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Avaliação da orientação terapêutica hipolipemiante no pós AVC isquémico/AIT em contexto de internamento numa enfermaria de medicina interna
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A doença cerebrovascular é uma das grandes causas de mortalidade e morbilidade a nível nacional. A melhoria assistencial e a detecção e tratamento precoces aumentaram a sobrevivência pós evento isquémico cerebrovascular e, consequentemente, a população com necessidade de prevenção secundária. A dislipidemia desempenha um papel importante na fisiopatologia do acidente vascular cerebral (AVC)/ acidente isquémico transitório (AIT). No entanto, embora o tratamento da dislipidemia esteja amplamente disponível e preconizado tanto em recomendações europeias como americanas, vários estudos enfatizam a existência de margens para melhorar as taxas de prescrição e adesão. Os dados a nível nacional são escassos e/ou inexistentes, o que fundamenta a importância de desenvolver este trabalho.
Neste estudo foram incluídos 191 doentes internados em um Serviço de Medicina de um hospital universitário e terciário, com o diagnóstico de AVC isquémico ou AIT durante o período de 12 meses compreendido entre outubro de 2019 e setembro de 2020. Os dados foram recolhidos através da consulta de notas de alta e a análise estatística feita considerando estatisticamente significativo um p-value < 0,05. Definiu-se como outcome principal a percentagem de doentes internados por AVC isquémico ou AIT que têm alta medicados com terapêutica hipolipemiante de intensidade alta e procurou-se estudar não só a terapêutica hipolipemiante pré e pós AVC/AIT mas também a adequabilidade, assim como a existência de factores que a possam influenciar (terapêutica hipolipemiante, eventos isquémicos prévios e níveis de LDL).
No estudo constatou-se que 62% dos doentes tiveram alta com terapêutica hipolipemiante de intensidade alta, com associação estatística com os valores de LDL elevados. Também a idade, o sexo feminino, o grau de dependência e a existência de terapêutica prévia influenciaram a estratégia terapêutica adoptada.
Conclui-se que, embora a maioria dos doentes tenham alta com terapêutica de alta intensidade, existe necessidade de otimização terapêutica em contexto de prevenção secundária.
Cerebrovascular disease is one of the major causes of mortality and morbidity in Portugal. The appropriate detection, treatment and medical assistance have increased survival rate to the ischemic cerebrovascular event and, thus, the need for secondary prevention. Dyslipidemia plays an important role in the physiopathology of stroke/ transient ischemic attack (TIA) and even though highly available and recommended by several guidelines, European and American, various studies show that there is still room for improvement in prescription rates and treatment adhesion. National data is scarce or nonexistent, facts that underline the importance of this paper. A total of 191 patients admitted to an Internal Medicine department of a University and tertiary care Hospital with a diagnosis of ischemic stroke/ TIA during the time comprised between October 2019 and 2020 were included in the study. Data was collected from discharge summary of the different wards and the statistical analysis was made considering a p-value < 0,05. The primary outcome of interest was percent of patients admitted for ischemic stroke/ TIA discharged with a high intensity lipid-lowering prescription and it was sought to study not only the pre and post lipid-lowering therapy but also its suitability as well as the factors that might influence it (previous prescription, ischemic event or LDL values) in the context of a medicine ward. In this study, 62 percent of the patients were discharged with high intensity lipid-lowering medication, with a statistically significant association with high LDL values. Age, female sex, performance status and previous ischemic events have also been proved to influence the adopted therapeutic strategy. In conclusion, although the majority of the patients were discharged with high intensity lipid-lowering medication, there is still the need to improve therapeutic optimization in the context of secondary prevention.
Cerebrovascular disease is one of the major causes of mortality and morbidity in Portugal. The appropriate detection, treatment and medical assistance have increased survival rate to the ischemic cerebrovascular event and, thus, the need for secondary prevention. Dyslipidemia plays an important role in the physiopathology of stroke/ transient ischemic attack (TIA) and even though highly available and recommended by several guidelines, European and American, various studies show that there is still room for improvement in prescription rates and treatment adhesion. National data is scarce or nonexistent, facts that underline the importance of this paper. A total of 191 patients admitted to an Internal Medicine department of a University and tertiary care Hospital with a diagnosis of ischemic stroke/ TIA during the time comprised between October 2019 and 2020 were included in the study. Data was collected from discharge summary of the different wards and the statistical analysis was made considering a p-value < 0,05. The primary outcome of interest was percent of patients admitted for ischemic stroke/ TIA discharged with a high intensity lipid-lowering prescription and it was sought to study not only the pre and post lipid-lowering therapy but also its suitability as well as the factors that might influence it (previous prescription, ischemic event or LDL values) in the context of a medicine ward. In this study, 62 percent of the patients were discharged with high intensity lipid-lowering medication, with a statistically significant association with high LDL values. Age, female sex, performance status and previous ischemic events have also been proved to influence the adopted therapeutic strategy. In conclusion, although the majority of the patients were discharged with high intensity lipid-lowering medication, there is still the need to improve therapeutic optimization in the context of secondary prevention.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Acidente vascular cerebral Acidente isquémico transitório Estatinas Prescrição Prevenção secundária