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The function to estimate lifetime cardiovascular risk -IBERLIFERISK- in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women.To recalibrate the current lifetime risk equation after extending the follow-up by 3 years.Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index.The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p0.05).The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update.

Resumen A partir de la bibliografia disponible actualmente, en este capitulo se evalua la evidencia cientifica sobre el papel que tienen los trigliceridos en el riesgo cardiovascular. En concreto, se analiza la prevalencia de la hipertrigliceridemia a partir de datos extraidos de estudios nacionales e internacionales; la evidencia cientifica de la relacion entre la hipertrigliceridemia y la enfermedad cardiovascular a partir de los estudios analiticos de cohortes, y finalmente, la evidencia disponible sobre ensayos clinicos, metaanalisis y revisiones sistematicas, que directa o indirectamente han evaluado una intervencion para reducir los valores de trigliceridos y su relacion con los accidentes cardiovasculares.

Background: The COVID-19 pandemic is a major challenge for health systems, citizens and policymakers worldwide. It is not known how many people are affected with longer term sequelae after acute COVID-19 and a wide range of prevalence estimates have been reported with a high heterogeneity between studies. Methods: We designed a cross-sectional study to estimate the prevalence of post COVID-19 conditions in a community setting. We selected a random sample of 579 individuals from three different primary health care centers and collected information on symptoms through a standardized questionnaire. Results: Our main study finding was an overall population prevalence of 14.34% (95% CI 11.58–17.46%) of post COVID-19. Only 9% of patients were hospitalized in our study. Prevalence was higher in women than men (15.63% versus 13.06%) and the most frequent persistent symptoms were fatigue (44.6%), smell impairment (27.7%) and dyspnea (24.09%). Conclusions: The prevalence of post COVID-19 condition was lower than expected according to other studies published in the literature. The prevalence was higher in women than men, and the most frequent persistent symptoms were fatigue, smell impairment, and dyspnea.

Resumen Introduccion y objetivos Desarrollar una funcion predictiva del riesgo cardiovascular de por vida de eventos cardiovasculares, mortales y no mortales en poblacion laboral espanola. Metodos Estudio de cohortes retrospectivo. Se selecciono a trabajadores de entre 18 y 65 anos sin antecedentes de enfermedad cardiovascular que realizaron un examen de salud entre los anos 2004 y 2007. El 70% de la cohorte se utilizo para desarrollar la ecuacion de riesgo y el 30%, para validar la ecuacion. Se construyeron 4 modelos de riesgos proporcionales de Cox en los que se utilizaron como variables dependientes la aparicion de eventos cardiovasculares y la aparicion de eventos competitivos; se usaron los mismos modelos en varones y mujeres. Los eventos mortales y no mortales se evaluaron hasta el ano 2014. Resultados Se incluyo a 762.054 sujetos, con una media de edad de 35,48 anos (el 71,14% varones). Resultaron factores significativos en el modelo la ocupacion manual, el tabaquismo, la diabetes mellitus, el tratamiento antihipertensivo, la presion arterial sistolica, el colesterol total, el colesterol unido a lipoproteinas de alta densidad y el tratamiento hipolipemiante; en varones, el consumo de alcohol, el indice de masa corporal, los antecedentes de enfermedad coronaria precoz en familiares de primer grado, la enfermedad renal y la presion arterial diastolica. El area bajo la curva c fue 0,84 (IC95%, 0,82-0,85) en varones y 0,73 (IC95%, 0,66-0,80) en mujeres. La calibracion mostro una subestimacion en los deciles de bajo riesgo y sobrestimacion en los de alto riesgo. Conclusiones El modelo de riesgo cardiovascular de por vida tiene una discriminacion y una calibracion satisfactorias, con mejores resultados para varones que para mujeres.

Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients’ perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences. Article funded by the Instituto de Salud Carlos III, Ministry of Science and Innovation of the Government of Spain (Group 26 of the Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, CIBERESP). Research funded by the research project of the Instituto de Salud Carlos III, code PI20/01334, Principal Investigator Dr. Blanca Lumbreras Lacarra, co-financed with FEDER funds from the European Union “A way of doing Europe”.

Background Evidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality. Methods Pragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015 and 2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention. Results 390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (− 0.62 [− 1.10, − 0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (− 1.26 [− 1.90, − 0.63]), and at follow-up (− 0.95 [− 1.62, − 0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG. Conclusions This study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas. Trial registration ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered

Based on the most recent scientific evidence, in this chapter we describe the relation of levels of triglycerides and risk of cardiovascular diseases. Particularly, we describe the prevalence of hypertriglyceridemia based on studies published at national and international reports; the relation between hypertriglyceridemia and cardiovascular diseases according to results of cohort studies; and finally, we describe the most recent evidence from clinical trials, meta-analysis and systematic reviews that have shown data on the efficacy of lowering triglyceride levels and reducing cardiovascular diseases.

Background: Cardiovascular risk estimation in people over 70 years is problematic. Most scores have been derived from cohorts of middle-aged people, with older persons under-represented. The predictive power of classical cardiovascular risk factors reduce with age. The aim is to develop a specific score for the elderly populationMethods: Population-based cohort established in 1995. Setting: Three geographical areas of Spain (Madrid, Ávila and Lugo). Participants: 3,729 people older than 64 years, free of any cardiovascular diseases (CVD), at baseline. Measurements: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were yearly investigated and confirmed using the WHO-MONICA criteria. All participants were followed until the occurrence of the first CVD event, until death or until December 31th 2015 if alive.Results: Age was the strongest predictor of 10-year CVD both in men and women. In men, variables associated to CVD were high blood pressure treatment (HR: 1,35; 95% CI: 1,067 , 1,710), diabetes (HR: 1,359; 95% CI: 0,997 , 1,852) and smoking (HR:1,207; 95%CI: 0,945 , 1,541), and in women smoking (HR: 1,881 95%CI: 1,356 , 2,609) and diabetes (HR:1,285; 95%CI:0,967 , 1,707). Total-cholesterol did not increased the risk of CVD either in males or females. However, total-cholesterol level (>200mg/dl) were negatively associated both in men and women.Conclusions: In old Spanish men, 10-year total CVD is significantly increased by age, diabetes and antihypertensive treatment, and in old women by diabetes and smoking. Total-cholesterol levels did not increased the risk of CVD either in males or females.

