Promoting cardiac rehabilitation program quality in low-resource settings: Needs assessment and evaluation of the International Council of Cardiovascular Prevention and Rehabilitation's registry quality improvement supports.

BACKGROUND: Cardiac rehabilitation (CR) registries have the potential to support quality improvement (QImp). This study investigated the QImp needs of International CR Registry-participating programs and their evaluation of its' supports. METHODS: ICRR offers comparative outcome dashboards and QImp sessions, among other features. In this qualitative study, ICRR data stewards from the 17 active on-boarded CR programs were invited to a focus group held in November 2023 via Teams; stewards not sufficiently-proficient in English were invited to provide written input. Deductive-thematic analysis using NVIVO was undertaken by 2 researchers; member-checking ensued. RESULTS: Nine participated, and four provided input, from eight countries. Three themes emerged; saturation was achieved. First, QImp facilitators included training, institutional requirements, dedicated staff, resources in academic centres and ICRR features. Second, QImp barriers included staffing issues, the global nature of the ICRR, and structural challenges in low-resource settings. Finally, ICRR supports for QImp included didactic webinars, hearing from other programs, 1-1 support offered and assessing minimum Certification standards. CONCLUSION: ICRR-participating programs are satisfied with QImp supports but encounter challenges, including related to language, staffing and other resources. CR registries should be leveraged and optimized to support CR programs to assess and improve their care quality.

Adherence to Treatment Guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aimed to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart failure (HF) medication prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2,528 patients in the registry, 1,384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement are suboptimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Translation, adaptation, and psychometrically validation of an instrument to assess disease-related knowledge in Spanish-speaking cardiac rehabilitation participants: The Spanish CADE-Q SV.

OBJECTIVE: To validate the Spanish Coronary Artery Disease Education Questionnaire Short Version(CADE-QSV). BACKGROUND: Knowledge assessment can tailor patient education strategies in CR. METHODS: Ten CR experts culturally-adapted the translated tool and 249 CR patients in three countries participated in the psychometrically validation. The internal consistency was assessed using KR-20 and Cronbach's alpha. Distribution- and anchor-based methods were used to estimate the MCID for interpretability analysis. Factor structure, acceptability, floor and ceiling effects and discriminant validity were also assessed. RESULTS: KR-20 was 0.75.Factor analysis revealed 5 factors, all internally consistent. Discriminant validity was supported by significant differences in educational level and family income at post-CR. Results showed that increases in knowledge can moderately increase mean steps per day, with MCID=3.00. Items were completed by 98% of participants. No evidence for ceiling/floor effects on total score. The area with the highest knowledge was nutrition and the lowest was medical condition. CONCLUSION: The Spanish CADE-QSV demonstrated preliminary validity and reliability.

Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study.

OBJECTIVES: To translate, cross-culturally adapt and validate a comprehensive evidence- and theoretically-based CR education intervention in Latin America. METHODS: First, best practices in translation and cross-cultural adaptation were applied through 6 steps. Then, the Spanish version was delivered to CR participants from programs in Colombia, Costa Rica and Peru for validation, such that the evaluation was pre-post, uncontrolled, pragmatic, observational, and prospective in design. Participants completed surveys assessing knowledge, health literacy, self-efficacy, and health behaviours. All outcomes were assessed pre-, and post-CR, as well as 6 months after CR completion. RESULTS: After translation of the patient guide from English to Spanish, 5 of the 9 booklets were culturally adapted. Two-hundred and forty-nine patients consented to participate, of which 184 (74 %) completed post-CR, and 121 (48 %) completed final assessments. There was a significant improvement in disease-related knowledge pre- to post-CR, as well as in health literacy, self-efficacy, and health behaviours (all p < 0.05). These gains were sustained 6 months post-program. With adjustment, CR attendance (i.e., exposure to the education) was associated with greater post-CR knowledge (ß = 0.026; p = 0.01). CONCLUSION: A patient education intervention for CR patients in Latin America has been validated, and wider implementation is warranted. PRACTICE IMPLICATIONS: Application of this first-ever validated CR education program for Spanish-speaking settings may result in secondary prevention.

