Implementation of a Telecardiology Service in a Health Unit in the City of Porto Alegre, Brazil: A Pilot Study

Abstract Background: The implementation of Telecardiology in primary care in the city of Porto Alegre, Brazil, is a viable and promising strategy. It would decrease the distance between patient and specialized professional services by reducing unnecessary referrals and improving the quality of primary care and satisfaction of patients and health professionals. Objective: To implement a Telecardiology service and assess user satisfaction using the CARDIOSATIS scale. Methods: This was a pilot study developed by a partnership between the Institute of Cardiology and the Telehealth Center of Rio Grande do Sul. The study was carried out at Eri Flores-Vila Vargas health center in the city of Porto Alegre, from May to October 2019, and included 21 patients attending the health center. The descriptive analysis of data was performed using the SPSS program (Statistical Package for the Sciences) version 23. Data normality was checked using the Kolmogorov-Smirnov test. Statistical significance was set at 10%. Results: Mean age of participants was 43.8 ± 16.1 years. The most common risk factors in the sample were physical inactivity (81%) and smoking (43%). Most patients had normal electrocardiogram (ECG) readings. The time elapsed from the performance of the ECG test, transmission of the ECG traces to Telehealth, and return of the final ECG report to the health center was 0-7 days. The CARDIOSATIS scale revealed a high prevalence of "very satisfied" users for the general satisfaction domain, and only 14.3% of patients were dissatisfied with their health. Conclusions: Telecardiology reduced the distance between patient and the specialized professional, with a high level of patient and health professional satisfaction. Our study can serve as a basis for the implementation of a telecardiology network in the city of Porto Alegre in the future.

Efeitos de um programa de acompanhamento multidisciplinar em hipertensos sobre o controle autonômico cardiovascular: ensaio clínico randomizado / Effects of a multidisciplinary monitoring program in hypertensive patients on the cardiovascular autonomic control: randomized clinical trial

Introdução: A hipertensão arterial sistêmica (HAS) é uma doença crônica, considerada como principal fator de risco para mortalidade por acidente vascular cerebral (AVC) e doença coronariana (DC) (40% óbitos). Apesar disso e da alta prevalência na população não existe um bom controle dos valores da pressão arterial (PA) dentro de metas pressóricas determinadas pelas Diretrizes nos indivíduos acometidos. Acredita-se que a disponibilização de um programa de atenção e acompanhamento do paciente hipertenso de natureza multidisciplinar (MULTIHAS), possa colaborar para a adesão e, consequentemente, para o melhor controle da PA. Além disso, a possibilidade de avaliar nesses pacientes a Variabilidade da Frequência Cardíaca (VFC) pode fornecer informações sobre o Sistema Nervoso Autônomo (SNA) e seu controle sobre o coração. Objetivo: Avaliar o efeito de um programa de assistência multiprofissional (MULTIHAS) sobre o controle autonômico cardiovascular e a PA em pacientes em hipertensos. Métodos: Ensaio clínico randomizado, controlado, em hipertensos submetidos a dois tipos de tratamentos: o multiprofissional grupo MULTIHAS composto pelos profissionais (médico, enfermeiro, nutricionista, fisioterapeuta e psicólogo) e o convencional (grupo Controle) (médico e o enfermeiro). Foram avaliadas variáveis como uso de medicações, bioquímica do sangue, índice de massa corporal (IMC), escore de qualidade de vida (QV), PA e VFC. As visitas no grupo MULTIHAS eram efetuadas a cada dois meses a todos os profissionais. No grupo Controle as visitas também ocorriam a cada dois meses acompanhados, somente, pelo médico e pelo enfermeiro. Ao final de um ano todas as variáveis foram novamente avaliadas em ambos grupos. Resultados: Após um ano de tratamento o grupo MULTIHAS apresentou diferença significativa no escore da QV(p<0,005) e nos valores do IMC (p<0,001); na posição supina tiveram melhora a PAS (p=0,015), a PAM (p=0,034), a VFC (p= 0,051) e no componente de alta frequência da VFC - HFabs (p= 0,042) em relação ao grupo Controle. No registro da FC pelo frequencímetro (Polar RS800 CX da Finlândia) esta respondeu à manobra ortostática nos valores da PAS (p=0,016), PAD (p=0,028), sendo a variância total da FC (p= 0,047) bem como o componente de baixa frequência da VFC - LFabs (p= 0,045) significativamente diferentes em relação ao grupo Controle. Conclusão: O atendimento multiprofissional deve ser considerado como um potencial recurso no manejo da pressão arterial, do IMC, do escore de QV bem como do sistema nervoso autônomo, pois esses parâmetros foram otimizados quando comparados ao grupo Controle.

