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Abstract Introduction Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years. Methods Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. Main measures: referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation. Results The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p

BackgroundAdverse events in the primary care setting result in a direct cost equivalent to at least 2.5% of total healthcare spending. Across OECD countries, they lead to more than seven million avoidable hospital admissions annually. In this manuscript, we describe the protocol of a trial aimed at evaluating the effectiveness of SinergiAPS (a patient-centered audit and feedback intervention) in reducing avoidable hospital admission and explore the factors that may affect its implementation.MethodsWe will conduct a 24-month, parallel, open-label, multicenter, pragmatic, hybrid type 1 randomized clinical trial. 118 primary healthcare centers with wide geographical distribution in Spain will be randomly assigned (ratio 1:1) to two groups. The intervention group will receive two audits (baseline and intermediate at 12 months) based on information collected through the administration of the PREOS-PC questionnaire (a measure of patient-reported patient safety) to a convenience sample of 100 patients per center. The intervention group will receive reports on the results of both audits, along with educational resources aimed at facilitating the design and implementation of safety improvement plans. The control group will receive care as usual. The primary outcome will be the rate of avoidable hospitalizations (administrative data). Secondary outcomes: patient-reported patient safety experiences and outcomes (PREOS-PC questionnaire); patient safety culture as perceived by professionals (MOSPSC questionnaire); adverse events reported by healthcare professionals (ad hoc questionnaire); the number of safety improvement actions which the re has implemented (ad hoc questionnaire). Outcome data will be collected at baseline and 24 months follow-up. For the evaluation of the implementation of the SinergiAPS intervention, we will draw on the Consolidated Framework for Implementation Research (CFIR). We will collect and analyze qualitative and quantitative data (30 individual interviews, implementation logbooks; questionnaires for professionals from intervention centers, and level of use of the SinergiAPS web tool).DiscussionThis study will expand the scarce body of evidence existing regarding the effects and implementation of interventions aimed at promoting patient and family engagement in primary healthcare, specifically for enhancing patient safety. The study has the potential to produce an impact on clinical practice, healthcare systems, and population health.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT05958108?term=sinergiAPS&rank=1 (NCT05958108).

BackgroundBehavioral and substance addictions are prevalent health problems that, alongside obesity, are linked to reduced physical activity and increased sedentary time. Similarly, arterial stiffness and vascular aging are processes that begin gradually at an early age and are closely associated with morbidity and mortality from cardiovascular diseases. The main objective of this study is to analyze how addictions are related to obesity and body fat distribution, physical activity, sedentary time, arterial stiffness and vascular aging, as well as sleep quality, cognitive function and gender differences in young adults aged between 18 and 34 years.MethodsThis cross-sectional descriptive observational study will analyze data from 500 subjects (250 men and 250 women) aged 18–34 without cardiovascular disease, selected by simple random sampling with replacement from the urban population of the city center of Salamanca (34,044 people aged 18–34, with 18,450 women and 15,594 men). Behavioral and substance addictions, as well as sleep quality and cognitive impairment will be assessed using questionnaires. The Pittisburg Sleep Quality Index (PSQI) will be used to measure sleep quality and the Ford questionnaire will be used to measure insomnia in response to stress. For obesity, weight, height, waist and hip circumference, body composition will be measured with the Inbody 230® impedance meter. For physical activity and sedentary time, we will use the Actigraph® accelerometer alongside the international physical activity questionnaire (IPAQ) and the Marshall questionnaire. The Sphygmocor System® will be used for pulse wave analysis and carotid-femoral pulse wave velocity (cfPWV), while the Vasera VS-2000® will measure cardio ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Vascular aging will be calculated with the 10th and 90th percentiles of cfPWV or baPWV. Demographic, analytical variables will be collected, as will data to assess vascular, cardiac, renal, and brain injury.DiscussionAddictions are on the rise in today’s society, affecting the mental health and well-being of those who suffer from them, generating important social problems such as job loss, family dysfunction, debt and social isolation. Together with obesity, they are prevalent health problems in young adults and are associated with lower physical activity and higher sedentary time. Meanwhile, arterial stiffness and vascular aging are processes that begin gradually at an early age and determine morbidity and mortality caused by cardiovascular diseases. The results of this project will allow us to understand the situation regarding behavioral and substance addictions in young adults. Better understanding of these addictions will in turn facilitate the development of more effective prevention strategies and intervention programs, which can then reduce the negative impact at both the individual and societal levels.Clinical trial registration[ClinicalTrials.gov], identifier [NCT05819840].

