[Prevalence of dyslipidemias in Mexico city and Its relation to other cardiovascular risk factors. Results from the CARMELA study]. / Prevalencia de dislipidemias en la ciudad de México y su asociación con otros factores de riesgo cardiovascular. Resultados del estudio CARMELA.

OBJECTIVE: To estimate the prevalence of dyslipidemias in Mexico city and its relation to other cardiovascular risk factors. METHODS: A cross sectional study was conducted to measure cardiovascular risk factors in Mexico City. All subjects were interviewed and anthropometric measures performed, as well as cholesterol, high-density lipoproteins (HDL-C) and triglycerides. Low-density lipoprotein (LDL-C) values were calculated. Means- as well as dyslipidemia-weighted prevalence were measured, with 95% confidence intervals. RESULTS: 833 males and 889 females were studied. The prevalence of cholesterol ≥ 240 mg/dl was 16.4% (95% CI: 14.2-18.7), and 34.1% (95% CI: 31.6-36.5) had values between 200 and 240 mg/dl. Very high values of triglycerides were seen in 2.6% of studied subjects and 29.9% (95% CI: 26.9-32.8) had high values. The prevalence of hypertriglyceridemia was higher in males (43.3%) than females (23%). Mean values of assessed parameters were in general higher in those with other cardiovascular risk factors. CONCLUSIONS: Lipid values in the population of Mexico City are high and so is the prevalence of dyslipidemias. There is an urgent need to implement health policies directed to diminish cardiovascular risk factors, mainly dyslipidemias.

Educational inequalities in obesity, abdominal obesity, and metabolic syndrome in seven Latin American cities: the CARMELA Study.

AIMS: Earlier reviews have found that the proportion of inverse associations between socioeconomic status and obesity increased according to the level of development of the studied country. Based on this finding, it has been hypothesized that in low- to middle- income countries the burden of obesity shifts to disadvantaged groups as a country develops. METHODS AND RESULTS: CARMELA is a cross-sectional, population-based observational study that sampled 11,550 women and men age 25-64 from seven major Latin American cities. We analyzed by gender the association of educational attainments (as proxy of socioeconomic status) with body mass index, waist circumference and metabolic syndrome. Participating cities were divided by country Human Development Index (HDI). An inverse gradient between socioeconomic status and body mass index in women was uniformly present in High HDI cities (Buenos Aires, Santiago, Mexico) but not in Medium HDI group (Barquisimeto, Bogota, Lima, Quito), where two cities showed an inverse gradient and two cities did not. In men, no clear socioeconomic gradients were found. Findings regarding waist circumference and metabolic syndrome closely mirrored those about body mass index. CONCLUSION: In women but not men, these results give support to the hypothesis of obesity shifting to the poor and extend it to the related concepts of abdominal obesity and metabolic syndrome. Obesity should be considered as a socially-generated disease and an indicator of socioeconomic disadvantage, to be approached by comprehensive strategies that bear in mind this perspective.

Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results.

BACKGROUND: Measurement of far wall common carotid artery intima-media thickness (CCAIMT) has emerged as a predictor of incident cardiovascular events. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was the first large-scale population-based assessment of both CCAIMT and cardiovascular risk factor prevalence in 7 Latin American cities; the relationship between CCAIMT and cardiovascular risk markers was assessed in these urban Latin American centers. METHODS: CARMELA was a cross-sectional, population-based, observational study using stratified, multistage sampling. The participants completed a questionnaire, were evaluated in a clinical visit and underwent carotid ultrasonography. Clinical measurements were obtained by health personnel trained, certified and supervised by CARMELA investigators. Mannheim intima-media thickness consensus guidelines were followed for measurement of CCAIMT. RESULTS: In all cities and for both sexes, CCAIMT increased with higher age. CCAIMT was greater in the presence of cardiovascular risk factors than in their absence. In all cities, there was a statistically significant linear trend between increasing CCAIMT and a growing number of cardiovascular risk factors (p < 0.001). After adjustment for age and sex, metabolic syndrome was strongly associated with increased CCAIMT (p < 0.001 in all cities), as were hypercholesterolemia, obesity and diabetes (p < 0.001 in most cities). By multivariate analysis, hypertension was independently associated with an increase in CCAIMT in all cities (p < 0.01). CONCLUSIONS: CARMELA was the first large-scale population study to provide normal CCAIMT values according to age and sex in urban Latin American populations and to show CCAIMT increases in the presence of cardiovascular risk factors and metabolic syndrome.

