Patients With High Cardiovascular Risk as Candidates to Bempedoic Acid, After Treatment With Statins, Ezetimibe and PCSK9 Inhibitors: An Estimation and Cost-Effectiveness Analysis.

ABSTRACT: Low-density lipoprotein cholesterol (LDLc) is the lead effector of atherosclerosis and main treatment target. Bempedoic acid is a novel oral drug in the therapeutic armamentarium which is able to reduce LDLc. The objectives of this study were (1) to select the potential patients for administering bempedoic acid such as those with a very high cardiovascular risk in which objectives of LDLc were not achieved despite conventional treatment with PCSK9 inhibitors (PCSK9i) and/or statins and ezetimibe and (2) to estimate the cost-effectiveness of bempedoic acid in different scenarios. The methods used were a multicenter and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 17 different hospitals. Before and on-treatment LDLc cholesterol levels, medical treatments, clinical indication, and baseline characteristics were recorded. The results obtained from 443 subjects in secondary prevention were analyzed. The mean (±) LDLc level at baseline was 142.5 ± 46.4 mg/dL and 61.5 ± 40.5 mg/dL in the follow-up, with a reduction of 55.9% ( P < 0.0001); 71.6% of the patients reached the target of LDL < 55 mg/dL or >50% reduction. Of those patients treated with medium-intensity and low-intensity statins plus PCSK9 inhibitors (with or without ezetimibe), only 5.7% of them were able to reduce LDL below 55 mg/dL and the main LDLc reduction in this group was the lowest (42.9% on average). Patients with TG values >135 mg/dL represented 41.6% of the sample, of which approximately 10% of them were using fibrates. Assuming only LDLc reduction and the UK price, the incremental cost-effectiveness ratio was 88,359€; 83,117€; 82,378€; and 79,015€ for different discount rates. In conclusion, one-third of the patients could achieve the target LDL proposed in the 2019 ESC/EAS guidelines. Approximately 10% of them could also benefit from treating hypertriglyceridemia as indicated in the 2021 ESC guidelines on cardiovascular disease prevention. Patients with medium-intensity and low-intensity statins plus PCSK9i and ezetimibe would be the most benefited. Bempedoic acid could be a not cost-efficacy therapy in all the scenarios, but we need to wait for the CLEAR OUTCOMES Trial results.

[Effectiveness of the contingency plan of the internal inflammatory disease unit before Covid-19 infection.] / Efectividad del plan de contingencia de la Unidad de Enfermedad Inflamatoria Intestinal ante la infección de Covid-19.

OBJECTIVE: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature. During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients. However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans. The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnés. METHODS: A team of managers and professionals adapted the 10 measures recommended by Deloitte to face a pandemic to the healthcare environment. The measures were then formulated as a checklist. From the Plan-Do-Check-Act improvement cycle, they were grouped into categories: risk management, organizational management and decision-making. Finally, an external team carried out a qualitative evaluation of the implementation of the contingency plan carried out. RESULTS: The Intestinal Inflammatory Disease Unit of the Digestive Service has obtained an assessment of compliance with the 10 recommended measures to confidently face a pandemic. CONCLUSIONS: Sharing the deployment of the contingency plan and its results is useful to identify good practices. This article shows a method to evaluate decision-making in pandemic situations. The outcomes faces the The Intestinal Inflammatory Disease Unit in an excelent position.

