ABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Heart Failure/complications , Heart Failure/diagnosis , Patient Readmission/statistics & numerical data , Obesity/complications , Prognosis , Kaplan-Meier Estimate , Multivariate Analysis , Logistic Models , Retrospective StudiesABSTRACT
BACKGROUND: Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). AIM: The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. METHODS: We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores RESULTS: The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. CONCLUSION: We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Risk Assessment/methods , Stroke/prevention & control , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Diagnosis, Computer-Assisted , Female , Humans , Male , Middle Aged , Registries , Retrospective Studies , Risk Factors , Severity of Illness Index , SpainSubject(s)
Humans , Hyperglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Diabetes Mellitus/drug therapy , Hospitalization/statistics & numerical data , Glycemic Index , Risk Factors , Hypoglycemia/prevention & control , Practice Patterns, Physicians' , Insulin/therapeutic use , Continuity of Patient Care/trendsABSTRACT
BACKGROUND: There is an increasing interest in the use of non-invasive methods for the detection of subclinical atherosclerosis to better identify patients with high risk of cardiovascular events The presence of diabetes mellitus (DM) and peripheral arterial disease (PAD) is associated with increased risk of events but their value in the acute coronary syndrome (ACS) patient has not been ascertained. METHODS: We performed a subanalysis of the PAMISCA study, designed to investigate the prevalence of PAD in patients admitted to Spanish hospitals with a diagnosis of an ACS. RESULTS: A total of 1410 patients were analysed (71.4% men, age 66 +/- 11.9 years, 35% DM). The prevalence of PAD was higher in DM vs. no-DM (41.5% vs. 30.6% respectively, p < 0.001). Patients with PAD and DM had more in-hospital cardiac complications such as atrial fibrillation/flutter, recurrent myocardial ischaemia and heart failure and a trend towards higher in-hospital mortality (p = 0.08). Non-DM patients with PAD and DM without PAD shared similar cardiac complications and the group without neither PAD nor DM had the best prognosis. In patients without PAD, DM was an independent predictor of three-vessel coronary disease (OR 1.6; 95% CI: 1.1-2.5, p < 0.05) after adjustment by age, sex, low density lipoproteins (LDL), smoking and the previous myocardial infarction. However, in PAD patients, DM failed to be an independent risk factor in the multivariate analysis (OR 1.0; 95% CI 0.6-1.6, p < 0.05). CONCLUSIONS: The concurrence of DM and PAD helps identify patients with an adverse risk profile.
Subject(s)
Acute Coronary Syndrome/etiology , Diabetic Angiopathies/complications , Peripheral Vascular Diseases/complications , Aged , Female , Hospitalization , Humans , Male , Prospective Studies , Risk Assessment , Risk FactorsABSTRACT
There are aetiopathogenic relationships that justify the epidemiological association between cardiovascular disease and renal failure. Organic lesions must be looked for in patients with renal failure as well as strict control of risk factors. Before including patients in a dialysis program, echocardiography to see whether cardiovascular disease or possible ventricular dysfunction is present. In patients included in a renal transplant program, the existence of ischaemic heart disease should be ruled out and the patient revascularised, if necessary, before the transplant should be performed.
Subject(s)
Cardiovascular Diseases/diagnosis , Renal Insufficiency/complications , Cardiovascular Diseases/etiology , HumansABSTRACT
Hay relaciones etiopatogénicas que justifican la asociación epidemiológica entre la enfermedad cardiovascular y la insuficiencia renal. En los pacientes con insuficiencia renal, debe realizarse una búsqueda de lesiones orgánicas y un control estricto de los factores de riesgo. Antes de incluir al paciente en un programa de diálisis, debe valorarse la existencia de enfermedad cardiovascular y la posible existencia de disfunción ventricular, por lo que se aconseja realizar un ecocardiograma. Asimismo, en los pacientes incluidos en un programa de trasplante renal, debe descartarse la existencia de cardiopatía isquémica y revascularizar al paciente, si lo precisa, antes de realizar el trasplante (AU)
There are aetiopathogenic relationships that justify the epidemiological association between cardiovascular disease and renal failure. An Organic lesions must be looked for in patients with renal failure as well as strict control of risk factors. Before including patients in a dialysis program, echocardiography to see whether cardiovascular disease or possible ventricular dysfunction is present. In patients included in a renal transplant program, the existence of ischaemic heart disease should be ruled out and the patient revascularised, if necessary, before the transplant should be performed (AU)
Subject(s)
Humans , Cardiovascular Diseases/diagnosis , Renal Insufficiency/complications , Cardiovascular Diseases/etiologyABSTRACT
Introducción. El objetivo del estudio es conocer el grado de control tensional y de los diferentes factores de riesgo cardiovascular en el paciente hipertenso con disfunción cardíaca en función del ámbito asistencial, sea Atención Primaria o Especializada, en España. Material y métodos. Se han reclutado de manera consecutiva 3.984 pacientes hipertensos con disfunción cardíaca (23,2 % desde Atención Primaria). Se han recogido parámetros demográficos y antropométricos, antecedentes cardiovasculares, factores de riesgo, presión arterial, electrocardiograma y ecocardiograma, datos analíticos y tratamiento. Resultados. Los pacientes reclutados desde Atención Primaria tenían una significativa mayor edad (71,46 frente a 68,51 años; p < 0,0001), así como un mayor índice de masa corporal (29,78 frente a 29,46 kg/m2; p < 0,05). En el análisis multivariante se observó un manejo terapéutico diferente entre ambas poblaciones, con un mayor empleo de betabloqueantes, antagonistas del calcio e inhibidores del eje renina-angiotensina en Atención Especializada. En ésta se observó una significativa mayor proporción de pacientes con colesterol HDL < 40 mg/dl, triglicéridos > 150 mg/dl, glucemias elevadas y microalbuminuria. No hubo diferencias en el control de las cifras de presión arterial, con un alto porcentaje de pacientes con valores > 130/80 mmHg (83,7 % en Atención Primaria frente a 85,9 % en Atención Especializada). Conclusiones. El manejo terapéutico del paciente hipertenso con disfunción cardíaca es diferente según el ámbito asistencial analizado. El control de las cifras de presión arterial y sobrepeso en esta población es subóptimo en ambos entornos
