Terapia con células madre e insuficiencia cardiaca: aspectos éticos / Ethics of stem cell therapy for heart failure

Heart failure is one of the first diseases in which stem cells were used for regenerative medicine. Since 2001, many publications have shown that stem cell therapy has the potential to mitigate heart diseases, but there is no solid scientific evidence to fully support its clinical application at present. The future of regenerative medicine requires validated clinical trials with standardized platforms and transdisciplinary efforts to enable the development of safe and effective regenerative therapies to protect patients and to promote the ethical application of this new and highly promising therapy. Doctors and scientists have a responsibility to discuss with patients the current reality of regenerative therapies. They also have a responsibility to discourage the indiscriminate and commercial use of these therapies, which are sometimes based on false hopes, since their inappropriate use can harm vulnerable patients as well as research efforts. Although regenerative medicine may be the medicine of the future and might bring the hope of cure for chronic diseases, it is not yet ready for its wide clinical application.

Situación actual de la rehabilitación cardiaca en Chile / Current status of cardiac rehabilitation in Chile

Background: Cardiac rehabilitation (CR) programs play an important role in the control and prevention of new cardiac events. Aim: A survey was performed to evaluate the current situation of CR programs in Chile. Material and Methods: A questionnaire evaluating the structure of rehabilitation centers, characteristics of the rehabilitation programs and patients, management of risk factors, reimbursement methods, human resources and potential barriers for an efficient rehabilitation, was mailed to centers dedicated to CR in Chile. Results: Eight centers were contacted and seven responded. Coronary heart disease is the most common underlying disease of attended patients and CR is carried out mainly during phases II and III. All CR centers perform an initial assessment, stratify patients, plan and provide tips on physical activity and nutrition. Only three centers provide help to quit smoking. Lipid profile and blood sugar are assessed in 62% of centers. Most practitioners involved are cardiologists, nurses, physiotherapists and nutritionists, all trained in cardiopulmonary resuscitation. The main barrier for their development is the lack of patient referral from practitioners. Conclusions: Despite the recognized value of CR in the care of patients after a cardiac event, this study reveals the need for further development of such programs and improvement of patient referrals.

Estado actual de la rehabilitación cardiovascular en Colombia (2010) / Current status of cardiovascular rehabilitation in Colombia (2010)

INTRODUCCIÓN: las enfermedades cardiovasculares representan la primera causa de morbimortalidad en muchos países del mundo, entre los que se incluye Colombia. Es así como la rehabilitación cardiovascular se convierte en una estrategia de prevención secundaria con intervención integral y costo-efectiva para este tipo de pacientes. OBJETIVO: evaluar la situación actual de los programas de Rehabilitación Cardiovascular en Colombia. MÉTODOS: estudio descriptivo, realizado por medio de un cuestionario escrito, aplicado al coordinador y/o responsable de cada programa de Rehabilitación Cardiovascular del país. ANÁLISIS DE RESULTADOS: 44 de 49 centros contactados respondieron el cuestionario. 88,6% de los programas pertenece a la red privada y 6,8% a la pública; 75% funciona dentro de un hospital o clínica y 25% son extra hospitalarios. La enfermedad coronaria es la principal patología que genera la remisión de los pacientes a los centros de rehabilitación cardiovascular. El recurso humano es variable en cuanto a su conformación, permanencia y actividades al interior del programa. Todos los centros realizan la fase II, seguida por las fases III (84,1%), I (70,5%) y IV (45,5%). 58% de los programas siempre incluye pruebas diagnósticas de factores de riesgo convencionales (colesterol total y fracciones, triglicéridos y glicemia); 97,7% de los programas refiere evaluar al paciente de manera integral con la inclusión de aspectos de actividad física y nutrición; sin embargo, se evidencia menor porcentaje de implementación del manejo del tabaquismo (45,5%), así como de programas de salud cardiovascular en la mujer (15,95%), prevención cardiovascular para la comunidad (18,2%), pruebas para detección de depresión (25%), apnea del sueño (0%) y caminata de seis minutos (65,9%). La principal barrera detectada en la atención de pacientes corresponde a la falta de remisión por parte del médico tratante (65,9%). CONCLUSIÓN: el desarrollo de los programas de Rehabilitación Cardiovascular en el país debe evaluarse de acuerdo con las cifras de morbimortalidad cardiovascular, la estratificación del riesgo de los pacientes, el acceso al servicio y los resultados más relevantes de este estudio, por lo cual se hace necesario trabajar en la definición de las líneas de base de los requerimientos de los programas que favorezcan el trabajo y la aproximación interdisciplinaria e integral así como el cumplimiento de los objetivos, dando prioridad a la seguridad del paciente.

INTRODUCTION: cardiovascular diseases are the leading cause of morbidity and mortality in many countries around the world, including Colombia. Thus, cardiovascular rehabilitation becomes a secondary prevention strategy with integral and cost-effective intervention for these patients. OBJECTIVE: to assess the current status of cardiac rehabilitation programs in Colombia. METHODS: a descriptive study, carried out through a written questionnaire, applied to the coordinator and/or responsible for each cardiac rehabilitation program in the country. RESULT ANALYSIS: 44 of 49 centers contacted answered the questionnaire. 88.6% of the programs belonging to the private network and 6.8% to the public; 75% work within a hospital or clinic and 25% are outpatient. Coronary heart disease is the main pathology that generates the referral of patients to cardiovascular rehabilitation centers. Human resources are variable in their shape, stay and activities within the program. All centers perform phase II, followed by stages III (84.1%), I (70.5%) and IV (45.5%). 58% of the programs always include diagnostic tests for conventional risk factors (total cholesterol and fractions, triglycerides and glucose), 97.7% of the programs referred to assess the patient in a holistic manner including aspects of nutrition and physical activity; however, a lower percentage of implementation of the management of smoking (45.5%), of cardiovascular health programs in women (15.95%), cardiovascular prevention for the community (18.2%), testing detection of depression (25%), sleep apnea (0%) and six minute walk (65.9%) was noticed. The main barrier identified in the care of patients corresponds to the lack of referral by the treating physician (65.9%). CONCLUSION: the development of cardiac rehabilitation programs in the country should be assessed according to the cardiovascular morbidity and mortality rates, risk stratification of patients, access to the service and the most important results of this study, thereby making necessary to work on defining the baselines of the requirements of the programs that encourage work and interdisciplinary and integral approach as well as the fulfillment of the objectives, giving priority to patient safety.