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5. Impacto medioambiental del Centro de Investigación biomédica de La Rioja (CIBIR): quince años cuidando la salud del medio ambiente

Author

Rivera Sanz, Félix, Pérez Matute, Patricia, Pinillos García, Carmen, Yustes Madrid, Iván, Rábanos Martínez, Jorge, Maiso Fernández de Bobadilla, J. Ignacio, Vilariño Cameán, Marcos, Fernández García, Susana, Díez Mencía, Venesa, Rivera Sanz, Félix, Pérez Matute, Patricia, Pinillos García, Carmen, Yustes Madrid, Iván, Rábanos Martínez, Jorge, Maiso Fernández de Bobadilla, J. Ignacio, Vilariño Cameán, Marcos, Fernández García, Susana, and Díez Mencía, Venesa

Published
2022

10. Impact of pre-radiation therapy quality of life in lung cancer survival: a prospective, intention-to-treat, multicenter study

Author

Nieto-Guerrero Gómez, J. M., Silva Vega, G. P., Cacicedo Fernández de Bobadilla, J., Delgado León, B. D., Herrero Rivera, Daniel, Praena-Fernández, Juan Manuel, Rivin del Campo, E., Ortiz Gordillo, M. J., López-Guerra, José Luis, Nieto-Guerrero Gómez, J. M., Silva Vega, G. P., Cacicedo Fernández de Bobadilla, J., Delgado León, B. D., Herrero Rivera, Daniel, Praena-Fernández, Juan Manuel, Rivin del Campo, E., Ortiz Gordillo, M. J., and López-Guerra, José Luis

Abstract

[Purpose]: Lung cancer (LC) has a significant impact on patients’ health-related quality of life (HRQoL). We investigate the correlations between pre-radiation therapy HRQoL and survival. [Materials and methods]: A prospective, intention-to-treat, multicentre study of 437 patients with LC recruited at the radiation oncology departments of three different institutions was conducted between 2012 and 2016. QoL was assessed using the EORTC-QLQ-C30 (v3.0) and EORTC-QLQ-LC13 questionnaires. Global health status (GHS), physical (PF), role functioning (RF), emotional (EF), cognitive (CF), and social functioning (SF) as well as symptoms scores were evaluated in univariate and multivariate analyses. [Results]: The cohort consisted of 376 men (86%) and 61 women, with a median age of 66 years (range 31–88). Histology was: 72% (n = 315) non-small cell lung cancer and 28% small cell lung cancer. The most common stage was III (80%) and the median follow-up for alive patients was 30 months (range 7–76). Multivariate analysis showed that RF was associated with a lower risk of mortality (HR: 0.693; p = 0.008) and recurrence (HR: 0.737; p = 0.040). Additionally, lower scores on EF and PF were associated with higher mortality (HR: 0.696; p = 0.003 and HR: 0.765; p = 0.044, respectively). Appetite loss, constipation, and dysphagia were associated with a higher risk of mortality (HR: 1.985; p < 0.001, HR: 1.373; p = 0.036, and HR: 1.659; p = 0.002, respectively), while appetite loss was the only symptom associated with a higher risk of recurrence (HR: 1.525; p = 0.014). [Conclusions]: Pre-radiation therapy scores on RF, EF, and PF and symptoms like appetite loss, dysphagia, and constipation were associated with the risk of mortality. This information could be added to other prognostic factors to guide our treatment decisions.

Published
2020

11. Multiplicity and degree as bi‐Lipschitz invariants for complex sets

Author

Fernandes, A., Fernández de Bobadilla, J., and Sampaio, J.E.

Abstract

We study invariance of multiplicity of complex analytic germs and degree of complex affine sets under outer bi-Lipschitz transformations (outer bi-Lipschitz homeomorphims of germs in the first case and outer bi-Lipschitz homeomorphims at infinity in the second case). We prove that invariance of multiplicity in the local case is equivalent to invariance of degree in the global case. We prove invariance for curves and surfaces. In the way we prove invariance of the tangent cone and relative multiplicities at infinity under outer bi-Lipschitz homeomorphims at infinity, and that the abstract topology of a homogeneous surface germ determines its multiplicity., The first named author is partially supported by IAS and by ERCEA 615655 NMST Consolidator Grant, MINECO by the project reference MTM2013-45710-C2-2-P, by the Basque Government through the BERC 2014-2017 program, by Spanish Ministry of Economy and Competitiveness MINECO: BCAM Severo Ochoa excellence accreditation SEV-2013-0323, by Bolsa Pesquisador Visitante Especial (PVE) - Ciencias sem Fronteiras/CNPq Project number: 401947/2013-0 and by Spanish MICINN project MTM2013-45710-C2-2-P. The second named author was partially supported by CNPq-Brazil grant 302764/2014-7. The third named author was partially supported by the ERCEA 615655 NMST Consolidator Grant and also by the Basque Government through the BERC 2014-2017 program and by Spanish Ministry of Economy and Competitiveness MINECO: BCAM Severo Ochoa excellence accreditation SEV-2013-0323.

