[Quaternary prevention in the Cardiovascular Health Program Rational use of complementary exams: A narrative review]

The Cardiovascular Health Program (PSCV), founded by the Ministry of Health of Chile (Minsal), is focused on the global cardiovascular risk of people with the purpose of preventing and reducing morbidity, disability and premature death caused by cardiovascular diseases, in congruence with its sanitary aims. Quaternary Prevention is defined as "actions taken to protect individuals from medical interventions that are likely to cause more harm than good". The PSVC's 2017 technical guidelines establish a battery of 11 complementary exams to request upon entering the program, however, neither the scientific evidence that supports them nor the periodicity of their request was mentioned. The aim of this revision is to evaluate the rationality of exams request, based on updated evidence, as a strategy for quaternary prevention and potential economic savings for the sanitary system.

A narrative review was conducted through searches on databases, updated clinical guidelines and international recommendations about 11 complementary exams on the follow-up of Type 2 Diabetes and Hypertension.

Based on the data analysis, recommendations were made according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

It was concluded that the costs of widely requested complementary exams could be reduced through a more efficient management guided by updated evidence. Our proposal entails changes in some processes and in the evaluation of fulfillment of the PSCV, as well as a deeper cost-effectiveness analysis of the recommendations in order to optimize the management of resources in primary health care.