Dyslipidemia in seven Latin American cities: CARMELA study.

OBJECTIVE: The objective of this study was to describe the prevalence of dyslipidemia in the CARMELA study population. METHODS: CARMELA was a cross-sectional study of cardiovascular risk conducted between September 2003 and August 2005 in adults (aged 25 to 64 years) living in Barquisimeto (n=1,824), Bogotá (n=1,511), Buenos Aires (n=1,412), Lima (n=1,628), Mexico City (n=1,677), Quito (n=1,620), and Santiago (n=1,605). Dyslipidemia was defined as the presence of one or more of the following conditions: triglycerides>/=200 mg/dL, or total cholesterol (TC)>/=240 mg/dL, or HDL cholesterol<40 mg/dL, or LDL cholesterol=not optimal, or currently taking antilipemic agents. RESULTS: Prevalence rates of dyslipidemia in men and women were: 75.5% (CI: 71.9-79.1) and 48.7% (CI: 45.4-51.9) in Barquisimeto; 70% (CI: 66.2-73.8) and 47.7% (CI: 43.9-51.5) in Bogotá; 50.4% (CI: 46.8-54.0) and 24.1% (CI: 21.0-27.2) in Buenos Aires; 73.1% (CI: 69.3-76.8) and 62.8% (CI: 59.2-66.5) in Lima; 62.5% (CI: 58.5-66.5) and 37.5% (CI: 33.5-41.6) in Mexico City; 52.2% (CI: 47.9-56.5) and 38.1% (CI: 34.5-41.7) in Quito; and, 50.8% (CI: 47.1-54.4) and 32.8% (CI: 29.3-36.3) in Santiago. CONCLUSIONS: Dyslipidemia was disturbingly prevalent and varied across cities. The most frequent dyslipidemia was low HDL-C followed by high triglycerides. The high TC/HDL-C ratios and non-HDL-C levels suggest a high risk of cardiovascular disease.

Prevalence of the metabolic syndrome in Latin America and its association with sub-clinical carotid atherosclerosis: the CARMELA cross sectional study.

BACKGROUND: Metabolic syndrome increases cardiovascular risk. Limited information on its prevalence in Latin America is available. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study included assessment of metabolic syndrome in 7 urban Latin American populations. METHODS: CARMELA was a cross-sectional, population-based, observational study conducted in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. The prevalence of metabolic syndrome, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and associated carotid atherosclerosis were investigated in 11,502 participants aged 25 to 64 years. RESULTS: Across CARMELA cities, metabolic syndrome was most prevalent in Mexico City (27%) and Barquisimeto (26%), followed by Santiago (21%), Bogota (20%), Lima (18%), Buenos Aires (17%), and Quito (14%). In nondiabetic participants, prevalence was slightly lower but followed a comparable ranking. Overall, 59%, 59%, and 73% of women with high triglycerides, hypertension, or glucose abnormalities, respectively, and 64%, 48% and 71% of men with abdominal obesity, hypertension, or glucose abnormalities, respectively, had the full metabolic syndrome. Prevalence of metabolic syndrome increased with age, markedly so in women. Mean common carotid artery intima-media thickness (CCAIMT) and prevalence of carotid plaque increased steeply with increasing numbers of metabolic syndrome components; mean CCAIMT was higher and plaque more prevalent in participants with metabolic syndrome than without. CONCLUSION: The prevalence of metabolic syndrome and its components by NCEP ATP III criteria was substantial across cities, ranging from 14% to 27%. CARMELA findings, including evidence of the association of metabolic syndrome and carotid atherosclerosis, should inform appropriate clinical and public health interventions.