Published
2018

12. Association of single nucleotide polymorphisms at HSPB1 rs7459185 and TGFB1 rs11466353 with radiation esophagitis in lung cancer

Author

Instituto de Salud Carlos III, Junta de Andalucía, Delgado, Blas David, Enguix-Riego, María del Valle, Cacicedo Fernández de Bobadilla, J., Herrero Rivera, Daniel, Nieto-Guerrero Gómez, J. M., Praena-Fernández, Juan Manuel, Rivin del Campo, E., Ortiz Gordillo, M. J., Fernández-Fernández, María Carmen, López-Guerra, José Luis, Instituto de Salud Carlos III, Junta de Andalucía, Delgado, Blas David, Enguix-Riego, María del Valle, Cacicedo Fernández de Bobadilla, J., Herrero Rivera, Daniel, Nieto-Guerrero Gómez, J. M., Praena-Fernández, Juan Manuel, Rivin del Campo, E., Ortiz Gordillo, M. J., Fernández-Fernández, María Carmen, and López-Guerra, José Luis

Abstract

[Background and purpose] Radiochemotherapy (RCT) success in lung cancer (LC) can be limited due to the onset of adverse effects in the adjacent normal tissue such as radiation-induced esophageal toxicity (RIET). Therefore, specific biomarkers to customize the RCT dose administration and esophageal toxicity prediction are necessary to improve treatment effectiveness., [Materials and methods] 47 LC patients prospectively recruited between 2012 and 2016 from 3 institutions were genotyped for 7 SNPs along TGFB1 and HSPB1 genes seeking an association with RIET risk development. Kaplan–Meier cumulative probability and Cox proportional hazards analyses were used to evaluate the effect of TGFB1 and HSPB1 genotypes on such risk., [Results] Multivariate analyses showed that patients carrying the HSPB1 rs7459185 CC genotype were associated with a significantly higher risk of acute grade 3 RIET than those carrying the GG/GC genotypes (HR = 17.73; 95% CI = 2.896–108.49; p = 0.002). LC patients who received higher (>median) volume of esophagus exposed to 30 Gy and harboring the rs7459185 GG/GC genotypes showed a significantly lower RIET incidence (p < 0.001). Additionally, LC patients carrying the TGFB1 rs11466353 GG genotype were found to be associated with a lower risk of late grade 2 RIET compared with those with the TT/TG genotypes (HR = 0.29; 95% CI = 0.103–0.830; p = 0.021). Patients receiving a high (>60 Gy) radiation dose who presented the rs11466353 GG genotype had a significantly lower RIET incidence (p = 0.025)., [Conclusion] The presence of different rs7459185/rs11466353 genotypes in LC patients associated with RIET risk and may be useful biomarkers along with other risk factors for guiding therapy intensity in an individualized therapy.

Published
2019

13. Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment

Author

Instituto de Salud Carlos III, Junta de Andalucía, López-Guerra, José Luis [0000-0001-6646-3751], Herrero Rivera, Daniel, Nieto-Guerrero Gómez, J. M., Cacicedo Fernández de Bobadilla, J., Delgado, D., Rivin del Campo, E., Praena-Fernández, Juan Manuel, Bernabé Caro, Reyes, Ortiz Gordillo, M. J., Fernández-Fernández, María Carmen, Instituto de Salud Carlos III, Junta de Andalucía, López-Guerra, José Luis [0000-0001-6646-3751], Herrero Rivera, Daniel, Nieto-Guerrero Gómez, J. M., Cacicedo Fernández de Bobadilla, J., Delgado, D., Rivin del Campo, E., Praena-Fernández, Juan Manuel, Bernabé Caro, Reyes, Ortiz Gordillo, M. J., and Fernández-Fernández, María Carmen

Abstract

[Purpose] Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC)., [Materials and methods] Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3–60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12–70]); and 50 (15%) patients underwent surgery., [Results] Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31–88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025)., [Conclusions] HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.

