Patient-related features associated with a delay in seeking care after stroke.

BACKGROUND: Different factors may weight on time from stroke onset to hospital arrival, and patients' alert certainly contributes to it. We sought to identify clinical and sociodemographic factors associated with a delayed alert and to delineate the profile of the potential latecomer in Catalonia (Spain). METHODS: We used data from the Stroke Code (SC) registry that prospectively recruited consecutive patients with acute stroke, in whom SC was activated (SCA) or not (SCNA), admitted to all Catalan hospitals. Additionally, SCNA patients underwent a structured interview to explore additional beliefs and attitudes related to a delayed alert. We applied a 6-h cut-off to define alert delay according to the time limit for SC activation in Catalonia. We determined independent predictors of delay amongst clinical and sociodemographic data by multivariate logistic regression and applied sample weighting because of different study periods in the SCA and SCNA arms. RESULTS: Of the patients, 37.2% delayed alert beyond 6 h. Compared to non-delayers, latecomers were more likely diabetics, illiterates, belonged to an unfavored social class, and were living alone. Fewer had concomitant atrial fibrillation and alerted through emergency medical service (EMS)/112 whilst suffering a mild or moderate stroke. Amongst patients interviewed, being unaware of stroke's vascular nature and erroneously self-perceiving stroke as a reversible or irrelevant condition independently predicted a longer delay. CONCLUSIONS: Delaying alert after stroke shows a multifactorial background with implication of pre-stroke health status, socioeconomic factors, stroke-related features and patients' beliefs and attitudes toward the disease. In planning future educational campaigns, all these features should be considered.

Hemodynamic effects of volume expansion in patients with cardiac tamponade.

BACKGROUND: Volume expansion has been proposed as an alternative treatment for cardiac tamponade; however, the scientific evidence for this recommendation is very poor. METHODS AND RESULTS: Forty-nine unselected patients (23 males; age 55+/-16 years) with large pericardial effusion and hemodynamic tamponade underwent fluid overload with intravenous administration of 500 mL of normal saline over 10 minutes. Cardiac index and intrapericardial, left ventricular end-diastolic, right atrial, and right ventricular end-diastolic pressures were measured during basal state (tamponade), after fluid overload, and after pericardiocentesis. Twenty-eight patients (57%) had physical signs of tamponade, and 10 (20%) were hypotensive. Size of pericardial effusion was 31+/-13 mm. Initial mean arterial pressure was 88+/-21 mm Hg, and cardiac index was 2.46+/-0.80 L x min(-1) x m(-2). Intrapericardial pressure was 8.31+/-5.98 mm Hg. Volume expansion caused a significant increase in mean arterial pressure (from 88+/-21 to 94+/-23 mm Hg, P=0.003) and cardiac index (from 2.46+/-0.80 to 2.64+/-0.68 L x min(-1) x m(-2), P=0.013), as well as in intrapericardial pressure (from 8.31+/-5.98 to 11.02+/-6.27 mm Hg, P=0.0001), right atrial pressure (from 9.76+/-5.91 to 12.82+/-6.34 mm Hg, P=0.0001), and left ventricular end-diastolic pressure (from 14.21+/-5.97 to 19.48+/-6.19 mm Hg, P=0.0001). Cardiac index increased by >10% in 23 patients (47%), remained unchanged in 11 (22%), and decreased in 15 (31%). No patient developed clinical complications. Predictors of this favorable response were systolic blood pressure <100 mm Hg and low cardiac index. CONCLUSIONS: Approximately one half of patients with cardiac tamponade develop a significant increase in cardiac output after volume overload. Low systolic blood pressure (<100 mm Hg) at baseline was the simplest clinical finding that was predictive of this favorable response.

Enoxaparin as bridging anticoagulant treatment in cardiac surgery.

