RESUMO
Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cardiologia/normas , Hipertensão/tratamento farmacológico , Padrões de Prática Médica/normas , Determinação da Pressão Arterial/normas , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Omã/epidemiologia , Valor Preditivo dos Testes , Fatores de Risco , Comportamento de Redução do Risco , Resultado do TratamentoRESUMO
Although atrial fibrillation (AF) is the most common cardiac arrhythmia, there is variation in practice with regard to the management of acute AF among the hospitals and even within the same hospital in Oman. This variation likely reflects a lack of high-quality evidence. Standard guidelines and textbooks do not offer clear evidence-based direction for physicians to guide the management of acute AF. Particularly controversial is the issue of using rhythm control or rate control. This stimulated Oman Heart Association (OHA) to issue a simplified protocol for the management of acute AF to be applied by the entire cardiac caregivers all over the country. The priorities for acute management of AF include stabilizing the patient's hemodynamic status, symptom control, treatment of the underlying and precipitating cause, and more importantly protecting the brain.
Assuntos
Antiarrítmicos/administração & dosagem , Anticoagulantes/administração & dosagem , Fibrilação Atrial , Cardioversão Elétrica/métodos , Doença Aguda , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Gerenciamento Clínico , Eletrocardiografia , Prática Clínica Baseada em Evidências , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , OmãRESUMO
In 2012, Oman Heart Association (OHA) published its own guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction, the aim was not to be comprehensive but rather simplified and practical in order to reduce the gap between the long comprehensive guidelines and our actual practice. However, we still feel that the busy registrars and residents need simpler and direct clinical pathways or protocol to be used in the emergency departments, coronary care units and in the wards. Clinical pathways are now one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes in acute care.
RESUMO
Although coronary heart disease is the leading cause of morbidity and mortality in the Middle East (ME), not much is known about patients with ST-segment elevation myocardial infarction (STEMI) from this region. The STEMI Chain of Survival can be used to target regional improvements in patient care. We tried to adopt a modified chain of survival for STEMI to highlight the challenges and difficulties and the possible solutions to improve the STEMI care in the Middle East based on the few data available.
Assuntos
Acessibilidade aos Serviços de Saúde , Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Garantia da Qualidade dos Cuidados de Saúde/métodos , Antagonistas Adrenérgicos beta/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Angiografia Coronária , Países em Desenvolvimento , Diagnóstico Precoce , Eletrocardiografia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Oriente Médio , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/uso terapêutico , Melhoria de Qualidade , Medição de Risco , Terapia Trombolítica , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Although current practice guidelines provide an evidence-based approach to the management of acute coronary syndromes, application of the evidence by individual physicians has been suboptimal. This gap between comprehensive guidelines and actual practice stimulated Oman Heart Association to issue a simplified series for the management of the common cardiac abnormalities to be applied by the entire cardiac caregivers all over the country. This simplified approach for the management of non-ST-elevation acute coronary syndrome provides a practical and systematic means to implement evidence-based medicine into clinical practice.