Validation of a Spanish Version of the Information Needs in Cardiac Rehabilitation Scale to Assess Information Needs and Preferences in Cardiac Rehabilitation.

BACKGROUND: The identification of information needs is considered the first step to increase knowledge that ultimately could improve health outcomes in cardiac rehabilitation (CR). OBJECTIVE: The aim of this study was to psychometrically validate the Spanish Information Needs in Cardiac Rehabilitation (INCR). METHODS: The Spanish INCR was psychometrically tested in 184 patients undergoing CR. The internal consistency was assessed using Cronbach α, factor structure was assessed using exploratory factor analysis, and criterion validity regarding educational level, occupation, and duration in CR was assessed. RESULTS: Cronbach α was .97. Factor analysis revealed 10 factors, all internally consistent. Criterion validity was supported by significant differences in total INCR scores by educational level (P < .01), occupation (P < .01), and duration in CR (P < .05). Emergency/safety was the greatest information need perceived by patients. CONCLUSIONS: The Spanish INCR was demonstrated to have good reliability and validity. This tool can be applicable in clinical and research settings, assessing patients' information needs during CR and as part of education programming.

Prevalencia de disfunción eréctil y factores asociados en pacientes con indicación de rehabilitación cardíaca / Erectile dysfunction in patients referred for cardiac rehabilitation: prevalence and associated factors

Introducción: La disfunción eréctil (DE) afecta a millones de personas en el mundo. Se caracteriza por daño endotelial vascular y actualmente es considerado un marcador de riesgo de enfermedad cardiovascular. Sin embargo, no es evaluada normalmente por el personal médico y los pacientes se rehúsan a discutirlo. El objetivo de este trabajo es determinar la prevalencia de DE y sus factores asociados en pacientes con indicación de rehabilitación cardíaca. Material y Método: Estudio descriptivo, transversal, incluyó 225 pacientes con indicación de rehabilitación cardíaca de 6 países de Latinoamérica: Chile (CH), Brasil (BR), Perú (PE), Colombia (CO), Argentina (AR) y Paraguay (PY) en el período de marzo-agosto 2014. Se obtuvo datos demográficos y se utilizó el cuestiona-rio Índice Internacional de Función Eréctil (CIIFE) auto administrado. Las variables fueron procedencia, edad, peso, talla, IMC, obesidad, hipertensión arterial (HTA), diabetes mellitus (DM), infarto agudo del miocardio (IAM), tabaquismo y uso de fármacos. Resultados: Se evaluó a 225 hombres. De acuerdo al CIIFE, 80,1% tuvo algun tipo de DE; 8,9% severa; 10,7% moderada; 26,2% media a moderada y 35,6% media. Los factores asociados significativamente fueron el país de procedencia, la DM, la edad y el tabaquismo. Conclusión: La prevalencia de Disfunción Eréctil en pacientes con indicación de rehabilitación cardíaca de Chile, Brasil, Perú, Colombia, Argentina y Paraguay fue 80,1% y sus factores asociados son edad, obesidad, IAM, DM, HTA y tabaquismo.

Background: Erectile dysfunction (ED) affects millions of males around the world. It is characterized by endothelial dysfunction and is currently considered to be a marker of cardiovascular disease. However, it is seldom evaluated by medical personnel and patients frequently refuse to discuss the subject. The aim of this investigation was to determine incidence and prevalence of ED and associated factors in patients referred for cardiac rehabilitation. Method: A descriptive, cross sectional study was performed in 225 patients referred for cardiac rehabilitation in 6 Latin American countries: Chile (CH), Brazil (BR), Perú (PE), Colombia (CO), Argentina (AR) and Paraguay (PY), from March to August 2014. Demographic data were collected and the self-administered International ED questionnaire was applied to evaluate ED. Variables included age, weight, height, BMI, obesity, hypertension (HT), diabetes mellitus (DM), acute myocardial infarction, smoking habit and use of different medications Results: 80.1% of subjects had some type of ED: it was severe in 8.9%, moderate in 10.7%. moderate to intermediate in 26.2% and intermediate in 35.6%. Factors associated to the presence of ED were country of origin, DM, age, and smoking habit Conclusion: ED was present in a mean of 80.1% of patients referred for cardiac rehabilitation in Chile, Brazil, Perú, Colombia, Argentina, and Paraguay. ED was associated to age, obesity, myocardial infarction, DM, HT, and smoking habit.

