Effectiveness of Statins for Primary Prevention of Cardiovascular Disease in Low- and Medium-Risk Males: A Causal Inference Approach with Observational Data.

In this study, we analyzed the effectiveness of statin therapy for the primary prevention of cardiovascular disease (CVD) in low- and medium-risk patients. Using observational data, we estimated effectiveness by emulating a hypothetical randomized clinical trial comparing statin initiators with statin non-initiators. Two approaches were used to adjust for potential confounding factors: matching and inverse probability weighting in marginal structural models. The estimates of effectiveness were obtained by intention-to-treat and per-protocol analysis. The intention-to-treat analysis revealed an absolute risk reduction of 7.2 (95% confidence interval (CI95%), -6.6-21.0) events per 1000 subjects treated for 5 years in the matched design, and 2.2 (CI95%, -3.9-8.2) in the marginal structural model. The per-protocol analysis revealed an absolute risk reduction of 16.7 (CI95%, -3.0-36) events per 1000 subjects treated for 5 years in the matched design and 5.8 (CI95%, 0.3-11.4) in the marginal structural model. The indication for statin treatment for primary prevention in individuals with low and medium cardiovascular risk appears to be inefficient, but improves with better adherence and in subjectvs with higher risk.

Effectiveness of 3 COVID-19 Vaccines in Preventing SARS-CoV-2 Infections, January-May 2021, Aragon, Spain.

Reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is a worldwide challenge; widespread vaccination could be one strategy for control. We conducted a prospective, population-based cohort study of 964,258 residents of Aragon, Spain, during December 2020-May 2021. We used the Cox proportional-hazards model with vaccination status as the exposure condition to estimate the effectiveness of 3 coronavirus disease vaccines in preventing SARS-CoV-2 infection. Pfizer-BioNTech had 20.8% (95% CI 11.6%-29.0%) vaccine effectiveness (VE) against infection after 1 dose and 70.0% (95% CI 65.3%-74.1%) after 2 doses, Moderna had 52.8% (95% CI 30.7%-67.8%) VE after 1 dose and 70.3% (95% CI 52.2%-81.5%) after 2 doses, and Oxford-AstraZeneca had 40.3% (95% CI 31.8%-47.7%) VE after 1 dose. All estimates were lower than those from previous studies. Results imply that, although high vaccination coverage remains critical to protect people from disease, it will be difficult to effectively minimize transmission opportunities.

Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization.

We sought to identify specific profiles of new lipid-lowering drug users based on adherence to a healthy lifestyle and persistence with medication, and to characterize co-morbidities, co-treatments, and healthcare utilization for each of the profiles identified. Observational study in 517 participants in the Aragon Workers' Health Study (AWHS) without previous cardiovascular disease (CVD) and who initiated lipid-lowering therapy. Data were collected from workplace medical examinations and administrative health databases (2010-2018). Using cluster analysis, we identified distinct patient profiles based on persistence with therapy and lifestyle. We then compared characteristics, morbidity, and healthcare utilization across clusters. Participants were aggregated into four clusters based on persistence with therapy, smoking status, adherence to Mediterranean diet, and physical activity. In cluster 1 (n = 113), comprising those with a healthiest lifestyle (14.2% smokers, 84.0% with medium-high adherence to Mediterranean diet, high physical activity), 16.8% were persistent. In cluster 3 (n = 108), comprising patients with the least healthy lifestyle (100% smokers, poor adherence to the Mediterranean diet, low level of physical activity), all were non-persistent. Clusters 2 (n = 150) and 4 (n = 146) both comprised patients with intermediate lifestyle behaviors, but differed in terms of persistence (100 and 0%, respectively). Compared with other clusters, the burden of morbidity, cardiovascular score, and healthcare utilization were lower in cluster 1. The healthy adherer effect was only observed in new lipid-lowering drug users of certain profiles. Furthermore, we found that differences in adherence to lifestyle and medication recommendations for CVD prevention influenced morbidity burden and healthcare utilization.