IntroductionPersonalized programs of integrated strength and balance activities have been shown their effectiveness in falls reduction in the older adults.ObjectiveTo measure whether a group intervention with the strength and balance principles of the sLiFE program is more effective than standard health advice in reducing the incidence of falls.MethodsThe study will comprise 650 participants with more than 65 years who live at home, observing established inclusion and exclusion criteria. Participants will be randomly assigned in two groups: group intervention (n = 325) and standard health advice (n = 325). The intervention group will follow the balance and strength activities described in the LiFE program manual. The group intervention will be carried out in groups of 12–14 and will consist of seven one-hour sessions over 12 weeks in health centres. Incidence of falls and quality of life will be assessed as primary outcome variables. Fear of falling and exercise adherence will be analysed as secondary outcome variables.DiscussionPhysical activity has been put forward as an effective treatment technique for these patients; however, long-term adherence to these programs remains a challenge. Group interventions could reduce dropout rates.ConclusionFalls represent a major health problem globally due to the disability they cause in older people. Prevention would help reduce not only their incidence but also the health costs derived from their treatment. Group intervention helps clinicians to save resources and time, being able to attend more people with the same quality of care.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05912088?distance=50&term=NCT05912088&rank=1, identifier NCT05912088.

Resumen: La Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), una red de referencia e impulsora de la investigación en atención primaria fue creada en 2003 gracias al programa Redes Temáticas de Investigación Cooperativa en Salud (RETICS) del Instituto de Salud Carlos III (ISCIII). Su creación ha supuesto un cambio radical en la situación de la investigación en atención primaria. A lo largo de sus 19 años (2003-2021) han participado distintos grupos de investigación y comunidades autónomas, y se han desarrollado distintas líneas de investigación con numerosos proyectos y publicaciones. A pesar de las dificultades sufridas, ha creado una experiencia de investigación colaborativa entre distintas comunidades autónomas con gran vitalidad y con importantes resultados para la atención primaria. La redIAPP, por tanto, ha sido un gran referente para la investigación en atención primaria y para la profundización de su área de conocimiento. Se sugieren varias líneas de mejora para el futuro de la investigación en atención primaria. Summary: The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.

Abstract The objective of this study was to evaluate the association of egg consumption with blood pressure (BP) and glycated hemoglobin (HbA1c). In addition, it was assessed whether this association changes according to body weight status. This cross-sectional study is based on multicenter data from Spanish adult participants in the EVIDENT II trial. Egg consumption was assessed with a Food Frequency Questionnaire, and data on BP and HbA1c were collected using standardized procedures. Linear regression and ANCOVA models adjusted for the main confounders were performed. The analyses were stratified by body weight status. A total of 668 participants were analyzed (mean age 52.4 ± 11.8 years, 62.3% women). Compared with lower consumption, higher egg consumption was associated with lower systolic (ß = − 6.15 ± 1.74; p-for-trend = 0.017), diastolic (ß = − 4.41 ± 1.03; p-for-trend = 0.002), and mean arterial pressure (ß = − 4.99 ± 1.17; p-for-trend = 0.003) and with lower HbA1c (ß = − 0.19 ± 0.06; p-for-trend = 0.019) levels. These associations lost statistical significance in the adjusted analyses. The results did not vary by body weight status. In conclusion, consumption of up to 1 egg per day is not associated with BP or HbA1c, even in overweight or obese individuals. Our findings suggested that this frequency of egg consumption is safe as part of a healthy diet and lifestyle for cardiometabolic risk.