Introduction: Systemic arterial hypertension (SAH) is a chronic high prevalent disease and a major risk factor for cardiovascular events such stroke (CVA) and coronary heart disease (CHD) (40% of deaths). Despite this, there is a lack of adequate control of blood pressure (BP) levels according with those described on guidelines for hypertensive patients. It is believed that specific care programs and multidisciplinary monitoring of the hypertensive patient (MULTIHAS) can contribute to improved BP control in this population. Moreover, the autonomic nervous system and its control over cardiovascular function are alter in this patients and can contribute to poor prognostic and outcomes in this population. Objective: To evaluate the effect of a multidisciplinary assistance program (MULTIHAS) on the cardiovascular autonomic control and BP levels in hypertensive patients, with one year follow-up. Methods: Randomized controlled trial, conducted in hypertensive patients undergoing two different interventions: multi professional attention (MULTIHAS group) of different health time members (doctor, nurse, dietitian, physical therapist and psychologist) and conventional attention (control group) of doctor and nurse. The variables evaluated were BP and HRV (Heart rate variability), and secondary: body mass index (BMI), quality of life score (QOL), medication use and blood biochemistry The visits of MULTIHAS occurred every two months with all the multi professional team. Control group visits also occurred every two months accompanied only by the doctor and the nurse. After one year, all variables were assessed again in both groups. Results: After 1 year of treatment, the MULTIHAS group had a significant difference in the QOL score (p <0.005) and in the BMI values (p <0.001) ; the BP and HRV showed a small improvement in supine SBP (p = 0.015), in MBP (p = 0.034), in HRV (p = 0.051), and in the high frequency component of HRV - HFabs (p = 0.042) compared to the control group. During the recording of FC the frequency meter (Polar RS800 CX of Finland), it responded to the orthostatic maneuver in the values of SBP (p = 0.016), DBP (p = 0.028), the total HR variance (p = 0.047) LFabs (p = 0.045) were significantly different in relation to the control group. Conclusion: Multidisciplinary care should be considered as a potential resource in the management of blood pressure, BMI, QOL score as well as the autonomic nervous system, since these parameters were optimized when compared to the Control group.

Insulin therapy does not interfere with venous endothelial function evaluation in patients with type 2 diabetes mellitus

INTRODUCTION: Endothelium-dependent dilation is improved in insulin-treated diabetic patients, but this effect is probably due to improved glycemic control. The objective of the present study was to compare endothelium-dependent dilation in patients with well-controlled type 2 diabetes who are or are not using insulin as part of their therapy. METHODS: We studied 27 patients with type 2 diabetes (11 women, 60.3 years ± 6 years, with HbA1c < 7 percent and no nephropathy), including 16 patients treated with anti-diabetic agents (No-Ins, 8 women) and 11 patients treated with insulin alone or in combination with anti-diabetic agents (Ins, 3 women). Endothelial function was evaluated by the dorsal hand vein technique, which measures changes in vein diameter in response to phenylephrine, acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation). RESULTS: Age, systolic blood pressure (No-Ins: 129.4 mmHg ± 11.8 mmHg, Ins: 134.8 mmHg ± 12.0 mmHg; P= 0.257), HbA1c, lipids and urinary albumin excretion rate [No-Ins: 9 mg/24 h (0-14.1 mg/24 h) vs. Ins: 10.6 mg/24 h (7.5-14.4 mg/24 h), P=0.398] were similar between groups. There was no difference between endothelium-dependent vasodilation of the No-Ins group (59.3 percent ± 26.5 percent) vs. the Ins group (54.0 percent ± 16.3 percent; P=0.526). Endothelium-independent vasodilation was also similar between the No-Ins (113.7 percent ± 35.3 percent) and Ins groups (111.9 percent ± 28.5 percent; P=0.888). CONCLUSIONS: Subcutaneous insulin therapy does not interfere with venous endothelial function in type 2 diabetes when glycemic and blood pressure control are stable.