Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial.

BACKGROUND: Dietary vitamin K is thought to be an important factor that interferes with anticoagulation stability, but the clinical applicability of this interaction has not been evaluated adequately in prospective studies. METHODS AND RESULTS: In a randomized controlled trial that enrolled outpatients with a recent international normalized ratio (INR) outside the therapeutic target, we compared 2 strategies to optimize long-term oral anticoagulation: (1) a conventional approach based on changes in anticoagulant prescription and (2) a dietary vitamin K-guided strategy based on simple modifications of the amount of vitamin K-rich foods ingested per week. The primary efficacy end point was the percentage of patients who achieved a prespecified INR target at 90 days after randomization. Study population (n=132) predominantly included men with mechanical heart prostheses (58%) or atrial fibrillation (35%). Over time, patients allocated to the vitamin K-guided strategy reached the prespecified INR more frequently so that after 90 days of follow-up, 74% were on target compared with 58% of patients managed conventionally (P=0.04). Patients allocated to the dietary vitamin K-guided strategy had the same magnitude and direction of INR variation as those observed with the conventional approach in the short term (15 days) for both underanticaogulated and overanticoagulated patients. Minor bleeding or use of parenteral vitamin K were also marginally less frequent in patients managed according to the dietary intervention (1 [1.5%] versus 7 [11%]; P=0.06). CONCLUSIONS: A vitamin K-guided management strategy to adjust long-term oral anticoagulation is feasible and safe and may result in an increased chance of reaching target levels of INR.

Nurses' performance in classifying heart failure patients based on physical exam: comparison with cardiologist's physical exam and levels of N-terminal pro-B-type natriuretic peptide.

AIM: The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed by cardiologist and correlate them with NT-ProBNP levels. BACKGROUND: The nurses' role in heart failure has been strongly focused in therapeutic, educational and self-care interventions. The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptide is a cardiac marker that reflects elevated filling pressures. DESIGN: Cross-sectional contemporaneous study. METHODS: Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by cardiologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriuretic peptide levels obtained. The nurses' ability to classify patients in hemodynamic profile was compared to the cardiologist's. RESULTS: Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scores obtained by nurse with those obtained by cardiologist was rs=0.86; p<0.001. The correlation of clinical congestion scores from nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows: rs=0.45; p<0.0001 and rs=0.51, respectively, p<0.0001. Patients with clinical congestion score≥3 had levels of NT-ProBNP significantly higher than those with clinical congestion score<3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml; p<0.0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml; p<0.0001). The nurse and cardiologist had similar capacity in classifying patients in congested quadrants (p=0.027) or in dry quadrants (p=0.03), according to the levels of N-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist to detect congestion was, respectively, 0.77 and 0.72. CONCLUSIONS: Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologist for the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure. RELEVANCE TO CLINICAL PRACTICE: Considering that consistent clinical assessment can identify congested or hypovolemic patients with reasonable reliability, as well as patients with low or normal cardiac output, our results may help confirm nurses' capability in performing reliable clinical assessment in heart failure patients. While nurses' led heart failure programmes are usually focused on the management of patients, nurses' ability to perform accurate assessment would expand nurses' role in these programmes. As many institutions now focus on home visits by heart failure nurses, accurate assessment would benefit patients and improve their clinical outcomes.

Venous endothelial function in heart failure: comparison with healthy controls and effect of clinical compensation.

BACKGROUND: Endothelial function has been extensively evaluated at the arterial bed in several cardiovascular scenarios. Venous endothelial dysfunction, however, has not been thoroughly explored particularly in heart failure (HF). AIMS: To characterize venous endothelial function in severe HF. METHODS AND RESULTS: Venous endothelial function was evaluated by the dorsal hand vein technique using a tripod holding a linear variable differential transformer. Dorsal hand veins were pre-constricted with phenylephrine and dose-response curves were constructed after acetylcholine and sodium nitroprusside administration. Maximum vasodilator response to acetylcholine, a marker of endothelium-dependent venodilation, was significantly lower (47+/-53% versus 102+/-54%, respectively, p=0.0004) in HF (n=27) patients compared to healthy controls (n=20). No difference in the endothelium-independent venodilator response was observed (p=0.87). Maximum vasodilator response to acetylcholine was also significantly lower on admission compared to the response immediately before hospital discharge in patients with acute decompensated HF (p<0.01). Improvement in venous endothelial function paralleled weight loss (mean difference of -3.8 kg, p<0.01) and improvement in the 6-minute walk test (mean difference of 107 m, p<0.01). There was no significant change in angiotensin-converting enzyme inhibitor or beta-blocker use during hospital stay. CONCLUSIONS: HF patients experience marked endothelium-dependent venous dysfunction with partial recovery during in-hospital management.