Background: SARS-CoV-2 infection affects the vascular endothelium, which mediates the inflammatory and thrombotic cascade. Moreover, alterations in the endothelium are related to arterial stiffness, which has been established as a marker of cardiovascular disease. The objective of this study is to analyse how the structure, vascular function, vascular ageing and endothelial damage are related to the biopsychological situation in adults diagnosed with persistent COVID and the differences by gender.Methods: This cross-sectional, descriptive, observational study will be carried out in the Primary Care Research Unit of Salamanca (APISAL) and in the BioSepsis laboratory of the University of Salamanca. The sample will be selected from the persistent COVID monographic office at the Internal Medicine Service of the University Hospital of Salamanca, and from the population of subjects diagnosed with persistent COVID in the clinical history of Primary Care. Through consecutive sampling, the study will include 300 individuals diagnosed with persistent COVID who meet the diagnosis criteria established by the WHO, after they sign the informed consent. Endothelial damage biomarkers will be measured using ELLA-SimplePlexTM technology (Biotechne). Their vascular structure and function will be analysed by measuring the carotid intima-media thickness (Sonosite Micromax); the pulse wave and carotid-femoral pulse wave velocity (cfPWV) will be recorded with Sphygmocor System®. Cardio Ankle Vascular Index (CAVI), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index will be analysed with Vasera VS-2000®. The integral assessment of the subjects with persistent COVID will be conducted with different scales that evaluate fatigue, sleep, dyspnea, quality of life, attention, nutrition state, and fragility. We will also evaluate their lifestyles (diet, physical activity, smoking habits and alcohol consumption), psychological factors, and cognitive deterioration, which will be gathered through validated questionnaires; moreover, physical activity will be objectively measured using a pedometer for 7 days. Body composition will be measured through impedance using an Inbody 230. Vascular ageing will be calculated with 10 and 90 percentiles of cfPWV and baPWV. Furthermore, we will analyse the presence of vascular injury in the retina, heart, kidneys and brain, as well as cardiovascular risk. Demographic and analytical variables will also be gathered.Discussion: Arterial stiffness reflects the mechanic and functional properties of the arterial wall, showing the changes in arterial pressure, blood flow, and vascular diameter that occur with each heartbeat. SARS-CoV-2 affects the endothelial cells that are infected with this virus, increasing the production of pro-inflammatory cytokines and pro-thrombotic factors, which can cause early vascular ageing and an increase of arterial stiffness. Persistent COVID is a complex heterogeneous disorder that affects the lives of millions of people worldwide. The identifications of potential risk factors to better understand who is at risk of developing persistent COVID is important, since this would enable early and appropriate clinical support. It is unknown whether vascular alterations caused by COVID-19 resolve after acute infection or remain over time, favouring the increase of arterial stiffness and early vascular ageing. Therefore, it is necessary to propose studies that analyse the evolution of persistent COVID in this group of patients, as well as the possible variables that influence it.Clinical Trial registration:ClinicalTrials.gov, identifier NCT05819840

Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach.Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length.Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx.Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination.Systematic Review Registration: PROSPERO (CRD42021276360).

Highlights This study is the first to find a negative association between total physical activity and arterial stiffness and vascular aging in adults with intermediate cardiovascular risk. This study also shows that the association of physical activity with arterial stiffness and vascular aging in adults with intermediate cardiovascular risk varies depending on its intensity, with a negative association being found only with intense physical activity. In the analysis by sex, the results found suggest that the association is greater in men.

