Design and validation of a new questionnaire with a gender perspective to measure medication adherence for secondary prevention of ischaemic heart disease: study protocol.

INTRODUCTION AND OBJECTIVES: Only about 50% of chronic patients in high-income countries adhere to their treatment. There are methods to measure medication adherence but none of them can be considered optimal. This study will aim to design and validate a questionnaire to measure medication adherence in patients with ischaemic heart disease using a direct method as a gold-standard adherence measure and taking into account the gender perspective. Moreover, the profile of low adherence in these patients will be determined. METHODS AND ANALYSIS: First study phase consists on the questionnaire design following the next steps: identification of the dimensions, definition of the target population, questionnaire items and order, response coding, questionnaire instructions, content validity by experts and understandability. In the second phase, a cross-sectional study will be performed to end the questionnaire development and validate it. Four hundred and forty patients (50% female) with acute coronary syndrome receiving treatment within the previous 12 months will be included. Patient will answer the initial questionnaire and adherence to aspirin and statin will be measured using a direct method (drug concentration analysis in blood) and other questionnaires. From the set of preselected questionnaire items, those most closely associated with the gold standard measure will be selected using multivariate statistics. ETHICS AND DISSEMINATION: All participants gave their written informed consent before participating in the study. The study protocol follows the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the three participating centres. The results of this study will be displayed at national and international conferences and in peer-reviewed scientific journals.

Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach.

OBJECTIVE: This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. METHODS: This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. CONCLUSIONS: Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.

Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial / Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension

Introducción y objetivos: La hipertensión arterial es el factor de riesgo más prevalente a nivel global. Se recomienda el cálculo del riesgo cardiovascular en pacientes hipertensos antes del inicio del tratamiento. Este estudio tuvo como objetivo evaluar el valor predictivo y la utilidad clínica de la escala SCORE para prevenir eventos cardiovasculares y mortalidad por todas las causas en los pacientes con hipertensión arterial. Métodos: Se incluyeron los pacientes con hipertensión arterial de la cohorte ESCARVAL-RISK. El riesgo cardiovascular se calculó mediante la escala SCORE. Todas las muertes y eventos cardiovasculares se registraron durante un periodo de 5 años de seguimiento. Se calculó la sensibilidad, la especificidad y los valores predictivos para diferentes puntos de corte, y se evaluó el efecto de diferentes factores de riesgo sobre la exactitud diagnóstica de las gráficas SCORE. Resultados: En una cohorte final de 9.834 pacientes, hubo 555 eventos cardiovasculares y 69 muertes. El valor de riesgo recomendado para iniciar tratamiento farmacológico (5%) presentó una especificidad del 92% para la muerte y del 91% para los eventos cardiovasculares, y una sensibilidad del 20% para la muerte y del 22% para los eventos cardiovasculares. Además, la escala clasificó al 80,4% de los pacientes que sufrieron un evento cardiovascular, y al 78,3% de los que murieron, como de bajo riesgo. La edad, el índice de masa corporal, la retinopatía y el tratamiento anticoagulante se asociaron con una reducción en la capacidad predictiva de la escala SCORE, mientras que ser mujer se asoció con mejor predicción de riesgo. Conclusiones: La capacidad predictiva de la escala SCORE para la enfermedad cardiovascular y la mortalidad total en los pacientes con hipertensión arterial es limitada.(AU)

Introduction and objectives: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. Methods: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. Results: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. Conclusions: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.(AU)

Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018.

OBJECTIVES: This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate. MATERIALS AND METHODS: A cross-sectional descriptive study taking a multicausal approach. RESULTS: Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases. CONCLUSIONS: In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups.

BACKGROUND: Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. METHODS: An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. RESULTS: Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. CONCLUSIONS: Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. / Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial.

INTRODUCTION AND OBJECTIVES: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Association of Visiting the Physiotherapist with Mortality in the Spanish General Population: A Population-Based Cohort Study.