Analysis of the decrease in deaths due to coronary disease between 1995 and 2010. IMPACT CHD Argentina Study. / [Análisis del descenso de muertes por enfermedad coronaria entre 1995 y 2010. Estudio IMPACT CHD Argentina.]

Objetive: To quantify the contribution of risk factors and treatments in the reduction of mortality due to coronary heart disease in Argentina between 1995 and 2010. Results: We used the validated IMPACTCHD model integrating data on effectiveness, use of treatments and changes in the risk factors between 1995 and 2010 in people older than 25 years in Argentina. The difference between the coronary deaths observed and expected in 2010 was distributed between treatments and risk factors. Conclusions: One out of every two MPP due to coronary heart disease in Argentina between 1995 and 2010 was due to treatments and one third to the improvement of risk factors. The decrease in blood pressure, cholesterol and smoking was limited by increases in the prevalence of obesity, sedentary lifestyle and diabetes. This study was possible thanks to the collaborative work to the cardiovascular epidemiology.

Objetivos: Cuantificar la contribución de los factores de riesgo (FR) y de los tratamientos en el descenso de mortalidad por enfermedad coronaria en Argentina entre 1995 y 2010. Métodos: Utilizamos el modelo validado IMPACTCHD integrando datos de efectividad y utilización de tratamientos y cambios en los FR en 1995 y 2010 en mayores de 25 años en Argentina. La diferencia entre las muertes coronarias observadas y esperadas en el 2010 se distribuyó entre los tratamientos y los FR. Resultados: Entre 1995 y 2010 las tasas ajustadas de mortalidad por enfermedad coronaria descendieron 29,8% (8 500 muertes prevenidas o pospuestas - MPP). Las mejoras en los tratamientos explicaron un 49,9%, en su mayoría por prevención secundaria del infarto agudo de miocardio (8,2%); tratamiento antihipertensivo (11,9%) y para insuficiencia cardíaca (13,2%). Las mejoras en los FR explicaron 32,9% de las MPP: presión arterial sistólica 34,6%; colesterol total 12,8%; tabaquismo 6,8%. Se encontró un exceso de muertes debido al aumento de diabetes (9,4%), obesidad (6,9%) y sedentarismo (5%). Un 17,2% de las MPP no fue explicado por el modelo. Conclusiones: Una de cada dos MPP por enfermedad coronaria en Argentina entre 1995 y 2010 se debió a los tratamientos y un tercio a la mejora de los FR. El descenso de la presión arterial, colesterol y tabaquismo fue limitado por aumentos en la prevalencia de obesidad, sedentarismo y diabetes. Este trabajo fue posible gracias al trabajo colaborativo en pos de la epidemiología cardiovascular.

General physicians and the management of heart failure in an Argentine population.

The aim of this study was to assess how general physicians (GP) think that heart failure (HF) should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named "Improvement" already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a "perception survey", and later on how a representative sample of patients was managed, with an "actual practice survey". The electrocardiogram and the chest radiograph were recorded in most patients (approximately equal to 90%), but the echocardiogram only in 67% of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16% of the patient records. Likewise coronary angiogram was performed in 7% of patients. Only 23% of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43% of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9% received these drugs in combination. At the last interview, 50% had hypertension (blood pressure > or = 140/90) and 15% had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.

Attributable risks for acute myocardial infarction in four countries of Latin America.

This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass Index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.

HDL-C, triglycerides and carotid IMT: a meta-analysis of 21,000 patients with automated edge detection IMT measurement.

