Fátima Ceia

Prevalence of chronic heart failure in Southwestern Europe: the EPICA study.

To estimate the prevalence of chronic heart failure (CHF) in mainland Portugal in 1998.

The diagnosis of heart failure in primary care: value of symptoms and signs.

The value of symptoms and signs in the diagnosis of CHF has rarely been tested in large numbers of patients in the community. The aim of this study was to evaluate the importance of symptoms, signs, and past medical history in the diagnosis of CHF in primary care.

Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care

To validate and estimate the performance statistics and concordance of seven clinical questionnaires for the diagnosis of chronic heart failure (HF).

The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community

There is a common assumption that a normal ECG or a normal heart size on chest X‐ray virtually rules out a diagnosis of heart failure.

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care.

How patients with heart failure are managed in Portugal.

The prevalence of heart failure is increasing all over the world. It is a common and growing public health problem in Portugal as in many other European countries. This article provides a review of health service organization and current heart failure management in Portugal, discusses primary care and ward practices in different hospitals and reports on the use of proven standard therapies for the treatment of heart failure in the community. Despite major advances in diagnosis and treatment, heart failure is only satisfactorily managed. Furthermore efforts are necessary before the beneficial effects observed in trials have a real impact in clinical practice. A broader view and priority for the management of this syndrome on a national level are needed to improve the quality of heart failure care in Portugal.

Systemic markers of the redox balance and apolipoprotein E polymorphism in atherosclerosis: the relevance for an integrated study.

Prospective studies have demonstrated that an imbalance between oxidative damage and antioxidative protection can play a role in the development and progression of atherosclerosis. Also, genotypes with the apolipoprotein E ζ4 allele have been associated with an increase risk for this pathology. Based on this knowledge, the aim of this study was to evaluate indicators of the redox balance, trace elements, and apolipoprotein E allelic profile in subjects from the Lisbon population with clinically stable atherosclerosis, at risk for atherosclerotic events, and in healthy subjects for comparison. The activities of superoxide dismutase in erythrocytes and glutathione peroxidase in whole blood, plasma total thiols, and serum ceruloplasmin were kept unchanged among the three groups. Serum α-tocopherol was increased in atherosclerotic patients. Total malondialdehyde in serum and protein carbonyls in plasma, which are indicators of lipid and protein oxidative damage, respectively, reached their highest values in risk subjects. The concentrations of potassium and calcium, in plasma and in blood cells, were slightly elevated in patients and might reflect an electrolytic imbalance. Regarding the apolipoprotein E polymorphism, atherosclerotic patients had an increased incidence of the high-risk genotypes for atherogenesis (ζ3/ζ4 and ζ4/ζ4). A multivariate model applied to the general population using most of the parameters clearly separated the three groups at study (i.e., the healthy group from the steady-state group of risk disease and from the atherosclerotic one). As shown by us, the usefulness of biochemical and complementary genetic markers is warranted for a better knowledge on atherosclerosis molecular basis.

The Implication of Socioeconomic Profile on Prognosis and Management Programs in Heart Failure Patients~!2009-05-26~!2009-11-02~!2010-02-24~!

Introduction: Little is known about the obstacles to patients’ compliance to Heart Failure (HF) treatment. Heart Failure management programs seem to be a strategy to overcome these problems. Aim: To evaluate in HF outpatients the role that socioeconomic characteristics and knowledge about the disease play in their compliance to treatment and long term mortality. Population and methods: We conducted a prospective study of consecutive HF outpatients attending our HF Clinic. Structured questionnaires directed to the patient or care giver were used. Patients ́ socio-economic characteristics and understanding of the disease, as well as, predictors of long term mortality were accessed. Results: We included 59 consecutive NYHA II-III HF patients, age 70.5±11.9 years. Sixty three percent were male and 59.3% had left ventricular systolic dysfunction. Most patients had multiple comorbidities, were polymedicated, lived with their family and belonged to middle-low or low Graffar socioeconomic class. Eighty five percent were retired, median monthly income was 350 , 41.5% had primary education and 22.6% were illiterate. More than half did not know they had HF, what HF was nor its main symptoms/ signs. Four year mortality was 23.6 %. Not knowing “what HF is” was the unique predictor of long-term mortality (p= 0.035; OR 0.097; CI: 0.011-0.846). Conclusions: In our study Heart Failure patients were elderly, retired, and frequently dependent. Literacy was predominantly low. The need of polypharmacy, poor income and poor understanding of the disease were the rule. The later was even a predictor of long term mortality. Heart Failure management programs must be tailored to the needs of their users, taking into account their social environment.

ACCURACY OF SEVERITY SCORES IN RISK STRATIFICATION OF INTERNAL MEDICINE WARD PATIENTS

MEDICINE WARD PATIENT’S Ana Abreu, Sara Augusto, Filipa Gandara, Ines Araujo, Rosa Cardiga, Ricardo Ferreira, Marisa Alface, Margarida Proenca, Daniel Romeira, Carolina Carvalho, Henrique Sousa, Bruna Ferreira, Sara Grazina, Elena Ndrio, Filipa Marques, Susana Jesus, Arturo Botella, Ana Leitao, Cândida Fonseca, Fatima Ceia Servico de Medicina III, Hospital Sao Francisco Xavier, Faculdade de Ciencias Medicas da Universidade Nova de Lisboa