OBJECTIVE: To assess enoxaparin as bridging anticoagulant treatment in cardiac surgery. METHODS: Prospective registry of those patients who underwent cardiac surgery in our centre between December 2003 and June 2004 and required long-term anticoagulation. Subcutaneous enoxaparin was used as bridging anticoagulant treatment according to a pre-established protocol. The global thromboembolic risk was carefully assessed in all patients. All patients were followed up for 3 months. RESULTS: Of 140 patients who were included (mean (SD) age 66 (11); 49% female), 51 were already receiving long-term acenocumarol treatment before the index intervention. 50% of the patients were at high or very high risk for thromboembolic events in the postoperative period. The mean (SD) number of days between surgery and the first dose of anticoagulant was 2.01 (7) for acenocumarol and 1 (1.01) for enoxaparin. The mean (SD) daily dose of enoxaparin was 1.1 (0.27) mg/kg. Six thromboembolic events (4.3%; 95% CI 1.6 to 9.1) occurred, but only four of them were plausibly related to enoxaparin (2.9%; 95% CI 0.8 to 7.1). Six major haemorrhagic events (4.3%; 95% CI 1.6 to 9.1) occurred, but only three were plausibly related to enoxaparin (2.1%; 95% CI 0.4 to 6.1). CONCLUSIONS: These findings show a reasonable rate of adverse events using enoxaparin as bridging anticoagulant treatment in cardiac surgery. Randomised studies are necessary to evaluate the real efficacy and safety of enoxaparin as bridging anticoagulant treatment in cardiac surgery.

Is psychometric scoring of the McNew Quality of Life after Myocardial Infarction questionnaire superior to the clinimetric scoring? A comparison of the two approaches.

OBJECTIVE: 'Clinimetric' and 'psychometric' approaches are currently used to develop health related quality of life questionnaires. The Quality of Life after Myocardial Infarction questionnaire (QLMI) was originally developed using 'clinimetric' criteria; it was subsequently modified (McNew QLMI) and a new domain structure was defined using factor analysis. The objective of this study was to compare the measurement properties of the McNew QLMI scores when both approaches for scoring are used. METHODS: The McNew QLMI and SF-36 were administered to patients 2 weeks and 2 months after myocardial infarction. Two sets of scores for the McNew QLMI were computed using the original 'clinimetric' and the subsequent 'psychometrically' derived scoring systems. Reliability statistics for the two sets of domains were compared and construct validity was assessed by establishing a priori hypotheses on the expected correlation between each score and the dimensions of the SF-36. RESULTS: Both sets of scores had similar reliability (Cronbach's alpha between 0.64 and 0.93) and responsiveness (SRMs between 0.17 and 0.87) while validity was better for the 'clinimetric' set of scores (concordance between observed and expected correlations was moderate for the 'clinimetric' scores and fair for the 'psychometric' scores). CONCLUSION: Since overall measurement properties of the 'clinimetrically' scored McNew QLMI are better than the 'psychometrically' scored version, we suggest that either the original 'clinimetric' system is used or that an improved 'psychometric' version is developed.

Infective endocarditis in Europe: lessons from the Euro heart survey.

OBJECTIVES: To describe the characteristics, treatment, and outcomes of active infective endocarditis (IE) in Europe. DESIGN: Prospective survey of medical practices in Europe. SETTING: 92 centres from 25 countries. PATIENTS: The EHS (Euro heart survey) on valvar heart disease (VHD) enrolled 5001 adult patients between April and July 2001. Of those, 159 had active IE. RESULTS: 118 patients (74%) had native IE and 41 (26%) had prosthetic IE. Mean (SD) age was 57 (16) years. Blood cultures were obtained for 113 patients (71%) before antibiotic treatment was started. Surgery was performed in 52% of patients. Reasons for surgery were heart failure in 60%, persistent sepsis in 40%, vegetation size in 48%, or embolism in 18%. Surgery was for implantation of mechanical prosthesis in 63%, bioprosthesis in 21%, aortic homograft in 5%, and valve repair in 11%. In-hospital mortality was 12.6%, being 10.4% in the medical group and 15.6% in the surgical group. Among the total population of 5001 patients, only 50% of those with native VHD had been educated on endocarditis prophylaxis and only 33% regularly attended dental follow up. Of patients with IE who had had a procedure at risk during the preceding year only 50% had received adequate prophylaxis. CONCLUSIONS: The EHS on VHD shows that patients with active IE have a high risk profile and often undergo surgery. However, there are deficiencies in obtaining blood cultures and applying prophylaxis. Mortality remains high, which is a justification for the improvement of patient management through education and the implementation of guidelines.

Experience with enoxaparin in patients with mechanical heart valves who must withhold acenocumarol.

