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1.
Consenso multidisciplinario sobre el uso de inhibidores de SGLT-2 (iSGLT-2) en la práctica clínica chilena mediante metodología GRADE
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Cabrera, Sebastián
; Walbaum, Magdalena
; Lorca, Eduardo
; Bórquez, Tamara
; Mezzano, Sergio
; Tagle, Rodrigo
; Zuñiga, Eric
; Belmar, Pamela
; Godoy, Gonzalo
; Vargas, Marcelo
; Brun, Gina
; Donat, Jorge
; Cortés, Camilo
; Sepúlveda, Luis
.
El consenso chileno sobre el uso de inhibidores de SGLT-2 (iSGLT-2) en la práctica clínica, elaborado conjuntamente por las sociedades Chilenas de Cardiología, Diabetes, Medicina Familiar y Nefrología, recomienda fuertemente el uso de estos fármacos en personas con insuficiencia cardíaca y fracción de eyección reducida, diabetes mellitus tipo 2 para prevención de eventos cardiovasculares y evitar la progresión de enfermedad renal crónica. En insuficiencia cardíaca con fracción de eyección conservada o levemente reducida, y enfermedad renal crónica sin diabetes, el consenso sugiere el uso de iSGLT-2. Se destaca la importancia de combinar iSGLT-2 con IECAs o ARA-II en enfermedad renal crónica, y se recomienda su uso en reemplazo de sulfonilureas como segunda línea para control glicémico en diabetes tipo 2. El consenso enfatiza la necesidad de estrategias para optimizar el diagnóstico, mejorar la adherencia y educar sobre los beneficios más allá del control glicémico. Se discuten consideraciones de seguridad y costo-efectividad para una implementación priorizada según la evidencia. El documento resalta la importancia de la colaboración multidisciplinaria y la generación de evidencia local para aprovechar al máximo el potencial de estos fármacos en el manejo de condiciones cardiometabólicas complejas en Chile.
The Chilean consensus on the use of SGLT-2 inhibitors (iSGLT-2) in clinical practice, jointly developed by the societies of Cardiology, Diabetes, Family Medicine, and Nephrology, strongly recommends the use of these drugs in people with heart failure with reduced ejection fraction, type 2 diabetes mellitus for prevention of cardiovascular events, and chronic kidney disease. In heart failure with preserved or mildly reduced ejection fraction, and chronic kidney disease without diabetes, the consensus suggests the use of iSGLT-2. The importance of combining iSGLT-2 with ACE inhibitors or ARBs in chronic kidney disease is highlighted, and their use is recommended to replace sulfonylureas as a second-line treatment for glycemic control in type 2 diabetes. The consensus emphasizes the need for strategies to optimize diagnosis, improve adherence, and educate about benefits beyond glycemic control. Safety and cost-effectiveness considerations for prioritized implementation according to evidence are discussed. The document highlights the importance of multidisciplinary collaboration and the generation of local evidence to maximize the potential of these drugs in the management of complex cardiometabolic conditions in Chile.
2.
Factores impulsores y métodos de puntuación para mejorar el control de la hipertensión en la práctica clínica de la atención primaria: recomendaciones del grupo de innovación de HEARTS en las Américas
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Brettler, Jeffrey W.
; Giraldo Arcila, Gloria P
; Aumala, Teresa
; Best, Allana
; Campbell, Norm RC
; Cyr, Shana
; Gamarra, Angelo
; Jaffe, Marc G.
; De la Rosa, Mirna Jimenez
; Maldonado, Javier
; Neira Ojeda, Carolina
; Haughton, Modesta
; Malcolm, Taraleen
; Perez, Vivian
; Rodriguez, Gonzalo
; Rosende, Andres
; Valdes Gonzalez, Yamile
; Wood, Peter W.
; Zuñiga, Eric
; Ordunez, Pedro
.
