Orientación Técnica Programa De Salud Cardiovascular

Objectives

Chile’s Cardiovascular Health Programme (PSCV) provides a national technical framework for integrated, family- and community-oriented cardiovascular prevention, risk management, treatment and follow-up within the public Primary Health Care system. It aims to reduce cardiovascular morbidity and mortality by standardising care across the health network, promoting self-care and healthy lifestyles, controlling hypertension, diabetes and dyslipidaemia, preventing complications and delivering secondary prevention after cardiovascular events.[1][2][3][4]

• Reduce cardiovascular risk through health promotion, prevention, risk-factor detection and individualised treatment according to 10-year cardiovascular risk.[5][3][6]
• Include people aged 15 years and over with established atherosclerotic cardiovascular disease, hypertension, type 2 diabetes, qualifying dyslipidaemia or tobacco use from age 55 in the PSCV.[3][7][8][9]
• Achieve risk-adjusted targets for blood pressure, glycaemic control and lipids, adapting clinical targets and decisions for older adults according to frailty, comorbidities, function and clinical judgement.[10][11]
• Prevent complications through early chronic kidney disease detection, retinal screening, diabetic-foot assessment and care, depression screening, medication adherence support and timely referral.[4][12][13][14][15]
• Promote healthy eating, physical activity, weight management, moderate alcohol use, tobacco cessation and prevention of second-hand smoke exposure.[10][16][17][18]
• Strengthen self-management through patient and family education, shared decisions, cognitive-behavioural support and workshops on cardiovascular health, exercise, nutrition, medicine adherence and mental health.[2][19][20]
• Extend prevention beyond clinical care through the Vida Sana Programme, which seeks to reduce poor diet, insufficient physical fitness and overweight or obesity among eligible National Health Fund beneficiaries aged 2 to 64 years.[21][16][22]

Implementation

The PSCV is delivered through integrated Primary Health Care-based service networks using a chronic care model, multidisciplinary teams, coordinated referral and counter-referral, active follow-up, clinical risk stratification and standardised records. National, regional, Health Service and local primary-care institutions share responsibilities for technical direction, adaptation, implementation, supervision and quality improvement.[3][13][23][24][25][26]

• Assign leadership to the Public Health Subsecretariat, Regional Ministerial Health Secretariats, the Subsecretariat of Healthcare Networks, Health Services and health establishments; designate local programme coordinators and make primary-care centre directors responsible for implementation.[23][24][25][26]
• Deliver person-centred care through doctors, nurses, nutritionists and nursing technicians, with pharmacists, psychologists, physiotherapists, social workers, podiatry technicians and physical-activity professionals contributing according to local capacity.[13][27][28][29]
• Use every contact with health services, including preventive consultations and emergency departments, to identify risk factors, offer examinations, recover people missing follow-up and refer patients for assessment or treatment intensification.[4][30]
• Confirm hypertension through repeated standardised blood-pressure measurements or 24-hour ambulatory monitoring where indicated, using validated upper-arm digital equipment, appropriate cuffs, correct preparation and calibrated devices.[8][31][32][33]
• Apply the Explicit Guarantees in Health Regime to confirm or exclude hypertension and diabetes within 45 days, while ensuring urgent clinical review for severe blood-pressure readings or symptoms requiring prompt assessment.[30]
• Maintain continuity through referral, counter-referral, shared follow-up, medicine reconciliation after care transitions, discharge notification after myocardial infarction or stroke, and follow-up within seven days of discharge.[34][19]
• Provide covered medicines and supplies through the Pharmacy Fund for type 2 diabetes, hypertension, dyslipidaemia and advanced diabetic-foot ulcer care; use Pharmacy and Therapeutics Committees to guide formulary selection, availability and appropriate use.[35][36]
• Monitor implementation through preventive-examination coverage, programme enrolment, effective hypertension and diabetes coverage, clinical control, diabetic-foot outcomes, retinal examinations and kidney-function assessment.[37][38]
• Use monthly statistical records, updated clinical registers, documented tracing protocols and periodic review of programme targets to support reporting, auditability and local performance improvement.[39][40][38][26][41]
• Provide constructive audit and feedback, clinical case review, staff induction and continuing education to improve practice and reduce therapeutic inertia.[28][42][43]

Monitoring & Evaluation

The guidance establishes a multi-level monitoring and accountability framework for the Cardiovascular Health Programme (PSCV), combining clinical risk assessment and follow-up with routine service reporting, programme indicators, record audits, supervisory oversight and feedback to care teams.[1][37][26][44]

