Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocol.

INTRODUCTION: Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). METHODS AND ANALYSIS: Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.

Compliance with quality prescribing indicators linked to financial incentives: what about not incentivized indicators?: an observational study.

OBJECTIVE: The aims of this study were to investigate whether general practitioners (GPs) who complied with quality prescribing indicators included in the pay-for-performance programmes also complied with quality prescribing indicators which are not linked to incentives and to compare the prescribing behaviour between those GPs who showed compliance with quality prescribing indicators linked to financial incentives and those who did not. DESIGN AND METHODOLOGY: This was a descriptive cross-sectional study which was conducted in 2007 in the Aljarafe Primary Care Area (Andalusia, Spain) and involved 37 Health Care Centres and 176 GPs. The main outcome was the results of a comparison of six quality prescribing indicators linked to incentives and 14 quality prescribing indicators not linked to incentives. The chi-square test was used to compare qualitative variables. Quantitative variables were tested using Student's t test upon confirmation of normality. RESULTS: Those GPs showing compliance with the indicators included in the pay-for performance programme showed low levels of compliance with quality prescribing indicators that were unincentivised. With respect to compliance with the indicators not linked to financial incentives, we found no statistical difference between GPs who showed compliance with incentivised indicators (n = 57) and those showing non-compliance (n = 112) in terms of drug selection, with the exception of the selection of second- and third-line antibiotics and antihistamines, nor in terms of the appropriate use of drugs linked to patient's clinical conditions. CONCLUSIONS: The compliance of GPs showing compliance with quality prescribing indicators included in pay-for-performance programmes was not better than that of those who showed no compliance with other relevant quality prescribing indicators not linked to financial incentives.

Actualización en anticoagulantes II: nuevos anticoagulantes orales / No disponible

Se presenta una revisión de los nuevos anticoagulantes orales (dabigatrán, rivaroxabán y apixabán). El artículo evalúa la eficacia, seguridad y eficiencia de estos fármacos, comparativamente entre ellos, y en relación con los anticoagulantes antivitamina K clásicos (warfarina y acenocumarol). Se establece el lugar en la terapéutica que ocupan los nuevos fármacos anti-coagulantes orales en base a las características del paciente y teniendo en cuenta los riesgos y beneficios asociados a estos nuevos tratamientos, de los que aún no se dispone de una información completa sobre su perfil de seguridad (AU)

It shows a review of the new oral anticoagulants (dabigatran, rivaroxaban and apixaban). The paper evaluates the efficacy, safety and effectiveness of these drugs, including comparatively, and in relation to the classical K antagonists anticoagulants (warfarin and acenocumarol). Establishing the place of new oral anticoagulants in therapy based on patient characteristics and taking into account the risks and benefits associated with these new treatments, which have yet to be fully informed of its safety profile (AU)

Estatinas en pacientes sin enfermedad cardiovascular: una revisión crítica / Statins in patients without cardiovascular disease: a critical review

Se muestra una revisión crítica de los metaanálisis que evalúan la eficacia de las estatinas en la prevención primaria de la enfermedad cardiovascular. Se realizaron búsquedas en MEDLINE, EMBASE y Cochrane (período: enero 2005 a diciembre de 2011) de metaanálisis de en sayos clínicos dirigidos a estudiar el efecto de las estatinas en la prevención primaria de la enfermedad cardiovascular. Se utilizó el cuestionario PRISMA para evaluar la precisión y fiabilidad de los metaanálisis. Se seleccionaron un total de 9 metaanálisis (promedio de pacientes: 88.006). Cinco estudios encontraron beneficio en los eventos cardiovasculares mayores (rango del riesgo relativo [RR]: 0,69-0,85). Siete metaanálisis obtuvieron mejoras en los eventos coronarios mayores (rango RR: 0,61-0,77). No hubo concordancia en los resultados de mortalidad total, mortalidad coronaria y accidentes cerebrovasculares. Esta revisión crítica de los últimos metaanálisis sugiere un modesto beneficio de las estatinas en la prevención primaria de la enfermedad cardiovascular (AU)

It shows a critical review of meta-analysis assessing the efficacy of statins in primary prevention of cardiovascular disease. We searched MEDLINE, EMBASE and Cochrane (period: January 2000 to December 2011) for meta-analysis of randomized trials conducted to study the effect of statins in primary prevention of cardiovascular disease. We used PRISMA statement to evaluate accuracy and reliability ofmeta-analysis. We selected 9 meta-analysis (mean of patients: 88.006). Five studies found a benefit in mayor cardiovascular events (range of relative risk [RR]: 0.69-0.85). Seven meta-analysis obtained improvement in mayor coronary events (range of RR: 0.61-0.77). There was no agreement between the results of total mortality, coronary mortality and cerebrovascular events. This critical review of meta-analysis suggests a modest benefit of statins in a primary prevention set-up (AU)