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic little information has been available about patients with mild or moderate symptoms attended and followed in the primary care setting, most of whom had an unknown status for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ObjectivesWe aim to measure the seroprevalence of antibodies against SARS-CoV-2 infection in a community sample of asymptomatic individuals and among symptomatic patients (without confirmed diagnosis) followed in a primary care setting.As a secondary objective, we estimated the proportions of symptomatic patients seeing at an emergency department (ED), hospitalized or dying, and identified the most important clinical symptoms associated with a positive infection.MethodsFrom April 21 to April 24 2020, we selected a random sample of 600 individuals stratified by age groups, from a total population of 19,899 individuals from a community area in Barcelona (study population 1). From April 29 to May 5 2020, we also invited all the patients that had been followed by general practitioners (GPs) (study population 2).We used for both populations COVID-19 Rapid lateral flow immunoassay which qualitatively assesses the presence of patient-generated IgG and IgM in approximately 10-15 minutes.The prevalence (95% confidence intervals [CI]) of infection (past and current) was defined as the proportion of individuals with antibody seropositivity. Odds ratios (ORs) for a positive test result were estimated using logistic regression analysis.ResultsThree hundred and eleven asymptomatic individuals from the randomly selected sample accepted to participate in the study. The overall mean age was 43.7 years (SD 21.79, range 1-94) and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting an overall prevalence of 5,47% (95% CI, 3.44-8.58).Six-hundred and thirty-four symptomatic patients were followed by GPs. The overall mean age was 46.97 years (SD 20.05, range 0-92) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive for IgM and/or IgG.During the follow-up period, 27.13% of symptomatic patients attended the ED, 11.83% were hospitalized and about 2% died.Results of the multivariate logistic regression analysis showed that the OR for a positive test was significantly increased in patients who had fever (>38°C), ageusia and contact with a patient diagnosed with COVID-19.ConclusionsThe seroprevalence of antibodies against SARS-CoV-2 among asymptomatic individuals in the general population was lower than expected.Approximately 40% of the symptomatic patients followed by GPs during the peak months of the pandemic in Barcelona, were positive. Fever (>38°C), anosmia, ageusia and contact with a patient diagnosed with COVID-19 were associated with a positive test result.

Resumen Objetivo El objetivo de este estudio fue analizar el impacto de la baja adherencia terapeutica (AT) y la inercia terapeutica de los profesionales (IT) sobre el mal control glucemico y de los factores de riesgo cardiovasculares en personas con DM2. Material y metodos Estudio transversal realizado en atencion primaria. Se incluyeron 320 personas con DM2. Se valoro si cumplian los objetivos de control (HbA1c ≤ 7%, PA ≤ 130/80 mmHg, LDL ≤ 100 mg/dl). Se considero falta de AT la retirada de farmacia Resultados Presentaron buen control de HbA1c, PA y cLDL el 62,5, el 40,9 y el 35,9%, respectivamente. Las personas mal controladas presentaron cifras de AT menores y la IT no se relaciono con la AT. En sujetos mal controlados para HbA1c, presentaban IT el 25,8%, el 24,8% mala AT y el 11,9% estaban afectados por ambos comportamientos. Para cLDL, el 3,6% presentaban mala AT, el 70,4% IT y el 16,0% mala AT e IT (p Conclusiones La falta de AT y la IT han estado implicadas en un porcentaje elevado de personas con DM2 mal controladas. La IT ha resultado de gran relevancia en el presente estudio.

Background Patients who have experienced a cardiovascular clinical event such as a myocardial infarction or stroke qualify for intensive risk factor evaluation and management. The aim of this study is to explore lifestyle changes as well as the achievement of targets for risk factors in patients with established cardiovascular disease. Methods Cross-sectional study conducted in primary care practices. The study was carried out in six European countries (Croatia, France, Portugal, Slovenia, Spain and Turkey). Patients with established cardiovascular disease (coronary heart disease and stroke) attended in primary care were selected and assessed from January to June 2016. Patients were recruited and assessed at the practice by research assistants between 6 months and 3 years after the event. Statistical comparisons were done with the unpaired two-sided Student’s t-test for continuous variables and Chi-square test for categorical variables. Results Nine hundred and seventy-three patients (32.4% females) were assessed. About 14% of them were smokers, 32% were physically inactive, and 30% had nutritionally poor eating behaviours. LDL cholesterol target value below 70 mg/dl was achieved in about 23% of patients, and in general, women were less cardio-protected by drugs than men. Conclusions Many patients with established cardiovascular disease who attended in general practice still fail to achieve the lifestyle, risk factor, and therapeutic targets set by European guidelines. These results are relevant to general practitioners because these patients have a high risk of subsequent cardiovascular events, including MI, stroke, and death.

Estimating cardiovascular risk with SCORE is not recommended in persons over 65 years. SCORE investigators have recently published specific tables for older people (SCORE Older Persons [SCORE OP]). The aim of this study is to assess the impact of using SCORE OP tables on a Spanish population aged over 64 years, and compare it with the use of SCORE in patients aged 65-69 years.Cross-sectional study carried out in 2 urban primary health care centres. Individuals between 65 and 85 years old without diabetes or established cardiovascular diseases were included. Cardiovascular risk using SCORE and the new SCORE OP tables for low risk countries was calculated.Cardiovascular risk was estimated in 3,425 patients. Mean values of the original SCORE and SCORE OP were 4.08 and 3.83, respectively in the group of patients aged 65-69 years old (n=974, 22.44%) (P.001). The percentage of patients at high or very high risk was 25.46% and 22.90% with the original SCORE and the SCORE OP, respectively (P.001). Using the original SCORE, 16.43% of the total patients should potentially be treated with lipid lowering drugs, while using the SCORE OP, 13.45% of the patients aged 65-69 years should potentially be treated. Using SCORE OP in patients older than 69 years, 61.49% patients should potentially be treated with lipid lowering drugs.SCORE OP identifies fewer patients at high or very high risk than the original SCORE, therefore, its utilization would imply treating fewer patients of this age with lipid lowering drugs.