Prevención secundaria de enfermedad coronaria: aún ajena a la práctica médica diaria / Secondary Prevention of Coronary Heart Disease: still outside the daily clinical practice

La enfermedad coronaria continúa siendo la principal causa de mortalidad y discapacidad prematura en la mayoría de países desarrollados y en vía de desarrollo a pesar de los diferentes e importantes avances en la terapéutica cardiovascular (1). La brecha entre los adelantos tecnológicos y la implementación de estrategias efectivas para el control de factores de riesgo y las causas subyacentes de la enfermedad, es evidente. La aproximación terapéutica y las intervenciones que se realizan bajo el concepto de prevención secundaria, tendrán el impacto correspondiente en la medida en que se avance en el verdadero cumplimiento de objetivos y metas, lo cual requiere mayor trabajo, vigilancia y control de los "cómo", dado que a la luz de la literatura científica no han sido suficientes los resultados con relación a la adherencia al tratamiento y el logro de metas. Encuestas y estudios ampliamente conocidos han transmitido las malas noticias; entre ellos vale la pena mencionar las encuestas EUROASPIRE I, II, III, llevadas a cabo durante doce años (1995/2000/2006-2007) que evaluaron cómo se lleva a la práctica de la prevención secundaria en pacientes que en los seis meses previos han sufrido revascularización miocárdica electiva o de urgencias, angioplastia percutánea, infarto agudo del miocardio o isquemia cardiaca. Se evidenció que Europa sigue sin encontrar la forma de alcanzar las metas de prevención secundaria de la enfermedad coronaria, pues: • Una quinta parte de los pacientes coronarios seguía fumando. • El sobrepeso y la obesidad avanzaron en forma significativa (4 de cada 5 pacientes tiene sobrepeso y hubo un aumento promedio de 4,9 kilos entre la primera y la tercera encuesta). • El manejo de la hipertensión arterial no mostró cambios significativos en las tres encuestas ya que la mitad de pacientes todavía tenía la presión arterial por encima del objetivo recomendado; sólo 41% logró la meta. • La prevalencia de diabetes incrementó reflejando el aumento de la obesidad. • El uso de medicamentos hipolipemiantes se elevó, pero aun casi la mitad de pacientes permanecían por encima de los objetivos lipídicos (2, 3)La enfermedad coronaria continúa siendo la principal causa de mortalidad y discapacidad prematura en la mayoría de países desarrollados y en vía de desarrollo a pesar de los diferentes e importantes avances en la terapéutica cardiovascular (1). La brecha entre los adelantos tecnológicos y la implementación de estrategias efectivas para el control de factores de riesgo y las causas subyacentes de la enfermedad, es evidente. La aproximación terapéutica y las intervenciones que se realizan bajo el concepto de prevención secundaria, tendrán el impacto correspondiente en la medida en que se avance en el verdadero cumplimiento de objetivos y metas, lo cual requiere mayor trabajo, vigilancia y control de los "cómo", dado que a la luz de la literatura científica no han sido suficientes los resultados con relación a la adherencia al tratamiento y el logro de metas. Encuestas y estudios ampliamente conocidos han transmitido las malas noticias; entre ellos vale la pena mencionar las encuestas EUROASPIRE I, II, III, llevadas a cabo durante doce años (1995/2000/2006-2007) que evaluaron cómo se lleva a la práctica de la prevención secundaria en pacientes que en los seis meses previos han sufrido revascularización miocárdica electiva o de urgencias, angioplastia percutánea, infarto agudo del miocardio o isquemia cardiaca. Se evidenció que Europa sigue sin encontrar la forma de alcanzar las metas de prevención secundaria de la enfermedad coronaria, pues: • Una quinta parte de los pacientes coronarios seguía fumando. • El sobrepeso y la obesidad avanzaron en forma significativa (4 de cada 5 pacientes tiene sobrepeso y hubo un aumento promedio de 4,9 kilos entre la primera y la tercera encuesta). • El manejo de la hipertensión arterial no mostró cambios significativos en las tres encuestas ya que la mitad de pacientes todavía tenía la presión arterial por encima del objetivo recomendado; sólo 41% logró la meta. • La prevalencia de diabetes incrementó reflejando el aumento de la obesidad. • El uso de medicamentos hipolipemiantes se elevó, pero aun casi la mitad de pacientes permanecían por encima de los objetivos lipídicos.