Background: In this study we analyzed the association between physical activity and sedentary lifestyle with vascular aging in Spanish populations aged 35–75 years. Methods: A cross-sectional study was developed, in which 501 subjects aged 35–75 years were recruited. Physical activity and sedentary time were measured with an accelerometer (Actigraph GTX3) for a week. We measured carotid–femoral pulse wave velocity (cfPWV) by a Sphygmo Cor® device and carotid intima-media thickness (cIMT) by ultrasound (Sonosite Micromax®). The vascular aging index (VAI) was calculated as described in the literature. Vascular aging was defined considering the 25th and 75th percentiles by age and sex of cfPWV and VAI, presence of vascular injury, type-2 diabetes mellitus or arterial hypertension. Individuals were classified into three groups: healthy, normal, and early vascular aging. Results: The mean age of the sample was 55.90 ± 14.24 years, 50% being women. Total physical activity was negatively associated with cfPWV (β = –0.454) and VAI (β = –1.845). Similarly, the number of steps per day obtained a negative association with cfPWV (β = –0.052) and VAI (β = –0.216), while sedentary time showed a positive association with cfPWV (β = 0.028) and VAI (β = 0.117). In the analysis by sex, the results showed similar values. The odds ratio (OR) of total physical activity of subjects classified as early vascular aging (EVA) with regarding those classified as healthy vascular aging (HVA) was 0.521 (95% confidence interval [CI] 0.317 to 0.856) for cfPWV, and 0.565 (95% CI 0.324 to 0.986) for VAI. In terms of the number of steps per day, the OR was 0.931 (95% CI 0.875 to 0.992) for cfPWV and 0.916 (95% CI 0.847 to 0.990) for VAI and for sedentary time the OR was 1.042 (95% CI 1.011 to 1.073) for cfPWV and 1.037 (95% CI 1.003 to 1.072) for VAI. The OR of subjects classified as vigorous physical activity was 0.196 (95% CI 0.041 to 0.941) using cfPWV and 0.161 (95% CI 0.032 to 0.820) using VAI. In the analysis by sex, the results showed an association in men when cfPWV was used and an association in women when VAI was used to define vascular aging. Conclusions: The results of this study indicate that the more time spent performing physical activity and the less sedentary time, the lower the arterial stiffness and the probability of developing early vascular aging. Clinical Trial Registration: The study was registered in ClinicalTrials.gov (number: NCT02623894).

AbstractIntroduction Little is known about the relationship between arterial stiffness and cardiovascular target organ damage (TOD) in the general population. The aim was to analyse the relationship between different measurements of arterial stiffness and TOD, in a general Spanish population without a history of cardiovascular event.Materials and methods Transversal descriptive study. Through stratified random sampling, a total of 501 individuals were included. Carotid-femoral pulse wave velocity (cf-PWV) was measured using a SphygmoCor System®, the cardio-ankle vascular index (CAVI) was determined with aVasera VS-1500® and brachial-ankle pulse wave velocity (ba-PWV)was calculated through a validated equation.Results The average age was 55.84 ± 14.26.The percentage of vascular TOD, left ventricular hypertrophy (LVH) and renal TOD was higher in men (p

The influence of dietary components on vascular dysfunction and aging is unclear. This study therefore aims to propose a model to predict the influence of macro and micronutrients on accelerated vascular aging in a Spanish population without previous cardiovascular disease. This cross-sectional study involved a total of 501 individuals aged between 35 and 75 years. Carotid-femoral pulse wave velocity (cfPWV) was measured using a Sphygmo Cor® device. Carotid intima-media thickness (IMTc) was measured using a Sonosite Micromax® ultrasound machine. The Vascular Aging Index (VAI) was estimated according to VAI = (LN (1.09) × 10 cIMT + LN (1.14) × cfPWV) 39.1 + 4.76. Vascular aging was defined considering the presence of a vascular lesion and the p75 by age and sex of VAI following two steps: Step 1: subjects were labelled as early vascular aging (EVA) if they had a peripheral arterial disease or carotid artery lesion. Step 2: they were classified as EVA if the VAI value was >p75 and as normal vascular aging (NVA) if it was ≤p75. To predict the model, we used machine learning algorithms to analyse the association between macro and micronutrients and vascular aging. In this article, we proposed the AdXGRA model, a stacked ensemble learning model for diagnosing vascular aging from macro and micronutrients. The proposed model uses four classifiers, AdaBoost (ADB), extreme gradient boosting (XGB), generalized linear model (GLM), and random forest (RF) at the first level, and then combines their predictions by using a second-level multilayer perceptron (MLP) classifier to achieve better performance. The model obtained an accuracy of 68.75% in prediction, with a sensitivity of 66.67% and a specificity of 68.79%. The seven main variables related to EVA in the proposed model were sodium, waist circumference, polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), total protein, calcium, and potassium. These results suggest that total protein, PUFA, and MUFA are the macronutrients, and calcium and potassium are the micronutrients related to EVA.