OBJETIVO: La toma de decisiones en los hospitales y en sus propios servicios asistenciales apenas está referenciada en la literatura. Durante el período de pandemia por Covid-19, los servicios asistenciales han puesto en marcha planes de contingencia para minimizar las consecuencias del coronavirus en los profesionales y pacientes. Sin embargo, apenas se comparte el despliegue de esos planes de contingencia, ni sus resultados, privando de referencias para refutar, comparar o emular los citados planes a otros servicios asistenciales u hospitales. El objetivo del trabajo fue la descripción de la puesta en marcha de dichos planes ante la pandemia de Covid-19 en la Unidad de Enfermedad Inflamatoria Intestinal de un Servicio de Digestivo en el Área Sanitaria de Pontevedra e O Salnés (Galicia). METODOS: Un equipo de directivos y profesionales adaptaron al entorno sanitario las 10 medidas recomendadas por Deloitte para afrontar una pandemia. A continuación, se formularon las medidas como listado de comprobación. A partir del ciclo de mejora Plan-Do-Check-Act, se agruparon las 10 medidas en las siguientes categorías: gestión del riesgo, gestión organizacional y toma de decisiones. Por último, un equipo externo realizó una evaluación cualitativa de la puesta en marcha del plan de contingencia realizado. RESULTADOS: La Unidad de Enfermedad Inflamatoria Intestinal del Servicio de Digestivo realizó un plan de contingencia que presenta un cumplimiento de las 10 medidas recomendadas para hacer frente a la pandemia de Covid-19 con garantías. CONCLUSIONES: Compartir el despliegue del plan de contingencia y sus resultados es útil para identificar buenas prácticas. Este trabajo ofrece un método para evaluar las tomas de decisiones en los plantes de contingencia en situaciones de pandemia. Los resultados sitúan a la Unidad de Enfermedad Inflamatoria Intestinal en el rango de la excelencia.

Relevant risk factors of repeated suicidal attempts in a sample of outpatients. / Factores predictores de riesgo de repetición de intento de suicidio en una muestra de pacientes ambulatorios.

INTRODUCTION: Suicide is, at present, an important global public health problem; detection of risk factors can be used as a method for prevention and intervention. This study aims to identify predictors of suicide in patients with suicidal attempt retry (SAR), who are followed-up an in the Intensive Intervention Program (PII). MATERIAL AND METHODS: The sample includes patients followed up at the Intensive Intervention Program because of a previous suicidal attempt. The following variables were collected during the 12 months follow-up (baseline, 6 months and 12 months): Repeated attempts, socio-demographic and clinical variables, lack of adherence and the Beck Depression Inventory and Hopelessness Scale. STATISTIC ANALYSIS: The association between SAR and qualitative study variables was performed using Chi-Square and for the quantitative, T-Student was used. The analysis was carried out with the software SPSS 19.0. The study has been approved by the Research Ethics Committee of Galicia. RESULTS: Of the 319 patients, 29 (9%) of them committed a new suicidal attempt, 22 (76%) of these new attempts happened during the first 6 month of the Program. Of those who repeat the attempt, 7 (24%) have a history of a previous attempt that precede the basal attempt (P=.033) in less than 180 days. Medication overdose is the most used method, as it was used by 240 of the patients (76%). 27 (93%) kept drug overdose as their retry method, also reaching significance(P<.001). CONCLUSIONS: Overdose as a method of attempt and re-attempt, and the time elapsed from the previous attempt, are the highlighted risk factors associated with repeated suicidal attempts. For this reason, it is crucial to identify patients with a new suicide attempt so that a more intense intervention and drug treatment control is delivered during the first 180 days.

[Effect of socioeconomic status on mortality in urban areas: a systematic critical review]. / Efecto del nivel socioeconómico sobre la mortalidad en áreas urbanas: revisión crítica y sistemática.

Socioeconomic inequalities cause more disease and death than most risk factors, especially in cities. This systematic review of the scientific evidence included articles in English, Spanish, Portuguese, and Italian and excluded studies with low levels of evidence and those that did not analyze associations between mortality and socioeconomic status in urban settings. Articles were selected by two independent reviewers, and data extraction used evidence tables. A total of 1,509 records were obtained, and 24 were included. All the studies showed higher mortality rates in poorer areas. Six studies showed an association with cardiovascular diseases, four with lung diseases, and three with AIDS, infectious and parasitic diseases, and cirrhosis. The selected studies showed low consistency in the results and important methodological limitations that prevented comparisons between studies or the extraction of relevant conclusions.

