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2. Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol

Author

Pérula-de-Torres LuisÁ, Martínez-Adell MiguelÁ, González-Blanco Virginia, Baena-Díez José M, Martín-Rioboó Enrique, Parras-Rejano Juan M, González-Lama Jesús, Martín-Alvarez Remedios, Ruiz-Moral Roger, Fernández-García JoséÁ, Pérez-Díaz Modesto, Ruiz-de-Castroviejo Joaquin, Pérula-de-Torres Carlos, Valero-Martín Antonio, Roldán-Villalobos Ana, Criado-Larumbe Margarita, Burdoy-Joaquín Emili, Coma-Solé Montserrat, Cervera-León Mercè, and Cuixart-Costa Lluís

Subjects
Atrial fibrillation, Screening, Opportunistic case finding, Secondary prevention, Primary care, Medicine (General), R5-920
Abstract

Abstract Background Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers. Methods/design An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis). Discussion If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines. Trial registration The study is registered as NCT01291953 (ClinicalTrials.gob)

Published
2012
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3. Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases

Author

Pericet-Rodriguez, Cristina, López-Aguilera, José, Durán-Torralba, Carmen, Castillo-Dominguez, Juan Carlos, Ruiz-Ortiz, Martín, Perea-Armijo, Jorge, Delgado-Ortega, Mónica, Mesa-Rubio, Dolores, González-Manzanares, Rafael, Ruiz de Castroviejo, Joaquín, Martín-Dorado, Ernesto, Gallo-Fernández, Ignacio, López-Baizán, Josúe, Pastor-Wulf, Daniel, Rodriguez-Almodovar, Ana, Pan Álvarez-Osorio, Manuel, and Anguita-Sánchez, Manuel

Published
2022
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4. Alteraciones electrocardiográficas y necesidad de marcapasos en amiloidosis cardiaca: análisis de 58 casos

Author

Pericet-Rodriguez, Cristina, López-Aguilera, José, Durán-Torralba, Carmen, Castillo-Dominguez, Juan Carlos, Ruiz-Ortiz, Martín, Perea-Armijo, Jorge, Delgado-Ortega, Mónica, Mesa-Rubio, Dolores, González-Manzanares, Rafael, Ruiz de Castroviejo, Joaquín, Martín-Dorado, Ernesto, Gallo-Fernández, Ignacio, López-Baizán, Josúe, Pastor-Wulf, Daniel, Rodriguez-Almodovar, Ana, Pan Álvarez-Osorio, Manuel, and Anguita-Sánchez, Manuel

Published
2022
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5. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial

Author

Alcala-Diaz, Juan F, Almaden Peña, Yolanda, Aranda, Enrique, Arenas de Larriva, Antonio P, Badimon, Lina, Badimon, Juan J, Blanco-Molina, Angeles, Blanco-Rojo, Ruth, Bolivar-Muñoz, Julia, Caballero-Villarraso, Javier, Camargo, Antonio, Chica, Javier, Corina, Andreea, Criado-Garcia, Juan, Cruz-Teno, Cristina, Daponte-Codina, Antonio, de Teresa Galvan, Eduardo, Delgado-Casado, Nieves, Delgado-Lista, Javier, Estruch, Ramon, Fernandez, Juan M, Fernandez-Gandara, Carolina, Fuentes-Jimenez, Francisco, Garcia-Carpintero Fernandez-Pacheco, Sonia, Garcia-Rios, Antonio, Gomez-Delgado, Francisco, Gomez-Garduño, Angela, Gomez-Luna, Purificacion, Gomez-Luna, Maria J, Gonzalez-Guardia, Lorena, Gonzalez-Requero, Ana I., Gutierrez-Mariscal, Francisco M, Haro-Mariscal, Carmen M, Jimenez-Lucena, Rosa, Jimenez-Morales, Ana I., Leon-Acuña, Ana, Lopez-Miranda, Jose, Lopez-Segura, Fernando, Marin-Hinojosa, Carmen, Meneses Alvarez, Maria E, Mesa-Luna, Dolores, Moya-Garrido, Maria N, Muñoz-Carvajal, Ignacio, Navarro-Martos, Vanessa, Ochoa, Juan J, Ordovas, Jose M, Ortiz-Minuesa, Juan A, Ortiz-Morales, Ana M, Pan, Manuel, Peña-Orihuela, Patricia, Perez-Caballero, Ana I, Perez-Corral, Isabel, Perez-Jimenez, Francisco, Perez-Martinez, Pablo, Pi-Sunyer, Francesc X, Quintana-Navarro, Gracia M, Ramirez-Lara, Irene, Rangel-Zuñiga, Oriol A, Rodriguez-Artalejo, Fernando, Rodriguez-Cantalejo, Fernando, Romero, Miguel A, Roncero-Ramos, Irene, Ruano-Ruiz, Juan A., Ruiz de Castroviejo, Joaquin, Sanchez-Villegas, Pablo, Suarez de Lezo, Jose, Suarez de Lezo, Javier, Torres-Peña, Jose D, Vals-Delgado, Cristina, Valverde, Roberto, Visioli, Francisco, Yubero-Serrano, Elena M, Fuentes, Francisco, and Gonzalez-Requero, Ana I