Resumen Antecedentes y objetivo Una de las limitaciones del SCORE es que no permite calcular el riesgo en mayores de 65 anos. Recientemente, los investigadores del SCORE han publicado unas tablas especificas para mayores (SCORE Older Persons [SCORE OP]). El objetivo del presente estudio fue evaluar el impacto de la utilizacion de las tablas SCORE OP en una poblacion espanola de pacientes mayores de 64 anos y su comparacion con las tablas SCORE en el grupo entre 65 y 69 anos. Pacientes y metodo Estudio transversal realizado en 2 centros de salud urbanos. Se seleccionaron individuos de entre 65 y 85 anos sin antecedentes de diabetes mellitus o enfermedad cardiovascular. Se calculo el riesgo utilizando las tablas para paises de bajo riesgo SCORE y las nuevas OP. Resultados Se calculo el riesgo cardiovascular a 3.425 pacientes. En el grupo de entre 65-69 anos (n = 974, 22,44%) la media de riesgo segun el SCORE fue de 4,08, y segun el SCORE OP, de 3,83 (p Conclusiones Las tablas SCORE OP para mayores de 64 anos identifican menos pacientes de alto riesgo que las tablas SCORE, lo que implicaria tratar potencialmente menos pacientes de esas edades con hipolipidemiantes.

Objectives The guidelines of the American College of Cardiology/American Heart Association, the British National Institute for Health and Clinical Excellence and the European Guidelines on cardiovascular disease prevention are worldwide disseminated. They recommend the use of different tables to estimate cardiovascular risk: atherosclerotic cardiovascular disease risk-ASCVD, the QRISK2 and the SCORE. ASCVD and QRISK2 measure risk of cardiovascular morbidity and mortality due to atherosclerosis disease and due to coronary heart disease and stroke, respectively, and SCORE measures risk of cardiovascular death. According to ASCVD a high-risk person is considered when risk is >7.5%, according to QRISK2 >10% and according to SCORE >5%, in the next ten years. The objective was to evaluate and compare the impact of using the American, the British and the European guidelines on the identification of high risk patients and on the percentage of patients requiring statin therapy in a Spanish working population. Method Observational study conducted among Spanish workers whose companies had contracted health monitoring services from the Sociedad de Prevencion de Ibermutuamur, who underwent a medical examination between 2004–2007. Cardiovascular risk was calculated for each worker using the SCORE cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. Diabetic patients were excluded. Following the recommendations of the European Guidelines on Cardiovascular Prevention, treatment targets for patients at high (SCORE 5%–9%) or very high risk (SCORE >10%) are LDL-C concentrations of 190 mg/dl, regardless the cardiovascular risk. Results A total of 227 371 workers between 40 and 65 years were included (75.54% men; mean age, 47.96 years; 42.62% were smokers; 10.1% were hypertensives; 11.0% had dyslipidemia; 7.2% were treated with antihypertensive drugs; 3.7% were treated with lipid lowering drugs). Individuals at high risk was found in 4.42% of the population according to the SCORE tables and in 17.79% and 26.02% according to the British and American tables, respectively. Lipid lowering treatment would be recommended in these high risk patients, except for the American Guidelines that the percentage would increase up to 33.74% (after including non-high risk patients with LDL-C >190 mg/dl). Conclusions We observed marked differences on the percentages of high risk patients when comparing the three different cardiovascular risk charts. The application of the American and British compare to the European guidelines would result in identifying more high risk patients and in treating a larger fraction of the population with lipid lowering drugs and with other intensive preventive pharmacotherapy such as use aspirin and anti-hypertensive agents, which would result in substantially increase costs. Clinicians may need to interpret cardiovascular risk estimates with caution in order to avoid overestimation of risk and overtreatment.

Introduction and objectives To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain. Methods Retrospective cohort study . We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014. Results A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment , systolic blood pressure , total cholesterol, high-density lipoprotein cholesterol , and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index , a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure . The area under the curve receiver operating characteristic was 0.84 (95% C I, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles. Conclusions The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women.

Resumen Introduccion y objetivos En Espana no existen unas cohortes poblacionales suficientemente grandes para hacer predicciones precisas del riesgo cardiovascular. Las ecuaciones de Framingham y EuroSCORE calibradas son las mas utilizadas en Espana. El objetivo es desarrollar la primera ecuacion de prediccion autoctona para estimar con precision el riesgo cardiovascular individual en Espana. Metodos Analisis conjunto de siete cohortes espanolas de poblacion de mediana edad y anciana. La poblacion del estudio —11.800 personas (6.387 mujeres)— aporto un total de 107.915 personas-ano de seguimiento y 1.214 eventos cardiovasculares (633 de ellos, mortales). Se efectuo un analisis de regresion de Cox para examinar la contribucion de los diferentes factores al riesgo de cualquier evento cardiovascular (mortal y no mortal). Resultados La edad fue el principal factor de riesgo de eventos cardiovasculares. La presion arterial sistolica, la diabetes mellitus, el tabaquismo y el tratamiento antihipertensivo fueron factores predictivos fuertemente asociados con el riesgo cardiovascular. En cambio, la contribucion del colesterol total serico fue pequena, especialmente en los mayores de 70 anos. El modelo final de riesgo mostro un buen poder discriminatorio (estadistico C = 0,789 en varones y C = 0,816 en mujeres). Conclusiones ERICE es una nueva ecuacion de riesgo cardiovascular genuinamente espanola obtenida a partir del riesgo concurrente individual de los participantes en varias cohortes. La ecuacion ERICE ofrece una estimacion directa y fiable del riesgo cardiovascular total teniendo en cuenta factores como la diabetes mellitus y el tratamiento farmacologico de los factores de riesgo cardiovascular, habitualmente no incluidos en otras ecuaciones.

