Cumplimiento de las recomendaciones de prevención secundaria de enfermedad coronaria en pacientes sometidos a revascularización coronaria percutánea en el Hospital Universitario Fundación Santa Fe de Bogotá

Article information

Marco de referencia

diferentes ensayos clínicos han mostrado que el efecto de las revascularizaciones y los procedimientos de angioplastia en el pronóstico del paciente, tiene sólo un efecto a corto plazo, mientras que la prevención secundaria (cambio de estilo de vida y tratamiento intensivo) mejora el pronóstico a largo plazo.

Objetivo

evaluar el cumplimiento de las recomendaciones para prevención cardiovascular secundaria, de los pacientes sometidos a revascularización coronaria percutánea en el hospital universitario Fundación Santa Fe de Bogotá, entre los años 2008 y 2010.

Materiales y métodos

estudio descriptivo, ambispectivo, cuya población estuvo conformada por 332 pacientes sometidos a intervención coronaria percutánea atendidos entre enero de 2008 a diciembre de 2010 en el servicio de hemodinamia del Hospital Universitario Fundación Santa Fe de Bogotá. La recolección de la información se realizó mediante revisión de las historias clínicas de los pacientes y vía telefónica. Las metas de control se basaron en las recomendaciones de la Asociación Americana del Corazón y el Colegio Americano de Cardiología.

Resultados

332 pacientes fueron sometidos a revascularización coronaria percutánea y 4 fueron excluidos del estudio por falta de datos. La presentación clínica más frecuente fue la angina inestable (32,93%). Sólo se contactaron 172 (52,43%) pacientes, de los cuales 77,4% eran hombres y 22,6% mujeres. Únicamente 6 (3,5%) cumplían con el 100% de las recomendaciones para la prevención secundaria de enfermedad coronaria y 17% cumplía menos del 50% de éstas.

Conclusiones

la experiencia en la Fundación Santa Fe de Bogotá muestra un pobre cumplimiento de las metas de prevención secundaria de enfermedad coronaria.

Palabras clave:

enfermedad coronaria

prevención secundaria

revascularización coronaria percutánea

Context

different clinical trials have shown that the effect of revascularization and angioplasty procedures in the prognosis of the patient has only a short-term effect, while secondary prevention (lifestyle change and intensive treatment) improves long-term prognosis.

Objective

to assess compliance with the recommendations for secondary prevention of cardiovascular disease in patients undergoing percutaneous coronary revascularization at the University Hospital Fundación Santa Fe de Bogotá, between 2008 and 2010.

Materials and methods

a descriptive ambispective study, whose population was conformed by 332 patients undergoing percutaneous coronary intervention seen between January 2008 and December 2010 in the service of hemodynamics of the University Hospital Fundación Santa Fe de Bogotá. The data collection was conducted by reviewing the medical records of the patients and by telephone. Control targets were based on the recommendations of the American Heart Association and the American College of Cardiology.

Results

332 patients underwent percutaneous coronary revascularization. 4 were excluded from the study due to lack of data. The most common clinical presentation was unstable angina (32.93%). Only 172 patients (52.43%) were contacted. From these, 77.4% were male and 22.6% female. Only 6 (3.5%) met 100% of the recommendations for secondary prevention of coronary heart disease and 17% met less than 50% of these recommendations.

Conclusions

the experience in the Fundación Santa Fe de Bogotá shows a poor compliance with the goals of secondary prevention of coronary disease.

Keywords:

coronary disease

secondary prevention

percutaneous coronary revascularization

Full text is only aviable in PDF

Bibliografía

[1.]

J. O'Keefe, M. Carter, C. Lavie.

Primary and secondary prevention of cardiovascular diseases.

Mayo Clinic Proc, 84 (2009), pp. 741-757

[2.]

S. Petersen, V. Peto, M. Rayner, J. Leal, R. Luengo-Fernández, A. Gray.

European Cardiovascular Disease Statistics.

British Heart Foundation, (2005),

[3.]

Ministerio de la Protección Social de Colombia. Situación de Salud en Colombia. Indicadores básicos 2006. Bogotá: Ministerio de la Protección Social; 2008.

[4.]

Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics, 2008 edition. British Heart Foundation; 2008. Disponible en: http://www.bhf.org.uk/publications/viewpublication.aspx?ps=1001443. [citado 30 Jun 2011].

[5.]

R. Gupta, P. Deedwania.

Interventions for cardiovascular disease prevention.

Cardiol Clin, 29 (2011), pp. 15-34

http://dx.doi.org/10.1016/j.ccl.2010.10.005 | Medline

[6.]

Ford Es, U.A. Ajani, J.B. Croft, et al.

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.

N Engl J Med, 356 (2007), pp. 2388-2398

http://dx.doi.org/10.1056/NEJMsa053935 | Medline

[7.]

S.C. Smith Jr., J. Allen, S.N. Blair, et al.

AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease.