[Insulin: cardiovascular effects and therapeutic applications]. / Insulina: efeitos cardiovasculares e aplicações terapêuticas.

Several studies have suggested a beneficial role of insulin and glucose infusions after myocardial infarction and in critically ill diabetic and non-diabetic patients. However, the insulin-glucose infusions are not routinely given to these patients, since no large randomized control trial was carried out, mechanisms involved in the benefits obtained are poorly understood, infusion protocols are complex and finally, health professionals need to change their cultural premises to apply them in their practice. Insulin has beneficial cardiovascular effects, such as the optimization of substrate use by cardiomyocites, coronary vasodilation, anti-inflammatory action and direct anti-apoptotic effects on myocardial cells. In this context, clinical studies of glucose and insulin infusions after myocardial infarction and cardiovascular surgery are reviewed, as well as possible pathophysiologic mechanisms leading to these benefits, and finally, a practical algorithm is proposed for use in intensive care and cardiovascular postoperative care units.

Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.

IMPORTANCE: The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. OBJECTIVE: To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF. DESIGN: Randomized, parallel-group clinical trial with blinded outcome assessments. SETTING: Emergency room, wards, and intensive care unit. PARTICIPANTS: Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less. INTERVENTION: Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake. MAIN OUTCOMES AND MEASURES: Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days. RESULTS: Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight loss was similar in both groups (between-group difference in variation of 0.25 kg [95% CI, -1.95 to 2.45]; P = .82) as well as change in clinical congestion score (between-group difference in variation of 0.59 points [95% CI, -2.21 to 1.03]; P = .47) at 3 days. Thirst was significantly worse in the IG (5.1 [2.9]) than the CG (3.44 [2.0]) at the end of the study period (between-group difference, 1.66 points; time × group interaction; P = .01). There were no significant between-group differences in the readmission rate at 30 days (IG, 11 patients [29%]; CG, 7 patients [19%]; P = .41). CONCLUSIONS AND RELEVANCE: Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01133236.

Education and telephone monitoring by nurses of patients with heart failure: randomized clinical trial.

BACKGROUND: Nursing approaches to manage patients with heart failure (HF) showed benefits in reducing the morbidity and mortality. However, combining intra-hospital education with telephone contact after hospital discharge has been little explored. OBJECTIVE: To compare two nursing intervention groups among patients hospitalized due to decompensated HF: the intervention group (IG) received educational nursing intervention during hospitalization followed by telephone monitoring after discharge and the control group (CG) received in-hospital intervention only. Outcomes were levels of HF and self-care knowledge, the frequency of visits to the emergency room, rehospitalizations and deaths in a three-month period. METHODS: Randomized clinical trial. We studied adult HF patients with left ventricle ejection fraction (LVEF) < 45% who could be contacted by telephone after discharge. HF awareness was evaluated through a standardized questionnaire that also included questions regarding self-care knowledge, which was answered during the hospitalization period and three months later. For patients in the IG group contacts were made using phone calls and final interviews were conducted in both groups at end of the study. RESULTS: Forty-eight patients were assigned to the IG and 63 to the CG. Mean age (63 ± 13 years) and L (around 29%) were similar in the two groups. Scores for HF and self-care knowledge were similar at baseline. Three months later, both groups showed significantly improved HF awareness and self-care knowledge scores (P < 0.001). Other outcomes were similar. CONCLUSION: An in-hospital educational nursing intervention benefitted all HF patients in understanding their disease, regardless of telephone contact after discharge.

Bradykinin or acetylcholine as vasodilators to test endothelial venous function in healthy subjects.