Resumen Introduccion y objetivos La guia para el manejo y el tratamiento de las dislipemias del American College of Cardiology/American Heart Association estadounidense y la del National Institute for Health and Clinical Excellence britanico recomiendan cambios importantes, como la supresion de los objetivos terapeuticos o la utilizacion de unas tablas de riesgo nuevas. Este estudio pretende evaluar el impacto de utilizar estas nuevas guias en comparacion con lo que supone la aplicacion de la guia europea. Metodos Estudio de tipo observacional realizado en trabajadores espanoles. Se incluyo a todos los trabajadores reconocidos por la Sociedad de Prevencion de Ibermutuamur durante el ano 2011 y cuyo riesgo cardiovascular era evaluable. De cada sujeto, se calculo el riesgo cardiovascular utilizando las tablas Systematic Coronary Risk Evaluation para paises de bajo riesgo y las tablas recomendadas por las guias estadounidense y britanica. Resultados Se incluyo a 258.676 trabajadores (el 68,2% varones; media de edad, 39,3 anos). Segun las tablas Systematic Coronary Risk Evaluation, el 3,74% de la poblacion resulto ser de alto riesgo, mientras que segun las tablas britanicas eran el 6,85% y segun las tablas estadounidenses, el 20,83%. Se deberia tratar a mas de 20.558 trabajadores si se sigue la guia estadounidense, 13.322 con la britanica y 2.612 siguiendo las recomendaciones de las sociedades europeas. Con la guia estadounidense, el coste diario de estatinas se multiplicaria casi por 8. Conclusiones La nuevas recomendaciones supondrian identificar a mas pacientes de alto riesgo y tratar con hipolipemiantes a mas poblacion que con las recomendaciones europeas, lo que aumentaria los costes.

Resumen Introduccion y objetivos En Espana disponemos de tablas SCORE para el calculo del riesgo cardiovascular en paises de bajo riesgo, tablas calibradas para la poblacion espanola, y unas tablas que permiten incluir el colesterol unido a lipoproteinas de alta densidad. Este estudio pretende evaluar el impacto de la utilizacion de una u otra tabla de riesgo en la practica clinica. Metodos Estudio transversal realizado en dos centros de salud. Se selecciono a sujetos de entre 40 y 65 anos de edad que contaran con un registro de presion arterial y colesterol total entre marzo de 2010 y marzo de 2012. Se excluyo a los sujetos con antecedente de diabetes mellitus o enfermedad cardiovascular. Se calculo el riesgo utilizando las tablas SCORE para paises de bajo riesgo, tablas SCORE con colesterol unido a lipoproteinas de alta densidad y tablas SCORE calibrado. Resultados Se calculo el riesgo cardiovascular a 3.716 pacientes. Los pacientes de alto o muy alto riesgo fueron el 1,24% con SCORE con colesterol unido a lipoproteinas de alta densidad, el 4,73% con SCORE para paises de bajo riesgo y el 15,44% con SCORE calibrado (p Conclusiones La tabla SCORE calibrado identifica a mas pacientes de alto riesgo que las del SCORE de bajo riesgo y el SCORE con colesterol unido a lipoproteinas de alta densidad, por lo que su utilizacion implicaria tratar a mas pacientes con estatinas. Son necesarios estudios de validacion del SCORE para valorar la tabla mas adecuada en nuestro medio.

In the year 2011, cardiovascular diseases were responsible of 31.2% of total deaths in Spain. The absolute number of cases of acute coronary syndrome in this year will be approximately 115,752 cases (95%CI: 114,822-116,687). The prevalence of stable angina in the population aged 25-74 years is 2.6% in men and 3.5% in women. Cardiovascular diseases were in the year 2011 the first cause of hospitalizations representing 14.1% of the total hospitalizations. Diagnose of ischaemic heart disease and acute myocardial infarction were responsible of 110,950 and 50,064 hospitalizations, respectively. In the year 2003, the hospitalization rate was 314 while in the year 2011 was 237 per 100,000, a reduction of 24.4%. The average cost of hospitalization due to ischaemic heart disease in 1997 was 3,093.7euros while in the year 2011 was 7,028.71euros. Cardiovascular mortality rates have decreased from 2007 to 2011, showing a relative reduction of 7% in women and 8% in men. With regard to myocardial infarction, it was observed a relative reduction of 17% in men and 20% in women. According to EUROASPIREIII survey done in 8,966 patients with ischaemic heart disease in Europe, 17% of patients were still smokers, 35% were obese, 56% has uncontrolled blood pressure, 51% has raised blood cholesterol and 25% were diabetics. With regard to drugs utilisation, 91% were treated with antiplatelets agents, 80% with beta blockers, 71% with ACE inhibitors/ARBs.

Objective To determine whether there is an increased risk of hip fracture associated with the use of proton pump inhibitors in a Mediterranean area after adjusting for other potential risk factors. Methods Retrospective multicenter case–control study carried out in 6 primary health care centers in Catalonia, Spain. Cases were patients aged 50 years and over with a fragility hip fracture registered between January 2007 and December 2010, matched with 2 controls by sex and age. Data collected: use of proton pump inhibitors (type, dosage) in the 5 years previous to the hip fracture, socio-demographic data, body mass index, alcohol and tobacco consumption as well as health conditions and drugs associated with an increase risk of fragility hip fracture. Results 358 cases were matched with 698 controls. The mean age was 82 years old in both groups. Women represented 77.1% in the case group and 76.9% in the control group. Crude association between proton pump inhibitors and hip fracture was 1.44 (95% CI, 1.09–1.89) and adjusted OR was 1.24 (95% CI, 0.93–1.65). No association was found with the continuous or discontinuous use of proton pump inhibitors, OR 1.17 (95% CI, 0.77–1.79), and OR of 1.16 (95% CI, 0.85–1.60) respectively. No association was found when restricting the analysis by sex, OR of 1.19 (95% CI, 0.27–5.14) or by age, younger or older than 80 years, OR of 0.72 (95% CI, 0.24–2.15). Conclusion The use of proton pump inhibitors was not associated with an increased risk of hip fracture after adjusting for other risk factors in a Mediterranean area. This result suggests the existence of protective environmental factors linked to this southern area of Europe that eventually could compensate for the potential harm produced by proton pump inhibitors.