Abstract Background Daily aerobic exercise such as healthy walking could have an immediate effect on parameters of arterial stiffness; however, there is little evidence in the diabetic population. Our aim, therefore, is to evaluate the association between healthy walking and acute effects on the parameters of arterial stiffness in subjects with type 2 diabetes. Methods The Effectiveness of a multifactorial intervention in diabetics study (EMID), is a study based on an application for smartphones, healthy walking and a nutritional workshop in patients with type 2 diabetes in primary care, is a randomized controlled trial of two parallel groups. This is a subanalysis of the intervention group to evaluate the response to the healthy walking according to age and sex, in 89 subjects with type 2 diabetes, aged between 40 and 70 years. The intervention was a 4 km of a healthy walking at low-moderate intensity. To value our aim, the main study variables were measured before and after it. Results The study population had an average age of 65.0 years (61.2–68.1). After the healthy walking, there was a decrease in the parameters of arterial stiffness: Cardio ankle vascular index (CAVI) of − 0.2 (95%CI:-0.4 to − 0.1) and pulse pressure (PP) of the lower extremities of − 3.9 mmHg (95%CI: -5.9 to − 2.0). Furthermore, in the lower extremities there was a decrease in systolic blood pressure of − 5.3 mmHg (95% CI: -7.3 mmHg to − 3.3 mmHg), in diastolic blood pressure of − 1.5 mmHg (95% CI: -2.6 mmHg to − 0.4 mmHg) (p 0.05), compared with females. Conclusions The findings of this study suggest that daily aerobic exercise at a low to moderate intensity, such as healthy walking, has an immediate beneficial effect on the cardio-ankle vascular index, especially in males. Trial registration ClinicalTrials.gov identifier: NCT02991079.

Background: Vitamin D deficiency affects the general population and is very common among elderly Europeans. This study compared different supervised learning algorithms in a cohort of Spanish individuals aged 35–75 years to predict which anthropometric parameter was most strongly associated with vitamin D deficiency. Methods: A total of 501 participants were recruited by simple random sampling with replacement (reference population: 43,946). The analyzed anthropometric parameters were waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), body roundness index (BRI), visceral adiposity index (VAI), and the Clinical University of Navarra body adiposity estimator (CUN-BAE) for body fat percentage. Results: All the anthropometric indices were associated, in males, with vitamin D deficiency (p < 0.01 for the entire sample) after controlling for possible confounding factors, except for CUN-BAE, which was the only parameter that showed a correlation in females. Conclusions: The capacity of anthropometric parameters to predict vitamin D deficiency differed according to sex; thus, WC, BMI, WHtR, VAI, and BRI were most useful for prediction in males, while CUN-BAE was more useful in females. The naïve Bayes approach for machine learning showed the best area under the curve with WC, BMI, WHtR, and BRI, while the logistic regression model did so in VAI and CUN-BAE.

Abstract Background Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. Methods This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the “5A’s”. It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the “Consolidated Framework for Implementation Research”, a set of discrete implementation strategies and an evaluation framework. Discussion EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. Trial registration ClinicalTrials.gov, NCT03136211.Retrospectively registered on May 2, 2017.

Abstract Background We aimed to simplify information from food frequency questionnaires (FFQs) in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV). Methods The sample from the EVIDENT study, consisting of 1553 subjects (aged 20–80 years) with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0–100) was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD). Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured. Results Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score) had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity). In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR), blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively (p