• Monitor cardiovascular risk through Framingham 10-year coronary-risk tables adapted to Chile, and use risk stratification to tailor treatment targets, review frequency and follow-up intensity.[3][13]
• Track preventive examination coverage for adults aged 20 to 64 years and people aged over 64 years, alongside PSCV enrolment coverage for hypertension and diabetes among people aged 15 years and over.[37]
• Measure effective coverage for hypertension and diabetes by assessing the proportion of the expected prevalence-based population under control who are clinically compensated.[37]
• Monitor clinical control and complication prevention through indicators including severe hypertension above 160/100 mmHg, diabetes with glycated haemoglobin above 9%, diabetic-foot ulceration and amputation, current retinal examinations, diabetic-foot assessments and current estimated glomerular filtration rate assessments.[37]
• Apply differentiated compensation thresholds by age: blood pressure below 140/90 mmHg for people aged 15 to 79 years and below 150/90 mmHg for those aged 80 years or over; glycated haemoglobin below 7% and below 8% respectively.[38]
• Review blood pressure, glycated haemoglobin and low-density lipoprotein cholesterol against risk-adjusted targets, assess adverse effects and adherence, and monitor decompensation, target-organ damage and therapeutic-goal attainment during follow-up.[10][11][13][27]
• Schedule diabetes reassessment using glycated haemoglobin three months after medicine or insulin adjustment, and monitor lipid profiles six to eight weeks after initiating or changing statin or fibrate therapy.[12]
• Screen people with diabetes or previous cardiovascular disease for depression using the Patient Health Questionnaire-9, and incorporate assessment of alcohol use, cancer screening, syphilis, tuberculosis and human immunodeficiency virus within comprehensive adult care.[12][13]
• Maintain blood-pressure measurement quality through validated equipment, manufacturer-directed maintenance and calibration, correct cuff selection, standardised patient preparation and recording of the arm and position used.[31][32][45][33]
• Use at least two further blood-pressure measurement sessions on separate days within 15 days of an initial measurement, repeat elevated readings during the consultation and retain the blood-pressure profile in the patient record.[45][33]
• Record PSCV patients by age, sex, risk, pathology and risk factors, including chronic kidney disease screening, while counting each person once within integrated care regardless of multiple conditions.[40][38]
• Trace patients absent from scheduled care through locally defined protocols, such as telephone contact, home visits or radio reminders, and document tracing and withdrawals in auditable records.[40][38]
• Classify a patient as abandoned only after more than 11 months and 29 days without attendance and after at least three tracing actions; retain cases without tracing as passive rather than removing them automatically.[40]
• Submit standardised monthly statistical records, known as REM, to the Department of Health Statistics and Information, using annual operational definitions to support management, compliance indicators and health-sector decisions.[39]
• Review programme targets monthly, quarterly, half-yearly and annually, including annual and half-yearly indicator evaluations, and technically review monthly records before submission.[26][41][44]
• Use electronic records to generate objective control measures for professional performance, such as proportions of people with type 2 diabetes achieving glycated haemoglobin below 7% and hypertension patients achieving blood pressure below 140/90 mmHg.[43]
• Provide periodic, constructive and time-bound verbal and written feedback, using audits and feedback to reduce therapeutic inertia and improve clinical practice rather than applying punitive performance management.[43]
• Supervise service continuity through network-manager oversight and random Health Service field visits, and monitor medicine availability through complaints systems, patient-data audits and appointment-management records.[35][34]
• Inspect establishments periodically and randomly, maintain information on coverage gaps, track compliance with Health Targets and the National Health Strategy, and hold technical meetings with programme leads.[24][25]
• Report compliance with standards, guarantees, records and operational difficulties to facility management and technical leads, and share local evaluations with sector teams, facility authorities and communities.[41][44]

Costing & Financing

Financing information is limited: the guidance identifies medicine and supply support through the Pharmacy Fund, known as Fondo de Farmacia (FOFAR), and specifies selected staffing and stock benchmarks, but provides no overall programme budget, expenditure allocation, unit costs, funding-gap estimate, resource-mobilisation target or economic assumptions.[35][29][36]

• Provide medicines and medical supplies free of charge through the Pharmacy Fund for type 2 diabetes, hypertension, dyslipidaemia and advanced diabetic-foot ulcer management.[35]
• Use the Pharmacy and Therapeutics Committee in each Health Service to guide medicine selection, availability and use, propose the primary-care basic pharmaceutical formulary and disseminate formulary information.[35]
• Reinforce pharmacy staffing in municipalities with more than 20,000 registered residents, using a benchmark of one pharmacy assistant or technician per 200 prescriptions.[35]
• Maintain a critical medicine stock equivalent to two months of health-network supply.[35]
• Support increased clinical pharmacist staffing in Family Health Centres through FOFAR resources from 2014, although the associated financial amount is not specified.[29]
• Consider maintenance-service costs, technical-support availability and calibration frequency when procuring blood-pressure measurement equipment; manufacturer information should inform these decisions.[31]
• Recognise that integrated cardiovascular and mental health care is described as improving service effectiveness and reducing costs, but no monetary estimate or economic assumption is provided.[20]