INTRODUCTION: The evaluation of endothelial function has been performed in the arterial bed, but recently evaluation within the venous system has also been explored. Endothelial function studies employ different drugs that act as endothelium-dependent vasodilatory response inductors. OBJECTIVES: The aim of this study is to compare the endothelium-dependent venous vasodilator response mediated by either acetylcholine or bradykinin in healthy volunteers. METHODS AND RESULTS: Changes in vein diameter after phenylephrine-induced venoconstriction were measured to compare venodilation induced by acetylcholine or bradykinin (linear variable differential transformer dorsal hand vein technique). We studied 23 healthy volunteers; 31% were male, and the subject had a mean age of 33 +/- 8 years and a mean body mass index of 23 +/- 2 kg/m(2). The maximum endothelium-dependent venodilation was similar for both drugs (p = 0.13), as well as the mean responses for each dose of both drugs (r = 0.96). The maximum responses to acetylcholine and bradykinin also had good agreement. CONCLUSION: There were no differences between acetylcholine and bradykinin as venodilators in this endothelial venous function investigation.

Non-pharmacological management of patients hospitalized with heart failure at a teaching hospital.

OBJECTIVE: To describe non-pharmacological management of patients admitted with heart failure (HF) in a teaching hospital. METHODS: A cohort longitudinal study of patients diagnosed with HF according to the Boston score. Within the first 72 hours of admission, the nursing staff of the HF clinic conducted structured interviews and medical chart reviews. RESULTS: Two hundred and eighty-three admissions of 239 patients (age = 64 +/- 15 years) were evaluated; approximately 50% of the patients were male and 37% had heart failure of ischemic etiology Non-pharmacological measures included salt restriction in 97%, urine output monitoring in 85%, fluid balance in 75%, weight monitoring in 61%, and fluid restriction in only 25% of the patients. However, they were often not carried out by the team in charge (p < 0.01 for all comparisons). Irregular use of prescribed drugs in the week prior to admission was 22% and 21% in non-readmitted and readmitted patients, respectively (p = 1.00). Readmitted patients (n = 38) had severe systolic dysfunction, more previous hospitalizations, and longer duration of HF symptoms, as compared to those non-readmitted; in addition they had better knowledge related to self-care (p values < 0.05). In the multivariate analysis, only duration of symptoms remained as an independent predictor of re-admissions. CONCLUSION: Our data suggest that, even at a teaching hospital, important gaps exist between prescribing non-pharmacological measures for HF patients and their being carried out. Readmitted patients seem to have good understanding of their condition; this finding, however, is significantly associated with HF severity and time of onset.

Educação e monitorização por telefone de pacientes com insuficiência cardíaca: ensaio clínico randomizado / Education and telephone monitoring by nurses of patients with heart failure: randomized clinical trial / Educación y monitoreo por teléfono de pacientes con insuficiencia cardíaca: ensayo clínico randomizado

FUNDAMENTO: Diferentes abordagens de enfermagem no manejo de pacientes com insuficiência cardíaca (IC) tem demonstrado benefícios na redução da morbidade e mortalidade. Entretanto, a combinação de educação intra-hospitalar com contato telefônico após a alta hospitalar tem sido pouco explorada. OBJETIVO: Comparar dois grupos de intervenção de enfermagem entre pacientes hospitalizados devido à IC descompensada: o grupo intervenção (GI) recebeu intervenção educativa de enfermagem durante a hospitalização, seguida de monitorização por telefone após a alta hospitalar e o grupo controle (GC) recebeu apenas a intervenção hospitalar. Os desfechos foram conhecimento da IC e autocuidado, número de visitas à emergência, re-hospitalizações e morte em um período de três meses. MÉTODOS: Ensaio clínico randomizado. Pacientes adultos com IC e fração de ejeção do ventrículo esquerdo (FEVE) < 45 por cento que podiam ser contatados por telefone após a alta foram estudados. O conhecimento da IC foi avaliado por meio de um questionário padronizado que também incluía questões referentes ao conhecimento do autocuidado, o qual foi respondido durante o período de hospitalização e três meses depois. Para os pacientes do grupo GI, os contatos foram realizados por meio de telefonemas e as entrevistas finais foram conduzidas em ambos os grupos ao final do estudo. RESULTADOS: Quarenta e oito pacientes foram alocados no GI e 63 no grupo GC. A idade média (63 ± 13 anos) e FEVE (aproximadamente 29 por cento) eram similares nos dois grupos. Os escores para conhecimento da IC e autocuidado foram similares na avaliação basal. Três meses depois, ambos os grupos demonstraram melhora significativa dos escores de conhecimento da IC e autocuidado (P < 0,001). Outros desfechos foram similares. CONCLUSÃO: A intervenção educativa de enfermagem intra-hospitalar beneficiou todos os pacientes com IC em relação ao conhecimento da doença e autocuidado, independente do contato telefônico após a alta hospitalar.

