Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment.

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient's characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.

Heart Failure Prevalence Rates and Its Association with Other Cardiovascular Diseases and Chronic Kidney Disease: SIMETAP-HF Study.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 years and to assess its association with cardiovascular diseases and chronic kidney disease. METHODS: A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis. RESULTS: The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk. CONCLUSIONS: This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.

Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials.

BACKGROUND: The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. RESULTS: Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. CONCLUSIONS: The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.

Optimización del control telemático de la presión arterial en atención primaria en España (Iniciativa Óptima): resultados de un estudio Delphi / Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study

Objetivo: Representantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos. Materiales y métodos: Estudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores. Resultados: Un total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤135/85mmHg se recomienda pautar una nueva cita telemática en 3-6meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥135/85mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma. Conclusiones: La teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.(AU)

Aim: Members of the working groups on hypertension or cardiovascular disease of the Spanish Societies of Primary Care Physicians (PCPs) [SEMERGEN], Family and Community Medicine [semFYC] and General and Family Physicians [SEMG], conducted a Delphi study to validate with a panel of PCPs with expertise in hypertension several recommendations to optimize teleconsultation in hypertensive patients. Materials and methods: Delphi study based on an online questionnaire with 59 recommendations based on the available evidence and the clinical experience of the authors. Results: 118 PCPs participated in two rounds of the questionnaire (98.3% of the invited physicians), reaching consensus in 53/62 statements (85%). The Primary Care team must proactively select the hypertensive patients suitable for telematic consultation and contact them to set up an appointment. Telematic consultation must begin explaining the reason and aims pursued, continuing with anamnesis, which must explore signs and symptoms of disease worsening, current treatments and level of adherence. In patients with a home blood pressure measurement (HBPM) ≤135/85mmHg, it is recommended to schedule a new telematic appointment in 3-6months. On the contrary, asymptomatic patients with a HBPM ≥135/85mmHg should undergo ambulatory blood pressure monitoring, treatment modification or, in case of warning signs or symptoms, referral to a face-to-face visit or to emergency department. Conclusions: Teleconsultation can complement face-to-face consultation, constituting an additional tool for the appropriate follow-up of hypertensive patients.(AU)

[Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study]. / Optimización del control telemático de la presión arterial en atención primaria en España (Iniciativa Óptima): resultados de un estudio Delphi.

AIM: Members of the working groups on hypertension or cardiovascular disease of the Spanish Societies of Primary Care Physicians (PCPs) [SEMERGEN], Family and Community Medicine [semFYC] and General and Family Physicians [SEMG], conducted a Delphi study to validate with a panel of PCPs with expertise in hypertension several recommendations to optimize teleconsultation in hypertensive patients. MATERIALS AND METHODS: Delphi study based on an online questionnaire with 59 recommendations based on the available evidence and the clinical experience of the authors. RESULTS: 118 PCPs participated in two rounds of the questionnaire (98.3% of the invited physicians), reaching consensus in 53/62 statements (85%). The Primary Care team must proactively select the hypertensive patients suitable for telematic consultation and contact them to set up an appointment. Telematic consultation must begin explaining the reason and aims pursued, continuing with anamnesis, which must explore signs and symptoms of disease worsening, current treatments and level of adherence. In patients with a home blood pressure measurement (HBPM) ≤135/85mmHg, it is recommended to schedule a new telematic appointment in 3-6months. On the contrary, asymptomatic patients with a HBPM ≥135/85mmHg should undergo ambulatory blood pressure monitoring, treatment modification or, in case of warning signs or symptoms, referral to a face-to-face visit or to emergency department. CONCLUSIONS: Teleconsultation can complement face-to-face consultation, constituting an additional tool for the appropriate follow-up of hypertensive patients.

Síndrome metabólico y enfermedad cardiovascular en la provincia de Cáceres: estudio SIMCERES / Metabolic syndrome and cardiovascular disease in the province of Caceres (Spain): the SIMCERES study

Introducción y objetivos El síndrome metabólico (SM) confiere un riesgo cardiovascular elevado a los individuos que lo padecen. El objetivo del estudio SIMCERES fue determinar la prevalencia de SM en pacientes con enfermedad cardiovascular (ECV) previa (cardiopatía isquémica, ictus y enfermedad arterial periférica), definido éste por los criterios de la National Cholesterol Education Program/Adult Treatment Panel (ATP) III y la Federación Internacional de Diabetes (IDF). Métodos Se eligió al azar mediante muestreo aleatorio usando el código de identificación de asistencia sanitaria de los médicos de atención primaria una muestra poblacional de 1.498 individuos mayores de 14 años de la provincia de Cáceres. Se les hicieron las determinaciones necesarias para realizar el diagnóstico de SM según criterios del ATP-III y la IDF, y se los interrogó sobre antecedentes personales y familiares de ECV. Se detectó a 204 individuos con ECV previa, un 13,6% de la población. Resultados La prevalencia de SM en individuos con ECV fue del 32,8% según criterios del ATP-III y del 42,6% según criterios de la IDF con una edad media de 72,26±12,61 años según el ATP-III y de 70,99±13,05 años según la IDF, sin que hubiera diferencias entre varones y mujeres en ninguna de las 2 definiciones. Se encontró asociación estadística entre la presencia de ECV y SM, tanto con los criterios del ATP-III (odds ratio ATP-III: 3,2/intervalo de confianza 95%: 2,29–4,47) como con los criterios de la IDF (odds ratio IDF: 3,08/intervalo de confianza 95%: 2,26–4,2) (p<0,0001). Conclusiones El SM es muy prevalente en la población de la provincia de Cáceres con ECV previa, y dicha prevalencia aumenta con la edad de la población, siendo igual en ambos sexos (AU)

Introduction and objectives Metabolic syndrome confers high cardiovascular risk in affected individuals. The objective of the SIMCERES study was to determine the prevalence of metabolic syndrome in patients with prior cardiovascular disease (ischemic heart disease, stroke and peripheral arterial disease), defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF). Methods A population-based sample of 1498 persons aged more than 14 years old from the province of Caceres was randomly chosen using the healthcare identification code of primary care physicians. The determinations required to make a diagnosis of metabolic syndrome according to ATP-III and IDF criteria were performed and participants were questioned about their personal and family history of cardiovascular disease. Prior cardiovascular disease was detected in 204 individuals, representing 13.6% of the population. Results The prevalence of metabolic syndrome in persons with cardiovascular disease was 32.8% according to ATP-III criteria and 42.6% according to IDF criteria, with a mean age of 72.26±12.61 years (ATP-III criteria) and 70.99±13.05 years (IDF criteria). There were no differences between men and women in either of the two definitions. A statistically significant association was found between the presence of cardiovascular disease and metabolic syndrome, with both the ATP-III criteria (OR ATP-III: 3.2/95% CI 2.29–4.47) and the IDF criteria (OR IDF: 3.08/95%: 2.26–4.2) (p<0.0001).Conclusions Metabolic syndrome is highly prevalent in the population of the province of Caceres with prior cardiovascular disease. The prevalence of this syndrome increases with the age of the population and is the same in both sexes (AU)