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Original Article M a i l i n g A d d r e s s : L e a n d r o R e i s T a v a r e s• R u a O t á v i o C a r n e i r o , 1 1 0 / 2 0 1 -2 4 2 3 0 -1 9 1 -N i t e r ó i , R J -B r a z i l E-mail: lreistavares@uol.com. OBJECTIVETo compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói. METHODSA qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality. RESULTSFD and CC reported that the most common signs and symptoms identifi ed by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classifi cation method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p < 0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p < 0.001). CC use beta-blockers (p < 0.001), angiotensin-converting enzyme inhibitors (p < 0.001) and spironolactone (p < 0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p < 0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature. CONCLUSIONCC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients. KEY WORDSHeart failure, diagnosis, management.

RESUMOObjetivo: O presente estudo visa testar a possibilidade de que indivíduos não diabéticos, com glicemia de jejum < 126 mg/dL e com HbA 1c alterada, já apresentem diminuição na filtração glomerular estimada (FGe) e aumento do MCP-1, em comparação com aqueles com HbA 1c normal, independente de outras alterações metabólicas. Materiais e métodos: Este estudo utilizou dados do Estudo CAMELIA (cardiometabólico renal familiar), de julho de 2006 a dezembro de 2007, com visitas aos módulos do Programa Médico de Família (PMF) de Niterói, RJ. Resultados: Verificamos associação independente entre a alteração da HbA 1c (≥ 5,7 e < 6,5% versus < 5,7%) e diminuição da taxa de filtração glomerular estimada. A HbA 1c mostrou ser um marcador subclínico de alterações metabólicas em pacientes não diabéticos e com glicemia de jejum < 126 mg/dL, em especial na população de mulheres e de indivíduos com a cor da pele preta. Conclusão: Essas observações indicam a possibilidade de se utilizar a HbA 1c no intuito de se triar grupos de risco, visando propor estratégias de intervenção precoce e, assim, promover a prevenção de doenças crônicas, como diabetes e doença renal crônica. Arq Bras Endocrinol Metab. 2013;57(5):381-7Descritores Diabetes melito; hemoglobina glicosilada; MCP-1; filtração glomerular; atenção primária ABSTRACT Objective: This study aims investigate if nondiabetic subjects with fasting glucose < 126 mg/dL but altered HbA 1c already have lower estimated glomerular filtration (eGFR) and high serum MCP-1 levels in comparison to nondiabetics with normal HbA 1c , independent of other metabolic changes. Materials and methods: Data were derived from the database of the CAMELIA (cardio-metabolic-renal family) study, a cross sectional study performed between July 2006 and December 2007, with participants recruited from the Family Doctor Program, Niterói, RJ. Results: An independent association between changes in HbA 1c (≥ 5.7 and < 6.5% versus < 5.7%) and decreased eGFR rate was found. The HbA 1c was shown to be a marker of metabolic changes in nondiabetic subjects with fasting glucose < 126 mg/ dL, particularly in women and blacks. Conclusion: These observations support the use of HbA 1c levels in strategies for early intervention and prevention of chronic diseases such as diabetes mellitus and chronic kidney disease. Arq Bras Endocrinol Metab. 2013;57(5):381-7