Estratificação de risco cardiovascular para qualificação da atenção à saúde de pacientes hipertensos e/ou diabéticos em uma Estratégia de Saúde da Família

Abstract

Systemic Arterial Hypertension and Diabetes Mellitus are prevalent chronic diseases with a high relationship with cardiovascular disease, the first being the main cause of death in Brazil and the world, so there is no doubt that they are of great relevance for public health policies. health due to the considerable impact on mortality and cardiovascular morbidity. The present work aimed to assist in the care planning of hypertensive and/or diabetic patients treated in a Basic Health Unit (UBS) through a line of care specifically aimed at these patients, which allowed to stratify cardiovascular risk, directing them within the health care network and making it possible to qualify the health care offered by a Family Health Strategy in the interior of Ceará. This is an epidemiological, individual, observational, cross-sectional study of the exploratory morbidity investigation type that evaluated and stratified the cardiovascular risk of hypertensive and/or diabetic patients, registered in the e-SUS system, belonging to the coverage area of the ESF of one of the UBS's located in the city of Crato. Data collection took place within the UBS during scheduled consultations with the unit's doctor, who promoted the flow of these patients to an appropriate room and collection took place together with the researcher. Initially, a form was applied to obtain lifestyle and sociodemographic data related to the interviewees' gender, race, marital status and education. To identify patients' cardiovascular risk, the risk stratification form for priority chronic conditions made available by the QualificaAPSUS Project was used, which brought together a set of clinical data obtained from the results of evaluations and examinations of these patients. Initially, the data were obtained and compiled in databases using Excel software, then the analysis was carried out through a thorough and detailed description of the variables used, with the aim of characterizing the study population. For numerical variables, such as Age and serum creatinine, centrality measures were used, such as mean and median, and dispersion measures, such as standard deviation, minimum and maximum, and quartiles. For categorical and ordinal categorical variables, absolute and relative frequency was used. Next, different statistical methods were used to investigate the associations between the study variables and cardiovascular risk. Thus, it was identified that of the 86 participants, aged between 38 and 82 years, 76.7% were women and 23.3% men, 74.4% were brown, 10.5% white, 9.3% black and 5.8% yellow; Regarding education, 33.7% had primary education from the 1st to the 4th grade and the majority, 58.1%, were married. When it came to health behaviors, the majority of individuals were not involved in physical activities (79.1%) and were not smokers (88.4%). Regarding alcohol consumption, 86% of participants reported not consuming it, while 14% admitted to drinking it. Hypertension was common in the sample (87.2%), in contrast to the presence of diabetes (40.7%). It was evident that this group presents a high risk of developing cardiovascular disease, the majority of which, 54 (62.79%) were classified as high risk, highlighting the strong relationship between the pathophysiological conditions caused by SAH and DM and the development of CVD ; analyzes of the relationships between variables and cardiovascular risk provided important insights, age, gender, diabetes, blood pressure classification, BMI, and electrocardiogram results emerged as risk factors for cardiovascular disease. On the other hand, several other variables did not demonstrate significant associations, emphasizing the complexity of determining cardiovascular risk and the multifactorial influence on this measure. Thus, despite the difficulties encountered in carrying out the stratification, in particular the absence of some test results and the non-attendance of patients at scheduled appointments, cardiovascular risk stratification was obtained for the 86 patients who participated in the research, of which the highest risk was classified as high risk, demonstrating a lack of quality in the care offered to patients, constituting an opportune device for ongoing health education. This study enabled a differentiated and equitable look at the groups formed, as patients were directed within the health network according to their risk classification, allowing for greater qualification of health care for these patients. In this way, the importance of applying the cardiovascular risk stratification tool of the QualificaAPSUS Project as well as investing in Primary Health Care becomes evident.