[Effectiveness of tertiary prevention on quality of life and control of risk factors in patients with ischemic coronary heart disease]. / Efectividad de la prevención terciaria en la calidad de vida y control de los factores de riesgo en pacientes con cardiopatía coronaria isquémica.

Objective: Determine the effectiveness of cardiac rehabilitation (CR) as a tertiary prevention strategy in the quality of life and control of risk factors of patients with ischemic coronary heart disease (ICC) of the National Cardiovascular Institute (INCOR) of EsSalud- Lima during the year 2018. Materials and methods: A retrospective cohort of 280 patients with a diagnosis of CCI was studied who, after medical, interventional, or surgical treatment, were referred to the INCOR CR program for tertiary prevention (PT) in 2018. The program was developed according to the institutional guide for eight weeks with exercise sessions and educational, psychological, nutritional, and recreational workshops. At the beginning and at the end of this, the QLMI-2 quality of life test was applied, and anthropometric, laboratory, and risk factor control measurements were performed. Results: Quality of life levels at the end of CR showed a statistically significant improvement in the emotional, social, physical, and global dimensions (p < 0.001). The same behavior was observed for the nutritional variables of weight, abdominal circumference, and BMI (p < 0.001). Physical capacity showed a statistically significant improvement in the aspects of muscle strength (12.2%), physical activity (38.0%), and functional capability (25.4%) (p < 0.001). The result was not homogeneous for the biochemical metabolic variables, where glycosylated hemoglobin, glycemia, and lipid profile did not show significant improvement, except for HDL, which raised its levels statistically significantly (p < 0.001). Conclusions: CR is effective as a central strategy to perform tertiary prevention in patients with ICC since it notably improves quality of life and coronary risk factors.

[Cardiac tele-rehabilitation in times of pandemic. Experience at the National Cardiovascular Institute INCOR in Lima-Peru]. / Tele-rehabilitación cardiaca en tiempos de pandemia. Experiencia en el Instituto Nacional Cardiovascular-INCOR.

Objective: Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic. Methods: A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing. Results: Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92. Conclusions: The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.

[Perceptions of resident physicians on the development of the cardiology resident program during the COVID-19 pandemic in Lima, Peru]. / Percepciones de los médicos residentes sobre el desarrollo del programa de residentado de cardiología durante la pandemia por COVID-19 en Lima, Perú.

Objective: To describe the perceptions of resident doctors about the development of their training program during the pandemic in the city of Lima - Peru. Materials and methods: Through a cross-sectional study, a questionnaire was applied to seventy-eight cardiology residents in the last two years of training in the specialty. The perceptions about the accompaniment and support of the universities in the educational venues, for the development of the training program in cardiology during the pandemic, were evaluated. Results: Regarding the support provided for their training, the items evaluated showed shortcomings above 60%, where permanent supervision was lacking in 90.0% of the residents. Regarding compliance with the rotations, the residents only received supervision in 24.4%, observing that they did not manage to carry out adequate rotations in 80.8% of the cases. The courses of the curricular plan were adequately developed in 92.5% of the cases, and the actions for the health of the resident were very low, highlighting that only in 9.0% of the cases did the university inquire about the state of health of the resident. Conclusions: The development of the cardiology residency training program during the pandemic presented important shortcomings, showing that the deficiencies were accentuated compared to previous studies.

[Compliance with the cardiology residency training program during the COVID-19 pandemic, Lima-Peru]. / Cumplimiento del programa de formación del residentado en cardiología durante la pandemia COVID-19, Lima-Perú.

Objective: To characterize compliance with the annual curricular program of second and third-year cardiology residents in hospital of Lima-Peru during the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted, through a questionnaire applied to seventy-eight cardiology residents from the second and third year of specialty. We evaluated the compliance with rotations in clinical fields, individual compliance with the annual program, and the achievement of minimum training standards. Results: Compliance with rotations in clinical fields was highly variable (from 7.9% in Cardiac Rehabilitation for the second year to 90.9% for imaging in cardiology). Regarding individual compliance, 98.7% did not manage to comply with the annual program. Finally, only the standard of evaluation by radionuclides of myocardial function and perfusion was achieved by all residents, concerning the scope of the other achievements, variations are reported from 4.4% for performing stress tests to 75.8% in the to participate in interventional cardiology procedures. Associations were found between compliance with rotations with the type of health organization and type of university. Conclusions: The COVID-19 pandemic has considerably affected the training of cardiology residents, mainly due to non-compliance with the annual curriculum.