Objetivo: Se describen los datos basales de clase y capacidad funcional, comorbilidades, calidad de vida y cambios en la medicación durante la optimización del tratamiento, en pacientes con insuficiencia cardiaca y función sistólica deprimida (ICFSD) incluidos en el estudio EFICAR. Diseño: Ensayo clínico aleatorizado multicéntrico. Emplazamiento: Siete Centros de Salud. Participantes: Ciento cincuenta pacientes con ICFSD; edad 68 ± 10 años, 77% varones Mediciones: Variables sociodemográficas e índice de Charlson. Se evaluó la calidad de vida y la capacidad funcional Se realizó optimización del tratamiento. Resultados: La etiología principal fue la cardiopatía isquémica (45%). Índice de Charlson global: 2,03 ± 1,05. El 31% ingresaron durante el último año por insuficiencia cardiaca. Fracción de eyección media: 37% ± 8. Clase funcional ii: 89%. Capacidad funcional con prueba de esfuerzo: 6,3 ± 1,6. Test 6 min: 446 ± 78 m. Test de la silla: 13,7 ± 4,4 s. Dinamómetro: 34,53 ± 10,12 kgf y 0,58 ± 0,16 bar. Short Form-36 Health Survey: salud física: 43,3 ± 8,4; salud mental: 50,1 ± 10,6. Minnesota Living with Heart Failure Questionnaire global: 22,8 ± 18,7. Tras optimizar el tratamiento no varió el porcentaje de pacientes ni la dosis media de fármacos analizados. Conclusiones: La mayoría de los sujetos están en clase funcional ii, con capacidad funcional y calidad de vida disminuida e índice de comorbilidad elevado. Un ajuste protocolizado del tratamiento no consigue aumentar la dosis ni el número de pacientes con fármacos eficaces para la insuficiencia cardiaca con función cardiaca deprimida.

An automated method for measuring arterial path length with devices that determine pulse wave velocity (PWV) in peripheral arteries is frequently applied. We aimed to compare arterial path length measurements based on mathematical height-based formulas with those measured manually and to assess whether the ankle-brachial difference (abD-PWV) measured with the VOPITB device is comparable to that obtained by manual measurements. In 245 patients, a metric measuring tape was used to determine the arterial path length from the suprasternal notch to the midpoint of the VOPITB cuffs wrapped around the extremities, and the results were compared with those obtained with height-based formulas. We examined the relationship between the abD-PWV measured with both methods. The arterial path length measured manually was shorter than that calculated automatically by 5 ± 2 and 30 ± 4 cm-of 13% and 21% for the arms and legs, respectively (difference of 13% and 21%). As a result, the abD-PWV calculated with the automatic method was greater (automatic abD-PWV vs. manual: 462 ± 90 vs. 346 ± 79 cm/s). The Blant Altman plot showed a percentage error of: 15,2%, 7,5% and 17,3% for heart-brachial, heart-ankle length and abD-PWV respectively. In conclusion there were significant differences between manual and automated arterial length measurements and it translates into difference abD-PWV calculate from both methods. However, the Bland-Alman plot showed that abD-PWV was comparable for both techniques. The advantages of height-based formulas for the calculation of arterial path lengths suggest that they may be the recommended method for measuring the abD-PWV.

This paper presents a technological platform specialized in assessing retinal vessel caliber and describing the relationship of the results obtained to cardiovascular risk. Retinal circulation is an area of active research by numerous groups, and there is general experimental agreement on the analysis of the patterns of the retinal blood vessels in the normal human retina. The development of automated tools designed to improve performance and decrease interobserver variability, therefore, appears necessary.

This paper presents a technological platform specialized in assessing retinal vessel caliber and describing the relationship of the results obtained to cardiovascular risk. Retinal circulation is an area of active research by numerous groups, and there is general experimental agreement on the analysis of the patterns of the retinal blood vessels in the normal human retina. The development of automated tools designed to improve performance and decrease interobserver variability, therefore, appears necessary.

It has been highlighted the original article (1) contained a typesetting mistake in the authorship, and that author Caterine Vicens was omitted.