Published
2022
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6. Caracterización y pronóstico del paciente con amiloidosis cardiaca: experiencia de un centro

Author

Pericet-Rodríguez, Cristina, López-Aguilera, José, Durán-Torralba, Carmen, Castillo-Domínguez, Juan Carlos, Ruiz-Ortiz, Martín, Perea-Armijo, Jorge, Delgado-Ortega, Mónica, Mesa-Rubio, Dolores, González-Manzanares, Rafael, Ruiz de Castroviejo, Joaquín, Esteban-Martínez, Fátima, López-Granados, Amador, Maza-Muret, Roberto, Espejo-Pérez, Simona, Ortega-Salas, Rosa, Álvarez-Ossorio, Manuel Pan, and Anguita-Sánchez, Manuel

Published
2022
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7. Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial

Author

González Blanco, Virginia, Pérula de Torres, Luis Ángel, Martín Rioboó, Enrique, Martínez Adell, Miguel Ángel, Parras Rejano, Juan Manuel, González Lama, Jesús, Ruiz Moruno, Javier, Martín Alvarez, Remedios, Fernández García, José Ángel, Ruiz de Castroviejo, Joaquin, Roldán Villalobos, Ana, and Ruiz Moral, Roger

Published
2017
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8. Cribado oportunista de fibrilación auricular frente a detección de pacientes sintomáticos de 65 años o más: ensayo clínico controlado por clúster

Author

González Blanco, Virginia, Pérula de Torres, Luis Ángel, Martín Rioboó, Enrique, Martínez Adell, Miguel Ángel, Parras Rejano, Juan Manuel, González Lama, Jesús, Ruiz Moruno, Javier, Martín Alvarez, Remedios, Fernández García, José Ángel, Ruiz de Castroviejo, Joaquin, Roldán Villalobos, Ana, and Ruiz Moral, Roger

Published
2017
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9. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial

Author

Delgado-Lista, Javier, primary, Alcala-Diaz, Juan F, additional, Torres-Peña, Jose D, additional, Quintana-Navarro, Gracia M, additional, Fuentes, Francisco, additional, Garcia-Rios, Antonio, additional, Ortiz-Morales, Ana M, additional, Gonzalez-Requero, Ana I, additional, Perez-Caballero, Ana I, additional, Yubero-Serrano, Elena M, additional, Rangel-Zuñiga, Oriol A, additional, Camargo, Antonio, additional, Rodriguez-Cantalejo, Fernando, additional, Lopez-Segura, Fernando, additional, Badimon, Lina, additional, Ordovas, Jose M, additional, Perez-Jimenez, Francisco, additional, Perez-Martinez, Pablo, additional, Lopez-Miranda, Jose, additional, Almaden Peña, Yolanda, additional, Aranda, Enrique, additional, Arenas de Larriva, Antonio P, additional, Badimon, Juan J, additional, Blanco-Molina, Angeles, additional, Blanco-Rojo, Ruth, additional, Bolivar-Muñoz, Julia, additional, Caballero-Villarraso, Javier, additional, Chica, Javier, additional, Corina, Andreea, additional, Criado-Garcia, Juan, additional, Cruz-Teno, Cristina, additional, Daponte-Codina, Antonio, additional, de Teresa Galvan, Eduardo, additional, Delgado-Casado, Nieves, additional, Delgado-Lista, Javier, additional, Estruch, Ramon, additional, Fernandez, Juan M, additional, Fernandez-Gandara, Carolina, additional, Fuentes-Jimenez, Francisco, additional, Garcia-Carpintero Fernandez-Pacheco, Sonia, additional, Gomez-Delgado, Francisco, additional, Gomez-Garduño, Angela, additional, Gomez-Luna, Purificacion, additional, Gomez-Luna, Maria J, additional, Gonzalez-Guardia, Lorena, additional, Gonzalez-Requero, Ana I., additional, Gutierrez-Mariscal, Francisco M, additional, Haro-Mariscal, Carmen M, additional, Jimenez-Lucena, Rosa, additional, Jimenez-Morales, Ana I., additional, Leon-Acuña, Ana, additional, Marin-Hinojosa, Carmen, additional, Meneses Alvarez, Maria E, additional, Mesa-Luna, Dolores, additional, Moya-Garrido, Maria N, additional, Muñoz-Carvajal, Ignacio, additional, Navarro-Martos, Vanessa, additional, Ochoa, Juan J, additional, Ortiz-Minuesa, Juan A, additional, Pan, Manuel, additional, Peña-Orihuela, Patricia, additional, Perez-Corral, Isabel, additional, Pi-Sunyer, Francesc X, additional, Ramirez-Lara, Irene, additional, Rodriguez-Artalejo, Fernando, additional, Romero, Miguel A, additional, Roncero-Ramos, Irene, additional, Ruano-Ruiz, Juan A., additional, Ruiz de Castroviejo, Joaquin, additional, Sanchez-Villegas, Pablo, additional, Suarez de Lezo, Jose, additional, Suarez de Lezo, Javier, additional, Vals-Delgado, Cristina, additional, Valverde, Roberto, additional, and Visioli, Francisco, additional

Published
2022
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10. Abrupt homeostatic responses to transient intracardiac occlusion during balloon valvuloplasty

Author

Suarez de Lezo, Jose, Montilla, Pedro, Pan, Manuel, Romero, Miguel, Sancho, Manuel, Ruiz de Castroviejo, Joaquin, Tejero, Inmaculada, Arizon, Jose, Carrasco, Jose Luis, Rejano, Ana, and Martinez, Carlos

Subjects
Homeostasis -- Measurement, Vasopressin -- Measurement, Hemodynamic monitoring -- Research, Natriuretic peptides -- Measurement, Balloon dilatation -- Complications, Health
Abstract

The present study analyzes the hemodynamics of intracardiac occlusive priods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 [+ or -] 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p [is less than]0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p [is less than]0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed., Homeostatic response refers to the adjustment of the body to maintain equilibrium which is sustained via feedback and regulation mechanisms. A study of the response to abrupt physiological changes was performed by the measurement of plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity prior to and at intervals after balloon valvuloplasty was performed on 49 patients. These three hormones are involved in the control of blood pressure by their effect on the blood vessels. Thirty-three patients had stenosis (narrowing or closing) of the mitral valve in the heart and 16 had stenosis of the aorta, the main arterial vessel leading from the heart. Balloon angioplasty involves the insertion of a tube with a small balloon at its end into the artery; the balloon is inflated at the point of closure to open the vessel and increase blood flow. Dilations were monitored from the ascending aorta and from the left atrium. Baseline blood level measurements of the hormones were first taken at 15 to 30 seconds after the procedure and again at one to seven hours after the procedure, and were then plotted against systemic blood pressure. Changes in concentrations of these hormones were observed to correlate with changes in blood flow produced by the angioplasty; abrupt release of ANF and vasopressin occurred. Increase in ANF was found to be proportional and elevated vasopressin concentrations correlated exponentially. No change in renin levels was recorded. The effect of vasopressin release may provide rapid control of arterial pressure and thus account for the patients' good general tolerance of the balloon valvuloplasty. However, the release of higher concentrations of ANF would likely counteract the effects of vasopressin. The benefits and the apparent contradictory behavior of these mechanisms need to be better understood and further research is recommended.

Published
1989

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