Reducción del riesgo cardiovascular en trabajadores de un instituto de salud especializado mediante un programa de prevención cardiovascular / Reduction of cardiovascular risk in professionals from a specialized health institute by a cardiovascular preventive program

RESUMEN Introducción. Los programas de rehabilitación cardiovascular (PRC) representan una estrategia médico-sanitaria multidisciplinaria eficaz en la prevención y control de los problemas cardiovasculares. Objetivos. Evaluar el impacto de un PRC realizado en el espacio de trabajo, en la reducción del riesgo cardiovascular absoluto en los trabajadores de INCOR. Métodos. Estudio experimental. Se incluyó a 41 trabajadores con diferentes niveles de riesgo cardiovascular, evaluados previa y posteriormente a su participación en el PRC sobre su capacidad funcional, sus factores de riesgo cardiovascular y niveles de estrés. El programa de intervención en el trabajo consistió en 36 sesiones de actividad física controlada, consejería nutricional, consejería psicológica y evaluación de laboratorio. Resultados. Se redujo el riesgo cardiovascular global al nivel bajo en el 100% medido mediante el índice de Framingham y en la medición con el score ASCVD 2013, se eliminó el nivel de riesgo alto y el nivel intermedio se redujo de 17,5% a 10%. La capacidad funcional mejoró, incrementándose la clase funcional I de 19,5% a 90%. Los niveles de VLDL, LDL, colesterol total y triglicéridos se redujeron significativamente en la post-intervención, mientras que para el HDL, la proporción de trabajadores con valores no recomendables se incrementó al final de la intervención. Se encontró disminución significativa del nivel de estrés. Conclusiones. Un PRC puede ser implementado en el mismo ámbito laboral y mostrar su comprobada eficacia para reducir el riesgo cardiovascular y el estrés.

ABSTRACT Introduction. The cardiovascular rehabilitation programs (CRP) represent an effective multidisciplinary medical-health strategy in prevention and control of cardiovascular problems. Objective. To assess the impact of a CRP carried out in the workplace, in reducing absolute cardiovascular risk in INCOR workers. Methods. An experimental study. 41 workers with different levels of cardiovascular risk were included and were evaluated before and after their participation in the CRP on their functional capacity, cardiovascular risk factors and stress levels. The work intervention program consisted of 36 sessions of controlled physical activity, nutritional counseling, psychological counseling and laboratory evaluation. Results. The intervention get a reduction of the overall cardiovascular risk to the low level in all workers (100%), measured by the Framingham index and when it was measured with the ASCVD 2013 score, the high-risk level was eliminated and the intermediate level was reduced from 17,5% to 10%. The functional capacity shows an improvement, with an increase of cardiovascular risk level I from 19,5% to 90%. Blood lipids levels as VLDL, LDL, total cholesterol and triglycerides were significantly reduced in the post-intervention. Contrarily, in the HDL levels, the proportion of workers with non-recommended values increased to the end of the intervention. Finally, the CRP showed effectiveness in reducing workers' stress. Conclusion. A CRP could to be implemented on workplace and it shows effectiveness in reducing cardiovascular risk and stress.

Cardiac rehabilitation in Latin America.

This article provides a description of the status of cardiovascular (CV) rehabilitation (CVR) in Latin America (LA) and the potential impact on CV disease in the region. We discuss the insufficient number of CVR programs in the region and describe the components of CVR that are more commonly available, like exercise interventions, medical assessment and patient education. Additionally, we discuss the heterogeneity in other components, like the evaluation of depression, sleep apnea, and smoking cessation programs. Lastly, we provide a brief review on the main characteristics of the health systems of each country regarding access to CVR programs and compare the average cost of CV procedures and treatments with CVR.

Calidad de la atención y grado de satisfacción del paciente cardíaco transferido de provincia a la consulta externa de cardiología del INCOR 2009 / Quality of care and satisfaction grade of cardiac patient transferred from province to the Outpatient Cardiology Service at the INCOR 2009