RESUMO Fundamentos. As doenças cardiovasculares (DCV) são as principais causas de morbimortalidade nas Américas, e a hipertensão arterial (HÁ) é o fator de risco modificável mais importante. Porém, as taxas de controle da HA continuam baixas, e a mortalidade por DCV está estagnada ou aumentando após décadas de redução contínua. Em 2016, a Organização Mundial da Saúde (OMS) lançou o pacote de medidas técnicas HEARTS para melhorar o controle da HA. A Organização Pan-Americana da Saúde (OPAS) criou a iniciativa HEARTS nas Américas para melhorar a gestão do risco cardiovascular (RCV), com ênfase no controle da HA. Até agora, essa iniciativa foi implementada em 21 países. Métodos. Para impulsionar a implementação, recrutou-se um grupo multidisciplinar de profissionais para selecionar impulsionadores-chave do controle da HA com base em evidências e elaborar um scorecard completo para monitorar sua implementação em unidades de atenção primária à saúde (APS). O grupo estudou sistemas de saúde com alto desempenho que haviam conseguido atingir um alto nível de controle da HA por meio de programas de melhoria da qualidade focados em medidas específicas de processo, com feedback regular para os profissionais das unidades de saúde. Resultados. Os oito fatores impulsionadores incluídos na seleção final foram categorizados em cinco domínios principais: (1) diagnóstico (exatidão da medição da pressão arterial e avaliação do RCV); (2) tratamento (protocolo padronizado de tratamento e intensificação do tratamento); (3) continuidade do cuidado e acompanhamento; (4) modelo de atenção (atendimento baseado em equipe, renovação da prescrição); e (5) sistema de avaliação do desempenho. Em seguida, os impulsionadores e as recomendações foram transformados em medidas de processo, gerando dois scorecards inter-relacionados integrados ao sistema de monitoramento e avaliação da Iniciativa HEARTS nas Américas. Interpretação. O foco nesses impulsionadores-chave da HA e nos scorecards resultantes orientará o processo de melhoria da qualidade para atingir as metas de controle, em nível populacional, dos centros de saúde participantes nos países que estão implementando a iniciativa HEARTS.
ABSTRACT Background. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries. Methods. To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities. Findings. The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system. Interpretation. Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries.
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3.
Trabajos de investigación presentados en el XLIX Congreso Mexicano de Anestesiología: Zacatecas 2015. México
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Sánchez, Claudia
; Osorio-Santiago, María Arelí
; Medina-Tarango, Marco Antonio
; Fernandez De Lara, Alfredo
; Castro-Salinas, Jose Ernesto
; Salazar-Luna, Miguel Angel
; Sanchez, Placido
; Castro-Cayetano, José Esteban
; Millán Hernández, Manuel
; Almonte, Hector Asencion
; Zamora-Aguirre, Salvador A.
; Gudiño, Yocelin Montserrat
; Reyes-Valle, Roberto
; Zepeda-Olivera, Silvia
; Ferretiz-López, Giancarlo
; Salgado, Mónica
; Moctezuma-Ramírez, Luis
; Hernández-Ortiz, Israel Ivan