Resumen Fundamento y objetivo La inercia terapeutica (IT) y el cumplimiento terapeutico (CT) limitan alcanzar los objetivos de control recomendados para los pacientes. Este estudio valora la IT y el CT en pacientes con diabetes mellitus 2 (DM2) en relacion al control glucemico, la presion arterial (PA) y el colesterol unido a lipoproteinas de baja densidad (colesterol LDL), valorando la relacion entre IT y CT. Pacientes y metodo Estudio transversal realizado en atencion primaria. Se incluyeron 320 pacientes diabeticos. Se valoro si cumplian los objetivos de control (hemoglobina glucosilada [HbA1c] ≤ 7%, presion arterial [PA] ≤ 130/80 mmHg, colesterol LDL ≤ 100 mg/dl), si se incurrio en IT (ausencia de modificaciones en el tratamiento en caso de no cumplir los objetivos de control) y el CT (recuento de recetas retiradas de farmacia). Resultados Un 66,4% de los pacientes alcanzaron el objetivo de control para la HbA1c, un 43,2% para la PA y un 40,5% para el colesterol LDL. Se incurrio en IT en un 86,4% para el colesterol LDL, en un 76,7% para la PA y en un 40,6% para la HbA1c. El porcentaje de incumplimiento terapeutico fue del 36,1, 37,5 y 32,0% para los antidiabeticos, antihipertensivos e hipolipidemiantes, respectivamente. Los pacientes con mayor edad fueron mejor cumplidores. La IT no se relaciono con el CT. No hubo diferencias segun sexo en cuanto al grado de control, la IT, la utilizacion de farmacos, ni el CT. Conclusiones La IT y el CT tienen un papel importante en la no consecucion de los objetivos de control en los pacientes diabeticos, especialmente en la PA y los lipidos. El CT no se relaciona con la IT.

ResumenObjetivosEl Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS), que la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) puso en marcha a finales de la década de 1980, tiene como objetivo la integración de las actividades preventivas y de promoción de la salud en el seno de las tareas desarrolladas en las consultas de atención primaria. Se pretende conocer el grado de cumplimentación del PAPPS en atención primaria.MétodosSe ha realizado una búsqueda bibliográfica de las publicaciones relacionadas con el PAPPS con el fin de evaluar su implementación y el impacto sus programas.ResultadosLas evaluaciones periódicas que se han ido realizando desde su inicio muestran que tanto el cumplimiento como el registro de las actividades preventivas han ido mejorando progresivamente hasta las últimas evaluaciones. El PAPPS es evaluado de forma positiva tanto por los profesionales como por los pacientes. En España, el médico de familia realiza actividades de prevención y promoción de la salud en un mayor porcentaje que el global de Europa.ConclusionesEl PAPPS sigue vigente 24 años después de su puesta en marcha, aunque es necesario un proceso de adaptación al actual escenario sanitario español. Las propuestas de cambio se centran en mejorar la accesibilidad y en ofrecer respuestas más ágiles a los usuarios. En los pacientes ancianos es importante valorar la esperanza de vida y priorizar las intervenciones preventivas basándose en ésta.AbstractObjectivesThe Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP.MethodsWe performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program.ResultsThe distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians.ConclusionsThe PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly.

Introduction and objectives: To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice. Methods: A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up.

ResumenObjetivoEvaluar las recomendaciones de las guías sobre el uso de aspirina en prevención primaria de la enfermedad cardiovascular.DiseñoRevisión sistemática. Búsqueda realizada por enfermedades, tratamiento y tipo de prevención.Fuentes de datosScience Citation Index, SCOPUS, PubMed, Ministerio de Sanidad y Consumo, Organización Mundial de la Salud, páginas web de sociedades científicas nacionales e internacionales.Extracción de datosRevisión independiente por parte de 2 evaluadores. Los aspectos evaluados fueron los siguientes: a) uso de antiagregantes en prevención primaria; b) identificación de población diana; c) identificación de dosis diaria recomendada; d) identificación de criterios de aplicación; e) publicaciones en inglés o en español, y f) difusión a nivel internacional y nacional (España).ResultadosSe revisaron 9 guías en prevención primaria y 5 guías en diabetes.La mayoría recomiendan dosis bajas de aspirina con un rango entre 75–325mg/día. Las guías recomiendan un determinado nivel de riesgo coronario para definir la población por tratar, pues existe una gran variabilidad en las tablas utilizadas para el cálculo del riesgo y en el umbral de riesgo para recomendar el tratamiento. Las guías para diabetes no definen ningún nivel de riesgo. Tres guías recomiendan que el uso de aspirina se haga cuando la presión arterial esté bien controlada.ConclusionesExiste una alta variabilidad entre las guías respecto al nivel de riesgo a partir del cual se deberían tratar los pacientes y en las dosis recomendadas. La mayoría de las guías recomiendan aspirina en prevención primaria en pacientes diabéticos, aunque existen discrepancias entre grupos internacionales e incluso en diferentes documentos de una misma sociedad.AbstractObjectiveTo review the guideline recommendations on aspirin use in primary prevention of cardiovascular diseases.DesignSystematic review. The search was made by condition, treatment and type of prevention.Data sourcesScience Citation Index, SCOPUS, PubMed, Spanish Ministry of Health, World Health Organisation, web sites of national and international scientific societies.Data extractionTwo investigators independently reviewed all the guidelines. Specific topics assessed: a) use of antiplatelet treatment in primary prevention b) identification of target population c) identification of recommended dosage, d) identification of criteria of aspirin use, e) publications in English and/or Spanish, f) dissemination at national (Spain) or international level.ResultsNine guidelines on primary prevention and 5 guidelines on diabetes were reviewed. Most of them recommended low dose aspirin ranging between 75mg and 325mg per day. All the guidelines recommend a specifc level of coronary risk to define the target population to be treated, showing high variability in risk tables used and in the level of risk which should be used to recommend treatment. The diabetes guidelines do not define any level of risk. Three guidelines recommend the use of aspirin when blood pressure is well controlled.ConclusionsThere is high variability among guidelines in terms of the level of risk from which patients should be treated, and also in dosages. Most of the guidelines recommend the use aspirin in diabetics, although some discrepancies exist among international panels, and even in different documents of the same scientific society