Determinar la influencia de la calidad de atención sobre la satisfacción del paciente cardiópata transferido a la consulta externa de Cardiología del Instituto Nacional del Corazón-INCOR en 2009. Diseño: observacional, descriptivo, transversal y de correlación. Lugar: Consultorio Externo de Cardiología del Instituto Nacional del Corazón-INCOR, Lima, Perú. Participantes: La población la constituyen todos los pacientes cardiópatas mayores de 15 años, referidos de provincias al consultorio externo de Cardiología del Instituto Nacional del corazón en el 2009. Intervenciones: Cuestionario de investigación SERVQUAL administrado a través de una entrevista. Los datos obtenidos se procesaron mediante una base de Datos en el paquete estadístico SPSS 15.0 para Windows. El Alpha de Cronbach's del instrumento aplicado tiene un valor de 0.821, valor que garantiza que los datos son confiables. Resultados: Se estudió a 470 pacientes, 44.5 por ciento fueron varones, la edad promedio fue 63.6 ± 11.7 años. El 33.19 de los pacientes tenían instrucción superior y el 38.34 por ciento grado de instrucción secundaria y menos del 1 por ciento sin instrucción, el 44.26 por ciento acudían a consultorio de Cardiología, el 66.6 por ciento se encontraba en condición de usuario y el 32.77 por ciento como acompañantes, el 42.3 por ciento tenían ocupación definida. Se evaluaron 5 dimensiones según el Cuestionario SERVQUAL encontrándose insatisfacción leve a moderada en: dimensión aspectos tangibles (71.28 por ciento), fiabilidad (84.04 por ciento) respuesta rápida (71.7 por ciento) dimensión seguridad (45.96 por ciento), dimensión empatía (61.49 por ciento), (p=0.0010). En la Dimensión seguridad se encontró el 52 por ciento de satisfacción Conclusiones: La atención que se le brinda al paciente de provincia referido al Instituto del Corazón no es de calidad según la percepción de los pacientes de Provincia y guarda relación con el grado de insatisfacción encontrado en estos...

To determine the influence of the quality of care to cardiac patients on the satisfaction levels of outpatients transferred to INCOR in 2009. Design: observational, descriptive, cross-sectional correlational study Location: Cardiology Outpatient Services of the National Heart Institute, INCOR, Lima, Peru. Participants: The population consists of all cardiac patients over 15 years referred from provinces other than Lima to Cardiology outpatient services in 2009. Interventions: SERVQUAL Research Questionnaire administered through an interview. The data was processed in a database built in SPSS 15.0, statistical software for Windows. Results: We studied 470 patients of which 44.5 per cent were male, and whose mean age was 63.6 ± 11.7 years. 33.19 per cent of the patients had higher education, 38.34 per cent had secondary education and less than 1 per cent had no education. 44.26 per cent came to cardiology medical consultation. 66.6 per cent of the patients were alone and 32.77 per cent were accompanied. 42.3 per cent had fixed occupations. Five dimensions were evaluated according to the SERVQUAL Questionnaire, finding mild to moderate dissatisfaction: tangible aspects (71.28 per cent), reliability (84.04 per cent), quick response (71.7 per cent), and empathy dimension (61.49 per cent), while security dimension scored a satisfaction rating of 52 per cent (p=0.0010). Conclusions: The attention given to patients from provinces other than Lima in the Heart Institute is not of good quality according to the individuals, and this is related to the degree of dissatisfaction found in these patients. The main causes of user dissatisfaction among patients from provinces other than Lima are the inadequate infrastructure and poor adherence to schedule. The aspects perceived as satisfactory are duly trained physicians services, and presentable, neat and properly identified personnel...

Rehabilitación cardíaca en pacientes portadores de cardiomiopatía dilatada isquémica. INCOR-EsSALUD 2004-2005 / Rehabilitation cardiac in carrying patients of cardiomiopatia expanded isquemica. INCOR-EsSALUD 2004-2005

El presente estudio prospectivo se realizó en el Area de Prevención y Rehabilitación Cardiaca del Instituto Nacional del Corazón (INCOR). Se evaluaron 50 pactes, con Diagnóstico de Cardiomiopatia Dilatada Isquémica. Todos con Fracción de Eyección Menor de 40 por ciento por Ecocardiografía, Cateterismo cardiaco y/o Perfusión Miocárdica. Estos pacientes no tenían más opción de revascularización por decisión en Reunión Clínica pero con tratamiento óptimo para falla cardiaca. La edad Promedio fue de: 62.1 con un Rango 54-81, 84 por ciento correspondieron al sexo masculino y 16 por ciento al sexo femenino, clínicamente estables en los 3 meses anteriores a su Reclutamiento. Los criterios de exclusión fueron: Angina Inestable, Infarto agudo de Miocardio, Enfermedad Cardiaca Valvular significativa, Enfermedad Pulmonar Crónica significativa, Insuficiencia Renal Crónica Terminal y limitación ortopédica o neurológica. Todos los pacientes fueron evaluados clínicamente previo al ingreso al programa, se les realizo un test ergométrico tipo Naughton. El mismo procedimiento se realizo al culminar el Programa. Los pacientes elegidos Clase funcional (CF) II-III siguieron el siguiente protocolo de Rehabilitación Cardiaca: Seguimiento: Durante 12 meses, con asistencia de 3 sesiones por semana, se trabajó con un pico VO2 de 70 por ciento, y con control de frecuencia cardiaca o por escala de Borg para la percepción del esfuerzo...