; Hernández-Zenteno, Norma Angelica
; Martinez, Raquel
; Sánchez-Hernández, Eloy
; Camacho-Gómez, Aldo Constantino
; Martinez, Raquel
; Chenge-Said, Jarumi
; Flores Fonseca, Elvia
; López-Centeno, Martha Alicia
; López, Angélica Yanine
; Jiménez-Ramos, Adriana
; Velasco-Sordo, Luis Ramón
; Hurtado-Reyes, Ignacio Carlos
; Castellanos, Antonio
; Rojas-Peñaloza, Janeth
; Zapién-Madrigal, Jesús Miguel
; Sánchez, Placido
; Sánchez-López, Eric Mauricio
; Mendoza- García, María Isabel
; Calzada-Grijalba, José Francisco
; Hernandez, Israel Ivan
; Castellanos De León, Edgar
; Luna Medina, Cinthya Isabel
; Alvarez-Mora, Lucy Andrea
; López, Angélica Yanine
; Jiménez-Ramos, Adriana
; Velasco-Sordo, Luis Ramón
; Hurtado-Reyes, Ignacio Carlos
; Diaz, Erica Raquel
; Hernandez-Gutierrez, Deoselina
; Gargiulo, Paul Raphael
; Barragán, Maria Jimena
; Ham Mancilla, Ofelia
; Zamora- Gutiérrez, Ana Lilia
; Arteaga, Jaime
; Hernández-Gutierrez, Deoselina
; Ríos-Navarro, Ramón Alejandro
; Romo-Serrano, Erika
; Castellanos, Antonio
; Zapién-Madrigal, Jesús Miguel
; Rojas- Peñaloza, Janeth
; Garduño, Araceli Marselle
; Flores-Rodriguez, Alfonso de Jesus
; Cuervo-Ggonzalez, Alma Kenia
; Puente-Solorio, Armando
; Benitez-Rebollar, Joel Enrique
; Gaona-Valle, Laura Soraya
; Jaime, Mayra Alicia
; Ortega-Suarez, Lizbeth
; Barrientos-Quintanilla, Luis Alberto
; Alvarado-Ramos, Salomon
; Moya-Morales, Yuliana
; Ferretiz, Giancarlo
; César, Julio
; Yañez, Pablo
; Reyes-Valle, Roberto
; Colores-Velazquez, Julio César
; Luna, Arístides De Jesús
; Almonte, Hector Asencion
; Márquez-Noyola, Elizabeth Alicia
; Castellanos, Antonio
; Barrera, Lorena
; Cabrera-Sánchez, Miroslava
; Fernanández-Muñoz, Angel Fernando
; Rolón-Sánchez, Yumara Georgina
; Barragán-Hernández, Adriana Guadalupe
; Lòpez, Estefania
; Osorio-Santiago, Maria Areli
; Muñoz, Beatriz Adelaida
; Cruz-Bautista, Mayra Ivette De La
; Ripoll-Aburto, Carlos Andres
; Ortiz-Maldonado, Jessie Karolina
; Hernández-Rasgado, Javier
; Cuj-Díaz, Alberto
; Sanchez, Placido
; Sarmiento, Lina
; Peña-Olvera, Silvia
; Santiago-Poot, Nohemí
; López, Angélica Yanine
; Jiménez-Ramos, Adriana
; Hurtado-Reyes, Ignacio Carlos
; Ferretiz, Giancarlo
; Pablo-Yañez, Julio César
; Flores-Martinez, Juan Ramón
; Chavez-Contreras, Sara Idali
; Gudiño-Larios, Yocelin Montserrat
; Velazquez, Sara
; Vences-Perez, Noemi Dolores
; Ayala-Bermudez, Celina Alejandra
; Garcia-Castro, Marco Tulio
; Gordillo-Parra, Alejandra
; Barrera, Lorena
; Cabrera-Sánchez, Miroslava
; Martínez-García, Claudia Lizeth
; Zuñiga-Iñiguez, Paloma
; Anaya-Romo, Eduardo
; Antelo-Corral, Jaqueline
; Ramos, Perla Del Carmen
; Hernández-Rasgado, Javier
; Cuj-Díaz, Alberto
; Fonz-Murillo, Elma Patricia
; Cruz-Bautista, Mayra Ivette De la
; Ripoll-Aburto, Carlos Andres
; Cruz, Mayra Ivette De La
; Cuj-Díaz, Alberto
; Hernández-Rasgado, Javier
; Vega-Cano, Miguel
; Ramos-Rodríguez, Perla del Carmen
; Muñoz-Hernández, Beatriz Adelaida
; Caceres, Leonardo Andres
; Arteaga-Favela, Claudia Berenice
; Nava-Osorio, Alejandro
; Arce-Bojorquez, Brisceyda
; Urias, Emma
; Rosario-Ayala, Yuridia Del
; Salazar-Castro, Laura Elena
; Nieblas-Torres, Mariela Lizet
