Factores influyentes en el desarrollo de la enfermedad cardiovascular reportados por pacientes de la Unidad de Rehabilitación Cardíca del Hospital Universitario de Caracas / Influent factors in the development of the cardivascular disease reported by patients of the Unidad de Rehabilitación Cardíaca del Hospital Universitario de Caracas

En un sentido preventivo es importante el control de los factores de riesgo cardiovascular y por ende evaluar directamente con el paciente su conocimiento al respecto. Este estudio evaluó el reporte de 20 pacientes que ingresaban a la Unidad de Rehabilitación Cardíaca (URC) del Hospital Universitario de Caracas (HUC) en relación con los factores que consideraban influyentes en el desarrollo de su enfermedad cardiovascular (ECV). Estudio de campo, de diseño no experimental, transaccional y descriptivo. El instrumento aplicado fue la Pregunta 4 de la entrevista psicológica, aplicada al ingreso a la unidad: ¿Cuáles factores cree usted que influyeron para el desarrollo de su enfermedad cardiovascular? Las respuestas fueron sometidas a un análisis de tipo cualitativo y categorizadas en tres tipos de factores (tradicionales, psicológicos y sociales). 1) 65% hombres de 58,25 años promedio, 2) Tipos de factores mayormente reportados, en orden decreciente: “Tradicionales” (70%), “Sociales” (50%) y “psicológicos” (40%). Igualmente se identificaron variables sociodemográficas. La mayoría de la muestra poseía un conocimiento adecuado sobre los factores de riesgo tradicionales, a diferencia de los factores psicológicos. Se discute el conocimiento y la conciencia que el paciente tiene sobre los factores de riesgo cardiovascular, la vía para medir estas variables, así como su importancia para garantizar una mayor adherencia al tratamiento integral del paciente. Secuestiona la responsabilidad exclusiva del paciente en relación con controlar los factores socioeconómicos considerados como influyentes para su ECV.

From a preventive point of view, the control of cardiovascular risk factors is important and in consequence, to evaluate directly with the patient his knowledge about this issue. This study evaluated the report of 20 patients entering the Cardiovascular Rehabilitation Unit of the Caracas University Hospital, with respect to the considered influent factors in the development of their cardiovascular disease (CVD). Non-experimental, transactional and descriptive design field study. The instrument used was Question 4 of the psychological interview, applied at the admission to the unit: ¿Which factors do you believe were influent in the development of your CVD? Answers were submitted to a qualitative analysis and categorized into three types of factors (traditional, psychological and social). 1) 65% men of 58.25 age average, 2) Type of factor mainly reported in decreasing order: “Traditional” factors (79%), “Social” factors (50%), and “psychological” factors (40%). Sociodemographic variables were also identified. The majority of the sample had an adequate knowledge about traditional risk factors, in contrast with psychological factors. The knowledge and awareness of the patient about cardiovascular risk factors, the way to measure these variables, as well as their importance to guarantee a greater adherence of the patient to integral treatment, are discussed. The exclusive responsibility of the patient to control socioeconomical factors considered as influent to his CVD are questioned.

Erectile dysfunction as a complication of heart failure.

Erectile dysfunction (ED) is an increasingly common problem in the aging population and has been associated with chronic heart failure (HF), either as an epiphenomenon or even as an early marker for underlying cardiovascular disease. ED has a significant effect on patients' quality of life. This chapter reviews ED in patients with HF and prevention and treatment based on current data from the literature. Causes include physiologic changes resulting in decreased cardiac function and exercise capacity, intrinsic vascular and neurohormonal abnormalities, and extrinsic factors such as medication side effects and psychological issues. Physicians should address these issues with patients and begin treatment by optimizing HF management and minimizing medications with ED side effects. Use of phosphodiesterase-5 inhibitors provides significant improvement of ED and quality of life. Further research still is needed regarding long-term effects of ED treatment, investigation of newer medications, and preventive measures in this patient population.

The 6-minute walk test: how important is the learning effect?

BACKGROUND: The 6-minute walk test is a submaximal exercise test that is widely used as an outcomes measure in clinical trials and cardiopulmonary rehabilitation. An initial learning effect with repeated administration is well documented, but it is unknown whether this learning effect persists with time. METHODS: This study was designed to determine whether the learning effect persists after 2 months. Fifty healthy adults (mean age, 30.6 years; 48% men, 82% white) unfamiliar with the 6-minute walk test completed 3 walks at baseline (walks 1-3) and 3 walks at follow-up (walks 4-6). Height, weight, and self-reported physical activity were assessed at both points. Distances walked during the 6 walks were compared with a general linear model for repeated measures with post-hoc pairwise comparisons corrected by the Bonferroni method. A P value <.05 was considered to be significant. RESULTS: The distance walked increased significantly between walks 1 and 3 (2046 +/- 228 ft to 2194 +/- 266 ft, P <.05). There was no difference in distance walked between walks 3 and 4, which were conducted 2 months apart. The distance walked increased significantly between walks 4 and 6 (2201 +/- 233 ft to 2285 +/- 257 ft, P <.05). The overall learning effect was inversely correlated with distance walked at walk 1, but was unrelated to age, sex, height, weight, or physical activity level. CONCLUSION: The initial learning effect is maintained during a 2-month period. A more modest additional learning effect occurs during the follow-up walks. Both learning effects should be taken into account when using the 6-minute walk test as an outcomes measure.

Racial differences in how patients perceive physician communication regarding cardiac testing.

OBJECTIVES: Recent studies documenting racial variation in the use of cardiac procedures highlight the need to understand if there are racial differences in processes of communication and decision making. Investigations of patients' perceptions of their interaction with providers regarding cardiac testing were conducted. METHODS: Four focus groups were convened with 13 patients who had undergone cardiac stress testing with positive results, stratified by race (white vs. black). Verbatim transcripts of discussions of their interactions with providers relating to their cardiac problems were analyzed qualitatively by a team of behavioral scientists and general internists to identify significant dimensions of communication and patient-provider relationships. RESULTS: Four domains of communication were identified that appeared to bear on patients' comfort and preferences regarding cardiac procedures. First, the substance of the information that was provided by physicians and other providers was described as incomplete, vague, ambiguous, and unclear. Second, some recommendations either were inconsistent with expectations or awakened fears based on distressing previous experiences. Third, patients said they needed to be convinced of the need for additional, invasive tests and therapeutic procedures, and in some cases providers' arguments failed in this regard. Fourth, the patients highlighted the importance of trusting their provider. Although there were no apparent differences by race in patients' perception of the information they received, black patients consistently expressed a preference for building a relationship with physicians (trust) before agreeing to an invasive cardiac procedure, and just as consistently complained that trust was lacking. Conversely, white patients tended to emphasize that they were inadequately convinced of the need for recommended procedures. CONCLUSIONS: This study provided qualitative information regarding patients' perceptions of physician-patient communication and racial differences in such perceptions. For both black and white patients, we found problematic aspects of the patients' experiences regarding communication about cardiac testing. Our findings suggest that although patients desire clarity from physicians, they are often confused regarding the information received. Both a lack of substance and vagueness of the information received may be linked to feelings of mistrust toward physicians when considering further diagnostic testing. Mistrust may be a source of some of the documented racial variation in health care utilization.