Availability and characteristics of cardiovascular rehabilitation programs in South America.

PURPOSE: Cardiac rehabilitation (CR) programs decrease morbidity and mortality rates in patients with coronary artery disease, the leading cause of death in Latin America. This study was carried out to assess the characteristics and current level of CR program implementation in South America. METHODS: We carried out a survey of CR programs that were identified using the directory of the South American Society of Cardiology and through an exhaustive search by the investigators. RESULTS: We identified 160 CR programs in 9 of the 10 countries represented in the South American Society of Cardiology and 116 of those responded to our survey. On the basis of survey results from the responding programs, we estimate that the availability of CR programs in South America is extremely low, approximately 1 CR program for every 2 319 312 inhabitants. These CR programs provided services to a median of 180 patients per year (interquartile range, 60-400) and were most commonly led by cardiologists (84%) and physical therapists (72%). Phases I, II, III, and IV CR were offered in 49%, 91%, 89%, and 56% of the centers, respectively. The most commonly perceived barrier to participation in a CR program was lack of referral from the cardiologist or primary care physician, as reported by 70% of the CR program directors. CONCLUSIONS: The number of CR programs in South America appears to be insufficient for a population with a high and growing burden of cardiovascular disease. In addition, there appears to be a significant need for standardization of CR program components and services in the region.

Estado actual de la rehabilitación cardiovascular en Colombia (2010) / Current status of cardiovascular rehabilitation in Colombia (2010)

INTRODUCCIÓN: 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. OBJETIVO: evaluar la situación actual de los programas de Rehabilitación Cardiovascular en Colombia. MÉTODOS: estudio descriptivo, realizado por medio de un cuestionario escrito, aplicado al coordinador y/o responsable de cada programa de Rehabilitación Cardiovascular del país. ANÁLISIS DE RESULTADOS: 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%). CONCLUSIÓN: 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.

INTRODUCTION: 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. OBJECTIVE: to assess the current status of cardiac rehabilitation programs in Colombia. METHODS: a descriptive study, carried out through a written questionnaire, applied to the coordinator and/or responsible for each cardiac rehabilitation program in the country. RESULT ANALYSIS: 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%). CONCLUSION: 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.

Teratoma quístico maduro de mediastino

Los teratomas benignos mediastinales son tumores de células germinales poco comunes, ocurriendo en un 5 por ciento a 8 por ciento de todos los tumores de esta localización; más del 95 por ciento de estos, se originan del compartimiento meidastinal anterosuperior, sólo 3 por ciento a 8 por ciento ocurren en otro lugar (1-5). Usualmente son descubiertos cuando aún son asintomáticos; cuando se presentan síntomas usualmente son secundarios a la compresión de estructuras adyacentes (6). Describimos el caso clínico y los hallazgos imagenológicos y operatorios de una paciente de 18 años de sexo femenino con un quiste de mediastino: Teratoma quístico maduro