Fundamentos: Con frecuencia encontramos deficiencias en el manejo de los factores de riesgo en las personas hipertensas. El objetivo del estudio fue evaluar el efecto de una intervención de mejora de calidad en la atención a los factores de riesgo cardiovascular en personas hipertensas. Métodos: Estudio de mejora de calidad. Dos centros de salud y catorce médicos de familia. Un centro (siete médicos) se seleccionó para recibir una intervención de mejora de calidad y otro como grupo control. Se incluyó a 482 personas hipertensas en el grupo de estudio [64% mujeres, edad media 61,4 años (DS:6.8)] y 360 en el grupo control (63% mujeres, edad media 60,7 (DS:7.4)). La intervención consistió en una auditoria de historias clínicas con feedback, sesiones de entrenamiento y discusión de guías clínicas. Previamente a la intervención y un año después de la misma se evaluaron criterios de proceso de atención a personas hipertensas, presión arterial, peso, lípidos, tabaco, riesgo cardiovascular y fármacos antihipertensivos. Resultados: La mejora media en el proceso después de la intervención fue de 5,3 puntos porcentuales (CI95%:3,7-6,9). La presión arterial sistólica descendió 3,5 mmHg (IC95%:1,6-5,3) y la presión arterial diastólica 2,5 mmHg (IC95%:1,3-3,8). El control adecuado de la presión arterial se incrementó en el grupo de intervención (29,1% a 40,9%; p

Fundamento La evolución del riesgo cardiovascular estimado, puede servir para valorar la efectividad de las diferentes intervenciones terapéuticas que se realizan en pacientes con seguimiento habitual en las consultas del médico de familia. El objetivo de este trabajo es comparar diferentes sistemas de evaluación del efecto de las intervenciones preventivas en la evolución del riesgo coronario en el seguimiento a largo plazo de personas hipertensas en Atención Primaria. Métodos: Estudio descriptivo longitudinal con seguimiento de 8.42 pacientes hipertensos de 34 a 70 años durante 6 años en dos centros de atención primaria, con una intervención de mejora de calidad (ciclo de mejora) en el último año en uno de ellos. El seguimiento mínimo en atención primaria previo al inicio del estudio fue de dos años. Las variables principales fueron edad y sexo, presión arterial, lípidos, tabaquismo, diabetes y riesgo cardiovascular (RCV)(Framingham-Wilson) en la situación real y considerando constante la edad en el primer supuesto y los factores de riesgo en el segundo y el riesgo relativo. Resultados: Se encontró un descenso de la presión arterial sistólica y diastólica de 11,78 mmHg (IC95%:10,51-13,05) y 8,83 mmHg (IC95%:8,13-9,53) respectivamente y LDL-Colesterol 15,94 mg/dl (IC95%:11,77-20,12), un ascenso del HDLColesterol de 7,53 mg/dl (IC95:6,39-8,66), disminución del tabaquismo del 31% y un aumento de diabéticos. El riego coronario disminuyó 1,40(IC95%:0,87-1,93) puntos porcentuales, el RCV con edad constante descendió 3,84(IC95%:3,35-4,33) y con factores de riesgo constantes incrementó 3,06(IC95%:2,82- 3,29). El Riesgo relativo descendió de 2,50 a 1,85. Conclusiones: El envejecimiento puede enmascarar el efecto logrado por la atención sanitaria en el control del riesgo cardiovascular absoluto. El riesgo relativo podría ser una alternativa para monitorizar el seguimiento.

We investigated the relationship between leukocyte subtype counts and vascular structure and function based on carotid intima-media thickness, pulse wave velocity, central augmentation index and cardio-ankle vascular index by gender in intermediate cardiovascular risk patients.This study analyzed 500 subjects who were included in the MARK study, aged 35 to 74 years (mean: 60.3±8.4), 45.6% women.Brachial ankle Pulse Wave Velocity (ba-PWV) estimate by equation, Cardio-AnkleVascular Index (CAVI) using the VaSera device and Carotid ultrasound was used to measure carotid Intima Media Thickness (IMT). The Mobil-O-Graph was used to measure the Central Augmentation Index (CAIx).Total leukocyte, neutrophil and monocyte counts were positively correlated with IMT (p < 0.01) in men. Monocyte count was positively correlated with CAIx in women (p < 0.01). In a multiple linear regression analysis, the IMT mean maintained a positive association with the neutrophil count (β = 1.500, p = 0.007) in men. CAIx maintained a positive association with the monocyte count (β = 2.445, p = 0.022) in women.The results of this study suggest that the relationship between subtype circulating leukocyte counts and vascular structure and function, although small, may be different by gender. In men, the neutrophil count was positively correlated with IMT and in women, the monocyte count with CAIx, in a large sample of intermediate-risk patients. These association were maintained after adjusting for age and other confounders.ClinicalTrials.gov NCT01428934.

