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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atherosclerosis is a progressive inflammatory process that can manifest in different vascular beds&#44; and causes major health problems such as myocardial infarction&#44; ischemic stroke and peripheral arterial disease&#46; It is associated with various risk factors such as hypertension&#44; dyslipidemia&#44; obesity&#44; diabetes and smoking&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The REACH registry&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> one of the most important international studies in the atherosclerosis population&#44; demonstrated that the rate of cardiovascular events at one year increases with the number of symptomatic territories&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The e-COR study&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> the results of which are representative of the whole of Portugal&#44; showed that 68&#37; of the Portuguese population had two or more risk factors for cardiovascular disease and 22&#37; had four or more&#46; This study reinforces data from previous studies with regard to the low level of control of risk factors for cardiovascular disease&#44; especially hypertension and diabetes&#44; with known implications in terms of morbidity and mortality from cerebrovascular and cardiovascular disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study by Ascen&#231;&#227;o et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> published in the current issue of the <span class="elsevierStyleItalic">Journal</span> aimed to characterize the population with atherosclerosis among primary health care users in the Lisbon and Tagus Valley Regional Health Administration&#46; A total of 318 692 adult users were identified who met at least one of the criteria of atherosclerosis used by the authors&#46; Three defining criteria were used&#58; &#40;1&#41; recording of at least one clinical manifestation of atherosclerosis in any field of the primary health care database of the Regional Health Administration &#40;SIARS&#41;&#59; &#40;2&#41; presence of at least three risk factors&#59; or &#40;3&#41; dispensing of an antiplatelet drug&#44; naphthridofuryl&#44; or pentoxifylline&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study&#39;s results suggest that patients without clinical manifestations of atherosclerosis have worse control of blood pressure and cholesterol than those with manifestations&#44; despite the proportion of patients taking antihypertensive drugs &#40;in the presence of hypertension&#41; and lipid-modifying drugs &#40;in the presence of dyslipidemia&#41; being similar in both groups&#44; which may denote low therapeutic intensity&#46; The overall results of the study suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis&#46; These results were put in the context of the health profile of the Portuguese population in general and with the results obtained in the REACH registry&#46; When the general population that participated in the first National Health Examination Survey &#40;INSEF 2015&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> was used as reference&#44; the results were similar&#46; The results of INSEF 2015 are in line with the prevalence estimated by the e-COR study &#40;43&#46;1&#37; and 8&#46;9&#37; for hypertension and diabetes&#44; respectively&#41;&#44; so the conclusions are similar for this comparison&#46; Although the REACH registry mostly included patients with clinical manifestations of atherosclerosis &#40;82&#37; vs&#46; 29&#37;&#41;&#44; Ascen&#231;&#227;o et al&#46; present similar results regarding recorded hypertension &#40;78&#37; vs&#46; 80&#37;&#41; and prescription of antidiabetic drugs &#40;36&#37; vs&#46; 38&#37;&#41; and lipid-modifying agents &#40;73&#37; vs&#46; 70&#37;&#41;&#46; Regarding control of risk factors&#44; particularly in hypertension&#44; the proportion of controlled individuals was higher in REACH &#40;50&#37; vs&#46; 40&#37;&#41;&#46; However&#44; as mentioned above&#44; most of the population included in REACH presented clinical manifestations of atherosclerosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study by Ascen&#231;&#227;o et al&#46; has several merits&#46; The main one is undoubtedly that it used clinical databases and the Control and Monitoring Center &#40;for invoiced drugs&#41; of the National Health Service as sources of information for health research&#46; The SIARS data are very useful for producing scientific evidence and supporting decisions in health care&#46; The characterization of patients using primary health care is valuable&#44; as observed by the authors&#44; for the understanding of atherosclerosis and its clinical relevance&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Systematic clinical records are crucial to clinical research&#46; These records enable quality control of the medical work and evaluation of the results obtained&#46; It is essential to create conditions for these records to become a mandatory part of clinical practice&#46; It is necessary to evaluate in order to improve quality&#46; These indicators should be used to improve care&#58; not as penalizing assessment processes&#44; and always from an integrative perspective&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The general practitioner is in a unique position to act on modifiable risk factors and reduce overall cardiovascular risk&#46; It is only a matter of creating the conditions for this role to be exercised&#44; particularly time to observe and communicate with the patient&#44; enter the documentation in computer records and verify adherence to drug therapy&#46; According to a community study in Portugal by Cabral et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> 28&#37; of hypertensive patients showed low adherence&#44; 38&#37; medium adherence and only 34&#37; reported high adherence to antihypertensive therapy&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient&#39;s clinical file should centralize all clinical records of primary and secondary care&#44; prescription and referral on a single platform&#44; where professionals exchange clinical information&#44; certifying that they have taken notice and ensuring therapeutic reconciliation &#8211; a practice already in operation in some northern European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In order to reduce the burden of disease and costs related to atherosclerosis in Portugal&#44; we cannot permanently postpone this reform of the mindset and responsibility of doctors&#44; family medicine practices&#44; hospitals&#44; universities and government entities&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Information sources and clinical records: Current challenges
Fontes de informação e registos clínicos: desafios atuais