OBJECTIVES: To evaluate the incidence of thromboembolic and haemorrhagic events in a cohort of patients with mechanical heart valves who had to withhold acenocumarol and were treated with enoxaparin. DESIGN: Observational prospective study. SETTING: In hospital; after discharge, and follow up by telephone call. PATIENTS AND METHODS: All consecutive patients with mechanical heart valves admitted to the authors' hospital between May 1999 and January 2002 who had to interrupt treatment with acenocumarol and were treated with enoxaparin as an alternative to other methods were enrolled. In each patient, the following characteristics were prospectively determined: the reason for interrupting acenocumarol, demographic data, estimated global risk for thromboembolic events, international normalised ratio before starting enoxaparin treatment, number of days taking enoxaparin, and mean level of anti-Xa activity during treatment. All patients were followed up through clinical history during the hospitalisation and by telephone after discharge to detect thromboembolic events. MAIN OUTCOME MEASURE: Presence of thromboembolic or haemorrhagic events. RESULTS: 82 patients were identified and followed up for a mean of 2.8 months (range 1.5-3.5 months) after discharge. 61 of them (74%) had one or more associated thromboembolic risk factors. Acenocumarol was interrupted (to perform an invasive procedure in 74 patients and because of haemorrhagic complication in 8) an average of 11.2 days (range 3-40 days). Most patients received the standard enoxaparin dose (1 mg/kg at 12 hour intervals). Mean (SD) anti-Xa activity was 0.58 (0.3) IU/ml (median 0.51). There were 8 minor and 1 major bleeding events during enoxaparin treatment. No thromboembolic complications were clinically detected during hospitalisation or during follow up (95% confidence interval 0% to 3.6%). CONCLUSIONS: Enoxaparin may be an effective and relatively safe substitute anticoagulant for patients with mechanical heart valves who must withhold acenocumarol.

Reproducibility of sequential head-up tilt testing in patients with recent syncope, normal ECG and no structural heart disease.

AIMS: To assess the reproducibility of the response to sequential head-up tilt tests. METHODS AND RESULTS: A head-up tilt test was performed early after syncope in 127 patients with a normal ECG and no structural heart disease. Patients with a positive response (82 patients) were randomized to two (1 week and 2 weeks later) or one (2 weeks later) additional head-up tilt tests, and patients with a negative response (45 patients) were randomized to a second head-up tilt test 1 or 2 weeks after the first. The reproducibility of a positive response in the second head-up tilt test was 80% after 1 week and 53% after 2 weeks (P<0.01). Only 53% of the patients with a positive response to a first and second head-up tilt test had a positive response to a third (P=0.01). Intra-individual variation in the time to a positive response was wide. The reproducibility of the cardioinhibitory responses was very poor. Reproducibility of a negative response was 80%. CONCLUSIONS: In patients with recent syncope, the rate of positive responses decreases with sequential head-up tilt tests. Furthermore, the time to a positive response in different head-up tilt tests shows important intra-individual variations, and the reproducibility of the cardioinhibitory responses is very poor. In contrast, the reproducibility of the negative responses is high.

[Medical care of patients with heart failure: clinical characteristics, determinants of prognosis and follow-up in primary care]. / La atención médica de los pacientes con insuficiencia cardíaca: características clínicas, determinantes del pronóstico y seguimiento en la atención primaria.

OBJECTIVE: To assess the process of care and prognosis of patients with heart failure (HF) attended in a tertiary hospital and follow up at the primary care level. DESIGN: Prospective study of 18 months of follow up.Setting. Tertiary hospital and primary care centers of the reference area. Participants. Patients admitted to a tertiary hospital from the first of july until de 31 of december of 1998. OUTCOME MEASUREMENTS: Pharmacological data and morbimortality at discharge and at the end of the follow-up, functional capacity of survivors. RESULTS: 265 patients were included, with a mean age of 75 years, 57% were females, 73.8% had HF as first diagnosis, 6.1% had MI, and 20% were attended for other medical reasons. The most frequent cause of HF was HTA. Drugs more prescribed at the discharge and follow up were diuretics and ACE inhibitors. Hospital mortality was 6.4% and mortality at the end of the follow-up was 46% (in 77% of those for cardiac reasons). After being discharged 38.5% of the patients were readmitted to the hospital with the diagnosis of HF, 72% were visited by the family physician, 43% at the outpatient clinic and 33% by the cardiologist; 60% of the patients who survived were in I-II NYHA functional class, 76% walked regularly, and 25% did recreational activities and physical exercise. CONCLUSIONS: Patients attended at the hospital with HF are an old population, have frequently associated other chronic diseases, and have a very bad prognosis. These patients spend an important amount of health resources. Drug prescription at the follow up is suboptimum. Patients who survived have an acceptable functional capacity.