Factors Associated with the Prescribing of High-Intensity Statins.

In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as "high-intensity" or "low-moderate-intensity". Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08-2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29-19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574-0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins.

[Influenza vaccination coverages and related factors among splenectomy patients from a health sector in Zaragoza (Spain)]. / Cobertura de vacunación antigripal y factores asociados en pacientes esplenectomizados de un sector de salud de Zaragoza (España).

OBJECTIVE: Influenza vaccination coverage in risk groups has been put forward as a healthcare quality indicator. Our objective was to determine the vaccination rate in splenectomized patients. METHODS: We carried out a cross-sectional study that included splenectomized patients in the Zaragoza III Sector from January 2012 to December 2016. The patients were identified through the database of the Clinical Documentation and File Management Services of the Sector Hospital under code 41.5 of the ICD-9. The variables (sociodemographic and surgical variables, and having received information and advice regarding vaccination when they were admitted to the Immunization Unit) were obtained after a review of the patients' records in the Specialized and Primary Care Services. The association with being vaccinated during the campaign corresponding to the surgery date was studied with bivariate analysis and multiple logistic regression model. RESULTS: 81 patients were analyzed; 60.5% were men, with an average age of 56.3 years. Neoplasms and hematological diseases were the most common motives for surgery (64.2%). The vaccination rate was 58%. Having been advised to vaccinate (OR=6.53; 95%CI=1.88-22.69) and having been vaccinated in the previous season (OR=4.79; 95%CI= 1.48-15.57) were associated with vaccination. CONCLUSIONS: The coverage rate ranks in an intermediate position when compared with other countries. It is necessary to improve the referral system of these patients to the Immunization Unit because the information obtained by this service leads to better results.

OBJETIVO: La cobertura vacunal antigripal en grupos de riesgo ha sido postulada como un indicador de la calidad asistencial. El objetivo de este estudio fue conocer dicha tasa de vacunación en esplenectomizados. METODOS: Se realizó un estudio transversal que incluyó a los esplenectomizados del sector Zaragoza III entre enero de 2012 y diciembre de 2016. La identificación de los pacientes se realizó a través de la base de datos del Servicio de Archivos y Documentación Clínica del hospital del sector, utilizando el código 41.5 de la Clasificación Internacional de Enfermedades (9ª edición). Las variables (sociodemográficas, quirúrgicas y el haber recibido información y consejo para vacunarse al ser atendido en la consulta hospitalaria de vacunas) fueron obtenidas revisando las historias de atención especializada y primaria. Se analizó la asociación con la vacunación en la campaña correspondiente a la fecha de la cirugía mediante un análisis bivariado y un modelo de regresión logística múltiple. RESULTADOS: Fueron estudiados 81 pacientes. El 60,5% eran hombres, con una edad media de 56,3 años. Las neoplasias y las enfermedades hematológicas fueron los motivos más frecuentes de cirugía (64,2%). La tasa de vacunación fue del 58%. Recibir la recomendación de vacunación (OR=6,53; IC95%=1,88-22,69) y haber sido vacunado en la temporada anterior (OR=4,79; IC95%=1,48-15,57) se asociaron con la acción de vacunarse. CONCLUSIONES: La cobertura se encuentra en una posición intermedia comparada con otros países. Se ha de mejorar la sistemática de derivación de estos pacientes a la consulta hospitalaria de vacunas, dado que la información facilitada en ella contribuye a obtener mejores resultados.

[Assessment of the effectiveness of an intervention to improve immunization coverage in splenectomy patients]. / Evaluación de la efectividad de una intervención para mejorar las coberturas vacunales en pacientes esplenectomizados.

