Grado de control del tratamiento anticoagulante oral en los centros de Atención Primaria de la Comunidad de Madrid: estudio CHRONOS-TAO / Quality control of oral anticoagulant therapy in Primary Care in Madrid City, Spain: CHRONOS-TAO study

Objetivos: Conocer el grado de control de los pacientes en tratamiento con anticoagulantes orales atendidos en Atención Primaria (AP) estimando el tiempo en rango terapéutico (TRT) según el método de Rosendaal, y compararlo con el porcentaje de international normalized ratio (INR, «razón normalizada internacional») en rango y el análisis transversal (última INR). Material y método: Estudio observacional retrospectivo con datos de la historia clínica electrónica de todos los centros de AP (n = 262) de la Comunidad de Madrid. Se incluyeron todos los pacientes en tratamiento con acenocumarol con rango terapéutico de INR entre 2 y 3. Se excluyeron los pacientes con valvulopatías y aquellos con seguimiento discontinuo (< 3 determinaciones de INR, período de > 90 días o ≥ 3 períodos de > 60 días entre 2 determinaciones). La población final fue de 49.312. Las variables consideradas fueron todos los valores de INR y sus fechas respectivas. Se calculó el TRT por los 3 métodos referidos, considerando «rango terapéutico» valores de INR entre 2-3, y rango «ajustado» valores de INR entre 1,8-3,2. Consideramos «control óptimo» en cada paciente si el TRT > 60%. Resultados: El TRT por el método de Rosendaal fue del 66,8% (81,7% ajustado), el porcentaje de INR en rango, del 58,8% (66,5% ajustado), y el análisis transversal, del 70,5% (76,8% ajustado). La media (desviación estándar) de los TRT por paciente fue del 65% (20,3), y el porcentaje de pacientes con un TRT > 60% fue del 63,3% (88,1% ajustado). Conclusión: El grado de control de los pacientes anticoagulados en AP es aceptable, similar o superior respecto a otros estudios y a los ensayos pivotales de nuevos anticoagulantes. Comparados con el método de Rosendaal, el porcentaje total de INR infraestima el grado de control, y el análisis transversal lo sobrestima ligeramente (AU)

Objectives: To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). Material and method: A retrospective observational study based on electronic medical record in routine clinical practice. Setting: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC (< 3 INR determinations in the studied period, a period of > 90 days or ≥ 3 periods of > 60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered 'therapeutic range' INR between 2-3 and 'adjusted range' INR between 1.8-3.2. Optimal control for each patient was considered TTR > 60%. Results: By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR > 60% was 63.3% (88.1% adjusted). Conclusion: The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it (AU)

[Quality control of oral anticoagulant therapy in Primary Care in Madrid City, Spain: CHRONOS-TAO study]. / Grado de control del tratamiento anticoagulante oral en los centros de Atención Primaria de la Comunidad de Madrid: estudio CHRONOS-TAO.

OBJECTIVES: To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). MATERIAL AND METHOD: A retrospective observational study based on electronic medical record in routine clinical practice. SETTING: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC (<3 INR determinations in the studied period, a period of>90 days or ≥ 3 periods of>60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered "therapeutic range" INR between 2-3 and "adjusted range" INR between 1.8-3.2. Optimal control for each patient was considered TTR>60%. RESULTS: By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR>60% was 63.3% (88.1% adjusted). CONCLUSION: The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.

Prevalencia, grado de control y tratamiento de la hipertensión arterial en al población de 30 a 74 años de la Comunidad de Madrid. estudio Predimerc / Prevalence, degree of control and treatment of hypertension in the adult population of Madrid, Spain