BACKGROUND: Nursing approaches to manage patients with heart failure (HF) showed benefits in reducing the morbidity and mortality. However, combining intra-hospital education with telephone contact after hospital discharge has been little explored. OBJECTIVE: To compare two nursing intervention groups among patients hospitalized due to decompensated HF: the intervention group (IG) received educational nursing intervention during hospitalization followed by telephone monitoring after discharge and the control group (CG) received in-hospital intervention only. Outcomes were levels of HF and self-care knowledge, the frequency of visits to the emergency room, rehospitalizations and deaths in a three-month period. METHODS: Randomized clinical trial. We studied adult HF patients with left ventricle ejection fraction (LVEF) < 45 percent who could be contacted by telephone after discharge. HF awareness was evaluated through a standardized questionnaire that also included questions regarding self-care knowledge, which was answered during the hospitalization period and three months later. For patients in the IG group contacts were made using phone calls and final interviews were conducted in both groups at end of the study. RESULTS: Forty-eight patients were assigned to the IG and 63 to the CG. Mean age (63 ± 13 years) and L (around 29 percent) were similar in the two groups. Scores for HF and self-care knowledge were similar at baseline. Three months later, both groups showed significantly improved HF awareness and self-care knowledge scores (P < 0.001). Other outcomes were similar. CONCLUSION: An in-hospital educational nursing intervention benefitted all HF patients in understanding their disease, regardless of telephone contact after discharge.

FUNDAMENTO: Diferentes abordajes de enfermería en el manejo de pacientes con insuficiencia cardíaca (IC) han demostrado beneficios en la reducción de la morbilidad y mortalidad. Entre tanto, la combinación de educación intrahospitalaria con contacto telefónico después del alta hospitalaria ha sido poco explorada. OBJETIVO: Comparar dos grupos de intervención de enfermería entre pacientes hospitalizados debido a IC descompensada: el grupo intervención (GI) recibió intervención educativa de enfermería durante la hospitalización, seguida de monitoreo por teléfono después del alta hospitalaria y el grupo control (GC) recibió apenas la intervención hospitalaria. Los desenlaces fueron conocimiento de IC y autocuidado, número de visitas a la emergencia, rehospitalizaciones y muerte en un período de tres meses. MÉTODOS: Ensayo clínico randomizado. Pacientes adultos con IC y fracción de eyección del ventrículo izquierdo (FEVI) < 45 por ciento que podían ser contactados por teléfono después del alta fueron estudiados. EL conocimiento de la IC fue evaluado por medio de un cuestionario estandarizado que también incluía preguntas referentes al conocimiento del autocuidado, el cual fue respondido durante el período de hospitalización y tres meses después. Para los pacientes del grupo GI, los contactos fueron realizados por medio de telefonemas y las entrevistas finales fueron conducidas en ambos grupos al final del estudio. RESULTADOS: Cuarenta y ocho pacientes fueron ubicados en el GI y 63 en el grupo GC. La edad media (63 ± 13 años) y FEVI (aproximadamente 29 por ciento) eran similares en los dos grupos. Los escores para conocimiento de la IC y autocuidado fueron similares en la evaluación basal. Tres meses después, ambos grupos demostraron mejora significativa de los escores de conocimiento de la IC y autocuidado (P<0,001). Otros desenlaces fueron similares. CONCLUSIÓN: La intervención educativa de enfermería intrahospitalaria benefició a todos los pacientes con IC en relación al conocimiento de la enfermedad y autocuidado, independiente del contacto telefónico después del alta hospitalaria.

Bradykinin or acetylcholine as vasodilators to test endothelial venous function in healthy subjects

INTRODUCTION: The evaluation of endothelial function has been performed in the arterial bed, but recently evaluation within the venous system has also been explored. Endothelial function studies employ different drugs that act as endothelium-dependent vasodilatory response inductors. OBJECTIVES: The aim of this study is to compare the endothelium-dependent venous vasodilator response mediated by either acetylcholine or bradykinin in healthy volunteers. METHODS AND RESULTS: Changes in vein diameter after phenylephrine-induced venoconstriction were measured to compare venodilation induced by acetylcholine or bradykinin (linear variable differential transformer dorsal hand vein technique). We studied 23 healthy volunteers; 31 percent were male, and the subject had a mean age of 33 ± 8 years and a mean body mass index of 23 ± 2 kg/m². The maximum endothelium-dependent venodilation was similar for both drugs (p = 0.13), as well as the mean responses for each dose of both drugs (r = 0.96). The maximum responses to acetylcholine and bradykinin also had good agreement. CONCLUSION: There were no differences between acetylcholine and bradykinin as venodilators in this endothelial venous function investigation.