Background and Objectives: The purpose of this retrospective population-based cohort study was to analyse the association between attendance of physiotherapy with mortality in the Spanish general population and describe the profile of people who do not visit a physiotherapist in Spain. Material and Methods: The data sources were the 2011/2012 National Health Survey (ENSE11) and the national database of death in Spain, and the participants were all adult respondents in the ENSE11. Results: Of 20,397 people, 1101 (5.4%) visited the physiotherapist the previous year, and the cumulative incidence of total mortality was 5.4% (n = 1107) at a mean follow-up of 6.2 years. Visiting the physiotherapist was associated with lower all-cause mortality in the population residing in Spain, quantified at 30.1% [RR = 0.699; 95% CI (0.528-0.927); p = 0.013]. The factors associated with not visiting a physiotherapist were the following: rating one's health as good (9.8%; n = 1017; p < 0.001), not having any hospital admission in the previous year (9.6%; n = 1788; p < 0.001), not having visited the general practitioner in the previous month (9.6%; n = 1408; p < 0.001), and not having attended a day hospital in the previous year (9.7%; n = 1836; p < 0.001). Conclusions: Visiting a physiotherapist was associated with a lower mortality from all causes in the population living in Spain.

The benefits of measuring the size and number of lipoprotein particles for cardiovascular risk prediction: A systematic review and meta-analysis / Los beneficios de medir el tamaño y el número de partículas de lipoproteínas para la predicción del riesgo cardiovascular: una revisión sistemática y un metaanálisis

Objective: Cardiovascular risk (CVR) is conventionally calculated by measuring the total cholesterol content of high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The purpose of this systematic review was to assess the CVR associated with LDL and HDL particle size and number as determined by nuclear magnetic resonance (NMR) spectroscopy. Material and methods: A literature search was performed using the electronic databases MEDLINE and Scopus. All cohort and case–control studies published before January 1, 2019 that met the following inclusion criteria were included: HDL-P, LDL-P, HDL-Z and/or LDL-Z measured by NMR spectroscopy; cardiovascular event as an outcome variable; risk of cardiovascular events expressed as odds ratios or hazard ratios; only adult patients. A meta-analysis was performed for each exposure variable (4 for LDL and 5 for HDL) and for each exposure measure (highest versus lowest quartile and 1-standard deviation increment). Results: This review included 24 studies. Number of LDL particles was directly associated with CVR: risk increased by 28% with each standard deviation increment. LDL particle size was inversely and significantly associated with CVR: each standard deviation increment corresponded to an 8% risk reduction. CVR increased by 12% with each standard deviation increase in number of small LDL particles. HD, particle number and size were inversely associated with CVR. Conclusion: Larger particle size provided greater protection, although this relationship was inconsistent between studies. Larger number of LDL particles and smaller LDL particle size are associated with increased CVR. Risk decreases with increasing number and size of HDL particles.(AU)

Objetivo: El riesgo cardiovascular (RCV) se calcula convencionalmente midiendo el contenido de colesterol total de las lipoproteínas de alta densidad (HDL) y las lipoproteínas de baja densidad (LDL). El propósito de esta revisión sistemática fue evaluar el RCV asociado con el tamaño y el número de partículas de LDL y HDL, según lo determinado por espectroscopia de resonancia magnética nuclear (RMN). Material y métodos: Se realizó una búsqueda bibliográfica utilizando las bases de datos electrónicas Medline y Scopus. Se incluyeron todos los estudios de cohortes y de casos y controles publicados antes del 1 de enero de 2019, que cumplieron con los siguientes criterios de inclusión: HDL-P, LDL-P, HDL-Z y/o LDL-Z medidos por espectroscopia de RMN; evento cardiovascular como variable de resultado; riesgo de eventos cardiovasculares expresado como cociente de posibilidades o cociente de riesgos instantáneos; solo pacientes adultos. Se realizó un metaanálisis para cada variable de exposición (cuatro para LDL y cinco para HDL) y para cada medida de exposición (cuartil más alto vs. más bajo e incremento de 1 desviación estándar [DE]). Resultados: Esta revisión incluyó 24 estudios. El número de partículas LDL se asoció directamente con el RCV: el riesgo aumentó 28% con cada incremento de la DE. El tamaño de las partículas de LDL se asoció inversa y significativamente con el RCV: cada incremento de la DE correspondió a una reducción del riesgo de 8%. El RCV aumentó 12% con cada aumento de la DE en el número de partículas pequeñas de LDL. HDL, número y tamaño de partículas se asociaron inversamente con CVR. Conclusión: El tamaño de partícula más grande proporcionó una mayor protección, aunque esta relación fue inconsistente entre los estudios. Un mayor número de partículas de LDL y un tamaño de partícula de LDL más pequeño se asocian con un aumento de la RCV. El riesgo disminuye con el aumento del número y tamaño de las partículas de HDL.(AU)

Tomographic Findings in the Retina of Unvaccinated Patients with COVID Pneumonia: Prospective Longitudinal Study.