Published
2019

15. EP-1367: Cardiovascular disease and survival in lung cancer: a multicenter prospective assessment

Author

Herrero Rivera, D., primary, Nieto-Guerrero Gómez, J.M., additional, Cacicedo Fernández De Bobadilla, J., additional, Delgado, D.B., additional, Sanchez-Camacho Mejías, A., additional, Gordito Soler, J.J., additional, Praena Fernández, J.M., additional, Enguix, M.V., additional, Ortiz Gordillo, M.J., additional, and López Guerra, J.L., additional

Published
2018
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18. Representation of surface homeomorphisms by tête-à-tête graphs

Author

Fernández de Bobadilla, J., Pe Pereira, M., and Portilla Cuadrado, P.

Subjects
Mathematics::Geometric Topology
Abstract

We use tête-à-tête graphs as defined by N. A'campo and extended versions to codify all periodic mapping classes of an orientable surface with non-empty boundary, improving work of N. A'Campo and C. Graf. We also introduce the notion of mixed tête-à-tête graphs to model some pseudo-periodic homeomorphisms. In particular we are able to codify the monodromy of any irreducible plane curve singularity. The work ends with an appendix that studies all the possible combinatorial structures that make a given filtered metric ribbon graph with some regularity conditions into a mixed tête-à-tête graph.

Published
2017

19. A Jacobian module for disentanglements and applications to Mond's conjecture

Author

Fernández de Bobadilla, J., Nuño-Ballesteros, J.J., and Peñafort Sanchis, Guillermo

Subjects
weighted homogeneous, Mathematics - Algebraic Geometry, Mathematics::Commutative Algebra, Image Milnor number, Image Milnor number, Ae-codimension, weighted homogeneous, Physics::Space Physics, FOS: Mathematics, Ae-codimension, 58K15 (Primary), 58K40, 58K65 (Secondary), Algebraic Geometry (math.AG)
Abstract

Let $f:(\mathbb C^n,S)\to (\mathbb C^{n+1},0)$ be a germ whose image is given by $g=0$. We define an $\mathcal O_{n+1}$-module $M(g)$ with the property that $\mathscr A_e$-$\operatorname{codim}(f)\le \dim_\mathbb C M(g)$, with equality if $f$ is weighted homogeneous. We also define a relative version $M_y(G)$ for unfoldings $F$, in such a way that $M_y(G)$ specialises to $M(g)$ when $G$ specialises to $g$. The main result is that if $(n,n+1)$ are nice dimensions, then $\dim_\mathbb C M(g)\ge \mu_I(f)$, with equality if and only if $M_y(G)$ is Cohen-Macaulay, for some stable unfolding $F$. Here, $\mu_I(f)$ denotes the image Milnor number of $f$, so that if $M_y(G)$ is Cohen-Macaulay, then Mond's conjecture holds for $f$; furthermore, if $f$ is weighted homogeneous, Mond's conjecture for $f$ is equivalent to the fact that $M_y(G)$ is Cohen-Macaulay. Finally, we observe that to prove Mond's conjecture, it is enough to prove it in a suitable family of examples., Bolsa Pesquisador Visitante Especial (PVE) - Ciˆencias sem Fronteiras/CNPq Project number: 401947/2013-0 DGICYT Grant MTM2015–64013–P CNPq Project number 401947/2013-0

Published
2016

20. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 2)

Author

The Merck Company Foundation, Rueda, A., Giralt, J., Mañós, M., Lozano, A., Sistiaga, A., García-Miragall, E., Cacicedo Fernández de Bobadilla, J., Esteban, Francisco, Scola, Bartolomé, Contreras, Julia, Ruiz, A., Carral, Anna, Sánchez-Aniceto, G., Pastor, Manuel, Herranz, J. J., Bernal, M., Mesía, R., The Merck Company Foundation, Rueda, A., Giralt, J., Mañós, M., Lozano, A., Sistiaga, A., García-Miragall, E., Cacicedo Fernández de Bobadilla, J., Esteban, Francisco, Scola, Bartolomé, Contreras, Julia, Ruiz, A., Carral, Anna, Sánchez-Aniceto, G., Pastor, Manuel, Herranz, J. J., Bernal, M., and Mesía, R.