Adecuación de la prescripción de beta-adrenérgicos de acción prolongada: resultados de una intervención en Atención Primaria / Quality prescribing of long-acting beta-agonists. Results of an intervention in Primary Care

Objetivo. Evaluar una intervención destinada a mejorar la adecuación de la prescripción de beta-adrenérgicos de acción larga (BAAL) en Atención Primaria. Material y métodos. Diseño: Estudio cuasi-experimental antes-después sin grupo control. Ámbito: Distrito de Atención Primaria (Servicio Andaluz de Salud). Sujetos: Médicos de familia con prescripciones de BAAL sin corticoides inhalados (CTi), que trabajaron más del 40% de los días hábiles del periodo estudiado. Unidad de estudio: Pacientes con prescripciones de BAAL sin CTi, seleccionados mediante muestreo aleatorio simple (fiabilidad 95%, precisión 5%). Intervenciones: Envío de carta y boletín con recomendaciones sobre uso adecuado de BAAL y la relación de pacientes con prescripciones inadecuadas. Variables: Adecuación de la prescripción de BAAL a las indicaciones autorizadas en fichas técnicas. En relación con los pacientes, se analizaron edad, sexo, tipo de BAAL y diagnóstico. Fuentes: Sistema de información de facturación de recetas e historia clínica informatizada. Resultados. Antes de la intervención, el porcentaje de inadecuación fue del 70,3%. Un 51,8% de los pacientes tenían una indicación de BAAL sin CTi no autorizada. El 18,5% no tenía registrado en su historia clínica diagnósticos relacionados con patologías respiratorias. Tras la intervención, el porcentaje de inadecuación pasó a ser del 4,5%, debido principalmente a la actualización de los tratamientos (retirada de BAAL o adición de CTi). Conclusiones. Existe un bajo grado de adecuación de la utilización de BAAL en Atención Primaria. El envío de material educativo con la relación de pacientes con prescripciones inadecuadas es una estrategia eficaz para mejorar los hábitos de prescripción en patologías respiratorias(AU)

Objective. To assess an intervention aimed to reduce inappropriate prescribing of long-acting beta-agonists (LABA) in Primary Care. Material and methods; Design Quasi-experimental pre/post study without control group. Setting: Aljarafe Primary Health Care Area (Seville, Spain). Participants: General practitioners with LABA prescriptions without inhaled corticosteroids (iCT), who worked more than 40% of working days in the study period. Study unit: Simple randomised sample of patients with LABA prescriptions without iCT. Interventions: Mailing educational material with recommendations on the appropriate use of LABA and a list of their patients with inappropriate prescriptions. Main measurement: Appropriateness of LABA prescriptions as indicated in the Product Summary Characteristics. Patient age, sex, type of LABA and diagnoses were analysed. Sources: An information system for billing computerized prescriptions and medical history. Results. Before intervention, prescriptions were inappropriate in 70.3% of patients, and 51.8% received LABA without iCT for unapproved conditions. A diagnosis associated with a respiratory condition was not recorded in the Computerised Medical Records of 18.5% of the patients. After intervention, the percentage of inappropriate prescriptions in the sample dropped to 4.5%, mainly due to a review of the treatment (LABA cessation or iCT addition). Conclusions. There is a high level of inappropriate use of LABA in Primary Health Care. Mailing educational materials combined with the list of patients with an inappropriate LABA prescription to general practitioners seems to be an effective strategy to improve quality prescribing in respiratory pathologies(AU)

[Quality prescribing of long-acting beta-agonists. Results of an intervention in Primary Care]. / Adecuación de la prescripción de beta-adrenérgicos de acción prolongada: resultados de una intervención en Atención Primaria.