OBJECTIVE: Common carotid artery (CCA) intima-media thickness (IMT), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), but not triglyceride levels, are markers of future cardiovascular events. The relationship between these three factors is, however, unclear. METHODS: We included six large observational studies that used the same harmonized, B-mode ultrasound protocol, the same software for IMT measurement by automatic edge detection on CCA in a plaque-free region, following the Mannheim consensus, and certification of all sonographers. Using the best view of the CCA, the sonographer had to confirm that the quality index was ≥ 0.5 on a measurement performed on 10-mm length. We used individual data meta-analysis to estimate the cross-sectional associations of lipids with CCA-IMT. RESULTS: Overall, 21,587 patients with complete information on lipids and CCA-IMT were available. Age- and sex-adjusted CCA-IMT differed by -7.8 µm (95% CI -9.1 to -6.5 µm, P < 0.001) per 1 SD higher HDL-C level. After further adjustment for other atherosclerosis risk factors, the relationship was attenuated, but remained significant (regression coefficient, -3.7 µm; P < 0.001). This was found regardless of LDL-C levels (P for heterogeneity = 0.70). After adjustment for age and sex, triglycerides were positively associated with CCA-IMT, overall and in each LDL-C subgroup, but not after further adjustments for other risk factors. CONCLUSIONS: Relationships between HDL-C and triglyceride levels and CCA-IMT were consistent with that previously observed with clinical events by the Emergency Risk Collaboration group, including at low LDL-C levels. This reinforces the need to verify whether raising HDL-C levels decreases both CCA-IMT and future clinical events.

[Diabetes in Mexico. CARMELA study].

BACKGROUND: Diabetes has demonstrated an epidemic behavior in Mexico, which is among the top countries with the highest number of patients with diabetes. The objective of this study was to estimate the prevalence of type 2 diabetes in Mexico City and its relation with some cardiovascular risk factors. METHODS: A cross-sectional study was conducted. A total of 1,772 adults of both genders, aged 25 to 64 years, were randomly selected. Type 2 diabetes and impaired fasting glucose prevalence were estimated as well as its relation with some cardiovascular risk factors such as hypertension, dyslipidemia, obesity, abdominal obesity and the common carotid artery intima-media thickness. RESULTS: The prevalence of type 2 diabetes was 9.7% in women and 8.0% in men. An age effect was evident. The proportion of patients who were unaware of having diabetes was 26%. The main risk factors related to diabetes were age, abdominal obesity, hypertension, low high-density cholesterol lipoproteins (HDL-c) and hypertriglyceridemia. Metabolic control was low. CONCLUSIONS: Prevalence of type 2 diabetes in Mexico is high and is a major health problem. Its close relation with cardiovascular risk factors demand health policies aimed to diminish risk factors related to its occurrence.

Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study.

BACKGROUND: Little information is available regarding hypertension, treatment, and control in urban population of Latin America. OBJECTIVE: We aimed to compare blood pressure (BP) distribution, hypertension prevalence, treatment, and control in seven Latin American cities following standard methodology. METHODS: The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was a cross-sectional, epidemiologic study assessing cardiovascular risk factors using stratified multistage sampling of adult populations (aged 25-64 years) in seven cities: Barquisimeto (Venezuela; n = 1848); Bogotá (n = 1553); Buenos Aires (n = 1482); Lima (n = 1652); Mexico City (n = 1720); Quito (n = 1638); and Santiago (n = 1655). The prevalence of hypertension and high normal BP were determined based on 2007 European Society of Hypertension and European Society of Cardiology definitions. RESULTS: BP increased with age in men and women; pulse pressure increased mainly in the upper age group. The hypertension prevalence ranged from 9% in Quito to 29% in Buenos Aires. One-quarter to one-half of the hypertension cases were previously undiagnosed (24% in Mexico City to 47% in Lima); uncontrolled hypertension ranged from 12% (Lima) to 41% (Mexico City). High normal BP was also evident in a substantial number of each city participants (approximately 5-15%). Majority of population has other cardiovascular risk factors despite hypertension; only 9.19% of participants have no risk factors apart from hypertension. CONCLUSION: From 13.4 to 44.2% of the populations of seven major Latin American cities were hypertensive or had high normal BP values. Most hypertensive patients have additional risk factors. Public health programs need to target prevention, detection, treatment, and control of total cardiovascular risk in Latin America.