Efecto del nivel socioeconómico sobre la mortalidad en áreas urbanas: revisión crítica y sistemática / Effect of socioeconomic status on mortality in urban areas: a systematic critical review / Efeito do status socioeconômico na mortalidade em áreas urbanas: análise crítica sistemática

Las desigualdades socioeconómicas son una causa de mortalidad y morbilidad superior a la mayoría de factores de riesgo, especialmente en el entorno urbano. Se llevó a cabo una revisión sistemática de la evidencia científica, en la que se incluyó artículos en inglés, castellano, portugués e italiano y se excluyeron estudios de baja evidencia, y en los que no se analizaba la relación entre mortalidad y nivel socioeconómico en un entorno urbano. La selección de artículos se llevó a cabo por dos revisores independientes y la extracción de datos se realizó con tablas de evidencia. Se obtuvieron 1.509 registros y se incluyeron 24. En todos los trabajos se observó mayor mortalidad en las áreas con peores indicadores de privación. Se observó asociación con patologías cardiovasculares en seis estudios, en cuatro con patologías pulmonares y en tres con SIDA, infecciones y parasitosis y cirrosis. Los estudios incluidos presentan resultados poco consistentes y limitaciones metodológicas importantes que impiden la comparación entre estudios y la extracción de conclusiones relevantes.

Socioeconomic inequalities cause more disease and death than most risk factors, especially in cities. This systematic review of the scientific evidence included articles in English, Spanish, Portuguese, and Italian and excluded studies with low levels of evidence and those that did not analyze associations between mortality and socioeconomic status in urban settings. Articles were selected by two independent reviewers, and data extraction used evidence tables. A total of 1,509 records were obtained, and 24 were included. All the studies showed higher mortality rates in poorer areas. Six studies showed an association with cardiovascular diseases, four with lung diseases, and three with AIDS, infectious and parasitic diseases, and cirrhosis. The selected studies showed low consistency in the results and important methodological limitations that prevented comparisons between studies or the extraction of relevant conclusions.

As desigualdades socioeconômicas são uma causa de mortalidade e morbidade superior à maioria dos fatores de risco, especialmente no ambiente urbano. Foi realizada uma revisão sistemática da evidência científica, na qual foram incluídos artigos em inglês, espanhol, português e italiano, e da qual foram excluídos estudos de baixa evidência, onde não constava análise da relação entre mortalidade e nível socioeconômico no ambiente urbano. A seleção de artigos foi efetuada por dois revisores independentes e a extração de dados foi feita através de tabelas de evidência. Foram obtidos 1.509 registros e incluídos 24. Em todos os trabalhos, foi observada maior mortalidade nas áreas com os piores indicadores de privação. Observou-se uma associação com patologias cardiovasculares em seis estudos, com patologias pulmonares, em quatro deles, e com a AIDS, infecções, parasitoses e cirrose em três. Os estudos incluídos apresentam resultados pouco consistentes e importantes limitações metodológicas, impedindo a comparação entre estudos e a inferência de conclusões relevantes.

[Impact of socio-economic inequities on the mortality of the City of Fortaleza, Ceara, Brazil during 2007]. / Efecto de las desigualdades socioeconómicas en la mortalidad de la ciudad de Fortaleza, Ceara, Brasil durante el año 2007.

BACKGROUND: Brazil is an important example to study the situation of poverty and its determinants. Brazil owns a great part of the poor population of Latin America and presents great potential to eradicate this situation. The present study tries to show the association between the mortality risk and poverty in the city of Fortaleza. METHODS: Cross-sectional ecological study, the unit of analysis was the districts of the city of Fortaleza. We included any death happened during year 2007. Mortality data were obtained through Unique System of Health, socioeconomic indicators and number of inhabitants was extracted from the Census of Inhabitants and Houses of the Brazilian Institute of Statistics of the year 2000. An index composed from the main simple indicators of deprivation was calculated using a Cluster technique. The deprivation index was divided in five groups, group 1 presented the best socio-economic conditions and group 5 the worst ones. Correlation analysis was done to evaluate the association between socioeconomic level and mortality. RESULTS: We observed a significant association of the socioeconomic level with total mortality (p < 0.001), circulatory disease (p < 0.001) and external causes (p < 0.001). In addition, 86% of the cases of aggression happened in groups 4 and 5. CONCLUSIONS: The results show a relation between socioeconomic conditions and mortality by any cause, by circulatory causes and by external causes.