OBJECTIVE: To assess an intervention aimed to reduce inappropriate prescribing of long-acting beta-agonists (LABA) in Primary Care. MATERIAL AND METHODS; DESIGN: Quasi-experimental pre/post study without control group. SETTING: Aljarafe Primary Health Care Area (Seville, Spain). PARTICIPANTS: General practitioners with LABA prescriptions without inhaled corticosteroids (iCT), who worked more than 40% of working days in the study period. Study unit: Simple randomised sample of patients with LABA prescriptions without iCT. INTERVENTIONS: Mailing educational material with recommendations on the appropriate use of LABA and a list of their patients with inappropriate prescriptions. MAIN MEASUREMENT: Appropriateness of LABA prescriptions as indicated in the Product Summary Characteristics. Patient age, sex, type of LABA and diagnoses were analysed. SOURCES: An information system for billing computerized prescriptions and medical history. RESULTS: Before intervention, prescriptions were inappropriate in 70.3% of patients, and 51.8% received LABA without iCT for unapproved conditions. A diagnosis associated with a respiratory condition was not recorded in the Computerised Medical Records of 18.5% of the patients. After intervention, the percentage of inappropriate prescriptions in the sample dropped to 4.5%, mainly due to a review of the treatment (LABA cessation or iCT addition). CONCLUSIONS: There is a high level of inappropriate use of LABA in Primary Health Care. Mailing educational materials combined with the list of patients with an inappropriate LABA prescription to general practitioners seems to be an effective strategy to improve quality prescribing in respiratory pathologies.

Acreditación de entrevistas individualizadas con los facultativos de Atención Primaria / Accreditation of individualized interviews for Primary Care professional

Una de las actividades realizadas por los farmacéuticos de Atención Primaria dirigidas a mejorar la calidad de la prescripción consiste en la entrevista cara a cara con los facultativos. La acreditación de estas entrevistas como actividad formativa aporta un valor añadido para el profesional entrevistado y para el farmacéutico, en cuanto a la incorporación de una metodología estructurada, el establecimiento de objetivos consensuados, el compromiso de colaboración mutua y el seguimiento periódico del perfil de prescripción. Esta metodología motiva al profesional a mejorar el perfil de prescripción ya que se enmarca en un contexto clínico y no puramente de gestión (AU)

One of the activities carried out by Primary Care pharmacists aimed at improving prescription quality is a face-to-face interview with the medical professionals. Accreditation of these interviews as a training activity provides added value for the professional interviewed and for the pharmacist, in regards to incorporation of a structured methodology, establishment of the objectives agreed on, commitment for mutual collaboration and periodic follow-up of the prescription profile. This methodology motivates the professional to improve the prescription profile since it puts it into a clinical context frame and not a purely management one (AU)

Interacciones farmacológicasen el anciano institucionalizado / No disponible

Objetivo. Analizar las posibles interacciones farmacológicas de los tratamientos indicados en una residenciageriátrica y ofrecer recomendaciones clínicas al médico de familia responsable. Material y métodos. Seanalizaron los tratamientos del total de 57 pacientes residentes en un centro geriátrico. Se valoraron lasposibles interacciones farmacológicas a partir de los siguientes programas: DrugDigest, Multi-Drug InteractionsChecker Medscape, Guía de Interacciones de Fármacos 2003 y The British National Formulary. Seelaboró un informe farmacoterapéutico de cada paciente dirigido a su médico de familia. Resultados. Lamedia de edad de los pacientes fue de 81,0 años, y el 61,4% de ellos eran mujeres. Se detectaron interaccionesfarmacológicas destacables en el 54,4% de los pacientes, siendo el promedio de interacciones por paciente de1,5. Se analizaron 84 interacciones farmacológicas en total. El 43,9% de los pacientes presentó una interacciónde carácter menor, el 36,8% de grado medio y el 5,3% de grado alto. Los informes redactados que seenviaron al médico de cabecera incluyeron un total de 149 propuestas de tratamiento; en 78 de ellas se recomendabala retirada de la medicación (70,2% de los pacientes), en 43 un cambio de fármaco (56,1%) y en 28alguna modificación relacionada con la posología (43,9%). Un 17,5% de los pacientes presentó duplicidad detratamientos. Conclusiones. La detección de un alto número de interacciones farmacológicas en los tratamientosprescritos en residencias geriátricas pone de manifiesto la necesidad de realizar revisiones periódicasen estos centros, para asegurar que se efectúa un uso adecuado de los medicamentos y evitar reaccionesadversas importantes en la población anciana (AU)

