Impact of different models of improvement of continuity of care on lipid control and the delay of visits to cardiology.

Aims: To analyze the impact of implementing three different models of continuity of care on the delay of first visits to the cardiologist (management end point) and on LDL-cholesterol control rates among patients with atherosclerotic vascular disease (clinical end point). Methods: Observational, longitudinal and retrospective study of patients with cardiovascular disease and LDL-cholesterol ≥70 mg/dl attended in three hospitals (H1/H2/H3). In H1 and H2, a virtual system (telecardiology) was developed (in H1, internal audits and specific medical education were also performed). In H3 a cardiologist was integrated into the primary care center. Results: The delay of visits to cardiologist significantly improved from 66.5 ± 29.1 days to 34.1 ± 14.1 days (p < 0.001), as well as the intensification of lipid-lowering treatment and the achievement of lipid goals. LDL-cholesterol control rates were higher in H1 and the reduction of the delay of visits in H3. Conclusion: Continuity of care is associated with improvements in management and clinical end points.

[Brachial artery flow-mediated dilation in healthy men, men with risk factors, and men with acute myocardial infarction. Importance of occlusion-cuff position]. / Dilatación de la arteria humeral mediada por flujo en varones sanos, con factores de riesgo e infarto agudo de miocardio importancia de la posición del manguito oclusor.

INTRODUCTION AND OBJECTIVES: Flow-mediated dilation (FMD) is endothelium-dependent and can be assessed by ultrasound in the brachial artery. We sought to determine the most suitable position for the occlusion cuff for the study of FMD in three groups of adult men. SUBJECTS AND METHODS: We included 160 subjects, mean age 58.5 7.8 years: 40 healthy subjects, 80 with cardiovascular risk factors, and 40 patients with AMI. In a subgroup of 60 subjects, the first 10, 30, and 20 of each group, respectively, FMD was evaluated twice, after upper arm occlusion and forearm occlusion to induce hyperemia. RESULTS: In the initial substudy, the FMD after upper arm occlusion was 7.6 2.4% in healthy subjects, 5.1 2.2% in men with risk factors (p < 0.0001), and 3.5 2.2% in AMI patients (p < 0.041, with respect to the risk-factor group). FMD after forearm occlusion was 4.6 1.5%, 2.3 2.1% (p < 0.006), and 2.2 1.9%, respectively, with no significant statistical differences between the risk-factor and AMI groups. Only upper arm occlusion was performed in the remaining participants, as planned, because it provided the most accurate information. Overall, the FMD was, respectively, 7.8 3.1%, 5 2.6% (p < 0.0001) and 3.3 3% (p < 0.004, with respect to the risk-factor group). FMD was directly related to HDL cholesterol and inversely related to resting diameter and number of risk factors. CONCLUSION: The best approach to studying FMD is proximal occlusion since it allows for a better stratification of the with endothelial dysfunction. With this technique, a worsening of endothelial function in acute myocardial infarction can be demonstrated.