Abstract

Head and neck cancer is one of the most frequent malignances worldwide. Despite the site-specific multimodality therapy, up to half of the patients will develop recurrence. Treatment selection based on a multidisciplinary tumor board represents the cornerstone of head and neck cancer, as it is essential for achieving the best results, not only in terms of outcome, but also in terms of organ-function preservation and quality of life. Evidence-based international and national clinical practice guidelines for head and neck cancer not always provide answers in terms of decision-making that specialists have to deal with in their daily practice. This is the first Expert Consensus on the Multidisciplinary Approach for Head and Neck Squamous Cell Carcinoma (HNSCC) elaborated by the Spanish Society for Head and Neck Cancer and based on a Delphi methodology. It offers a number of specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved.

Published
2017

21. Patrón de cumplimiento terapéutico de antihipertensivos y/o hipolipemiantes en pacientes hipertensos y/o dislipémicos en Atención Primaria

Author

Sicras Mainar, A., Fernández de Bobadilla, J., Rejas Gutiérrez, J., and García Vargas, M.

Subjects
Dislipemia, Risk factors, Hipertensión, Cumplimiento, Factores de riesgo, Compliance
Abstract

Fundamento y objetivo: La falta de cumplimiento es uno de los principales factores responsables en las diferencias entre los resultados de los ensayos clínicos y la efectividad real encontrada en la práctica clínica diaria, y contribuye a un control insuficiente de los factores de riesgo cardiovascular (FRCV). Existe poco conocimiento de los factores que contribuyen a la falta de cumplimiento y en España los datos son escasos: Los objetivos de este estudio son: a) determinar de forma indirecta el grado de cumplimiento, en sujetos con hipetensión y/o dislipidemia; y b) estudiar qué factores se asocian con el cumplimiento. Material y método: Se seleccionaron 9.001 pacientes hipertensos y/o dislipémicos adscritos a cuatro centros de atención primaria de Cataluña: a) se comparó el grado de cumplimiento entre los pacientes dislipémicos sin hipertensión (DL sin HTA), hipertensos con dislipemia (HTA con DL) e hipertensos sin dislipemia (HTA sin DL); y b) se construyó un modelo multivariante de regresión múltiple escalonado descriptivo, para explicar la variable cumplimiento terapéutico. Resultados: 1. El cumplimiento fue 79,0% en los DL sin HTA, significativamente menor que en los HTA DL: 81,2% (p < 0,0001) y que en los HTA sin DL: 82,4% (p < 0,0001). También hubo diferencias significativas entre estos dos últimos grupos (p = 0,001). 2. Las variables explicativas de un mejor cumplimiento en el análisis multivariante fueron: a) inactividad laboral (p=0,000); b) relacionados con el médico que trata al sujeto (p = 0,000) y la intensidad del seguimiento (p = 0,04); y c) el tipo de fármaco (p = 0,000); el precio (a mayor precio mayor cumplimiento) (p = 0,006) y el número de principios activos utilizados (a menor número, mayor cumplimiento) (p = 0,019). Conclusiones: 1. Los pacientes dislipémicos muestran un peor cumplimiento que los hipertensos y la dislipemia es un FRCV que empeora el cumplimiento global en los pacientes hipertensos. 2. Las características del sujeto, la actitud del médico, el grado de seguimiento, el tipo de fármaco empleado y la simplicidad del tratamiento se asocian al cumplimiento terapéutico. Background and objective: Lack of compliance is a major factor responsible for the differences between clinical trial results and real effectiveness in daily medical practice, contributing to an insufficient control of the cardiovascular risk factors (CVRF). Knowledge of the factors contributing to lack of compliance is limited, and in Spain data are scarce. The objectives of this study are: a) to indirectly determine the level of compliance among patients with hypertension and/or dyslipidemia; and b) to determine factors associated with compliance. Material and method: 9,001 hypertensive and/or dyslipidemic patients from four primary care centres in Catalonia were enrolled in Disease Management programmes during the previous four years. Compliance was estimated by the relationship between the amount of dispensed and prescribed pills: a) the levels of compliance of dyslipidemic patients without hypertension (DL-non HT), hypertensive patients with dyslipidemia (HT+DL) and hypertensives without dyslipidemia (HT-non DL) were compared; and b) an stepwise, multivariate, descriptive; multiple regression model was designed in order to explain compliance. Results: 1. Compliance was 79% in DL-non HT, significantly lower than in HT+DL (81.2%, p=0.000) and in HT-non DL (82.4%, p=0.000). There were also statistically significant differences between these last two groups (p=0.001). 2. Explanatory variables of a better compliance in the multivariate analysis were: a) patient related factors: labour inactivity (p = 0.000); b) management related factors: specific doctor (p = 0.000) and intensity of follow-up (p = 0.04); and c) drug related factors: the drug group (p < 0.0001); the drug price (the higher price determines higher compliance, p = 0.006) and the number of active principles used (the higher number determines lower compliance, p = 0.019). Conclusions: 1. Dyslipidemic patients show a worse compliance than hypertensive patients, and dyslipidemia worsened global compliance in hypertensive patients. 2. Patient characteristics, doctor attitude, follow-up intensity, drug group and simplicity of treatment are related to compliance in daily medical practice.