; Arce-Bojorquez, Brisceyda
; Prince-Angulo, Silvia Annel
; Espinoza-Quintero, Erendira
; Alzate, Ana Lizette
; Camacho, Jesus Erick
; Aviles-Lozoya, Jose Trinidad
; Urias, Emma
; Espinoza-Quintero, Erendira
; Castellanos, Antonio
; Cruz, Nora Cecilia
; Rendón-Salazar, Dafne Denisse
; González-Cordero, Gustavo
; Garduño-Chávez, Belia Inés
; Orozco, Arturo Emmanuel
; Guerrero-Morales, Fernando
; Gonzalez-Ortiz, Julio Cesar
; Casillas-Cruz, Angel Alberto
; Aquino-Tamayo, Blanca Olga
; Estrada, Haydeé Lucía
; Soberanes-Alderete, Francisco Javier
; Ojeda-Ramos, Joel
; Martinez-Flores, Carlos
; Sandoval-Rivera, Arturo Guadalupe
; Cáceres-Figeroa, Leonardo Andres
; Ortega, Columba
; Torres-Mata, Lizbeth Yareli
; Peña-Olvera, Silvia
; Huerta, Juana Geraldine
; Sarmiento-Kamar, Rodrigo Ignacio
; Espinoza, Erendira
; Gerardo-Angulo, Alma Ruth
; Nieblas-Torres, Mariela Lizet
; Martinez-Felix, Jesus Israel
; Rochin-Parra, Julia Teresa
; Chavez, Veronica
; Buendía-Roque, Daniel
; Pinales-Aguilar, Guillermina
; Sandoval, Linda Alejandra
; Ovalle-Bueno, Claudia
; Armendáriz-Salinas, Jaime
; Valdovinos, Salvador
; Castellanos, Antonio
; Sandoval, Linda Alejandra
; Medina-Piqué, Sheila
; Aguilar, Hugo
; Barrera, Eduardo
; Márquez, Elizabeth Alicia
; León, Héctor Almonte De
; Castellanos, Antonio
; Rojas-Peñaloza, Janeth
; Zapién-Madrigal, Jesús Miguel
; Paez, Nancy
; Borquez-Torres, Samantha Anabel
; Chinchillas-Chinchillas, Yanira Zelene
; Silva-Romo, Luis Julian
; Aldana, Jorge Pablo
; Hernández-Gutiérrez, Deoselina
; Sánchez-Hernández, Eloy
; Castellanos, Antonio
; Coronel, Berta
; Fuentes-González, Nalleli del Carmen
; Mendoza-García, María Isabel
; Yañez, Gonzalo
; Contreras-Salomón, José Luis
; Garcia-Simbron, Emma
; Chable-Juárez, Randy Josue
; Manriquez-Merino, Ricardo
; Martinez, Raquel
; Chenge-Said, Jarumi
; Hernández Gutiérrez, Deoselina
; Sánchez, Placido
; Arrieta-Ruiz, Marelyn
; González-Velázquez, Felipe
; Estrada-Utrera, Sandra
; Castellanos, Antonio
; Meza, Oscar Eduardo
; Jimenez-Gonzalez, Adriana Guadalupe
; Pilar-Velazquez, Estefania
; Romo-Cortes, Ramona
; Torres-Soto, Maria de la Luz
; Estrada, Maria Sandra
; Espinoza, Cinthia Yadira
; Islas-Ruz, Felix Gilberto
; Perez-Diaz, Roberto
; Manuel-Serna, Roberto Aurelio
; Arce-Bojorquez, Brisceyda
; Medina-Lopez, Francisco de Jesus
; Nieblas-Torres, Mariela Lizet
; Espinoza-Quintero, Erendira
; Ayala-Camargo, Yuridia
; Guadarrama, Hugo
; Flores-Rodriguez, Alfonso de Jesus
; Benitez-Rebollar, Joel Enrique
; Cedillo-Hernandez, Carolina
; Acevedo-Corona, Arturo
; Gaona-Valle, Laura Soraya
; Morfin, Cecilia
; Flores Rodriguez, Alfonso de Jesus
; Cortes-Aceves, Hector Omar
; Rodríguez-Martínez, José Carlos
; Puente Solorio, Armando
; Gaona-Valle, Laura Soraya
; Reyes, Agustin
; Uscanga-Villa, Maria Nieves
; Molina-Rodriguez, Gloria
; Aquino-Tamayo, Blanca Olga
; Cabrera, Francisco
; Motta-Amezquita, Luis Gerardo
; Castellanos-Olivares, Antonio
; Joffre-Mora, Oscar Paul
; Moncada, Adriana Patricia
; Hernandez-Baez, Humberto Trinidad
; Cecilia, Nora
; Garduño-Chávez, Belia Inés
; González-Cordero, Gustavo
; Palacios-Ríos, Dionicio
.
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