[European study of ambulatory management of heart failure by cardiologists]. / Estudio europeo del tratamiento ambulatorio de la insuficiencia cardíaca realizado por cardiólogos.

INTRODUCTION AND OBJECTIVES: This cross-sectional study examined the overall clinical characteristics and management of 1252 outpatients with heart failure in 3 countries (Spain, France and Germany). MATERIAL AND METHOD: A standardized questionnaire was used to record demographic, diagnostic, clinical and treatment data for all patients seen on one day (26 April 2001) by 465 outpatient cardiologists. RESULTS: Men accounted for 62.1% of the patients in the population, and mean age of the patients was 68.3 years. In the twelve months prior to the study 78% of the patients consulted their physician at least once because of heart failure, and 36.2% had hospital admissions. Differences between the three countries were observed in reported causes of heart failure (alone or in combination) such as ischemic heart disease (France 40.7%, Germany 41.3%, Spain 26%, P<.0001) and hypertension (France 10.7%, Germany 16.7%, Spain 43.6%, P<.0001). How-ever the proportion of patients with prior myocardial infarction was very similar (France 63.7%, Germany 69.5%, Spain 65%, P=NS). Diuretics were not prescribed in 19.7% of the patients, ACE inhibitors were not prescribed in 27.9%, and beta blockers were not prescribed in 52.3%. CONCLUSIONS: The study provides further information on the consumption of large amounts of medical resources because of heart failure. The reported etiologies differed between countries. However, the proportion of patients with prior myocardial infarction was very similar. Treatment with ACE inhibitors and beta blockers was slightly more common than previously reported, although beta blockers continue to be underused.

Control of risk factors in and treatment of patients with coronary heart disease: the TRECE study.

The aim of the TRECE study was to describe treatment in patients with coronary heart disease (CHD). It was an observational, cross-sectional multicenter study of patients who were treated in either an internal medicine (n=50) or cardiology (n=50) department or in primary care (n=100) during 2006. The patients' history, risk factors and treatment were recorded, and noncardiac disease was evaluated using the Charlson index. Optimal medical treatment (OMT) was regarded as comprising combined administration of antiplatelet agents, statins, beta-blockers, and renin-angiotensin-aldosterone system blockers. In total, data on 2897 patients were analyzed; their mean age was 67.4 years and 71.5% were male. Overall, 25.9% (95% confidence interval, 25.6-26.2%) received OMT. Multivariate analysis showed that prescription of OMT was independently associated with hypertension, diabetes, current smoking, myocardial infarction and angina. In contrast, nonprescription of OMT was associated with atrial fibrillation, chronic obstructive pulmonary disease and a Charlson index>/=4. The main findings were that few CHD patients were prescribed OMT and that its prescription was determined by the presence of symptoms and comorbid conditions.

Differences in medical treatment of chronic coronary heart disease patients according to medical specialities.

Coronary heart disease (CHD) patients are currently attended by many different medical specialities. CHD patients must achieve the highest grade of treatment implementation and risk factors control. The aims were to describe differences in medical treatment of CHD according to the medical specialities. For this purpose we conducted an observational, cross-sectional, and multicenter study of CHD patients attended by internal medicine (IM), outpatient clinic cardiologist (OCC), hospital cardiologist (HC), and general practitioners (PC). Burden of noncardiac diseases was evaluated by the Charlson index. Joint prescription of antiplatelets, statins, beta-blockade agents and blockade of the renin-angiotensin system by angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptors blockers (ARB) was considered optimal medical treatment (OMT). A total of 2987 patients, mean age 67.4 (11.5) years and 71.5% males, were analyzed. Patients visited by IM physicians had slightly higher mean age and higher prevalence of hypertension, diabetes, and noncardiac diseases (median Charlson index 3.0, 1.0-5.0, vs. 2.0, 1.0-4.0, of total sample). OMT was prescribed in 25.9% (95% CI 25.6-26.2) of the patients and was statistically more frequently carried out by HC (32.1%) and OCC (29.0%) compared to IM (22.0%) and PC practitioners (21.5%). Multivariate analysis showed an independent association between OMT prescription and HC (OR 1.42; 95% CI 1.08-1.87) or OCC (OR 1.31; 95% CI 1.04-1.67); this association remained after including the Charlson index. Noncardiac diseases are the main clinical differences in CHD patients visited by different medical specialist although it does not explain the higher prescription of OMT by cardiologist.

Health-related quality of life in unselected outpatients with heart failure across Spain in two different health care levels. Magnitude and determinants of impairment: the INCA study.