Introduccion y objetivos El objetivo de este estudio es evaluar si una intervencion domiciliaria reduce la mortalidad y los reingresos hospitalarios de pacientes con insuficiencia cardiaca y mejora su calidad de vida. Metodos Ensayo clinico aleatorizado, realizado desde enero de 2004 a octubre de 2006. Se aleatorizo a 283 pacientes, diagnosticados de insuficiencia cardiaca e ingresados en el hospital, al grupo de atencion domiciliaria (grupo intervencion) o al grupo de atencion habitual (grupo control). La variable principal de resultado se midio al ano de seguimiento y fue la combinacion de la mortalidad por todas las causas y los reingresos hospitalarios debido al empeoramiento de la insuficiencia cardiaca. Resultados La variable principal se observo en el 41,7% de los pacientes del grupo intervencion y en el 54,3% del grupo control. La razon de riesgos (HR) fue 0,70 (intervalo de confianza [IC] del 95%, 0,55-0,99). Incluyendo variables clinicas relevantes, la razon de riesgos disminuyo ligeramente (HR = 0,62; IC del 95%, 0,50-0,87). Al final del estudio, los pacientes del grupo intervencion tenian una mejor calidad de vida que los pacientes del grupo control (18,57 frente a 31,11; p Conclusiones Una intervencion basada en la atencion domiciliaria en pacientes con insuficiencia cardiaca reduce el conjunto de mortalidad y reingresos hospitalarios y mejora la calidad de vida.

Introduction and objectives The objective of this study was to determine whether a home-based intervention can reduce mortality and hospital readmissions and improve quality of life in patients with heart failure. Methods A randomized clinical trial was carried out between January 2004 and October 2006. In total, 283 patients admitted to hospital with a diagnosis of heart failure were randomly allocated to a home-based intervention (intervention group) or usual care (control group). The primary end-point was the combination of allcause mortality and hospital readmission for worsening heart failure at 1-year follow-up. Results The primary end-point was observed in 41.7% of patients in the intervention group and in 54.3% in the control group. The hazard ratio was 0.70 (95% confidence interval [CI], 0.55-0.99). Taking significant clinical variables into account slightly reduced the hazard ratio to 0.62 (95% CI, 0.50-0.87). At the end of the study, the quality of life of patients in the intervention group was better than in the control group (18.57 vs 31.11; P Conclusions A home-based intervention for patients with heart failure reduced the aggregate of mortality and hospital readmissions and improved quality of life.

Estudio observacional para identificar los determinantes del control de la presion arterial ( El 70,2% eran varones con una media de edad de 66,4 anos. El 50,9% (intervalo de confianza [IC] del 95%, 46,9%–54,8%) mostro mal control de la presion arterial y el 60,1% (IC del 95%, 56,3%–63,9%), del cLDL. Determinantes de mal control de la presion arterial fueron: diabetes, hipertension arterial, no tener diagnostico previo de insuficiencia cardiaca, diagnostico de enfermedad arterial periferica o ictus, obeso y no recibir tratamiento hipolipemiante. Determinantes de mal control del cLDL fueron: no recibir tratamiento hipolipemiante, no tener diagnostico de cardiopatia isquemica, no recibir tratamiento antihipertensivo y dislipemia. Los determinantes de mal control de presion arterial difieren de los del cLDL, resultado que considerar al aplicar las recomendaciones para alcanzar los objetivos terapeuticos en prevencion secundaria.

Objetivo el medico de familia es el primer profesional de salud que puede actuar preventivamente sobre la poblacion anciana de riesgo. El objetivo de este estudio es evaluar la eficacia de una intervencion multifactorial tras la valoracion geriatrica integral (VGI) en terminos de morbimortalidad. Material y metodos ensayo clinico aleatorizado, con grupo control (GC), en personas mayores de 75 anos visitadas en las consultas de un centro de atencion primaria durante un periodo de 18 meses. Segun la VGI, se clasifico al anciano como fragil o no; en el grupo de intervencion (GI) los pacientes fragiles recibieron una intervencion personalizada, mientras que a los no fragiles se les ofrecio participar en una sesion grupal. Resultados participaron en el estudio 620 sujetos, el 49,7% aleatorizados al GI y el 50,3% al GC. Realizaron la visita de seguimiento 430 (69,4%) pacientes. En la visita final, los pacientes del GC mostraron un riesgo significativamente superior de depresion (Yesavage) que el GI (p = 0,048). Durante el seguimiento, el 13% del GI modifico su estado inicial de fragiles a no fragiles frente al 5% del GC, mientras que el 11 % del GI paso a ser nuevos pacientes fragiles frente al 22% del GC (p Conclusiones la intervencion se mostro efectiva al contener el numero de pacientes fragiles de nuevo diagnostico y al aumentar el numero de pacientes que revirtieron el proceso en el GI durante el seguimiento. La VGI resulta efectiva si se asocia a una intervencion.

