamiento. El control del dolor y la administración de agentes antiplaquetarios son imperativos y si la intervención coronaria percutánea (angioplastia primaria) no es factible dentro de las ventanas de tiempo universalmente recomendadas, se debiera realizar un tratamiento fibrinolítico, seguido por angioplastia diferida.
ABSTRACT: Treatment of acute myocardial infarction should be initiated in the prehospital scenario at the site of first medical contact. Prompt electrocardiographic diagnosis should be performed ideally within 10min after consultation and diagnosis confirmed by a specialist. Teletransmission of the electrocardiogram to a call center staffed with specialists on a 24/7 basis is a very efficient model, ideally as part of a network of treatment. Pain control and administration of antiplatelets agents are mandatory and if primary percutaneous intervention is not feasible within time limits universally recommended, prehospital fibrinolyisis should be performed followed by deferred angioplasty.
Subject(s)
Humans , Myocardial Infarction/drug therapy , Myocardial Infarction/therapy , Remote Consultation/methods , Electrocardiography , Prehospital Services , FibrinolysisABSTRACT
This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.
Subject(s)
Humans , Atherosclerosis/prevention & control , Cardiovascular Agents/administration & dosage , Cardiovascular Diseases/prevention & control , Medication Adherence/statistics & numerical data , Atherosclerosis/epidemiology , Cardiovascular Diseases/epidemiology , Chile/epidemiology , Cost-Benefit Analysis , Risk Factors , Secondary PreventionABSTRACT
Background: Lack of adherence with medications is the main cause of antihypertensive treatment failure. Aim: To assess adherence to antihypertensive drugs and its determinants. Material and Methods: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. Results: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). Conclusions: Only half of hypertensive patients comply with their antihypertensive therapy.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Medication Adherence/statistics & numerical data , Age Factors , Antihypertensive Agents/administration & dosage , Cross-Sectional Studies , Logistic Models , Nutritional Status/physiology , Primary Health Care , Prospective Studies , Quality of Life/psychology , Socioeconomic Factors , Surveys and Questionnaires , Unemployment/psychologySubject(s)
Humans , Cardiovascular Diseases/prevention & control , Hyperlipidemias/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Atherosclerosis , Chile , Cholesterol/blood , Diabetes Mellitus , Dyslipidemias/drug therapy , Patient Selection , Risk Assessment , Risk GroupsABSTRACT
Antecedentes: Los hipertensos presentan elevada prevalencia de obesidad lo que puede predisponer para el desarrollo de enfermedades músculo-esqueléticas (EME). Actualmente se desconoce la magnitud de estas patologías en población hipertensa chilena. Objetivo: Determinar prevalencia de EME en hipertensos bajo control en el programa de salud cardiovascular de la Región Metropolitana y su posible asociación con obesidad. Método: Estudio transversal en una muestra aleatoria simple (n = 1194 sujetos) a partir del universo (N = 391.129) distribuida en 52 comunas de Santiago. Se registró diagnóstico de EME (CIE10, códigos MM00-99), edad, sexo, presión arterial, índice de masa corporal (IMC), obesidad (IMC ³ 30 kg/m2) y carga psicológica. La asociación con obesidad se exploró a través de regresión logística estimando odds ratio (OR) con intervalos de confianza al 95% (IC95%). Resultados: La prevalencia de EME fue 36,5% (39,9% mujeres y 28,3% hombres, p<0.01). En ambos sexos las patologías más frecuentes fueron lumbago, artrosis de rodilla y artralgias. La asociación de EME y obesidad presentó un OR crudo de 1,09 (1,06-1,19) en hombres y de 1,24 (1,22-1,26) en mujeres; luego de ajuste multivariante el OR fue de 1,19 (1,15-1,23) y 1,49 (1,46-1,52) respectivamente. Conclusiones: Además de la edad, sexo femenino y carga psicológica, la obesidad aparece como un factor de riesgo para EME en población hipertensa. La elevada prevalencia observada enfatiza la necesidad de acentuar el control de peso, incluir el ejercicio físico y brindar acceso a la kinesioterapia en la atención primaria chilena.
Background: Hypertensive subjects frequently are obese, which may lead to development of muscular and skeletal diseases (MSD). There is no data regarding the frequency of this complications in Chile. Aim: to determine the prevalence of MSD in hypertensive subjects being followed by the Cardiovascular Health Program in the Region Metropolitana; to determine the association of MSD to obesity in those subjects. Methods: Cross sectional study using a simple random sample of 1194 subjects from the population of 391,129 hypertensives distributed in 52 municipalities in Santiago, Chile. Diagnosis of MSD was established according to CIE 10 codes MM00-99). Age, sex, blood pressure, body mass index and psychological burden were determined. Obesity was defined as IMC ³ 30 kg/m2). Association of MSD with obesity was explored using logistic regression and OR with 95% confidence intervals (95% CI). Results: The prevalence of obesity was 36.5% (39.0% in women, 28.3% in males, p<0.01). In both sexes, lumbar pain, knee osteoarthritis and joint pain were the most common forms of MSD. OR for the association of MSD and obesity was 1.09 (95% CI 1.06-1.19) in males and 1.24 (1.22-1.26) in females. After multivariate adjustment the respective OR became 1.19 (1.15-1.23) and 1.49 (1.46-1.52). Conclusion: In addition to age, female sex and psychological burden, obesity is an independent risk factor for MSD en hypertensive patients. These findings stress the need for better weight control in hypertensives. Physical exercise and physical therapy should be helpful in the primary care of this population.