The importance of pharmacotherapeutic adherence evaluation in subjects with cardiovascular disease

En Colombia son pocos los programas de vigilancia a la ad- herencia farmacoterapéutica. El objetivo de este estudio fue evaluar la prevalencia y los predictores de no-adherencia en un programa de seguimiento farmacoterapéutico de una co- horte de sujetos con enfermedad cardiovascular y se identi- ficaron los factores asociados con mejoras en la adherencia y evitabilidad. Métodos: Estudio observacional prospectivo transversal du- rante 9 meses en sujetos con enfermedad cardiovascular de una institución de alta complejidad y se evaluó la adherencia farmacoterapeútica con las metodologías DADER, Escala de New York y criterios Stopp/Start. Resultados: Se estudiaron 265 sujetos, 72,4% con enfer- medad isquémica, 8% enfermedad valvular, 0,7% insuficien- cia cardiaca y 18,9% enfermedad cardiaca no especificada. Se informaron un total de 484 Problema Relacionado con el Uso de los Medicamentos (PRUM) y 184 Resultado Negativo asociado a la Medicación (RNM). Los PRUM de tipo inte- racción medicamentosa representaron el 56% y el 10% se caracterizó como evitable; los PRUM de tipo administración errónea del medicamento representaron el 20,7% y el 100% se caracterizó como evitable. Los RNM de tipo inseguridad no cuantitativa representaron el 30,6% y el 5% se caracterizó como evitable. Conclusiones: Se identificaron los factores susceptibles de intervención para promover el uso seguro de medicamentos, así como los asociados con la evitabilidad, la adherencia a la terapia y PRUM. Lo que permitió implementar estrategias para minimizar estos errores durante su tratamiento.In Colombia there are few surveillance programs for phar- macotherapeutic adherence. The objective of this study was to evaluate the prevalence and predictors of non-adherence in a pharmacotherapeutic follow-up program of a cohort of subjects with cardiovascular disease, and the factors associ- ated with improvements in adherence and avoidability were identified. Methods: A prospective, cross-sectional observational study over a period of 9 months in subjects with cardiovascular dis- ease from a high-complexity institution, and pharmacothera- peutic adherence was evaluated using the DADER method- ologies, the New York Scale and the Stopp / Start criteria. Results: 265 subjects were studied, 72.4% with ischemic disease, 8% valvular disease, 0.7% heart failure and 18.9% unspecified heart disease. A total of 484 Medication Use- Related Problems (PRUM) and 184 Medication-Associated Negative Result (NRM) were reported. Drug interaction type PRUMs represented 56% and 10% were characterized as avoidable; PRUMs of erroneous administration of the drug represented 20.7% and 100% were characterized as avoid- able. Non-quantitative insecurity NRMs represented 30.6% and 5% were characterized as avoidable. Conclusions: Factors susceptible to intervention to promote the safe use of medications, as well as those associated with avoidability, adherence to therapy and PRUM were identified, which allowed the implementation of strategies to minimize these errors during their treatmen

Machine learning approach applied to human activity recognition – an application to the VanKasteren dataset

Reminders are a core component of many assistive technology systems and are aimed specifically at helping people with dementia function more independently by compensating for cognitive deficits. These technologies are often utilized for prospective reminding, reminiscence, or within coaching-based systems. Traditionally, reminders have taken the form of nontechnology based aids, such as diaries, notebooks, cue cards and white boards. This article is based on the use of machine learning algorithms for the detection of Alzheimer’s disease. In the experimentation, the LWL, SimpleLogistic, Logistic, MultiLayerPercepton and HiperPipes algorithms were used. The result showed that the LWL algorithm produced the following results: Accuracy 98.81%, Precission 100%, Recall 97.62% and F- measure 98.80

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

La importancia de la evaluación de la adherencia farmacoterapéutica en sujetos con enfermedad cardiovascular

En Colombia son pocos los programas de vigilancia a la adherencia farmacoterapéutica. El objetivo de este estudio fue evaluar la prevalencia y los predictores de no-adherencia en un programa de seguimiento farmacoterapéutico de una cohorte de sujetos con enfermedad cardiovascular y se identificaron los factores asociados con mejoras en la adherencia y evitabilidad. Métodos: Estudio observacional prospectivo transversal durante 9 meses en sujetos con enfermedad cardiovascular de una institución de alta complejidad y se evaluó la adherencia farmacoterapeútica con las metodologías DADER, Escala de New York y criterios Stopp/Start. Resultados: Se estudiaron 265 sujetos, 72,4% con enfermedad isquémica, 8% enfermedad valvular, 0,7% insuficiencia cardiaca y 18,9% enfermedad cardiaca no especificada. Se informaron un total de 484 Problema Relacionado con el Uso de los Medicamentos (PRUM) y 184 Resultado Negativo asociado a la Medicación (RNM). Los PRUM de tipo interacción medicamentosa representaron el 56% y el 10% se caracterizó como evitable; los PRUM de tipo administración errónea del medicamento representaron el 20,7% y el 100% se caracterizó como evitable. Los RNM de tipo inseguridad no cuantitativa representaron el 30,6% y el 5% se caracterizó como evitable. Conclusiones: Se identificaron los factores susceptibles de intervención para promover el uso seguro de medicamentos, así como los asociados con la evitabilidad, la adherencia a la terapia y PRUM. Lo que permitió implementar estrategias para minimizar estos errores durante su tratamiento

Software applications to health sector: a systematic review of literature

Technology has become a strategic ally for the automation and improvement of processes in the health sector. Many of the current developments have supported the automatic, efficient and efficient detection of different pathologies which results in quality of life and treatment of patients. This study proposes a systematic review of the literature which compiles different developments that have contributed to the solution of different problems in the sector and the advances that have contributed to the processes of continuous improvement of detection and treatment

