Marcha nórdica para prevención cardiovascular en pacientes con cardiopatía isquémica crónica o síndrome metabólico / Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome

Antecedentes y objetivo: La enfermedad aterosclerótica ha aumentado en Europa debido, en parte, al estilo de vida sedentario de la población. El ejercicio físico es efectivo en prevención cardiovascular. La marcha nórdica (MN) moviliza numerosos grupos musculares y es muy popular en el norte de Europa. No se tienen datos en el entorno sanitario del área mediterránea. Proponemos un programa de MN para promover la actividad física y el control de factores de riesgo cardiovascular (FRCV), mejorar la calidad de vida y el cumplimiento terapéutico en pacientes con cardiopatía isquémica crónica o síndrome metabólico. Métodos: Se seleccionaron pacientes con FRCV no controlados. Realizaron 2 sesiones semanales durante un año. Los datos basales de la historia clínica, cuestionarios de calidad de vida y cumplimiento terapéutico se compararon con los obtenidos tras el programa. Resultados: Los FRCV no controlados se redujeron de 4,78 a 3, con una tendencia a la mejoría de la calidad de vida y el cumplimiento terapéutico. Conclusiones: Un programa de MN es factible en el sistema sanitario público y puede ser útil para mejorar el control de los FRCV (AU)

Background and objective: The incidence of atherosclerotic diseases has increased in Europe due in part to the population’s sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact in the healthcare system of the Mediterranean area. We propose the implementation of a NW program to promote physical activity and control cardiovascular risk factors (CVRF), as well as to improve quality of life and the adherence to medical treatment in patients with a chronic ischemic heart disease or metabolic syndrome. Methods: We selected patients with uncontrolled CVRFs. These patients performed 2 weekly sessions of NW over the course of one year. Baseline data extracted from the patients’ medical history, quality of life questionnaires and on adherence to treatment was compared with the results obtained at the end of the program. Results: A reduction in the rate of CVRFs from 4.78 to 3 was observed, with an evident trend towards the improvement of the patients’ quality of life and a better adherence to the treatment. Conclusions: The implementation of a NW program is feasible in the public healthcare system and can aid in the management of CVRFs (AU)

Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome. / Marcha nórdica para prevención cardiovascular en pacientes con cardiopatía isquémica crónica o síndrome metabólico.

BACKGROUND AND OBJECTIVE: The incidence of atherosclerotic diseases has increased in Europe due in part to the population's sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact in the healthcare system of the Mediterranean area. We propose the implementation of a NW program to promote physical activity and control cardiovascular risk factors (CVRF), as well as to improve quality of life and the adherence to medical treatment in patients with a chronic ischemic heart disease or metabolic syndrome. METHODS: We selected patients with uncontrolled CVRFs. These patients performed 2 weekly sessions of NW over the course of one year. Baseline data extracted from the patients' medical history, quality of life questionnaires and on adherence to treatment was compared with the results obtained at the end of the program. RESULTS: A reduction in the rate of CVRFs from 4.78 to 3 was observed, with an evident trend towards the improvement of the patients' quality of life and a better adherence to the treatment. CONCLUSIONS: The implementation of a NW program is feasible in the public healthcare system and can aid in the management of CVRFs.

Integración entre cardiología y atención primaria: impacto sobre la práctica clínica / Integration between cardiology and primary care: impact on clinical practice

Introducción y objetivos. Evaluar el impacto de un programa de integración entre cardiología y atención primaria en la práctica clínica, comparado con la atención convencional. La integración consiste en un cardiólogo hospitalario en cada centro de atención primaria, historia clínica común, guías clínicas consensuadas, sesiones de consultoría y otras herramientas de coordinación. Métodos. Estudio observacional de dos muestras transversales sobre prevalencias en periodos antes y después de la intervención: atención convencional y atención integrada. Se analiza: distribución de pacientes atendidos, impacto en indicadores de buena práctica clínica en los pacientes con cardiopatía isquémica, insuficiencia cardiaca y fibrilación auricular, satisfacción de atención primaria y uso de recursos. Resultados. Se incluyó a 3.194 pacientes (1.572 en atención convencional y 1.622 en integrada). La integración redistribuyó a los pacientes y aumentó el control del cardiólogo sobre enfermedades graves y el control desde primaria de los factores de riesgo y pacientes estables. En cardiopatía isquémica, mejoró el control de colesterolemia, presión arterial, optimización del tratamiento y documentación de la función ventricular. En insuficiencia cardiaca, aumentó el tratamiento con bloqueadores beta y la valoración funcional. En fibrilación auricular, mejoró el estudio con ecocardiografía e indicación de anticoagulación. El uso de recursos no aumentó. La satisfacción de los médicos de primaria se incrementó con la integración. Conclusiones. Tras la integración, mejoró el control y el tratamiento crónico de los pacientes con cardiopatía isquémica, insuficiencia cardiaca y fibrilación auricular, se redistribuyó a los pacientes crónicos entre atención primaria y cardiología, y aumentó la satisfacción de los médicos de familia, sin objetivarse incremento en el uso de recursos (AU)

Introduction and objectives. To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools. Methods. Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources. Results. We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, Beta-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased. Conclusions. Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians¡¯ satisfaction levels improved. There was no increase in use of resources (AU)

[Integration between cardiology and primary care: impact on clinical practice]. / Integración entre cardiología y atención primaria: impacto sobre la práctica clínica.

INTRODUCTION AND OBJECTIVES: To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools. METHODS: Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources. RESULTS: We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, ß-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased. CONCLUSIONS: Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians' satisfaction levels improved. There was no increase in use of resources. Full English text available from: www.revespcardiol.org.

Heparin-binding EGF-like growth factor in human serum. Association with high blood cholesterol and heart hypertrophy.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) belongs to the EGF family of growth factors which are ligands of the ErbB receptors. Studies in animals suggest the role of HB-EGF in several pathogenic processes such as atherosclerosis and heart hypertrophy. Here, we set up an assay to measure HB-EGF in human serum. Our ELISA determined serum HB-EGF in the range of 0.03-3 nM. It did not cross-react with EGF or with transforming growth factor-alpha. The mean serum HB-EGF was 0.26 nM (confidence interval: 0.13-0.39) in women and 0.28 nM (confidence interval: 0.09-0.47) in men. In a cohort of 121 healthy volunteers, we identified nine individuals with high serum HB-EGF (above 0.47 nM). These individuals had higher left ventricle mass (determined by Colour Doppler echocardiography) and greater total and low density lipoprotein cholesterol than control. On the basis of our results, we propose that increased serum HB-EGF is associated with heart hypertrophy and elevated blood cholesterol.