Text Messages to Promote Secondary Prevention after Acute Coronary Syndrome (IMPACS trial)

Abstract Background Short message service (SMS) to promote healthcare improves the control of cardiovascular risk factors, but there is a lack of evidence in low and middle-income countries, particularly after acute coronary syndromes (ACS). Objective This study aims to evaluate whether the use of SMS increases risk factor control after hospital discharge for ACS. Methods IMPACS is a 2-arm randomized trial with 180 patients hospitalized due to ACS at a tertiary hospital in Brazil. Eligible patients were randomized (1:1) to an SMS intervention (G1) or standard care (G2) upon hospital discharge. The primary endpoint was set to achieve 4 or 5 points in a risk factor control score, consisting of a cluster of 5 modifiable risk factors: LDL-C <70mg/dL, blood pressure (BP) <140/90mmHg, regular exercise (≥5 days/week, 30 minutes/session), nonsmoker status, and body mass index (BMI) <25 kg/m2] at 6 months. Secondary outcomes were components of the primary outcome plus rehospitalization, cardiovascular death, and death from any cause. Results are designated as significant if p<0.05. Results From randomized patients, 147 were included in the final analysis. Mean age was 58 (51-64) years, 74% males. The primary outcome was achieved by 12 (16.2%) patients in G1 and 15 (20.8%) in G2 (OR=0.73, 95%CI 0.32-1.70, p=0.47). Secondary outcomes were also similar: LDL-C<70 mg/dl (p=0.33), BP<140/90 mmHg (p=0.32), non-smoker (p=0.74), regular exercise (p=0.97), BMI (p=0.71), and rehospitalization (p=0.06). Death from any cause occurred in three participants (2%), including one cardiovascular death in each group. Conclusion SMS intervention did not significantly improve cardiovascular risk factor control when compared to standard care in patients discharged after ACS in Brazil.

Avaliação do nível de conhecimento dos pacientes sobre o tratamento de síndrome coronariana aguda baseado no maugerl cardiac prevention-questionnaire / Evaluation of the level of knowledge of patients with regards to the treatment of acute coronary syndrome using the maugerl cardiac prevention-questionnaire / Evaluación del nivel de conocimiento de los pacientes sobre el tratamiento del síndrome coronario agudo en base al maugerl cardiac prevention-questionnaire

OBJETIVOS: descrever o nível de conhecimento do paciente em tratamento de síndrome coronariana aguda (SCA). MÉTODO: estudo transversal com aplicação do Maugerl Cardiac Prevention-Questionnaire aos pacientes com SCA submetidos ao cateterismo cardíaco (CATE) após alta da unidade coronariana de cuidados intensivos. RESULTADOS: amostra composta de 50 pacientes, 76% do sexo masculino, com média de idade de 58 anos (±10.2), sendo que 72% apresentaram como principal fator de risco a hipertensão arterial sistêmica. Os pacientes apresentaram, de modo geral, bom índice de desempenho no questionário, apesar do baixo nível de escolaridade. A pontuação média no questionário foi proporcional à renda familiar (p=0,002) e ao nível de escolaridade (p=0,007). CONCLUSÃO: a utilização do instrumento O Micro-Q permitiu constatar que a escolaridade e o nível socioeconômico influenciam no entendimento do paciente sobre a própria doença. O instrumento foi uma ferramenta útil para a avaliação do nível de conhecimento do paciente acometido pela SCA, pois a adequada caracterização do perfil dos pacientes atendidos em cada instituição torna-se uma ferramenta facilitadora para planejamentos assistenciais e programas de vigilância em saúde.(AU)

Objectives: describing the level of knowledge of patients undergoing treatment for Acute Coronary Syndrome (SCA). Method: cross-sectional study applying the Maugerl Cardiac Prevention-Questionnaire to SCA patients who underwent cardiac catheterization (CATE) after being discharged from the coronary intensive care unit. Results: the sample was made up of 50 patients, 76% of whom were males, with a mean age of 58 years old ((±10.2). The main risk factor for most of them was the systemic arterial hypertension. Patients presented, in general, a good performance in the questionnaire, despite their low educational level. The mean score in the questionnaire was proportional to family income (p=0.002) and to educational level (p=0.007). Conclusion: using the MICRO-Q instrument allowed this work to observe that educational level and socioeconomic level influence the understanding of the patient with regards to their own disease. The instrument was a useful tool to evaluate the level of knowledge of the patient affected by the SCA, since the adequate characterization of the profile of the patients cared for in each institution becomes a tool that makes it easier to plan assistance and health surveillance programs.(AU)

Objetivo: describir el nivel de conocimiento del paciente en tratamiento del síndrome coronario agudo (SCA). Método: estudio transversal con la aplicación del Cuestionario de Prevención Cardíaca Maugerl a pacientes con SCA sometidos a cateterismo cardíaco (CATE) después del alta de la unidad de cuidados intensivos coronarios. Resultados: muestra compuesta de 50 pacientes, 76% varones, edad media de 58 años (±10.2), 72% de ellos con hipertensión arterial como principal factor de riesgo. En general, los pacientes lograron un buen desempaño en el cuestionario, a pesar del bajo nivel de educación. El puntaje promedio en el cuestionario fue proporcional al ingreso familiar (p=0,002) y al nivel de educación (p=0,007). Conclusión: el uso del instrumento Micro-Q mostró que la educación y el nivel socioeconómico influyen en la comprensión del paciente de la enfermedad en sí. El instrumento fue una herramienta útil para evaluar el nivel de conocimiento de los pacientes afectados por SCA ya que la caracterización adecuada del perfil de los pacientes tratados en cada institución se convierte en una herramienta facilitadora para la planificación de la atención y los programas de vigilancia de ln salud.(AU)