Consenso latinoamericano para el manejo del riesgo residual cardiometabólico. Consenso realizado por la Academia Latinoamericana de Lipidología y Riesgo Cardiometabólico (ALALIP), con el aval de la Sociedad Interamericana de Cardiología (SIAC), la Sociedad Interamericana de Aterosclerosis (IAS) y el Colegio Panamericano de Endotelio (PACE)

Hypertension, hyperglycemia, dyslipidemia, overweight, obesity, and tobacco (smoking, chewing, and vaping), together with a pro-inflammatory and procoagulant state, are the main risk factors related to atherosclerotic cardiovascular disease. Objective and methods: A group of experts from the Americas, based on their clinical expertise in cardiology, cardiovascular prevention, and cardiometabolic (CM) diseases, joined together to develop these practical recommendations for the optimal evaluation and treatment of residual CM risk factors in Latin America, using a modified Delphi methodology (details in electronic TSI) to generate a comprehensive CM risk reduction guideline, and through personalized medicine and patient-centered decision, considering the cost-benefit ratio The process was well defined to avoid conflicts of interest that could bias the discussion and recommendations. Results: Residual risk reduction should consider therapeutic options adapt- ed to specific patient needs, based on five treatment objectives: triglyceride-rich lipoproteins, inflammation, impaired glucose metabolism, high blood pressure, and prothrombotic status. Comprehensive control of all CM risk factors should be a priority to deal with this important public health problem and prevent premature deaths. The recommendations in this paper address the evidence-based treatment of CM risk and are intended for clinical application in Latin American countries.Un grupo de factores de riesgo cardiometabólicos (hipertensión, hiperglucemia, dislipidemia, sobrepeso, obesidad y tabaco (fumado, masticado, vaporizado), junto con un estado proinflamatorio y procoagulante, son los principales factores de riesgo relacionados con la enfermedad cardiovascular aterosclerótica. Objetivo y métodos: Basándose en su experiencia en cardiología, prevención cardiovascular y enfermedades cardiometabólicas, un grupo de expertos de las Améri- cas se unió para desarrollar estas recomendaciones prácticas para la evaluación y tratamiento óptimos de los factores de riesgo cardiometabólicos residuales en América Latina, utilizando una metodología Delphi modificada con el objetivo de generar una guía integral de pautas para la reducción del riesgo cardiometabólico, mediante la medicina personalizada y la decisión centrada en el paciente teniendo en cuenta la relación costo-beneficio. El proceso fue bien definido para evitar conflictos de intereses que podrían sesgar la discusión y las recomendaciones. Resultados: La reducción del riesgo resid- ual debe considerar opciones terapéuticas adaptadas a las necesidades específicas del paciente, basadas en 5 objetivos de tratamiento: lipoproteínas ricas en triglicéridos inflamación, metabolismo de la glucosa, presión arterial alta y estado protrom- bótico. El Control integral de todos los factores de riesgo cardiometabólicos debe ser una prioridad para hacer frente a este importante problema de salud pública y prevenir las muertes prematuras. Las recomendaciones de este documento abordan el tratamiento basado en evidencia del riesgo cardiometabólico y están destinadas a la aplicación clínica en los países de América Latina

Dyslipidaemias and their treatment in high complexity centres in Colombia

Q3Background and objective Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). Materials and methods Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. Results Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. Conclusions Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000187062Revista Internacional - Indexad

Colombian guidelines for the diagnosis and treatment of hypertension

La hipertensión arterial es un problema de salud de particular importancia dadas su prevalencia e impacto en la población general. El acercamiento diagnóstico y en especial el tratamiento de la misma, cambian con la aparición de nuevos métodos diagnósticos y nuevos medicamentos, a medida que se reconocen efectos diferentes sobre los órganos blanco, producidos por fármacos de uso corriente. Por la complejidad y la extensión del tema, se hace difícil para muchos médicos tener una idea clara y precisa acerca de la aproximación más recomendable hacia un paciente o situación en particular. Es arduo seguirle la pista a tantas publicaciones que aportan a la resolución de una duda en particular, a veces con resultados contradictorios. Estas guías pretenden ayudar a solucionar esas dificultades.Q4Artículo original187-31

Task Force of the Latin American Society of Hypertension

ABI, ankle-brachial index; ABPM, ambulatory blood pressure monitoring; ACCORD, Action to Control Cardiovascular Risk in Diabetes; ACE-I, angiotensin-converting-enzyme-inhibitors; ARB, AT1 blockers; BP, blood pressure; CARMELA, Cardiovascular Risk Factor Multiple Evaluation in Latin America; CARMEN, Community Actions for Multifactorial Reduction of Non- Communicable Diseases; CCB, calcium channel blocker; CCM, Wagner’s Chronic Care Model; CDC, Chronic Disease Center; CTA, computed tomography angiography; CV, cardiovascular; DALY, disability-adjusted life year; DPP- 4, dipeptidyl-peptidase-4; GLP-1, glucagon-like peptide 1; HBPM, home blood pressure monitoring; HOPE, Heart Outcomes Prevention Evaluation; HOT, Hypertension Optimal Treatment; HT, hypertension; LA, Latin America; LASH, Latin American Society of Hypertension; MRA, magnetic resonance angiography; NCD, noncommunicable disease; OSAS, obstructive apnea–hypopnea syndrome; PAD, peripheral artery disease; PAHO, Pan American Health Organization; RAAS, renin–angiotensin–aldosterone system; RISS, Redes Integradas de Servicios de Salud; SGLUT2, sodium–glucose cotransporter-2; SPRINT, SBP Intervention Trial; UKPDS, United Kingdom Prospective Diabetes Study; VIDA, Veracruz Initiative for Diabetes Awarenes