Circulation, (2006), pp. 113

http://dx.doi.org/10.1161/CIRCINTERVENTIONS.109.887406 | Medline

[8.]

S.C. Smith, E.J. Benjamin, R.O. Bonow, L.T. Braun, M.A. Creager.

AHA/ACCF Secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 Update.

JACC, 58 (2011), pp. 2432-2446

http://dx.doi.org/10.1016/j.jacc.2011.10.824 | Medline

[9.]

R.D. Brook, P. Greenland.

Secondary prevention.

Preventive cardiology, 2nd, pp. p515e42

[10.]

A. Schömig, J. Mehilli, A. de Waha, M. Seyfarth, J. Pache, A. Kastrati.

A meta-analysis of 17 randomized trials of a percutaneous coronary intervention based strategy in patients with stable coronary artery disease.

J Am Coll Cardiol, 52 (2008), pp. 894-904

http://dx.doi.org/10.1016/j.jacc.2008.05.051 | Medline

[11.]

R.V. Leupker.

Decline in incident coronary heart disease. Why are rates falling?.

Circulation, 117 (2008), pp. 592e3

[12.]

R. Clendenning.

The optimal low-density lipoprotein is 50 to 70 mg/dl.

J Am Coll Cardiol, 45 (2005), pp. 1732

http://dx.doi.org/10.1016/j.jacc.2005.02.051 | Medline

[13.]

Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group.

A randomized trial of therapies for type 2 diabetes and coronary artery disease.

N Engl J Med, 360 (2009), pp. 2503-2515

http://dx.doi.org/10.1056/NEJMoa0805796 | Medline

[14.]

T.R. Frieden, D.M. Berwick.

The “Million Hearts” initiative-preventing heart attacks and strokes.

N Engl J Med, 365 (2011), pp. e27

http://dx.doi.org/10.1056/NEJMp1110421 | Medline

[15.]

J. Leal, R. Luengo-Fernández, A. Gray, S. Petersen, M. Rayner.

Economic burden of cardiovascular diseases in the enlarged European Union.

Eur Heart J, 27 (2006), pp. 1610-1619

http://dx.doi.org/10.1093/eurheartj/ehi733 | Medline

[16.]

V.L. Roger, A.S. Go, D.M. Lloyd-Jones, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al.

Heart disease and stroke statistics—2011 update.

Circulation, 123 (2011), pp. e18-e209

http://dx.doi.org/10.1161/CIR.0b013e3182009701 | Medline

[17.]

I. Graham, D. Atar, K. Borch-Johnsen, G. Boysen, G. Burell, et al.

European guidelines on cardiovascular disease prevention in clinical practice.

Eur Heart J, 28 (2007), pp. 2375-2414

http://dx.doi.org/10.1093/eurheartj/ehm316 | Medline

[18.]

Grupo de Trabajo de Revascularización Miocárdica de la Sociedad Europea de Cardiología (ESC) y de la Asociación Europea de Cirugía Cardiotorácica (EACTS).

Rev Esp Cardiol, 63 (2010), pp. 1485e1-e14876

[19.]

E. Guarda, M. Acevedo, M.T. Lira, G. Chamorro, R. Corbalán.

Prevalence of cardiovascular risk factors among patients suffering vascular events on admission and one year later.

Rev Med Chil, 133 (2005), pp. 1147-1152

http://dx.doi.org//S0034-98872005001000003 | Medline

[20.]

The health benefits of smoking cessation. Washington: US Department of Health and Human Services; 1990.

[21.]

A. McEwen, P. Hajek, H. McRobbic, R. West.

Manual of smoking cessation.

Blackwell, (2006),

[22.]

EUROASPIRE Study Group.

European Society of Cardiology survey of secondary prevention of coronary Herat disease: principal results.

Eur Heart J, 18 (1997), pp. 1569-1592

Medline

[23.]

EUROASPIRE II Group.

Lifestyle and risk factor management and use of drug therapies in coronary patients: principal results from EUROASPIRE II.

Eur Heart J, 22 (2001), pp. 554-572

http://dx.doi.org/10.1053/euhj.2001.2610 | Medline

[24.]

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.

Major cardiovascular events in hypertensive patients randomized to doxazosinvschlorthalidone.

JAMA, 283 (2000), pp. 1967-1975

Medline

[25.]

W.C. Cushman, C.E. Ford, J.A. Cutler, ALLHAT Collaborative Research Group, et al.

Success and predictors of blood pressure control in diverse North American settings.

J Clin Hypertens (Greenwich), 4 (2002), pp. 393-404

[26.]

Blood Pressure Lowering Treatment Trialists’ Collaboration.

Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults.

BMJ, 336 (2008), pp. 1121-1123

http://dx.doi.org/10.1136/bmj.39548.738368.BE | Medline

[27.]

J.A. De Velasco, J. Cosin, J.L. López-Sendón, E. de Teresa, M. de Oya, J.L. Carrasco, et al.

