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.
evaluar la situación actual de los programas de Rehabilitación Cardiovascular en Colombia.
estudio descriptivo, realizado por medio de un cuestionario escrito, aplicado al coordinador y/o responsable de cada programa de Rehabilitación Cardiovascular del país.
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%).
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.
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.
to assess the current status of cardiac rehabilitation programs in Colombia.
a descriptive study, carried out through a written questionnaire, applied to the coordinator and/or responsible for each cardiac rehabilitation program in the country.
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%).
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.
Background The Berlin Questionnaire (BQ) has been used to identify patients at high risk for sleep-disordered breathing (SDB) in a variety of populations. However, there are no data regarding the ...validity of the BQ in detecting the presence of SDB in patients after myocardial infarction (MI). The aim of this study was to determine the performance of the BQ in patients after MI. Methods We conducted a cross-sectional study of 99 patients who had an MI 1 to 3 months previously. The BQ was administered, scored using the published methods, and followed by completed overnight polysomnography as the “gold standard.” SDB was defined as an apnea-hypopnea index of ≥ 5 events/h. The sensitivity, specificity, and positive and negative predictive values of the BQ were calculated. Results Of the 99 patients, the BQ identified 64 (65%) as being at high-risk for having SDB. Overnight polysomnography showed that 73 (73%) had SDB. The BQ sensitivity and specificity was 0.68 and 0.34, respectively, with a positive predictive value of 0.68 and a negative predictive value of 0.50. Positive and negative likelihood ratios were 1.27 and 0.68, respectively, and the BQ overall diagnostic accuracy was 63%. Using different apnea-hypopnea index cutoff values did not meaningfully alter these results. Conclusion The BQ performed with modest sensitivity, but the specificity was poor, suggesting that the BQ is not ideal in identifying SDB in patients with a recent MI.
Objectives This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background In ...CAD patients, mortality has been reported to vary inversely with BMI (“obesity paradox”). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio HR: 1.10; 95% confidence interval CI: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.
To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome ...(ARDS), in the era of lung-protective mechanical ventilation (MV).
A 6-month prospective, epidemiological, observational study.
A network of 22 multidisciplinary ICUs in Spain.
Consecutive mechanically ventilated patients with AHRF (defined as Pao
/Fio
≤ 300 mm Hg on positive end-expiratory pressure PEEP ≥ 5 cm H
O and Fio
≥ 0.3) and followed-up until hospital discharge.
None.
Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 26.8% met Berlin ARDS criteria and 908 73.2% did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H
O, Fio
0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H
O. ARDS patients received higher Fio
and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H
O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H
O, respectively
< 0.0001). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d;
< 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% 95% CI, 29.7-40.2 vs 35.5% 95% CI, 32.3-38.7;
= 0.837).
AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.
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