Introduction. This study aims to evaluate the degree of blood pressure (BP) and the control of different cardiovascular risk factors in hypertensive patients with cardiac dysfunction, according to the type of health care setting in Spain: Primary or Specialized Care. Material and methods. A total of 3,984 hypertensive patients with cardiac dysfunction were recruited consecutively (23.2 % from Primary Care). Demographic and anthropometric parameters, cardiovascular events, risk factors, BP, electrocardiogram, echocardiogram, laboratory analysis data and treatment were collected. Results. Patients from Primary Care were significantly older (71.46 vs 68.51 years; p < 0.0001), and had higher body mass index (29.78 vs 29.46 kg/m2; p < 0.05). The multivariate analysis showed differences between both groups regarding therapeutic management: beta blockers, calcium channel blockers and renin-angiotensin inhibitors were used more in specialized care vs. Primary Care setting. Patients recruited from specialized care settings showed significantly higher proportion of plasma HDL-cholesterol level < 40 mg/dl, plasma triglyceride level > 150 mg/dl, hyperglycemia and microalbuminuria. There were no differences in BP control between groups, with a very high percentage of patients with values of BP > 130/80 mmHg (83.7 % in Primary Care versus 85.9 % in Specialized Care). Conclusion. Therapeutic management of hypertensive patients with cardiac dysfunction differs according to the health-care setting analyzed. In this population analyzed, both BP and overweight control is suboptimal in both groups
Subject(s)
Humans , Hypertension/drug therapy , Antihypertensive Agents/therapeutic use , Risk Factors , Hypertension/complications , Primary Health Care/methods , Cardiovascular Diseases/epidemiology , Electrocardiography , Health Care Levels/trendsSubject(s)
Anti-Bacterial Agents/adverse effects , Clarithromycin/adverse effects , Long QT Syndrome/etiology , Pulmonary Disease, Chronic Obstructive/complications , Respiratory Tract Infections/complications , Aged, 80 and over , Electrocardiography , Humans , Male , Respiratory Tract Infections/drug therapyABSTRACT
No disponible
Subject(s)
Male , Humans , Electrocardiography , Respiratory Tract Infections/complications , Cardiovascular Diseases/diagnosisSubject(s)
Atrial Fibrillation/etiology , Cardiomyopathies/complications , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/drug therapy , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/drug therapy , Echocardiography, Doppler , Electrocardiography , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Echocardiography, Doppler , Treatment Outcome , Atrial Fibrillation , Anti-Arrhythmia Agents , Amiodarone , Electrocardiography , CardiomyopathiesABSTRACT
Objetivos. El objetivo del presente estudio fue evaluar la acción de la trimetazidina (TMZ), un fármaco antiisquémico, en el deterioro de la función sistólica que se produce en el miocardio sometido a isquemias breves y repetidas. Métodos. Se han analizado 12 perros mestizos de ambos sexos, randomizados a tratamiento con TMZ durante 7 días (grupo TMZ) o a tratamiento con placebo (grupo control). Se ha realizado un protocolo isquémico consistente en 20 obstrucciones completas de la arteria coronaria descendente anterior de 2 minutos de duración y separadas de 3 minutos de reperfusión entre ellas. Las variables analizadas al final de cada período de oclusión y reperfusión han sido: frecuencia cardíaca (FC), presión ventricular izquierda (PVI), dP/dt y las curvas de función regional de la zona isquémica y de una zona testigo (longitud telediastólica, telesistólica y fracción de acortamiento). Resultados. El grupo placebo está formado por 6 perros, con un peso medio de 30,08 kg; el grupo TMZ está constituido por 6 perros, con un peso medio de 24,25 kg. Los parámetros hemodinámicos (FC, PVI y dP/dt) no presentan diferencias significativas entre ambos grupos, con poca variabilidad de sus valores respecto a los basales en los diferentes procesos de isquemia/reperfusión. La fracción de acortamiento de la zona isquémica experimenta una caída, estadísticamente significativa, durante las sucesivas fases de isquemia en ambas series, alcanzando valores de acinesia/discinesia, con recuperación parcial durante las reperfusiones en el grupo placebo (aturdimiento), mientras que en la serie TMZ la recuperación es completa (64 por ciento frente 94 por ciento).Conclusiones. Nuestro estudio indica que la TMZ mejora la recuperación de la contractilidad miocárdica afectada por isquemias/reperfusiones breves y repetidas, limitando la aparición de miocardio aturdido (AU)
Subject(s)
Animals , Female , Male , Dogs , Trimetazidine/pharmacology , Vasodilator Agents/pharmacology , Myocardial Stunning , Myocardial Contraction , Myocardial Reperfusion/adverse effects , Disease Models, AnimalABSTRACT
La trimetazidina es un fármaco con propiedades antiisquémicas que protege el miocardio del daño isquémico a través de la preservación del metabolismo oxidativo mitocondrial, sin ejercer ninguna acción hemodinámica. Dicho fármaco ha demostrado disminuir las crisis de angina y mejorar la tolerancia al esfuerzo en pacientes con cardiopatía isquémica. Presentamos el efecto de dicho fármaco sobre la sintomatología anginosa de una paciente hipertensa diagnosticada de angina microvascular (AU)