ObjetivoEstimar los costes reales asistenciales por grupos patológicos de un centro de salud.DiseñoEstudio descriptivo, retrospectivo, realizado a partir de la revisión de historias clínicas informatizadas.EmplazamientoCentro de salud urbano.ParticipantesTodos los pacientes que se visitaron en el centro de salud durante el año 2005.Medidas principalesSe ha calculado el coste asistencial medio en euros por visita diferenciando por profesional, procedimientos y gasto farmacéutico, imputándose a la enfermedad que lo ha generado.ResultadosLas visitas por problemas de los aparatos respiratorio, locomotor, circulatorio y digestivo fueron las más frecuentes. El número medio de visitas por paciente atendido fue de 8,7±9,4, y por paciente adscrito al centro, de 5,9±8,7. Los costes más altos se atribuyen problemas circulatorios (18,96%; intervalo de confianza [IC] del 95%, 18,93-18,99%), del aparato locomotor (11,21%; IC del 95%, 11,18-11,23%), psicológicos (10,69%; IC del 95%, 10,66-10,71%), respiratorios (10,20%; IC del 95%, 10,17-10,22%) y del sistema endocrino-metabólico y nutrición (9,61%; IC del 95%, 9,58-9,63%). El gasto farmacéutico representó el 65% de los costes totales, las visitas al profesional el 33% y los procedimientos, el 2%. El coste total por habitante fue de 239,1±493,6 euros, y por habitante visitado, de 349,5±563,5 euros.ConclusionesLas enfermedades del aparato circulatorio son, con diferencia, las que tienen un coste asistencial total más alto. Los problemas psicológicos ocupan el segundo lugar desde un punto de vista del gasto farmacéutico y el tercer lugar desde un punto de vista de costes asistenciales totales.ObjectiveTo estimate the real costs of medical care by diagnostic groups at a primary care centre.DesignDescriptive, retrospective study, based on the review of computerized medical records.SettingUrban primary care centre (PCC).ParticipantsAll patients who attended the PCC during 2005.Main measurementsMean medical care cost per visit in euros, broken down for health professionals, diagnostic procedures and drugs costs, and stratified by diagnostic groups.ResultsThe most frequent visits were for pulmonary, locomotor, cardiovascular, and gastro-intestinal conditions. The mean number of visits per patient attended was 8.7 (SD, 9.4); and per patient registered at the centre, 5.9 (8.7). The highest costs were for cardiovascular (18.96%; 95% CI, 18.93%-18.99%), locomotor (11.21%; 95% CI, 11.18%-11.23%), psychological (10.69%, 95% CI, 10.66%-10.71%), pulmonary (10.20%; 95% CI, 10.17%-10.22%) and endocrinal-nutritional (9.61%; 95% CI, 9.58%-9.63%) problems. Drugs expenditure accounted for 65% of the total cost; visits to health professionals, for 33%; and procedures, for 2%. Overall cost per inhabitant was 239.1 (493.6) euros, and per patient attended was 349.5 (563.5).ConclusionsCardiovascular disease conditions are much the most costly ones in terms of overall medical cost. Psychological conditions are located in second place in terms of pharmaceutical cost; and in third place, in terms of overall medical-care cost.

Background Recent guidelines recommend assessment of lifetime cardiovascular risk on the basis of traditional risk factors in adults who are not at high short-term risk. The aim of this study is to determine the implications of estimating the lifetime cardiovascular risk in individuals in a large occupational cohort in Spain. Design National cross-sectional study in an occupational cohort with an in-person interview including laboratory tests. Methods Volunteer workers who were examined between January 2011 and December 2011 were included. A total of 580,236 workers were eligible during this year and 259,834 were examined (participation rate of 44.7%). Short-term (10-year) and lifetime cardiovascular risk were estimated using the American College of Cardiology (ACC) and the American Heart Association (AHA) tool and the QRISK2 and QRISK. Results Sixty-eight per cent were male, mean age was 39 years, with an age range of 16 to 75 years. Total number of individuals included in this study was 258,676. The percentage of patients at high short-term risk was 6.85% (95% confidence interval (CI) 6.75%-6.95% and 20.83% (95% CI 20.60%-21.07%) with the QRISK2, and the ACC/AHA risk equations, respectively. Of the percentage of patients classified as not at high risk with the different tools 1.61% (95% CI 1.55%-1.66%) were high lifetime risk on QRISK, and 27.41% (95% CI 27.11%-27.70%) on ACC/AHA risk. Conclusions Application of lifetime cardiovascular risk engages greater numbers of individuals at high risk with substantial differences between the different methods available. These differences can have important clinical implications specifically in the percentage of candidates for lifestyle changes and eventually lipid lowering drugs.

Objective To evaluate health-related quality of life (HRQoL) changes in patients treated with indinavir three-times daily after switching to a twice-daily indinavir/ritonavir regimen or continuing with the same regimen. Methods Patients on HAART including indinavir three-times-daily with undetectable viral load were randomly assigned to continue with this therapy or to change to a twice-daily indinavir/ritonavir (800/100 mg) regimen. The Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire was used as the HRQoL measure. Results A total of 118 patients participated in the study, of which 59 (50%) were randomly assigned to continue with the three-times-daily regimen. Patients had a mean age of 39 years and 80% of them were male. At baseline, subjects included in the three-times-daily group presented a significantly greater number of symptoms than subjects in the twice-daily group, but no statistically significant differences were observed in MOS-HIV scores between the groups. In the intention-to-treat (ITT) analysis, a reduction in HRQoL scores was observed in both groups, which was greater in the twice-daily group. In the per protocol analysis, reduction of HRQoL was minimal. Conclusions A HRQoL deterioration, greater in the twice-daily group, was observed in this study in the ITT analysis, while HRQoL remained stable in both groups in patients who continued with and tolerated the allocated regimen.