Published
2006

22. Análisis coste-efectividad del uso de atorvastatina en pacientes diabéticos de tipo 2: modelo farmacoeconómico del estudio CARDS

Author

Fernández de Bobadilla, J., López de SA, E., Alonso Troncoso, I., Moreno Gómez, R., Rubio-Terrés, C., and Soto Álvarez, J.

Subjects
Diabetes mellitus, Primary prevention, Coste efectividad, Atorvastatina, Atorvastatin, Prevención primaria, Cost effectiveness
Abstract

Fundamento y objetivo: Efectuar un análisis coste-efectividad del uso de Atorvastatina 10 mg en la prevención primaria de la enfermedad cardiovascular en el paciente con Diabetes Mellitus tipo 2 (DM2). Método: Se elaboró un modelo retrospectivo y determinístico basado en un análisis de decisión a partir del estudio CARDS (Collaborative Atorvastatin Diabetes Study). En el estudio CARDS se había demostrado que Atorvastatina 10 mg versus placebo en prevención primaria en pacientes con DM2 y alguna patología asociada, reduce la morbimortalidad cardiovascular (5,8 vs. 9,0%, p = 0,001). En el presente análisis coste-efectividad, las unidades de efectividad utilizadas fueron años de vida ganados (AVG) y años de vida ajustados por calidad (AVAC), obtenidos a partir de las diferencias de morbimortalidad y de la esperanza de vida de los diabéticos, con y sin eventos previos, obtenidos de la literatura. El consumo de recursos de las alternativas en evaluación se ha extraído del estudio CARDS aplicando costes españoles. Resultados: El cociente coste-efectividad incremental derivado de utilizar Atorvastatina 10 mg versus placebo fue 5.886 € por AVG y de 8.046 € por AVAC. Los análisis de sensibilidad confirmaron la estabilidad del modelo. Conclusiones: En la prevención primaria del riesgo cardiovascular en pacientes diabéticos tipo 2, el uso de Atorvastatina 10 mg es coste-efectivo, con un coste por AVG y por AVAC por debajo de otras alternativas empleadas ampliamente en el Sistema Nacional de Salud español, y también por debajo de un valor que podría considerarse como un umbral razonable para nuestro país, situado oficiosamente en torno a los 30.000 € por AVAC. Background and objective: To perform a cost-effectiveness analysis of the use of Atorvastatin 10 mg in the primary prevention of cardiovascular disease in patients with type 2 diabetes (DM2). Method: A deterministic and retrospective model by a decision analysis based on CARDS study (Collaborative Atorvastatin Diabetes Study) was performed. In the CARDS study, a significant reduction in cardiovascular morbimortality by the use of Atorvastatin 10 mg versus placebo (5.8 vs. 9.0%, p=0.001) in DM2 patients with an additional condition, had previously been demonstrated. In the present cost-effectiveness analysis, effectiveness units were life years gained (LYG) and quality adjusted life years (QALY), obtained from differences in morbimortality and life expectancy in DM2 patients, with and without previous cardiovascular events. Costs of the evaluated alternatives were obtained from the CARDS results. Results: Incremental cost-effectiveness ratio of using Atorvastin 10 mg versus placebo was 5,886 € per LYG and 8,046 € per QALY. Sensitivity analyses confirmed the model stability. Conclusions: In the primary prevention of the cardiovascular disease in type 2 diabetic patients, the use of Atorvastatin 10 mg is cost-effective, with a cost per LYG and per QALY below that of other alternatives widely used in the Spanish National Health System, and also below a value considered as a reasonable threshold for our country, which might unofficialy be around 30,000 €/ QALY.