ObjectiveTo analyze the relationship between regular physical activity, as assessed by accelerometer and 7-day physical activity recall (PAR), and plasma fibrinogen concentrations.MethodsA cross-sectional study in a previously established cohort of healthy subjects was performed. This study analyzed 1284 subjects who were included in the EVIDENT study (mean age 55.0±13.6 years; 60.90% women). Fibrinogen concentrations were measured in blood plasma. Physical activity was assessed with a 7-day PAR (metabolic equivalents (METs)/hour/week) and GT3X ActiGraph accelerometer (counts/minute) for 7 days.ResultsPhysical exercise, which was evaluated with both an accelerometer (Median: 237.28 counts/minute) and 7-day PAR (Median: 8 METs/hour/week). Physical activity was negatively correlated with plasma fibrinogen concentrations, which was evaluated by counts/min (r = -0.100; pConclusionsPhysical activity, as assessed by accelerometer and 7-day PAR, was negatively associated with plasma fibrinogen concentrations. This relation is maintained in subjects who performed more exercise even after adjusting for age and other confounders.

BackgroundHigh systolic blood pressure is one of the leading global risk factors for mortality, contributing significantly to cardiovascular diseases. Despite advances in treatment, a large proportion of patients with hypertension do not achieve optimal blood pressure control. Arterial stiffness (AS), measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and overall mortality. Various antihypertensive drugs exhibit differential effects on PWV, but the extent to which these effects vary depending on individual patient characteristics is not well understood. Given the complexity of selecting the most appropriate antihypertensive medication for reducing PWV, machine learning (ML) techniques offer an opportunity to improve personalized treatment recommendations. ObjectiveThis study aims to develop an ML model that provides personalized recommendations for antihypertensive medications aimed at reducing PWV. The model considers individual patient characteristics, such as demographic factors, clinical data, and cardiovascular measurements, to identify the most suitable antihypertensive agent for improving AS. MethodsThis study, known as the RIGIPREV study, used data from the EVA, LOD-DIABETES, and EVIDENT studies involving individuals with hypertension with baseline and follow-up measurements. Antihypertensive drugs were grouped into classes such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, diuretics, and combinations of diuretics with ACEIs or ARBs. The primary outcomes were carotid-femoral and brachial-ankle PWV, while the secondary outcomes included various cardiovascular, anthropometric, and biochemical parameters. A multioutput regressor using 6 random forest models was used to predict the impact of each antihypertensive class on PWV reduction. Model performance was evaluated using the coefficient of determination (R2) and mean squared error. ResultsThe random forest models exhibited strong predictive capabilities, with internal validation yielding R2 values between 0.61 and 0.74, while external validation showed a range of 0.26 to 0.46. The mean squared values ranged from 0.08 to 0.22 for internal validation and from 0.29 to 0.45 for external validation. Variable importance analysis revealed that glycated hemoglobin and weight were the most critical predictors for ACEIs, while carotid-femoral PWV and total cholesterol were key variables for ARBs. The decision tree model achieved an accuracy of 84.02% in identifying the most suitable antihypertensive drug based on individual patient characteristics. Furthermore, the system’s recommendations for ARBs matched 55.3% of patients’ original prescriptions. ConclusionsThis study demonstrates the utility of ML techniques in providing personalized treatment recommendations for antihypertensive therapy. By accounting for individual patient characteristics, the model improves the selection of drugs that control blood pressure and reduce AS. These findings could significantly aid clinicians in optimizing hypertension management and reducing cardiovascular risk. However, further studies with larger and more diverse populations are necessary to validate these results and extend the model’s applicability.