Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Glucemia basal alterada y riesgo de diabetes mellitus a los 10 años. Estudio de cohorte / Impaired fasting glucose and risk of diabetes mellitus at 10 years. Cohort study

Fundamento y objetivo: El objetivo del estudio fue conocer la incidencia de diabetes mellitus tipo 2 en pacientes con glucemia basal alterada y su asociación con factores de riesgo. Pacientes y método: Se incluyeron 115 pacientes > 18 años, seleccionados aleatoriamente en un Centro de Salud, diagnosticados de glucemia basal alterada con los criterios de la Asociación Americana de Diabetes de 1997 y seguidos durante 10 años. Como factores predictivos para desarrollar diabetes mellitus se consideraron: edad, sexo, tabaquismo, hipertensión arterial, hipercolesterolemia, antecedentes familiares de diabetes mellitus tipo 2, antecedente de diabetes gestacional y obesidad. Resultados: En 10 años de seguimiento evolucionaron a diabetes mellitus 33 pacientes (28,7%; intervalo de confianza del 95% [IC 95%] 20,4-37,0%), a normoglucemia 57 pacientes (49,6%; IC 95% 40,4-58,7%), permaneciendo como glucemia basal alterada 25 pacientes (21,7%; IC 95% 14,2-29,3%). Solo la obesidad se asoció con la progresión a diabetes mellitus (hazard ratio ajustada 2,01; IC 95% 1,00-4,03, p=0,050).Conclusiones: La mitad de los pacientes con glucemia basal alterada normalizaron su glucemia y el 28,7% desarrollaron diabetes mellitus, especialmente si tenían obesidad. Estos resultados sugieren una historia natural diferente respecto a la intolerancia a la glucosa (AU)

Background and objective: The aim of this study was to define the incidence of type 2 diabetes mellitus in patients with impaired fasting glucose and its association with risk factors.Patients and method: 115 patients aged > 18 years old, randomly selected in a Healthcare Center, diagnosed of impaired fasting glucose with 1997 American Diabetes Association criteria, followed 10 years. Predictive factors for developing diabetes mellitus were: age, sex, smoking, hypertension, hypercholesterolemia, family history of type 2 diabetes mellitus, antecedent of diabetes in pregnancy, and obesity.Results: During the 10 years of follow-up, 33 patients developed type 2 diabetes mellitus (28.7%; 95% CI 20.4-37.0%), 57 patients progressed to normoglycaemia (49.6%; 95% CI 40.4-58.7%), and 25 patients remained with an impaired fasting glucose (21.7%; 95% CI 14.2-29.3%). Only obesity was associated with progression to type 2 diabetes mellitus (adjusted hazard ratio 2.01; 95% CI 1.00-4.03, p=0.050).Conclusions: Half of the patients with impaired fasting glucose normalized their glycaemia, and 28.7% developed diabetes mellitus, especially patients with obesity. These results suggest a different natural history to respect glucose intolerance (AU)

[Impaired fasting glucose and risk of diabetes mellitus at 10 years. Cohort study]. / Glucemia basal alterada y riesgo de diabetes mellitus a los 10 años. Estudio de cohorte.

BACKGROUND AND OBJECTIVE: The aim of this study was to define the incidence of type 2 diabetes mellitus in patients with impaired fasting glucose and its association with risk factors. PATIENTS AND METHOD: 115 patients aged > 18 years old, randomly selected in a Healthcare Center, diagnosed of impaired fasting glucose with 1997 American Diabetes Association criteria, followed 10 years. Predictive factors for developing diabetes mellitus were: age, sex, smoking, hypertension, hypercholesterolemia, family history of type 2 diabetes mellitus, antecedent of diabetes in pregnancy, and obesity. RESULTS: During the 10 years of follow-up, 33 patients developed type 2 diabetes mellitus (28.7%; 95% CI 20.4-37.0%), 57 patients progressed to normoglycaemia (49.6%; 95% CI 40.4-58.7%), and 25 patients remained with an impaired fasting glucose (21.7%; 95% CI 14.2-29.3%). Only obesity was associated with progression to type 2 diabetes mellitus (adjusted hazard ratio 2.01; 95% CI 1.00-4.03, p=0.050). CONCLUSIONS: Half of the patients with impaired fasting glucose normalized their glycaemia, and 28.7% developed diabetes mellitus, especially patients with obesity. These results suggest a different natural history to respect glucose intolerance.