La prevención secundaria del infarto agudo de miocardio en España. Estudio PREVESE.

Rev Esp Cardiol, 50 (1997), pp. 406-415

Medline

[28.]

J.A. De Velasco, J. Cosin, J.L. López-Sendón, E. de Teresa, M. de Oya, G. Sellers.

Nuevos datos sobre la prevención secundaria del infarto agudo de miocardio en España. Estudio PREVESE II.

Rev Esp Cardiol, 55 (2002), pp. 801-809

Medline

[29.]

P. Poirier, T.D. Giles, G.A. Bray, Y. Hong, J.S. Stern, F.X. Pi-Sunyer, et al.

Obesity and cardiovascular disease.

Circulation, 113 (2006), pp. 898-918

http://dx.doi.org/10.1161/CIRCULATIONAHA.106.171016 | Medline

[30.]

F. Fabiani, T. Arrobas, R. Iglesia, J.M. Vega, T. Holgado.

Cumplimiento de objetivos terapéuticos en pacientes con revascularización miocárdica en el Área Virgen Macarena de Sevilla.

Clin Invest Arterioscl, 20 (2008), pp. 1-7

[31.]

C.P. Cannon, E. Braunwald, C.H. McCabe, J.D. Rader, J.L. Rouleau, R. Belder, et al.

Intensive versus moderate lipid lowering with statins after acute coronary syndromes.

N Engl J Med, 350 (2004), pp. 1495-1504

http://dx.doi.org/10.1056/NEJMoa040583 | Medline

[32.]

Heart Protection Study Collaborative Group.

MRC/BHF. Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial.

Lancet, 360 (2002), pp. 7-22

http://dx.doi.org/10.1016/S0140-6736(02)09327-3 | Medline

[33.]

H.N. Ginsberg, P. Kris-Etherton, B. Dennis, et al.

Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy subjects: the DELTA Study, protocol 1.

Arterioscler Thromb Vasc Biol, 18 (1998), pp. 441-449

Medline

[34.]

B. Howard, L. Van Horn, J. Hsia, J.E. Manson, et al.

Low-fat dietary pattern and risk of cardiovascular disease: the Women’ s Health Initiative Randomized Controlled Dietary Modification Trial.

JAMA, 295 (2006), pp. 655-666

http://dx.doi.org/10.1001/jama.295.6.655 | Medline

[35.]

A. Rosengren, L. Wilhelmsen.

Physical activity protects against coronary death and deaths from all causes in middle aged men.

Ann Epidemiol, 7 (1997), pp. 69-77

Medline

[36.]

R. Taylor, A. Brown, S. Ebrahim, J. Jolliffe, H. Noorani, K. Rees, et al.

Exercise-based rehabilitation for patients with coronary heart disease.

Am J Med, 116 (2004), pp. 682-692

http://dx.doi.org/10.1016/j.amjmed.2004.01.009 | Medline

[37.]

Antithrombotic Trialists’ Collaboration.

Collaborative meta- analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk people.

BMJ, 324 (2002), pp. 71-86

Medline

[38.]

CURE Trial Investigators.

Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.

N Engl J Med, 345 (2001), pp. 494-502

http://dx.doi.org/10.1056/NEJMoa010746 | Medline

[39.]

N. Freemantle, J. Cleland, P. Young, J. Mason, J. Harrison.

Beta-blockade after myocardial infarction: systematic review and meta regression analysis.

BMJ, 318 (1999), pp. 1730-1737

Medline

[40.]

W.E. Boden, R.A. O’Rourke, K.K. Teo, P.M. Hartigan, D.J. Maron, W.J. Kostuk, COURAGE Trial Research Group, et al.

Optimal medical therapy with or without PCI for stable coronary disease.

N Engl J Med, 356 (2007), pp. 1503-1516

http://dx.doi.org/10.1056/NEJMoa070829 | Medline

[41.]

N.K. Choudhry, J. Avorn, R.J. Glynn, E.M. Antman, S. Schneeweiss.

Full coverage for preventive medications after myocardial infarction.

N Engl J Med, 365 (2011), pp. 2088-2097

http://dx.doi.org/10.1056/NEJMsa1107913 | Medline

[42.]

Third joint task force of European and other societies of cardiovascular disease. Prevention in Clinical Practice.

European Guidelines on Cardiovascular disease prevention in clinical practice.

Eur Heart J, 24 (2003), pp. 1601-1610

Medline

[43.]

T.A. Pearson, I. Laurora, H. Chu, S. Kafonek.

The lipid treatment assessment project (L-sTAP).

Arch Intern Med, 160 (2000), pp. 459-467

Medline

[44.]

N.K. Choudhry, J. Avorn, R.J. Glynn, E.M. Antman, S. Schneeweiss.

Full coverage for preventive medications after myocardial infarction. Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) Trial.

N Engl J Med, 365 (2011), pp. 2088-2097

http://dx.doi.org/10.1056/NEJMsa1107913 | Medline

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter