Christiane Wahast Ávila

Improved Oral Anticoagulation After a Dietary Vitamin K–Guided Strategy. A Randomized Controlled Trial

Background— Dietary vitamin K is thought to be an important factor that interferes with anticoagulation stability, but the clinical applicability of this interaction has not been evaluated adequately in prospective studies. Methods and Results— In a randomized controlled trial that enrolled outpatients with a recent international normalized ratio (INR) outside the therapeutic target, we compared 2 strategies to optimize long-term oral anticoagulation: (1) a conventional approach based on changes in anticoagulant prescription and (2) a dietary vitamin K–guided strategy based on simple modifications of the amount of vitamin K–rich foods ingested per week. The primary efficacy end point was the percentage of patients who achieved a prespecified INR target at 90 days after randomization. Study population (n=132) predominantly included men with mechanical heart prostheses (58%) or atrial fibrillation (35%). Over time, patients allocated to the vitamin K–guided strategy reached the prespecified INR more frequently so that after 90 days of follow-up, 74% were on target compared with 58% of patients managed conventionally (P=0.04). Patients allocated to the dietary vitamin K–guided strategy had the same magnitude and direction of INR variation as those observed with the conventional approach in the short term (15 days) for both underanticaogulated and overanticoagulated patients. Minor bleeding or use of parenteral vitamin K were also marginally less frequent in patients managed according to the dietary intervention (1 [1.5%] versus 7 [11%]; P=0.06). Conclusions— A vitamin K–guided management strategy to adjust long-term oral anticoagulation is feasible and safe and may result in an increased chance of reaching target levels of INR.

Cross-cultural adaptation and validation of the European Heart Failure Self-care Behavior Scale for Brazilian Portuguese

OBJECTIVE To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale. METHODS The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting) and validation (assessment of face validity, content validity, and internal consistency reliability) were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF) and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care). RESULTS The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbachs Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87. CONCLUSION Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.

Fatores de risco para doença arterial coronariana em pacientes admitidos em unidade de hemodinâmica

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.Estudo transversal para avaliar a prevalencia de fatores de risco (FR) para doenca arterial coronariana (DAC) em pacientes submetidos a procedimentos cardiacos em unidade de hemodinâmica. Incluiu-se 302 pacientes, com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR mais prevalente foi o sedentarismo 227 (75%), seguido da hipertensao 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabete mellitus 81 (27%), tabagismo 77 (25,5%), consumo de alcool 67 (22%) e alimentacao pobre em frutas e verduras 15 (5%). A correlacao entre o numero de FR e as variaveis: escolaridade, renda, idade, estado civil, atividade profissional e sexo, alem do numero de procedimentos a que foram submetidos, comparado aqueles que apresentavam mais do que cinco FR para DAC nao foi significativa; no entanto, existe uma associacao positiva, reforcando a importância de estrategias que visem a diminuicao ou eliminacao dos FR modificaveis.

Pharmacological adherence to oral anticoagulant and factors that influence the international normalized ratio stability.

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Adesão farmacológica ao anticoagulante oral e os fatores que influenciam na estabilidade do índice de normatização internacional

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Adhesión farmacológica al anticoagulante oral y factores que influyen en la estabilidad del índice de estandarización internacional

Este e um estudo transversal, desenvolvido com o objetivo de relacionar a estabilidade do indice de normatizacao internacional (INR), utilizado como parâmetro para monitorar os niveis de coagulacao do sangue, com adesao, idade, escolaridade, nivel socioeconomico, interacao com outras medicacoes, comorbidades, ingesta de vitamina K, tempo de anticoagulacao (ACO) e custo com medicacoes. Incluiram-se 156 pacientes, idade media 57±13 anos, 53,8% pertencente ao sexo masculino; 61 (39,1%) tiveram alta adesao, 91 (58,3%) media e 4 (2,6%) baixa adesao ao tratamento; 117 (75%) apresentaram estabilidade do INR de ate 50% e 39 (25%) >; a 75%; pacientes com menor tempo de ACO apresentaram maior estabilidade; aqueles que gastavam menos com a medicacao permaneciam mais estaveis e com melhor adesao. Concluiu-se que mais de 90% dos pacientes apresentaram alta e media adesao referida, e que tempo de anticoagulacao e custo com a medicacao foram os fatores relacionados a estabilidade da ACO.Cross-sectional study developed to relate the international normalized ratio (INR), used as a parameter to monitor the levels of blood clotting, stability to adherence, age, level of education, socioeconomic level, interaction with other drugs, comorbidities, vitamin K intake, anticoagulation time and drug cost. 156 patients were included, mean age 57 ± 13 years, (53.8%) male, 61 (39.1%) had high adherence, 91 (58.3%) medium and 4 (2.6%) low adherence to treatment, 117 (75%) had INR stability up to 50% and 39 (25%) > 75%, patients with shorter time of anticoagulation presented higher stability, those who spent less on the drug remained more stable and had better adherence. It was concluded that more than 90% of patients had high and medium adherence and that the anticoagulation time and drug cost were the factors related to the anticoagulation stability.

Risk factors for coronary artery disease in patients admitted in hemodynamics unit

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.Estudo transversal para avaliar a prevalencia de fatores de risco (FR) para doenca arterial coronariana (DAC) em pacientes submetidos a procedimentos cardiacos em unidade de hemodinâmica. Incluiu-se 302 pacientes, com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR mais prevalente foi o sedentarismo 227 (75%), seguido da hipertensao 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabete mellitus 81 (27%), tabagismo 77 (25,5%), consumo de alcool 67 (22%) e alimentacao pobre em frutas e verduras 15 (5%). A correlacao entre o numero de FR e as variaveis: escolaridade, renda, idade, estado civil, atividade profissional e sexo, alem do numero de procedimentos a que foram submetidos, comparado aqueles que apresentavam mais do que cinco FR para DAC nao foi significativa; no entanto, existe uma associacao positiva, reforcando a importância de estrategias que visem a diminuicao ou eliminacao dos FR modificaveis.

Factores de riesgo para enfermedad arterial coronaria en pacientes de una unidad de hemodinamia

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.Estudo transversal para avaliar a prevalencia de fatores de risco (FR) para doenca arterial coronariana (DAC) em pacientes submetidos a procedimentos cardiacos em unidade de hemodinâmica. Incluiu-se 302 pacientes, com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR mais prevalente foi o sedentarismo 227 (75%), seguido da hipertensao 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabete mellitus 81 (27%), tabagismo 77 (25,5%), consumo de alcool 67 (22%) e alimentacao pobre em frutas e verduras 15 (5%). A correlacao entre o numero de FR e as variaveis: escolaridade, renda, idade, estado civil, atividade profissional e sexo, alem do numero de procedimentos a que foram submetidos, comparado aqueles que apresentavam mais do que cinco FR para DAC nao foi significativa; no entanto, existe uma associacao positiva, reforcando a importância de estrategias que visem a diminuicao ou eliminacao dos FR modificaveis.