Published
2006

33. Estimación de la prevalencia, incidencia, comorbilidades y costes directos asociados en pacientes que demandan atención por ictus en un ámbito poblacional español

Author

C. Sánchez-Maestre, Fernández de Bobadilla J, Soto-Alvarez J, A. Planas‐Comes, A. Sicras-Mainar, Ruth Navarro-Artieda, Alvarez-Martín C, and Ezpeleta-Echevarri D

Subjects
Neurology (clinical), General Medicine
Abstract

Objetivo. Estimar la prevalencia e incidencia, asi como la comorbilidad, objetivos terapeuticos y costes del ictus en un ambito poblacional espanol. Pacientes y metodos. Es un diseno retrospectivo-multicentrico. Se incluyeron pacientes mayores de 30 anos que demandaron asistencia por ictus, pertenecientes a cinco equipos de atencion primaria y dos hospitales durante el ano 2006. Grupo comparativo: pacientes sin ictus. Principales variables: edad, sexo, casuistica/comorbilidad (cardiovascular/otras), parametros bioquimicos y modelo de costes directos (medicamentos, procedimientos, derivaciones, visitas, hospitalizaciones y urgencias). Analisis estadistico: regresion logistica y de analisis de covarianza (ANCOVA) para la correccion de los modelos, p < 0,05. Resultados. De los 57.026 pacientes, el 4,5% (n = 2.585; IC 95% = 4,3-4,7%) presento ictus. Incidencia: 220 casos nuevos por cada 100.000 habitantes. Los pacientes con/sin ictus mostraron: edad, 72,5/53,5 anos; varones, 58,2/44,6%; episodios al ano, 7,9/4,8; visitas al ano, 15,8/8,1; p < 0,001. El ictus tuvo relacion independiente con: edad (OR = 1,4), varones (OR = 2,3), diabetes (OR = 1,6), hipertension (OR = 1,5), fumadores (OR = 1,5), alcoholismo (OR = 1,4), depresion (OR = 1,4), dislipemia (OR = 1,3) y demencias (OR = 1,2). Algunos resultados metabolicos fueron: tension sistolica (134,1 frente a 127,6 mmHg) y colesterol-LDL (116,4 frente a 126,2 mg/dL), en presencia/ausencia de ictus, p < 0,001. El promedio de coste anual fue de 2.590,36 frente a 985,26 euros,p < 0,001, y se mantuvo despues de corregir por edad-sexo y comorbilidades: 1.774,33 (IC 95% = 1.720,10-1.828,55) frente a 1.021,98 euros (IC 95% = 1.010,92-1.033,03), p < 0,001. Todos los componentes del coste fueron mayores en el ictus. Conclusiones. Los pacientes que demandaron atencion por ictus presentaron un elevado numero de comorbilidades y un mayor coste total/paciente/ano. Los objetivos terapeuticos de control siguen siendo mejorables, sobre todo en la prevencion primaria de los factores de riesgo cardiovascular.

Published
2008
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35. Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain.

Author

Sicras-Mainar A, Navarro-Artieda R, Rejas-Gutiérrez J, Fernández-de-Bobadilla J, Frías-Garrido X, and Ruiz-Riera R

Abstract

BACKGROUND: This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP). METHODS: This is a retrospective, observational study including patients > or =18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance. RESULTS: A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7-80.5%) in PP and 20.9% (95% CI: 18.2-23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4-22.2%) in PP and 60.8% (95% CI: 57.6-64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00-1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03-1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06-1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22-1.89); p = 0.000] were covariates associated to the use of aspirin in PP. CONCLUSION: Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved. [ABSTRACT FROM AUTHOR]

Published
2007

39. Long term clinical outcomes in survivors after out-of-hospital cardiac arrest.

Author

Rey JR, Caro-Codón J, Rodríguez Sotelo L, López-de-Sa E, Rosillo SO, González Fernández Ó, Fernández de Bobadilla J, Iniesta ÁM, Peña Conde L, Antorrena Miranda I, Armada E, Ruiz Cantador J, and López-Sendón JL

Subjects
Adult, Aged, Cohort Studies, Hospitalization, Humans, Male, Middle Aged, Patient Discharge, Retrospective Studies, Survivors, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest therapy
Abstract

Introduction and Objectives: Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events., Methods: Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up., Results: A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9-69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578-7.777)], non-shockable rhythm [HR 2.926 (1.390-6.163)], time to onset of CPR [HR 1.063 (0.997-1.134)], older age [1.036 (1.008-1.064)) and worse ejection fraction at discharge [1.033 (1.009-1.058)]., Conclusions: Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care., Competing Interests: Declaration of Competing Interest There are no competing interests for any authors. Electronic ICMJE COI disclosure forms have been completed and were provided during the present submission process., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2020
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40. Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management.