AIMS: To assess health-related quality of life (HRQL) in Spanish outpatients with chronic heart failure (CHF). METHODS: Cross-sectional study carried out in a sample of CHF patients (echocardiography was performed in all of them) followed either in Primary Care (PC) centres or Cardiology outpatient clinics throughout Spain. HRQL was evaluated using the EuroQol 5D (EQ-5D) and Minnesota Living with Heart Failure (MLWHF) Questionnaire. RESULTS: The study subjects were 2161 CHF patients (1412 PC; 749 Cardiology). Patients were older and had more severe disease in PC than in Cardiology settings. Their HRQL scores were likewise worse. After adjusting for clinical variables, the differences in global and physical MLWHF disappeared, but persisted to a smaller degree in EQ-5D and mental MLWHF. HRQL was worse than in a representative sample of the Spanish population and in other chronic conditions such as rheumatoid arthritis or type 2 diabetes, being only comparable to severe chronic obstructive pulmonary disease (COPD). CONCLUSION: All domains of HRQL were significantly impaired in CHF patients. Differences found in HRQL between PC and Cardiology should possibly be attributed to a large extent to the different clinical characteristics of the patients attended. In spite of the differences between EQ-5D and MLWHF, our results suggest that both questionnaires adequately reflect the severity of the disease.

[Electrocardiographic criteria for left ventricular hypertrophy and cardiovascular risk in hypertensives. VIIDA study]. / Criterios electrocardiográficos de hipertrofia ventricular izquierda y perfil de riesgo cardiovascular en hipertensos. Estudio VIIDA.

INTRODUCTION AND OBJECTIVES: To determine whether Cornell and Sokolow-Lyon criteria identify different groups of patients with left ventricular hypertrophy (LVH), and whether there is a relationship between hypertrophy severity and the prevalence of cardiovascular disease. METHODS: Cross-sectional multicenter study carried out in cardiology departments on hypertensive patients with electrocardiographic LVH, as defined by Cornell or Sokolow-Lyon criteria. Blood pressure (BP) and clinical and laboratory data were recorded. The study population was divided into quartiles according to electrocardiographic findings to enable relationships with cardiovascular disease to be evaluated. RESULTS: Overall, 3074 patients with LVH were studied: 978 (31.8%) met both LVH criteria, 1244 (40.5%) met Cornell criteria only, and 852 (27.7%) met Sokolow-Lyon criteria only. Fulfillment of Sokolow-Lyon criteria was associated with male gender, a low body mass index (BMI), a low prevalence of diabetes, and a high prevalence of myocardial infarction. Fulfillment of Cornell criteria was associated with female gender, a high BMI, and a high prevalence of diabetes. Fulfillment of both criteria was associated with poor BP control and a high prevalence of heart failure. Associations were observed between LVH severity and the prevalence of cardiovascular disease: the adjusted odds ratio for the upper versus the lower quartile was 1.65 (P=.011) for Sokolow-Lyon criteria, 1.59 (P=.014) for Cornell criteria, and 2.03 (P=.001) for both combined. CONCLUSIONS: Sokolow-Lyon and Cornell criteria identify patients with different high-risk cardiovascular risk profiles. Consequently, it would be preferable to use both criteria as this would increase the detection rate of electrocardiographic LVH. Moreover, there is a relationship between the severity of electrocardiographic LVH and the prevalence of established cardiovascular disease.

[Blood pressure control in hypertensive patients with left ventricular hypertrophy. The VIIDA Study]. / Control de las cifras de presión arterial en los pacientes hipertensos con hipertrofia ventricular: estudio VIIDA.

INTRODUCTION AND OBJECTIVES: The aims were to determine the effectiveness of blood pressure (BP) control in hypertensive patients with left ventricular hypertrophy (LVH), as detected by ECG, and to identify the variables associated with poor control, particularly in diabetics. METHODS: The study included hypertensive patients with ECG evidence of LVH who attended cardiology outpatient clinics between April 2003 and November 2004. Patient characteristics and clinical variables were recorded on admission to the study. RESULTS: Of the 16,123 patients included, 4037 (25.04%) had LVH at presentation. Some 58.1% of these latter patients had a history of cardiovascular disease. Only 8.1% of diabetic patients had BP values below 130/80 mmHg, whereas 22.4% of nondiabetic patients were well-controlled. Multivariate analysis showed that the only independent predictors of poor BP control were diabetes (odds ratio [OR] 3.62, 95% confidence interval [CI] 2.7-4.7), female sex (OR 1.18, 95% CI 1.02-1.33), increased voltage recording in lead V5 (OR 1.027 per mm, 95% CI 1.01-1.03), and body mass index (OR 1.03, 95% CI 1.00-1.05), whereas a history of cardiovascular disease was associated with good BP control (OR 0.57, 95% CI 0.48-0.70). CONCLUSIONS: The prevalence of LVH, as identified by ECG, was high in hypertensive patients attending cardiology outpatient clinics, and comorbid conditions were common. Control of BP was suboptimal, particularly in diabetic patients, fewer than 10% of whom were well-controlled. Finally, BP control in patients with LVH was influenced by sex, body mass index, and a history of cardiovascular disease.