Validez del cuestionario cardiovascular MONICA comparado con la historia clínica / Validity of the MONICA cardiovascular questionnaire compared with clinical records

ObjetivoEstudiar la validez del cuestionario cardiovascular Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) comparado con la historia clínica.MétodosEstudio descriptivo, prospectivo, multicéntrico, realizado en 3.329 personas >50 años de edad (estudio ARTPER [arteriografía periférica]). La muestra se seleccionó por muestreo aleatorio simple en 32 centros de salud de atención primaria. Los diagnósticos considerados fueron: infarto agudo de miocardio, ángor, enfermedad vascular cerebral, hipertensión arterial, diabetes mellitus e hipercolesterolemia. Se estudió además el tratamiento con antihipertensivos, hipolipemiantes o insulina, hipoglucemiantes y antiagregantes o anticoagulantes. La validez entre cuestionario y registro en la historia clínica se estudió con la sensibilidad, la especificidad, los valores predictivos y el índice kappa.ResultadosLa edad media fue de 65 años (desviación estándar: 8,9), y el 54,8% eran mujeres. La sensibilidad del cuestionario fue >90% en todas las variables, excepto en el ángor (89,9%) y la enfermedad vascular cerebral (86,5%). La especificidad también fue >90%, excepto en el ángor (88,3%) y la hipercolesterolemia (77,5%). El valor predictivo positivo fue >90% en todos los tratamientos farmacológicos; >80% en el ángor, el infarto agudo de miocardio y la hipertensión arterial; 79,4% en la enfermedad vascular cerebral; 79,1% en la hipercolesterolemia, y 73,4% en la diabetes mellitus. Los valores predictivos negativos fueron >90% en todos los casos. Los índices kappa fueron >0,80 en todas las variables, excepto en la hipercolesterolemia (0,69) y la diabetes mellitus (0,79)(AU)

ObjectiveTo assess the validity of the questionnaire Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) compared with clinical records.MethodsA descriptive, prospective, multicenter study was performed within the framework of the Peripheral Arterial Disease Study (PERART) in 3,329 persons aged >50 years old. The sample was selected by simple random sampling in 32 primary health care centers. The diagnoses included were acute myocardial infarction, angina pectoris, cerebrovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia. Treatment variables were also considered (antihypertensive, lipid-lowering and hypoglycemic agents or insulin, as well as antiplatelet or anticoagulant agents). The sensitivity, specificity, predictive values, and kappa index were computed to test the validity of the MONICA questionnaire.ResultsThe mean age was 65 years (SD 8.9) and 54.8% were women. The sensitivity of the questionnaire was >90% for all the variables apart from angina pectoris (89.9%) and cerebrovascular disease (86.5%). Specificity was also >90%, except for angina pectoris (88.3%) and hypercholesterolemia (77.5%). The positive predictive value was >90% for all the treatments; >80% for angina pectoris, acute myocardial infarction and hypertension; 79.4% for cerebrovascular disease; 79.1% for hypercholesterolemia and 73.4% for diabetes mellitus. The negative predictive value was >90% for all the variables. The kappa indexes were >0.80 for all the variables apart from hypercholesterolemia (0.69) and diabetes mellitus (0.79).ConclusionsThe MONICA cardiovascular questionnaire is valid in the assessment of cardiovascular disease, risk factors and treatments in patients aged >50 years old(AU)

[Validity of the MONICA cardiovascular questionnaire compared with clinical records]. / Validez del cuestionario cardiovascular MONICA comparado con la historia clínica.

OBJECTIVE: To assess the validity of the questionnaire Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) compared with clinical records. METHODS: A descriptive, prospective, multicenter study was performed within the framework of the Peripheral Arterial Disease Study (PERART) in 3,329 persons aged >50 years old. The sample was selected by simple random sampling in 32 primary health care centers. The diagnoses included were acute myocardial infarction, angina pectoris, cerebrovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia. Treatment variables were also considered (antihypertensive, lipid-lowering and hypoglycemic agents or insulin, as well as antiplatelet or anticoagulant agents). The sensitivity, specificity, predictive values, and kappa index were computed to test the validity of the MONICA questionnaire. RESULTS: The mean age was 65 years (SD 8.9) and 54.8% were women. The sensitivity of the questionnaire was >90% for all the variables apart from angina pectoris (89.9%) and cerebrovascular disease (86.5%). Specificity was also >90%, except for angina pectoris (88.3%) and hypercholesterolemia (77.5%). The positive predictive value was >90% for all the treatments; >80% for angina pectoris, acute myocardial infarction and hypertension; 79.4% for cerebrovascular disease; 79.1% for hypercholesterolemia and 73.4% for diabetes mellitus. The negative predictive value was >90% for all the variables. The kappa indexes were >0.80 for all the variables apart from hypercholesterolemia (0.69) and diabetes mellitus (0.79). CONCLUSIONS: The MONICA cardiovascular questionnaire is valid in the assessment of cardiovascular disease, risk factors and treatments in patients aged >50 years old.

[Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study]. / Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes.

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk. PATIENTS AND METHOD: A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors. RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (>/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (>/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r = 0.242; p < 0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9). CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

Papel de la presión de pulso, presión arterial sistólica y presión arterial diastólica en la predicción del riesgo cardiovascular. Estudio de cohortes / Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study

FUNDAMENTO Y OBJETIVO: Analizar el papel de la presión de pulso (PP), la presión arterial sistólica(PAS) y la diastólica (PAD) en la predicción del riesgo cardiovascular.PACIENTES Y MÉTODO: Se realizó un estudio de cohortes, prospectivo, en 2 centros de salud, queincluyó a 932 personas de 35-84 años sin episodios cardiovasculares, seleccionadas por muestreoaleatorio simple y seguidas durante 8 años. La PP, PAS y PAD se categorizaron en tercilesy el superior se comparó con los 2 inferiores. Se registró como variable combinada el primerepisodio cardiovascular, mortal o no, en forma de cardiopatía isquémica, enfermedad cerebrovasculary arteriopatía periférica. Los resultados se analizaron mediante modelos de Cox ajustandopor edad, sexo, tabaquismo, colesterol total, colesterol unido a lipoproteínas de alta densidady diabetes mellitus. Se estudió la correlación entre PP y PAS, PAD y factores de riesgocardiovascular.RESULTADOS: Se registraron 85 episodios cardiovasculares: 43 casos de cardiopatía isquémica,27 de enfermedad cerebrovascular y 17 de arteriopatía periférica. Los cocientes de riesgo ajustadospara la variable combinada fueron: tercil superior (>= 59 mmHg) de la PP = 1,3 (intervalode confianza [IC] del 95%, 0,8-2,1); tercil superior (>= 140 mmHg) de la PAS = 1,5 (IC del95%, 1,0-2,5); tercil superior (>= 84 mmHg) de la PAD = 1,1 (IC del 95%, 0,7-1,8). Los resultadosfueron similares para los episodios cardiovasculares específicos. La PP se correlacionócon la PAS (r = 0,825; p < 0,001), la edad (r = 0,422; p < 0,001), la diabetes mellitus(r = 0,242; p < 0,001) y el tabaquismo (r = –0,158; p = 0,01), siendo su cociente de riesgoajustado por estas variables de 1,0 (IC del 95%, 0,6-1,9).CONCLUSIONES: La PP es un componente de la presión arterial muy relacionado con la PAS yotros factores de riesgo, pero no es mejor predictor del riesgo cardiovascular que la PAS

BACKGROUND AND OBJECTIVE: To analize the role of pulse pressure (PP), systolic (SBP) and diastolicblood pressure (DBP), in the prediction of cardiovascular risk.PATIENS AND METHOD: A prospective cohort study carried out in 2 primary care center, including932 patients aged between 35-84 years old, without cardiovascular events, selected by simplerandom sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles,comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such ascoronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded asa composite variable. Results were studied according to Cox models, adjusting for age, sex,smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studiedthe correlation between PP with SBP, DBP, and cardiovascular risk factors.RESULTS: We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovasculardisease, and 17 peripheral arterial disease. The adjusted hazard ratios for compositevariable were: upper PP tertile (>= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1);upper SBP tertile (>= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>= 84 mmHg) =1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlatedwith SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r =0.242; p < 0.001), and smoking (r = –0.158; p = 0.01), with adjusted hazard ratio for thesevariables of 1.0 (95% CI, 0.6-1.9).CONCLUSIONS: PP is an arterial pressure component very correlated with SBP and other factors,but is not a better cardiovascular risk predictor than SBP

Validaciones de las tablas de riesgo cardiovascular: ¿nos aclaran o nos confunden todavía más? / Validation of cardiovascular risk tables: are we more or less confused?

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