Author

Caro-Codón J, Rey JR, Lopez-de-Sa E, González Fernández Ó, Rosillo SO, Armada E, Iniesta ÁM, Fernández de Bobadilla J, Ruiz Cantador J, Rodríguez Sotelo L, Irazusta FJ, Rial Bastón V, Merás Colunga P, and López-Sendón JL

Subjects
Adult, Age Factors, Aged, Aggression, Depression epidemiology, Female, Humans, Male, Memory Disorders epidemiology, Mental Status and Dementia Tests, Middle Aged, Outcome Assessment, Health Care, Prevalence, Prospective Studies, Time Factors, Cognitive Dysfunction epidemiology, Executive Function, Hypothermia, Induced methods, Out-of-Hospital Cardiac Arrest therapy, Quality of Life, Survivors statistics & numerical data
Abstract

Background: This study aimed to assess long-term cognitive and functional outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted-temperature management, investigate the existence of prognostic factors that could be assessed during initial admission and evaluate the usefulness of classic neurological scales in this clinical scenario., Methods: Patients admitted due to OHCA from August 2007 to November 2015 and surviving at least one year were included. Each patient completed a structured interview focused on the collection of clinical, social and demographic data. All available information in clinical records was reviewed and a battery of neurocognitive and psychometric tests was performed., Results: Seventy-nine patients were finally included in the analysis. Forty-three patients (54.4%) scored below the usual cut-off points for the diagnosis of mild cognitive impairment, even though most of these deficits went unnoticed when patients were assessed using CPC and modified Rankin scale. Nineteen (24%) developed certain degree of impairment in their attention capacity and executive functions. A significant proportion developed new memory-related disorders (43%), depressive symptoms (17.7%), aggressive/uninhibited behavior (12.7%) and emotional lability (8.9%). A greater number of weekly hours of intellectual activity and a qualified job were independent protective factors for the development of cognitive impairment. However, being older at the time of the cardiac arrest was identified as a poor prognostic factor., Conclusions: There is a high prevalence of long-term cognitive deficits and functional limitations in OHCA survivors. Most commonly used clinical scales in clinical practice are crude and lack sensitivity to detect most of these deficits., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Published
2018
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41. Dataset regarding baseline and follow-up characteristics of out-of-hospital cardiac arrest patients focused on neurological outcomes.

Author

Caro-Codón J, Rey JR, Lopez-de-Sa E, González Fernández Ó, Rosillo SO, Armada E, Iniesta ÁM, Fernández de Bobadilla J, Ruiz Cantador J, Rodríguez Sotelo L, Irazusta FJ, Rial Bastón V, Merás Colunga P, and López-Sendón JL

Abstract

This data article contains the data related to the research article entitled "Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management" (Caro-Codón et al., 2018). In this dataset, we report details regarding the flow chart of the included patients and the specific exclusion criteria. We also include information on the difference between the patients who attended the structured personal interview (and therefore were finally included in the study) and those who did not attend. Neuropsychiatric and functional data before and after cardiac arrest are also reported. Finally, we list all the "de novo" focal neurological deficits identified after cardiac arrest in the related population.

Published
2018
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42. Annular abscess in HACEK infective endocarditis.

Author

Moral Cuesta D, Rodríguez-Sánchez I, and Fernández de Bobadilla J

Subjects
Aged, 80 and over, Female, Humans, Abscess diagnosis, Aortic Valve microbiology, Cardiobacterium isolation & purification, Endocarditis, Bacterial diagnosis, Gram-Negative Bacterial Infections diagnosis, Heart Valve Diseases diagnosis
Published
2017
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43. Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

Author

Cedillo S, Sicras-Mainar A, Jiménez-Ruiz CA, Fernández de Bobadilla J, and Rejas-Gutiérrez J

Subjects
Adult, Aged, Cardiovascular Diseases psychology, Diabetes Mellitus, Type 2 psychology, Female, Health Care Costs statistics & numerical data, Humans, Male, Markov Chains, Middle Aged, Models, Economic, Pulmonary Disease, Chronic Obstructive psychology, Smoking Cessation methods, Spain, Cardiovascular Diseases economics, Cost-Benefit Analysis, Diabetes Mellitus, Type 2 economics, Insurance, Health, Reimbursement economics, Pulmonary Disease, Chronic Obstructive economics, Smoking Cessation economics, Varenicline economics
Abstract

Aims: The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD)., Methods: The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied., Results: A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling., Conclusion: Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation., (© 2016 S. Karger AG, Basel.)