Manejo não-farmacológico de pacientes hospitalizados com insuficiência cardíaca em hospital universitário / Non-pharmacological management of patients hospitalized with heart failure at a teaching hospital

OBJETIVO: Descrever o manejo não-farmacológico de pacientes internados com insuficiência cardíaca (IC) em um hospital universitário. MÉTODOS: Estudo de coorte longitudinal de pacientes com IC diagnosticados pelo escore de Boston. Durante as 72 horas iniciais de internação, enfermeiras da clínica de IC realizaram entrevistas padronizadas e revisões de prontuários. RESULTADOS: Foram avaliadas 283 internações de 239 pacientes (idade = 64 ± 15 anos), aproximadamente 50 por cento sexo masculino e 37 por cento de etiologia isquêmica. O padrão de prescrição dos diferentes cuidados não-farmacológicos foi restrição de sal em 97 por cento, controle de diurese em 85 por cento, balanço hídrico em 75 por cento, controle de peso em 61 por cento e restrição hídrica em apenas 25 por cento das internações. Embora os cuidados referidos estivessem nas prescrições, freqüentemente não eram realizados pela equipe responsável (p < 0,01 para todas as comparações). O uso irregular dos fármacos prescritos na semana anterior à hospitalização ocorreu em 22 por cento e 21 por cento dos pacientes sem e com re-internações, respectivamente (p = 1,00). Os pacientes com reinternações (n = 38) apresentaram disfunção sistólica grave, mais hospitalizações prévias e tempo prolongado de sintomas de IC, quando comparados aos não-reinternados, além de terem conhecimento mais adequado de aspectos relacionados com autocuidado (todos valores de p < 0,05). Na análise multivariada, apenas tempo de doença sintomática permaneceu como preditor independente de reinternações. CONCLUSÃO: Nossos dados indicam que mesmo em hospital universitário há importantes lacunas relativas à prescrição e realização de medidas não-farmacológicas de autocuidado na IC. Demonstramos que pacientes que reinternam aparentam bom conhecimento da doença; esse achado, entretanto, está relacionado de forma importante com a gravidade e o tempo de evolução da IC.

OBJECTIVE: To describe non-pharmacological management of patients admitted with heart failure (HF) in a teaching hospital. METHODS: A cohort longitudinal study of patients diagnosed with HF according to the Boston score. Within the first 72 hours of admission, the nursing staff of the HF clinic conducted structured interviews and medical chart reviews. RESULTS: Two hundred and eighty-three admissions of 239 patients (age = 64 ± 15 years) were evaluated; approximately 50 percent of the patients were male and 37 percent had heart failure of ischemic etiology Non-pharmacological measures included salt restriction in 97 percent, urine output monitoring in 85 percent, fluid balance in 75 percent, weight monitoring in 61 percent, and fluid restriction in only 25 percent of the patients. However, they were often not carried out by the team in charge (p < 0.01 for all comparisons). Irregular use of prescribed drugs in the week prior to admission was 22 percent and 21 percent in non-readmitted and readmitted patients, respectively (p = 1.00). Readmitted patients (n = 38) had severe systolic dysfunction, more previous hospitalizations, and longer duration of HF symptoms, as compared to those non-readmitted; in addition they had better knowledge related to self-care (p values < 0.05). In the multivariate analysis, only duration of symptoms remained as an independent predictor of re-admissions. CONCLUSION: Our data suggest that, even at a teaching hospital, important gaps exist between prescribing non-pharmacological measures for HF patients and their being carried out. Readmitted patients seem to have good understanding of their condition; this finding, however, is significantly associated with HF severity and time of onset.