CARMELA: assessment of cardiovascular risk in seven Latin American cities.

OBJECTIVE: This cross-sectional, population-based observational study using stratified multistage sampling assessed the prevalence of cardiovascular risk factors and carotid plaques and measured carotid intima-media thickness in individuals living in major cities in 7 Latin American countries. PATIENTS AND METHODS: The study comprised individuals (n=11,550) aged 25 to 64 years, living in Barquisimeto, Bogota, Buenos Aires, Lima, Mexico City, Quito, and Santiago. Data on anthropometric parameters, blood pressure, fasting glucose, total and high-density lipoprotein cholesterol, triglycerides, carotid intima-media thickness, carotid plaque, and smoking status were collected through household interviews and clinical, biochemical, and sonographic measurements. RESULTS: The overall prevalence rates (ranges across cities) were as follows: hypertension (> or = 140/90 mm Hg or pharmacologic treatment), 18% (9%-29%); hypercholesterolemia (total cholesterol > or = 240 mg/dL), 14% (6%-20%); diabetes (glycemia > or = 126 mg/dL or self-reported diabetes), 7% (4%-9%); metabolic syndrome, 20% (14%-27%); obesity (body mass index > or = 30 kg/m2), 23% (18%-27%); smoking, 30% (22%-45%); and plaque, 8% (5%-14%). The mean intima-media thickness was 0.65 mm (0.60-0.74 mm). CONCLUSION: The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes was similar to that in the developed countries. Tobacco use in women living in Santiago and Buenos Aires was among the world's highest. Intima-media thickness and carotid plaque prevalences varied widely.

Evaluación del riesgo cardiovascular en siete ciudades de Latinoamérica: las principales conclusiones del estudio CARMELA y de los subestudios / Evaluation of Cardiovascular Risk in Seven Cities in Latin America: The Main Conclusions of the CARMELA Study / Assessment of Cardiovascular Risk in Seven Latin American Cities: The Main Conclusions of the CARMELA Study and Substudies

Para evaluar el nivel de riesgo cardiovascular de la población latinoamericana se diseñó un estudio en siete ciudades de la región a fin de realizar un muestreo poblacional homogéneo con metodología única, exámenes de laboratorio y físicos estandarizados y controlados para obtener así datos epidemiológicos confiables. El estudio CARMELA (Cardiovascular Risk Factor Multiple Evaluation in Latin America) evaluó 11.550 sujetos de la población general. Los resultados mostraron que la hipertensión tuvo una prevalencia equiparable a nivel mundial sólo en tres ciudades, en tanto que en el resto fue menor. La hipercolesterolemia fue muy prevalente aun en ciudades de diferente nivel socioeconómico. La diabetes se halló entre el 7% y el 9% en Ciudad de México, Bogotá y Santiago de Chile. El tabaquismo fue muy alto en ambos sexos en Santiago de Chile y en Buenos Aires. La obesidad abdominal y el síndrome metabólico predominaron en las mujeres de bajos recursos. El espesor íntima-media y la prevalencia de placa carotídea tuvieron una amplia variación entre ciudades. Los datos epidemiológicos recabados en el estudio CARMELA completan el panorama del riesgo cardiovascular de nuestra región y muestran que su prevalencia indica la necesidad de contar con políticas de salud racionales.

To assess the cardiovascular risk of the Latin American population, we conducted a homogeneous population-based sampling study in seven cities of the region following controlled and standardized methods, laboratory tests and physical examination and thus obtain reliable epidemiological data. The CARMELA study (Cardiovascular Risk Factor Multiple Evaluation in Latin America) evaluated 11550 subjects from the general population. The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes ranged between 7% and 9% in Mexico City, Bogotá and Santiago de Chile. Tobacco use was high in both sexes in Santiago and Buenos Aires. Abdominal obesity and the metabolic syndrome were more prevalent in women of low resources. Intima-media thickness and carotid plaque prevalence varied widely. The epidemiological data obtained in the CARMELA study complete the outlook of the cardiovascular risk in our region and indicate the need of rationale urban health policies.