OBJECTIVE: Splenectomized patients have an increased risk of sepsis caused by encapsulated bacteria. Pneumococcal, meningococcal and Haemophilus influenzae B vaccination is recommended in this group. The aim of our study was to assess the impact of the introduction of an immunization hospital clinic on their immunization coverages. METHODS: Quasi-experimental study. The control group included patients splenectomized between January 2012-April 2014, and the intervention group included patients splenectomized between May 2014-December 2016. The global and specific immunization coverages were compared between both groups using a Chi-square test. RESULTS: 80 patients were analyzed. The most commonly administered vaccine was the 23-valent pneumococcal polysaccharide vaccine (65.0%). A significant improvement was observed both in the global immunization rate (17.1% in the pre-intervention study vs. 57.8% in the post-intervention study) (RR: 3.37; 95% CI: 1.56-7.27) and in the specific immunization rate for the Haemophilus influenzae B, meningococcal C and 13-valent pneumococcal conjugate vaccines. CONCLUSIONS: Introducing an immunization hospital clinic is an effective measure to improve the immunization coverage of splenectomy patients.

OBJETIVO: Los pacientes esplenectomizados presentan riesgo elevado de sepsis por bacterias encapsuladas, motivo por el que se recomienda vacunarles frente a neumococo, meningococo y Haemophilus infl uenzae B. El objetivo de nuestro trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en sus coberturas de vacunación. METODOS: Estudio cuasiexperimental. Constituyeron el grupo control los esplenectomizados entre enero 2012-abril 2014, y el grupo intervención los operados entre mayo 2014-diciembre 2016. Se compararon las coberturas vacunales global y específica para cada vacuna según grupo utilizando la prueba chi-cuadrado. RESULTADOS: Se analizaron 80 pacientes. La vacuna más administrada fue la antineumocócica polisacárida 23-valente (65,0%). Hubo una mejora significativa en la tasa de vacunación global (17,1% en el periodo preintervención versus 57,8% en el postintervención) (RR=3,37; IC95%:1,56-7,27) así como específicamente para las vacunas frente a Haemophilus influenzae de tipo B, antimeningocócica C y antineumocócica conjugada 13-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una medida efectiva para mejorar las coberturas vacunales de estos pacientes.

Cobertura de vacunación antigripal y factores asociados en pacientes esplenectomizados de un sector de salud de Zaragoza (España) / Influenza vaccination coverages and related factors among splenectomy patients from a health sector in Zaragoza (Spain)

OBJECTIVE: Influenza vaccination coverage in risk groups has been put forward as a healthcare quality indicator. Our objective was to determine the vaccination rate in splenectomized patients. METHODS: We carried out a cross-sectional study that included splenectomized patients in the Zaragoza III Sector from January 2012 to December 2016. The patients were identified through the database of the Clinical Documentation and File Management Services of the Sector Hospital under code 41.5 of the ICD-9. The variables (sociodemographic and surgical variables, and having received information and advice regarding vaccination when they were admitted to the Immunization Unit) were obtained after a review of the patients' records in the Specialized and Primary Care Services. The association with being vaccinated during the campaign corresponding to the surgery date was studied with bivariate analysis and multiple logistic regression model. RESULTS: 81 patients were analyzed; 60.5% were men, with an average age of 56.3 years. Neoplasms and hematological diseases were the most common motives for surgery (64.2%). The vaccination rate was 58%. Having been advised to vaccinate (OR=6.53; 95%CI=1.88-22.69) and having been vaccinated in the previous season (OR=4.79; 95%CI= 1.48-15.57) were associated with vaccination. CONCLUSIONS: The coverage rate ranks in an intermediate position when compared with other countries. It is necessary to improve the referral system of these patients to the Immunization Unit because the information obtained by this service leads to better results