There is no definitive evidence on the extent of SARS-CoV-2's effect on the retina. This study aims to determine if the natural history of SARS-CoV-2 infection affects tomographic findings in the retina of patients with COVID-19 pneumonia. This is a prospective cohort study of patients hospitalized with COVID-19 pneumonia. The patients underwent ophthalmological explorations and optical coherence tomography during the acute phase of the infection and at a follow-up 12 weeks later. The primary outcomes were the central retinal thickness and central choroidal thickness, which were compared longitudinally and with non-COVID-19 historical controls. No statistically relevant differences were observed in the longitudinal analysis of the thickness of the central retina (p = 0.056), central choroid (p = 0.99), retinal nerve fiber layer (p = 0.21), or ganglion cell layer (p = 0.32). Patients with acute COVID-19 pneumonia showed significantly greater central retinal thickness than non-COVID controls (p = 0.006). In conclusion, tomographic measures of the retina and choroid are not influenced by the phase of COVID-19 infection and remain stable during 12 weeks. The central retinal thickness may increase in the acute phase of COVID-19 pneumonia, but more epidemiological studies using optical coherence tomography in the early stages of the disease are needed.

The benefits of measuring the size and number of lipoprotein particles for cardiovascular risk prediction: A systematic review and meta-analysis.

OBJECTIVE: Cardiovascular risk (CVR) is conventionally calculated by measuring the total cholesterol content of high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The purpose of this systematic review was to assess the CVR associated with LDL and HDL particle size and number as determined by nuclear magnetic resonance (NMR) spectroscopy. MATERIAL AND METHODS: A literature search was performed using the electronic databases MEDLINE and Scopus. All cohort and case-control studies published before January 1, 2019 that met the following inclusion criteria were included: HDL-P, LDL-P, HDL-Z and/or LDL-Z measured by NMR spectroscopy; cardiovascular event as an outcome variable; risk of cardiovascular events expressed as odds ratios or hazard ratios; only adult patients. A meta-analysis was performed for each exposure variable (4 for LDL and 5 for HDL) and for each exposure measure (highest versus lowest quartile and 1-standard deviation increment). RESULTS: This review included 24 studies. Number of LDL particles was directly associated with CVR: risk increased by 28% with each standard deviation increment. LDL particle size was inversely and significantly associated with CVR: each standard deviation increment corresponded to an 8% risk reduction. CVR increased by 12% with each standard deviation increase in number of small LDL particles. HD, particle number and size were inversely associated with CVR. CONCLUSION: Larger particle size provided greater protection, although this relationship was inconsistent between studies. Larger number of LDL particles and smaller LDL particle size are associated with increased CVR. Risk decreases with increasing number and size of HDL particles.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020.

OBJECTIVES: To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS: We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS: We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS: Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.

Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes.

OBJECTIVES: The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM). METHODS: This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators. RESULTS: The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739. CONCLUSIONS: The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.

Trends in hospitalizations due to endometriosis in Spain, 1999-2019.

OBJECTIVE: Although there have been variations in the management of the patients with endometriosis, an important population of these women still require hospitalization . This study aimed to analyze the trends in hospital admissions associated with endometriosis from 1999 to 2019 in Spain. METHODS: An observational study of temporal trends was performed including women aged 15 to 54 years who were admitted to hospital for endometriosis in Spain from 1999 to 2019. Data on hospitalizations were drawn from the minimum basic data set. The data source used for the population was the continuous civil registry. The study variables were: age, year of admission, type of admission (elective/emergency), if there was surgical intervention during admission and length of hospital stay. Direct age-standardized admission rates were calculated using the 2013 European Standard Population differentiating between hospital admissions for elective surgery and any emergency admissions. Joinpoint regression models were fitted to estimate the annual percent change (APC). RESULTS: Admissions for elective surgery increased significantly, by 5.7% annually, until 2003, when they began to decrease slightly at different speeds until 2019. The mean APC for the entire study period was -0.88% (95%CI: -2.74; 1.02). There was a significant mean decrease of 4% in annual emergency admissions until 2012. Then, there was a significant average increase of 2% per year until 2019. Regarding the length of stay, there was a gradual decrease until 2012, after which slight, oscillating increases were apparent. CONCLUSION: There was a reduction of hospital admissions for elective surgery to treat endometriosis from 2003 to 2019 in Spain but emergency hospitalizations due to endometriosis have been growing since 2012. The mean length of hospital decreased for the study period.