Objective. To analyse the possible pharmacological interactions of the treatments prescribed in a geriatrichome and to provide the GP in charge with clinical recommendations. Material and methods. The treatmentsof the total of 57 patients living in a geriatric centre were analysed. The possible pharmacologicalinteractions were assessed through the following programmes: Drugdigest, Multi-Drug Interactions CheckerMedscape, the Guide to Drug Interactions of 2003 and The British National Formulary. A pharmacotherapeuticreport was drawn up for each patient and addressed to his/her GP. Results. The average age of thepatients was 81.0 years, and 61.4% were women. Pharmacological interactions of interest were found in54.4% of the patients, with the average number of interactions per patient being 1.5. A total of 84 pharmacologicalinteractions were analysed. In 43.9% of the patients the degree of the interaction found was minor, in36.8% it was average and in 5.3% of the cases it was high. The reports issued to the GP included a total of 149suggested treatments. Noteworthy were 78 recommendations to stop the medication (70.2% of the patients);43 changes of medicine (56.1% of the patients) and 28 recommendations related to the dosage (43.9% of thepatients). Duplicate treatments were found in 17.5% of the patients. Conclusions. The detection of a highnumber of pharmacological interactions in the treatments prescribed in geriatric homes highlights the needfor those centres to be checked periodically, in order to make sure that the medication is being used appropriatelyand to avoid serious adverse reactions in the elderly population (AU)

Sobre el cambio de atorvastatina por simvastatina. Respuesta / No disponible

No disponible

Estudio comparativo de tablas de riesgo cardiovascular. Implicaciones en el tratamiento en atención primaria / No disponible

Fundamento y objetivo: Valorar la indicación de fármacos hipolipemiantes en prevención primaria, segúndiferentes cálculos del riesgo cardiovascular (RCV) y recomendaciones de tratamiento de distintas sociedadescientíficas.Material y método: Estudio transversal aleatorio que seleccionó a un total de 104 pacientes dislipémicos,sin enfermedad cardiovascular previa. Las variables recogidas para el cálculo del RCV correspondieron alas que presentaba el individuo antes del inicio del tratamiento hipolipemiante. Se calculó el RCV de cadapaciente utilizando las tablas de Framingham, REGICOR y SCORE. La correcta indicación de tratamientofue valorada según los criterios del Grupo PAPPS de la SEMFYC, CEIPC y NCEP III.Resultados: Los valores medios de RCV obtenidos fueron los siguientes: Framingham, 14,5% (DE: 8,7);REGICOR, 7,4% (DE: 4,8); SCORE, 5,5% (DE: 6,3). La adecuación del tratamiento farmacológico se ajustó enun 56,8% (p= 0,006) al criterio REGICOR-PAPPS y en un 47,1% (p= 0,751) al SCORE-CEIPC. No se observógrado de concordancia (kappa= –0,13, p= 0,195) en las intervenciones de tratar o no tratar con una estatinacuando se compararon los criterios REGICOR-PAPPS y SCORE-CEIPC. SCORE-CEIPC seleccionó a pacientescon una edad media superior (65 años, IC 95%: 63-66), con inferior proporción de casos con hipercolesterolemia(colesterol >250 mg/dL) y mayor porcentaje de pacientes diabéticos.Conclusiones: El criterio SCORE-CEIPC estableció un nuevo grupo de pacientes candidatos a ser tratadoscon fármacos hipolipemiantes que no se justificaría por las evidencias científicas actuales. Es necesariofomentar en atención primaria el uso de tablas de RCV adaptadas a la prevalencia de factores de riesgo cardiovascular de la población española

Background and objective: To determine the prescription of antilipemic agents in primary preventionaccording different calculations of cardiovascular risk (CVR) and recommendations made by several scientificsocieties.Subjects and method: Transversal randomised study of 104 patients without previous cardiovascular disease. Calculation of CVR was estimated by using risk factors presented in the subjects before antilipemicagents were indicated. CVR was achieved using the equations of Framingham, REGICOR and SCORE. Theadequate use of treatment was assessed according PAPPS-SEMFYC, CEIPC and NCEP III criteria.Results: Cardiovascular risk scores were: Framingham, 14.5% (S.D.: 8.7); REGICOR, 7.4% (S.D.: 4.8) andSCORE, 5.5% (S.D.: 6.3). Indications to treat with antilipemic agents were adequate to REGICOR-PAPPScriteria in 56,8% (p= 0.006) of patients and in 47.1% (p= 0.751) according SOORE-CEIPC criteria. Noagreement was observed (kappa= –0.13, p= 0.195) between REGICOR-PAPPS and SOCRE-CEIPC criteria ininterventions to treat or not to treat with a statin. SCORE-CEIPC criteria classified a group of patients ofavarage aged 65 (CI 95%: 63-66), with lower proportion of hypercholesterolemia and higher percentageof diabetic subjets.Conclusions: SCORE-CEIPC criteria established a group of patients to be treated with antilipemic agentswithout scientific evidence. It is important to promote the use of cardiovascular equations adapted to Spanishpopulation