Medicação da insuficiência cardíaca com fração de ejeção reduzida, nos cuidados primários da região Centro de Portugal: um estudo observacional de 2022
DOI:
https://doi.org/10.32385/rpmgf.v40i4.13770Keywords:
Heart failure with reduced ejection fraction, General practice, Family medicine, MedicinesAbstract
Objetivo: Avaliar a concordância da terapêutica com medicamentos modificadores de prognóstico (MMP) em pessoas com insuficiência cardíaca crónica com fração de ejeção reduzida (P-CICFEr), em cuidados de saúde primários (CSP) na região Centro de Portugal, com as diretrizes da Sociedade Europeia de Cardiologia (ESC) de agosto de 2021.
Métodos: Estudo observacional transversal de uma amostra representativa do tamanho, intervalo de confiança de 95% e margem de erro de 8%, da população com CICFEr em 31/dezembro/2021. Foram estudados idade, sexo, ano de diagnóstico da introdução da Classificação Internacional para Cuidados Primários-2 (ICPC-2, K-77), anos desde o último ecocardiograma, MMPs para P-CICFEr e outras terapêuticas para P-CICFEr. Participaram, convidadas por conveniência, 11 Unidades de Saúde Familiar após parecer positivo da Comissão de Ética.
Resultados: Num universo de n=2.381 pessoas com insuficiência cardíaca (PCIC) encontraram-se n=453 (19,0%) (P-CICFEr) estudando-se uma amostra representativa de n=133 (5,6%), n=95 homens (71,4%). Verificou-se prescrição de medicamentos inibidores do sistema renina-angiotensina-aldosterona (iSRAA) 91,0%, de betabloqueadores em 75,2%, de antagonistas mineralocorticoides em 40,6%, de inibidores da SGLT2 em 44,4%, de inibidores da neprilisina em 38,3% e de diuréticos de ansa em 72,2%. A terapêutica farmacológica quádrupla verificou-se em n=28 (21,1%) P-CICFEr e a tripla em n=38 (28,6%). Verificou-se idade média de 74,3±11,6 anos, 75,1±4,0 no homem e 76,6±6,0 na mulher, p=0,088. A mediana de tempo desde o diagnóstico ICPC-2 foi de 6,0 anos no homem e de 4,0 anos na mulher, p=0,031. O tempo mediano desde o último ecocardiograma foi de três anos, p=0,750.
Conclusão: Os medicamentos modificadores de prognóstico, segundo as diretrizes mais recentes da ESC para a CICFEr, estavam subutilizados em 50,4% dos casos. Apesar dos resultados encontrados é necessária reflexão acerca das barreiras que os médicos possam encontrar para aplicar as diretrizes em P-CICFEr.
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