Insulina: efeitos cardiovasculares e aplicações terapêuticas / Insulin: cardiovascular effects and therapeutic implications

Vários estudos têm sugerido benefício do uso de insulina após o infarto do miocárdio e em pacientes criticamente doentes, diabéticos e não diabéticos. No entanto, não se estabeleceu rotineiramente o uso das infusões de insulina e glicose, pela ausência de estudos randomizados de grande porte, entendimento precário dos mecanismos pelos quais estas infusões seriam efetivas, complexidade para administrá-las e principalmente pela mudança cultural que é exigida dos profissionais de saúde para aplicá-las na sua prática. A insulina tem efeitos benéficos no coração, tais como a otimização do uso de substratos pelos cardiomiócitos, o aumento do fluxo coronariano, efeito anti-inflamatório e também ações diretas anti-apoptóticas nas células miocárdicas. Dentro deste contexto, são revisados os resultados clínicos das infusões de insulina e glicose após infarto e cirurgia cardíaca, possíveis mecanismos fisiopatológicos responsáveis por estes benefícios e, finalmente, uma proposta de um protocolo padrão para o uso em unidades de terapia intensiva e de pós-operatório de cirurgia cardíaca.

A presença de ansiedade não influencia na recuperação pós-operatória de cirurgia cardíaca / The presence of anxiety does not have any influence in the post-operative recovery process of heart surgery

Pacientes cirúrgicos sofrem graus variados de estresse psicológico no período pré-operatório. Com o objetivo de relacionar o nível de ansiedade no pré-operatório com possíveis complicações no pós-operatório de cirurgia cardíaca, utilizou-se a Escola Hamilton de Ansiedade (EHA). Após a cirurgia os pacientes foram acompanhados quanto a evolução clinica e complicações durante sua permanência em unidade intensiva. Dos 83 pacientes avaliados, a ansiedade leve foi apresentada por 88% seguida por ansiedade moderada (6%) e severa (6%). Não houve associação entre o nível de ansiedade e complicações pós-operatórias, tempo de internação, agitação psicomotora e necessidade de analgesia e sedação.

Surgical patients suffer degrees of psychological stress before the operation. To relate anxiety level before and after heart surgery, The Hamilton Anxiety Scale Was used (HAS). After surgery, the fallow-up focused on clinical evolution and complications during their stay at the intensive Care Unit. Eight-three patients were evaluated, With 88% showing slight anxiety 6% moderate symptoms and 6% severe anxiety. No associations was apparent between level of anxiety and post operative complications, time of hospitalization and psychomotor agitation, analgesics and sedation.

Intervenções de enfermagem em pacientes com cardiopatia: métodos e avaliação de eficácia em pacientes com insuficiência cardíaca / Nursing interventions in patients with heart disease: methods and evaluation of efficacy in heart failure patients

As doenças cardiovasculares constituem-se atualmente nos maiores agravos à saúde em todo o mundo. O arsenal terapêutico disponível para este subgrupo de pacientes, que inclui tanto o tratamento farmacológico como o não-farmacológico, é complexo e de difícil seguimento estrito. Estratégias que visem melhorar a taxa de adesão de pacientes às prescrições são requeridas e podem contribuir para a redução de desfechos clínicos. Especificamente no cenário de atendimento de pacientes com insuficiência cardíaca, a avaliação, o acompanhamento e a prevenção de fatores precipitantes de descompensação melhoram sintomas e previnem internação. No grupo de Insuficiência Cardíaca e Transplante Cardíaco do Hospital de Clínicas de Porto Alegre, temos desenvolvido projetos de pesquisa envolvendo ferramentas e estratégias educativas para melhorar o acompanhamento e seguimento deste pacientes conforme as melhores práticas baseadas em evidências. Evidências de eficácia desta intervenção e perspectivas de pesquisa são apresentadas nesta revisão.

Cardiovascular diseases are responsible for a large part of the global burden of diseases. Pharmacological and non-pharmacological interventions aiming the prevention and treatment of cardiovascular diseases are effective but complex and difficult to follow. Strategies to improve the adherence rates to the prescriptions may contribute to the reduction of clinical outcomes. With regard to the care of heart failure patients, prevention and correction of precipitant factors improve symptoms and lower the frequency of hospitalizations. In the unit of heart failure and cardiac transplant at HCPA, we have developed research projects with strategies for education and follow-up of such patients, according to the best evidencebased clinical practice. In this review, we present results of these interventions and the perspectives for the future development of research and care of patients with cardiovascular disease.