General physicians and the management of heart failure in an Argentine population

Los m¨¦dicos generales y el tratamiento de la insuficiencia card¨ªaca en una muestra de la poblaci¨®n argentina. El objetivo de este estudio fue evaluar c¨®mo los m¨¦dicos generales (MG) piensan que debe tratarse la insuficiencia card¨ªaca (IC) y c¨®mo ponen en pr¨¢ctica su conocimiento. Se realiz¨® en la ciudad de Buenos Aires y su ¨¢rea suburbana, con la colaboraci¨®n de 5 cardi¨®logos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicit¨® que guardasen las historias cl¨ªnicas de todos los pacientes que ellos hab¨ªan atendido con IC. Se obtuvieron los datos de 220 pacientes. La metodolog¨ªa fue similar a la utilizada en una iniciativa internacional llamada Improvement realizada en Europa. Se evalu¨® el conocimiento de los MG y su percepci¨®n sobre el manejo de la IC mediante una ¡°encuesta de percepci¨®n¡±, y c¨®mo una muestra representativa de pacientes fue tratada, a trav¨¦s de una ¡°encuesta sobre la pr¨¢ctica¡±. El lectrocardiograma y la radiograf¨ªa de t¨®rax se le pidieron a la mayor¨ªa de los pacientes (≅90%), pero el ecocardiograma se pidi¨® s¨®lo en el 67% de casos. Cuarenta por ciento de los pacientes ten¨ªan historia de infarto de miocardio y de angina de pecho, pero la ergometr¨ªa no fue considerada como una prueba de diagn¨®stico importante y s¨®lo se asent¨® en el 16% de las HC. Igualmente la cinecoronariograf¨ªa se realiz¨® en el 7% de pacientes. S¨®lo el 23% de los pacientes ten¨ªan una fracci¨®n de eyecci¨®n del ventr¨ªculo izquierdo documentada en sus HC. En la pr¨¢ctica, el 43% de pacientes estaban recibiendo un inhibidor de la ECA y una tercera parte betabloqueantes. S¨®lo 9% recibieron estas drogas combinadas. En la ¨²ltima entrevista, 50% ten¨ªan hipertensi¨®n arterial (¡Ý 140/ 90 mmHg) y en 15% no se hab¨ªa consignado este dato en las HC de los pacientes. Este estudio mostr¨® que el conocimiento y tratamiento de la IC en una muestra de MG, era menor que el ¨®ptimo.

General physicians and the management of heart failure in an Argentine population

Los m¿¬dicos generales y el tratamiento de la insuficiencia card¿¬aca en una muestra de la poblaci¿½n argentina. El objetivo de este estudio fue evaluar c¿½mo los m¿¬dicos generales (MG) piensan que debe tratarse la insuficiencia card¿¬aca (IC) y c¿½mo ponen en pr¿øctica su conocimiento. Se realiz¿½ en la ciudad de Buenos Aires y su ¿ørea suburbana, con la colaboraci¿½n de 5 cardi¿½logos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicit¿½ que guardasen las historias cl¿¬nicas de todos los pacientes que ellos hab¿¬an atendido con IC. Se obtuvieron los datos de 220 pacientes. La metodolog¿¬a fue similar a la utilizada en una iniciativa internacional llamada Improvement realizada en Europa. Se evalu¿½ el conocimiento de los MG y su percepci¿½n sobre el manejo de la IC mediante una íºencuesta de percepci¿½ní±, y c¿½mo una muestra representativa de pacientes fue tratada, a trav¿¬s de una íºencuesta sobre la pr¿øcticaí±. El lectrocardiograma y la radiograf¿¬a de t¿½rax se le pidieron a la mayor¿¬a de los pacientes (≅90%), pero el