OBJETIVO: La cobertura vacunal antigripal en grupos de riesgo ha sido postulada como un indicador de la calidad asistencial. El objetivo de este estudio fue conocer dicha tasa de vacunación en esplenectomizados. MÉTODOS: Se realizó un estudio transversal que incluyó a los esplenectomizados del sector Zaragoza III entre enero de 2012 y diciembre de 2016. La identificación de los pacientes se realizó a través de la base de datos del Servicio de Archivos y Documentación Clínica del hospital del sector, utilizando el código 41.5 de la Clasificación Internacional de Enfermedades (9ª edición). Las variables (sociodemográficas, quirúrgicas y el haber recibido información y consejo para vacunarse al ser atendido en la consulta hospitalaria de vacunas) fueron obtenidas revisando las historias de atención especializada y primaria. Se analizó la asociación con la vacunación en la campaña correspondiente a la fecha de la cirugía mediante un análisis bivariado y un modelo de regresión logística múltiple. RESULTADOS: Fueron estudiados 81 pacientes. El 60,5% eran hombres, con una edad media de 56,3 años. Las neoplasias y las enfermedades hematológicas fueron los motivos más frecuentes de cirugía (64,2%). La tasa de vacunación fue del 58%. Recibir la recomendación de vacunación (OR=6,53; IC95%=1,88-22,69) y haber sido vacunado en la temporada anterior (OR=4,79; IC95%=1,48-15,57) se asociaron con la acción de vacunarse. CONCLUSIONES: La cobertura se encuentra en una posición intermedia comparada con otros países. Se ha de mejorar la sistemática de derivación de estos pacientes a la consulta hospitalaria de vacunas, dado que la información facilitada en ella contribuye a obtener mejores resultados

Evaluación de la efectividad de una intervención para mejorar las coberturas vacunales en pacientes esplenectomizados / Assessment of the effectiveness of an intervention to improve immunization coverage in splenectomy patients

OBJETIVO: Los pacientes esplenectomizados presentan riesgo elevado de sepsis por bacterias encapsuladas, motivo por el que se recomienda vacunarles frente a neumococo, meningococo y Haemophilus infl uenzae B. El objetivo de nuestro trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en sus coberturas de vacunación. MÉTODOS: Estudio cuasiexperimental. Constituyeron el grupo control los esplenectomizados entre enero 2012-abril 2014, y el grupo intervención los operados entre mayo 2014-diciembre 2016. Se compararon las coberturas vacunales global y específica para cada vacuna según grupo utilizando la prueba chi-cuadrado. RESULTADOS: Se analizaron 80 pacientes. La vacuna más administrada fue la antineumocócica polisacárida 23-valente (65,0%). Hubo una mejora significativa en la tasa de vacunación global (17,1% en el periodo preintervención versus 57,8% en el postintervención) (RR=3,37; IC95%:1,56-7,27) así como específicamente para las vacunas frente a Haemophilus influenzae de tipo B, antimeningocócica C y antineumocócica conjugada 13-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una medida efectiva para mejorar las coberturas vacunales de estos pacientes

OBJECTIVE: Splenectomized patients have an increased risk of sepsis caused by encapsulated bacteria. Pneumococcal, meningococcal and Haemophilus influenzae B vaccination is recommended in this group. The aim of our study was to assess the impact of the introduction of an immunization hospital clinic on their immunization coverages. METHODS: Quasi-experimental study. The control group included patients splenectomized between January 2012-April 2014, and the intervention group included patients splenectomized between May 2014-December 2016. The global and specific immunization coverages were compared between both groups using a Chi-square test. RESULTS: 80 patients were analyzed. The most commonly administered vaccine was the 23-valent pneumococcal polysaccharide vaccine (65.0%). A significant improvement was observed both in the global immunization rate (17.1% in the pre-intervention study vs. 57.8% in the post-intervention study) (RR: 3.37; 95% CI: 1.56-7.27) and in the specific immunization rate for the Haemophilus influenzae B, meningococcal C and 13-valent pneumococcal conjugate vaccines. CONCLUSIONS: Introducing an immunization hospital clinic is an effective measure to improve the immunization coverage of splenectomy patients