Fundamento y objetivo: Durante la ultima decada el calculo del riesgo cardiovascular se ha convertido en la piedra angular de las guias de practica clinica de prevencion cardiovascular. El objetivo de este estudio es evaluar la utilidad del calculo del riesgo coronario basado en la ecuacion del estudio de Framingham en nuestro entorno, evaluando la eficacia diagnostica del riesgo coronario (asumiendo que el riesgo coronario superior al 20% fuera una prueba diagnostica positiva de enfermedad coronaria). Pacientes y metodo: Estudio de casos y controles prospectivo realizado en un hospital publico terciario. Resultados: Se seleccionaron 138 casos y se emparejaron por edad y sexo con 223 controles. El nivel de riesgo igual o superior al 20% fue el que mejor clasifico a los pacientes (un 70% de los pacientes clasificados correctamente como casos y como controles), siendo el area bajo la curva ROC del 73,5%, lo que representa una exactitud moderada. Los pacientes con riesgo coronario superior al 20% tienen una probabilidad 6 veces mayor de pertenecer al grupo de los casos que al grupo de los controles (odds ratio = 6,09; intervalo de confianza del 95%, 3,30-11,22). Conclusiones: La utilizacion del modelo de Framingham para la prediccion de la enfermedad coronaria es un metodo util para identificar a los pacientes de riesgo. Se recomienda su uso en la practica clinica mientras no se disponga de un modelo genuino o basado en poblaciones con riesgo basal de enfermedad coronaria semejante al nuestro que prediga el riesgo con mayor exactitud

Despite best practice, it may not be achievable in some patients to reach the optimal goals of secondary prevention recommendations for various reasons, such as co-morbidity, contraindications for some drugs or side effects.Our aim was to estimate the achievable standards for audit purposes in primary care for prophylactic treatment of secondary prevention of myocardial infarction.We conducted a survey of consecutive patients with a hospital diagnosis of first acute myocardial infarction during 1997 who were identified from discharge books from four hospitals and interviewed at their primary health centre 2 years after admission. The achievable standard for a prophylactic drug was then defined as the proportion of patients that could benefit from the treatment excluding those that for one justified reason or another were off medication.Three hundred and sixty-nine patients were interviewed in the follow-up. Aspirin or another antiplatelet regimen was prescribed in 86.9 patients, beta-blockers in 50.2%, angiotensin-converting enzyme (ACE) inhibitors in 32.5% and lipid-lowering drugs in 52%. The estimated achievable standards for those prescribed drugs were 94.5, 71,8, 50.5 and 69.8%, respectively.There is an underuse of prophylactic drug therapies after myocardial infarction. The standards established in this study for secondary preventive drug treatment might be achieved through a reasonable effort by GPs working in primary care committed to improving the quality of care.

Objetivos Evaluar la influencia de los metodos de presentacion de los resultados sobre la percepcion cuantitativa de la eficacia de farmacos utilizados en prevencion primaria y secundaria de la enfermedad coronaria y la probabilidad de comenzar el tratamiento con dichos farmacos. Metodo Estudio realizado en 1.408 cardiologos espanoles a los que se asigno, de forma aleatoria, tres cues-tionarios en los que se utilizaban diferentes medidas de efecto de ensayos clinicos publicados. Resultados Se pudo aplicar 559 cuestionarios (40%). A partir de las respuestas a los cuestionarios se estimo, en una escala del 0 al 10 (valor este maximo de eficacia), la percepcion de la eficacia media de diferentes farmacos utilizados en ensayos clinicos cuyos resultados fueron expresados en terminos de reduccion relativa del riesgo, reduccion absoluta del riesgo y numero necesario de pacientes a tratar para evitar un caso, respectivamente, obteniendose: prevencion primaria con estatinas: 6,79, 6,38 y 5,43; prevencion primaria con aspirina: 6,84, 5,06 y 4,25; prevencion secundaria con estatinas: 8,16, 7,76 y 7,54; prevencion secundaria con inhibidores de la enzima conversiva de la angiotensina (IECA): 7,11, 7,81 y 7,19, y prevencion secundaria con bloqueadores beta: 7,22, 7,43 y 6,98. Sin embargo, la probabilidad de iniciar el tratamiento con los farmacos considerados se vio poco influida debido a la forma de presentacion de los resultados en los ensayos clinicos. Conclusiones La presentacion de resultados en los ensayos clinicos en forma de reduccion relativa del riesgo, en comparacion con su presentacion en forma de reduccion absoluta del riesgo o numero necesario de pacientes a tratar, dio lugar globalmente a una percepcion de mayor eficacia de la intervencion, sin influir, sin embargo, en la probabilidad de iniciar el tratamiento con los farmacos.

Introduccion y objetivos Analizar las caracteristicas basales, los patrones de manejo y los resultados clinicos a los 18 meses del ingreso en pacientes diagnosticados de insuficiencia cardiaca en un hospital terciario de Cataluna. Metodos Se identificaron y analizaron las historias clinicas de los 256 pacientes ingresados en el Hospital General Vall d’Hebron desde julio a diciembre de 1998, diagnosticados de insuficiencia cardiaca y que cumplieran los criterios del estudio. Se entrevisto a los pacientes telefonicamente 18 meses despues. Resultados La edad media de los pacientes era de 75 ± 12 anos, el 42% correspondia a varones, el 19% habia ingresado por enfermedades distintas de la insuficiencia cardiaca y el 62% tenia comorbilidad significativa. Se estudio la funcion ventricular en el 68% (basicamente en pacientes con mejor pronostico), y se considero normal en un 41%. Se administraron inhibidores de la enzima conversiva o antagonistas de la angiotensina II en un 54% y bloqueadores beta en un 4%. La mortalidad a los 18 meses fue del 46%, siendo de causa cardiaca en el 77% de estos. Los predictores independientes de mortalidad fueron la edad avanzada, la insuficiencia cardiaca grave o antigua y la comorbilidad. A los 18 meses, un 69% de los supervivientes se hallaba en clase funcional I o II. Conclusiones 1) Al igual que sucede en otras areas geograficas, los pacientes de este estudio constituyen, como media, una poblacion anciana y con pobre supervivencia; 2) los patrones de manejo registrados son claramente mejorables; 3) la comorbilidad afecta significativamente al pronostico, y 4) la calidad de vida despues del alta es aceptable en una llamativa proporcion de supervivientes.