Factors Associated with Colorectal Cancer Screening in Spain: Results of the 2017 National Health Survey.

This study aimed to determine the CRC screening coverage of people aged between 50 and 69 years who were living in Spain in 2017 and describe the factors associated with not having had a faecal occult blood test (FOBT). A cross-sectional study was performed using data from the Spanish National Health Survey 2017. We analysed 7568 individuals between the ages of 50 and 69 years. The proportion of respondents between 50 and 69 years old who had had an FOBT was 29.0% (n = 2191). The three autonomous communities with the lowest proportion of respondents who had had an FOBT were Extremadura (8.7%, n = 16), Ceuta-Melilla (10.4%, n = 3), and Andalucia (14.1%, n = 186). The variables associated with not having had an FOBT were being 50-54 years old (PR = 1.09; 95% CI 1.04-1.14), having been born outside of Spain (PR = 1.11; 95% CI 1.06-1.16), not having been vaccinated against the flu (PR = 1.09; 95% CI 1.04-1.15), never having had a colonoscopy (PR = 1.49; 95% CI 1.40-1.59), not having had an ultrasound scan in the last year (PR = 1.09; 95% CI 1.04-1.14), and not having seen a primary care physician in the last month (PR = 1.08; 95% CI 1.04-1.12). The factors associated with not getting an FOBT were young age, having been born outside of Spain, not having been vaccinated against the flu in the last campaign, and not making frequent use of healthcare services.

Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.

The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.

Early Detection of Atrial Fibrillation in Community Pharmacies-CRIFAFARMA Study.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population. OBJECTIVE: This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF. METHODS: A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk. RESULTS: The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale. CONCLUSIONS: AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.

Lifestyle and cardiovascular mortality in menopausal women: a population-based cohort study.

INTRODUCTION AND OBJECTIVES: There are models for cardiovascular risk prediction in the general population, but the prediction of risk in postmenopausal women has not been specifically studied. This study aimed to determine the association of lifestyle habits and chronic diseases with cardiovascular risk in menopausal women, as well as to build a risk scale. METHODS: Retrospective population-based cohort study using data from the 2011 National Health Survey of Spain as a data source, Women ≥ 50 years were included. The characteristics that best defined the life habits of the study women were collected, as well as their health status and self-reported medical history at the time of the survey. Follow-up data on all-cause mortality were obtained from participants from 2011 to 2017. RESULTS: A total of 5953 women ≥ 50 years of age were included, with a mean age of 66.4 ± 11.4 years. The incidence of cardiovascular mortality in the follow-up period was 4%. Vegetable consumption less than 1 time/week (HR, 1.758), smoking (HR, 1.816) or excess hours of sleep (≥ 9h/day, HR, 1.809), or o have main daily activity sitting most of the time (HR, 2.757) were related to cardiovascular mortality. The predictive model presents an honest C-index in test sample of 0.8407 (95%CI, 0.8025-0.8789). CONCLUSIONS: Life habits such as the consumption of vegetables, daily main activity, sleeping hours or smoking are risk factors for cardiovascular mortality of great relevance among menopausal women. A simple 6-year self-reported risk scale with high predictive capacity is provided.

Gender Differences in the Diagnosis of Dyslipidemia: ESCARVAL-GENERO.

Evidence shows that objectives for detecting and controlling dyslipidemia are not being effectively met, and outcomes differ between men and women. This study aimed to assess gender-related differences in diagnostic inertia around dyslipidemia. This ambispective, epidemiological, cohort registry study included adults who presented to public primary health care centers in a Spanish region from 2008 to 2012, with dyslipidemia and without cardiovascular disease. Diagnostic inertia was defined as the registry of abnormal diagnostic parameters-but no diagnosis-on the person's health record in a window of six months from inclusion. A total of 58,970 patients were included (53.7% women) with a mean age of 58.4 years in women and 57.9 years in men. The 6358 (20.1%) women and 4312 (15.8%) men presenting diagnostic inertia had a similar profile, although in women the magnitude of the association with younger age was larger. Hypertension showed a larger association with diagnostic inertia in women than in men (prevalence ratio 1.81 vs. 1.56). The overall prevalence of diagnostic inertia in dyslipidemia is high, especially in women. Both men and women have a higher risk of cardiovascular morbidity and mortality.

Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017.

The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0-14 years, 15-34 years, 35-44 years, 45-64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.