Fundamentos: La hipertensión arterial (HTA) es uno de los principales factores de riesgo cardiovascular modificables. El objetivo del estudio es estimar en la población de 30 a 74 años de la Comunidad de Madrid (CM) la prevalencia de hipertensión arterial, el nivel de conocimiento y tratamiento farmacológico, y grado de control. Métodos: Estudio transversal de una muestra poblacional en 2007 entre los residentes en la Comunidad Madrid de entre 30 y 74 años, obtenida por muestreo aleatorio por conglomerados bietápico. Se aplicó un cuestionario epidemiológico por vía telefónica. En el centro de salud se realizó la exploración física por un equipo de enfermeras entrenadas. Para las variables cuantitativas se han calculado las medias e intervalos de confianza del 95% (IC del 95%) y para las cualitativas el porcentaje y el IC del 95% . Para evaluar el control de la HTA según número de principios activos se calcularon las Odds ratio mediante regresión logística. Resultados: La muestra definitiva incluyó a 1.085 hombres y 1.183 mujeres, con una edad media de 48,3 años. La prevalencia de hipertensión fue de 29,3% (IC95%:27,3-31,5) (35,1% en hombres y 23,9% en mujeres (p<0,01). De las 665 personas hipertensas detectadas el 68,6% conocía su condición (62,4% los varones y 76,65 las mujeres, p<0,05) de los cuales el 54% estaba en tratamiento farmacológico (45,4% los varones y 64,5% las mujeres, p<0,05). De las 265 personas hipertensas en tratamiento tenían controlada la tensión arterial el 33% de los varones frente al 49% de las mujeres (p<0,05). Las personas tratadas con dos o más principios activos mejoraron su control frente a las tratadas con monoterapia [ORa: 1,89; (IC95%:1,09-33,27)]. Conclusiones: Nuestras cifras de prevalencia, tratamiento y control ocupan un lugar intermedio-bajo entre las publicadas en estudios previos sobre poblaciones españolas y europeas. Sin embargo la HTA es un problema de salud pública en la CM. Un porcentaje importante de personas hipertensas no están diagnosticadas. De los hipertensos que conocen su diagnóstico y reciben tratamiento sólo 1 de cada 3 varones y una de cada 2 mujeres están bien controlados(AU)

Background: Hypertension (HT) is a major modifiable cardiovascular risk factors. The objective of this study is to estimate the adult population of the Community of Madrid (30-74 years) prevalence of hypertension, knowledge, degree of control and drug treatment. Methods: We studied a random sample population in 2007 among residents of Madrid Community of between 30 and 74 years, obtained by cluster sampling. An epidemiological questionnaire was applied through telephone interview. Physical examination was conducted by a team of trained nurses in the health center. . ; To assess control of hypertension by number of active ingredients Odds were calculated through logistic regression models. Results: The final sample included 1,085 men and 1,183 women with a mean age of 48.3 years. The prevalence of hypertension was 29.3% (35.1% men and 23.9% in women (p <0.01). Of the 665 hypertensives identified 68.6% knew their condition (62.4 76.65% in males and females, p <0.05), of which 54% were in drug treatment (45.4% in men and 64.5% in women, p <0.05). Of the 265 treated hypertensive patients, blood pressure was controlled in 33% of males and 49% of women, p <0.05. Patients treated with two or more active improves your control (aOR: 1, 89). Conclusions: Our data on prevalence, treatment and control are at the lower-intermediate between those reported in previous studies on Spanish and European populations. However, the HA is a public health problem in the CM. Many hypertensive patients are not detected. Of those detected, only 1 in3 of men and 1 in 2 women are well controlled(AU)

[Prevalence, degree of control and treatment of hypertension in the adult population of Madrid, Spain]. / Prevalencia, grado de control y tratamiento de la hipertensión arterial en la población de 30 a 74 años de la Comunidad de Madrid: Estudio PREDIMERC.

BACKGROUND: Hypertension (HT) is a major modifiable cardiovascular risk factors. The objective of this study is to estimate the adult population of the Community of Madrid (30-74 years) prevalence of hypertension, knowledge, degree of control and drug treatment. METHODS: We studied a random sample population in 2007 among residents of Madrid Community of between 30 and 74 years, obtained by cluster sampling. An epidemiological questionnaire was applied through telephone interview. Physical examination was conducted by a team of trained nurses in the health center. To assess control of hypertension by number of active ingredients odds were calculated through logistic regression models. RESULTS: The final sample included 1,085 men and 1,183 women with a mean age of 48.3 years. The prevalence of hypertension was 29.3% (35.1% men and 23.9% in women (p<0.01). Of the 665 hypertensives identified 68.6% knew their condition (62.4 76.65% in males and females, p<0.05), of which 54% were in drug treatment (45.4% in men and 64.5% in women, p<0.05). Of the 265 treated hypertensive patients, blood pressure was controlled in 33% of males and 49% of women, p<0.05. Patients treated with two or more active improves your control (aOR: 1, 89). CONCLUSIONS: Our data on prevalence, treatment and control are at the lower-intermediate between those reported in previous studies on Spanish and European populations. However, the HA is a public health problem in the CM. Many hypertensive patients are not detected. Of those detected, only 1 in 3 of men and 1 in 2 women are well controlled.