Published
2017
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44. Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention.

Author

Gemma D, Moreno Gómez R, Fernández de Bobadilla J, Galeote García G, López Fernandez T, López-Mínguez JR, and López-Sendón JL

Subjects
Acenocoumarol therapeutic use, Anticoagulants therapeutic use, Atrial Fibrillation complications, Cardiac Surgical Procedures, Combined Modality Therapy methods, Female, Humans, Middle Aged, Mitral Valve Stenosis complications, Mitral Valve Stenosis diagnostic imaging, Thromboembolism etiology, Treatment Outcome, Atrial Appendage surgery, Atrial Fibrillation drug therapy, Atrial Fibrillation surgery, Mitral Valve Stenosis surgery, Septal Occluder Device, Thromboembolism prevention & control
Abstract

Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications., (Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Published
2016
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45. Cardiologists and electronic cigarettes.

Author

Fernández de Bobadilla J, Dalmau R, and Saltó E

Subjects
Humans, Cardiology, Electronic Nicotine Delivery Systems statistics & numerical data, Physicians, Public Health, Smoking adverse effects, Smoking Cessation methods
Published
2015
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46. Update in cardiology: vascular risk and cardiac rehabilitation.

Author

Galve E, Cordero A, Bertomeu-Martínez V, Fácila L, Mazón P, Alegría E, Fernández de Bobadilla J, García-Porrero E, Martínez-Sellés M, and González-Juanatey JR

Subjects
Global Health, Heart Diseases epidemiology, Humans, Morbidity trends, Risk Factors, Cardiac Rehabilitation methods, Cardiology trends, Heart Diseases rehabilitation
Abstract

As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case., (Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2015
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47. Laws restricting smoking in public places reduce the incidence of acute coronary syndrome in Spain.

Author

Fernández de Bobadilla J, Dalmau R, and Galve E

Subjects
Humans, Incidence, Myocardial Infarction epidemiology, Myocardial Infarction prevention & control, Spain epidemiology, Tobacco Smoke Pollution adverse effects, Tobacco Smoke Pollution legislation & jurisprudence, Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome prevention & control, Smoking legislation & jurisprudence
Published
2014
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48. Update in cardiology: vascular risk and cardiac rehabilitation.

Author

Galve E, Alegría E, Cordero A, Fácila L, Fernández de Bobadilla J, Lluís-Ganella C, Mazón P, de Pablo Zarzosa C, and González-Juanatey JR

Subjects
Cardiovascular Diseases epidemiology, Humans, Practice Guidelines as Topic, Risk Factors, Risk Reduction Behavior, Cardiovascular Diseases etiology, Cardiovascular Diseases prevention & control
Abstract

Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Published
2014
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49. [Cardiovascular risk in Spanish smokers compared to non-smokers: RETRATOS study].

Author

Fernández de Bobadilla J, Sanz de Burgoa V, Garrido Morales P, and López de Sá E

Subjects
Adult, Cardiovascular Diseases epidemiology, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Spain, Cardiovascular Diseases etiology, Smoking adverse effects
Abstract

Aim: To evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics., Design: Epidemiologic, cross-sectional and multicentre study., Setting: Primary Care., Patients: Every investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria., Measurements: The 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events., Results: 10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40±5.3) vs. non-smokers (1.9±2.5) (P<.0001)., Risk Stratification: low (< 3%) [78.0% non-smokers vs. 60.7% smokers (P<.0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers (P<.001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers (P<.001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P<.0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P=.0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P=.0507)., Conclusions: Smoking is related to a high risk of fatal cardiovascular disease. Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Published
2011
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50. [All-cause mortality and incidence of major cardiovascular events in hypertensive patients with ASCOT-type profile in a Spanish population setting].

Author

Sicras-Mainar A, Fernández de Bobadilla J, Navarro-Artieda R, and Rejas-Gutiérrez J

Subjects
Adult, Aged, Aged, 80 and over, Cardiovascular Diseases mortality, Cause of Death, Female, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Spain epidemiology, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Hypertension complications
Abstract

Objectives: Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects., Methods: A retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects., Results: A total of 11,104 were included in the analysis; 68.0+/-11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8-1.9) and 1.6 (0.9-2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8-2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3-2.4), p<0.001]., Conclusions: Hypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Published
2010
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