José Eduardo Aguiar
Cardiology Functional Unit, North Alentejo Local Health Unit, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atherosclerosis is a progressive inflammatory process that can manifest in different vascular beds&#44; and causes major health problems such as myocardial infarction&#44; ischemic stroke and peripheral arterial disease&#46; It is associated with various risk factors such as hypertension&#44; dyslipidemia&#44; obesity&#44; diabetes and smoking&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The REACH registry&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> one of the most important international studies in the atherosclerosis population&#44; demonstrated that the rate of cardiovascular events at one year increases with the number of symptomatic territories&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The e-COR study&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> the results of which are representative of the whole of Portugal&#44; showed that 68&#37; of the Portuguese population had two or more risk factors for cardiovascular disease and 22&#37; had four or more&#46; This study reinforces data from previous studies with regard to the low level of control of risk factors for cardiovascular disease&#44; especially hypertension and diabetes&#44; with known implications in terms of morbidity and mortality from cerebrovascular and cardiovascular disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study by Ascen&#231;&#227;o et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> published in the current issue of the <span class="elsevierStyleItalic">Journal</span> aimed to characterize the population with atherosclerosis among primary health care users in the Lisbon and Tagus Valley Regional Health Administration&#46; A total of 318 692 adult users were identified who met at least one of the criteria of atherosclerosis used by the authors&#46; Three defining criteria were used&#58; &#40;1&#41; recording of at least one clinical manifestation of atherosclerosis in any field of the primary health care database of the Regional Health Administration &#40;SIARS&#41;&#59; &#40;2&#41; presence of at least three risk factors&#59; or &#40;3&#41; dispensing of an antiplatelet drug&#44; naphthridofuryl&#44; or pentoxifylline&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study&#39;s results suggest that patients without clinical manifestations of atherosclerosis have worse control of blood pressure and cholesterol than those with manifestations&#44; despite the proportion of patients taking antihypertensive drugs &#40;in the presence of hypertension&#41; and lipid-modifying drugs &#40;in the presence of dyslipidemia&#41; being similar in both groups&#44; which may denote low therapeutic intensity&#46; The overall results of the study suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis&#46; These results were put in the context of the health profile of the Portuguese population in general and with the results obtained in the REACH registry&#46; When the general population that participated in the first National Health Examination Survey &#40;INSEF 2015&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> was used as reference&#44; the results were similar&#46; The results of INSEF 2015 are in line with the prevalence estimated by the e-COR study &#40;43&#46;1&#37; and 8&#46;9&#37; for hypertension and diabetes&#44; respectively&#41;&#44; so the conclusions are similar for this comparison&#46; Although the REACH registry mostly included patients with clinical manifestations of atherosclerosis &#40;82&#37; vs&#46; 29&#37;&#41;&#44; Ascen&#231;&#227;o et al&#46; present similar results regarding recorded hypertension &#40;78&#37; vs&#46; 80&#37;&#41; and prescription of antidiabetic drugs &#40;36&#37; vs&#46; 38&#37;&#41; and lipid-modifying agents &#40;73&#37; vs&#46; 70&#37;&#41;&#46; Regarding control of risk factors&#44; particularly in hypertension&#44; the proportion of controlled individuals was higher in REACH &#40;50&#37; vs&#46; 40&#37;&#41;&#46; However&#44; as mentioned above&#44; most of the population included in REACH presented clinical manifestations of atherosclerosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study by Ascen&#231;&#227;o et al&#46; has several merits&#46; The main one is undoubtedly that it used clinical databases and the Control and Monitoring Center &#40;for invoiced drugs&#41; of the National Health Service as sources of information for health research&#46; The SIARS data are very useful for producing scientific evidence and supporting decisions in health care&#46; The characterization of patients using primary health care is valuable&#44; as observed by the authors&#44; for the understanding of atherosclerosis and its clinical relevance&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Systematic clinical records are crucial to clinical research&#46; These records enable quality control of the medical work and evaluation of the results obtained&#46; It is essential to create conditions for these records to become a mandatory part of clinical practice&#46; It is necessary to evaluate in order to improve quality&#46; These indicators should be used to improve care&#58; not as penalizing assessment processes&#44; and always from an integrative perspective&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The general practitioner is in a unique position to act on modifiable risk factors and reduce overall cardiovascular risk&#46; It is only a matter of creating the conditions for this role to be exercised&#44; particularly time to observe and communicate with the patient&#44; enter the documentation in computer records and verify adherence to drug therapy&#46; According to a community study in Portugal by Cabral et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> 28&#37; of hypertensive patients showed low adherence&#44; 38&#37; medium adherence and only 34&#37; reported high adherence to antihypertensive therapy&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient&#39;s clinical file should centralize all clinical records of primary and secondary care&#44; prescription and referral on a single platform&#44; where professionals exchange clinical information&#44; certifying that they have taken notice and ensuring therapeutic reconciliation &#8211; a practice already in operation in some northern European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In order to reduce the burden of disease and costs related to atherosclerosis in Portugal&#44; we cannot permanently postpone this reform of the mindset and responsibility of doctors&#44; family medicine practices&#44; hospitals&#44; universities and government entities&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Revista Portuguesa de Cardiologia
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