La atención médica de los pacientes con insuficiencia cardíaca: características clínicas, determinantes del pronóstico y seguimiento en la atención primaria / Medical care in patients with heart failure: clinical characteristics, determinants of prognosis and follow-up in primary care

Objetivo. Analizar el proceso asistencial de los pacientes ingresados con el diagnóstico de insuficiencia cardíaca (IC) y posteriormente durante el seguimiento en la atención primaria. Diseño. Estudio prospectivo de un año y medio de seguimiento. Emplazamiento. Hospital terciario y centros de atención primaria del área de referencia. Participantes. Pacientes diagnosticados de IC al alta hospitalaria desde el 1 de julio hasta el 31 de diciembre de 1998.Mediciones principales. Datos farmacológicos al alta y al final del seguimiento, morbimortalidad al final del seguimiento, capacidad funcional de los supervivientes. Resultados. Se incluyó a 265 pacientes. La edad media de los mismos era de 75 años, el 57 por ciento eran mujeres, el 73,9 por ciento ingresó por IC, el 6,1 por ciento por infarto agudo de miocardio (IAM) y el 20 por ciento por otros motivos. El factor causal más frecuente fue la hipertensión arterial. Los fármacos más utilizados tanto al alta hospitalaria como en el seguimiento fueron los diuréticos, seguidos de los inhibidores de la enzima conversiva de la angiotensina (IECA). La mortalidad hospitalaria fue del 6,4 por ciento, y a los 18 meses de seguimiento, de un 46 por ciento (en un 77 por ciento de éstos de causa cardíaca). Tras el alta hospitalaria el 38,5 por ciento de los pacientes reingresó por IC, el 72 por ciento se visitaba por el médico de familia, el 43 por ciento en consultas externas del hospital y el 33 por ciento por el cardiólogo; un 76 por ciento caminaba regularmente y el 25 por ciento hacía actividades recreacionales y ejercicio físico. Conclusiones. La población atendida por IC es una población envejecida, con alta comorbilidad y un mal pronóstico, que precisa una cantidad destacable de recursos sanitarios. La prescripción farmacológica en el seguimiento es subóptima. La población superviviente disfruta de una aceptable capacidad funcional. (AU)

Long term results of mechanical prostheses for treatment of active infective endocarditis.

OBJECTIVE: To analyse the long term results of mechanical prostheses for treating active infective endocarditis. DESIGN: Prospective cohort study of a consecutive series of patients diagnosed with infective endocarditis and operated on in the active phase of the infection for insertion of a mechanical prosthesis. SETTING: Tertiary referral centre in a metropolitan area. RESULTS: Between 1975 and 1997, 637 cases of infective endocarditis were diagnosed in the centre. Of these, 436 were left sided (with overall mortality of 20.3%). Surgical treatment in the active phase of the infection was needed in 141 patients (72% native, 28% prosthetic infective endocarditis). Mechanical prostheses were used in 131 patients. Operative mortality was 30.5% (40 patients). Ninety one survivors were followed up prospectively for (mean (SD)) 5.4 (4.5) years. Thirteen patients developed prosthetic valve dysfunction. Nine patients suffered reinfection: four of these (4%) were early and five were late. The median time from surgery for late reinfection was 1.4 years. During follow up, 12 patients died. Excluding operative mortality, actuarial survival was 86.6% at five years and 83.7% at 10 years; actuarial survival free from death, reoperation, and reinfection was 73.1% at five years and 59.8% at 10 years. CONCLUSIONS: In patients surviving acute infective endocarditis and receiving mechanical prostheses, the rate of early reinfection compares well with reported results of homografts. In addition, prosthesis dysfunction rate is low and long term survival is good. These data should prove useful for comparison with long term studies, when available, using other types of valve surgery in active infective endocarditis.

Variations in diagnostic yield of head-up tilt test and electrophysiology in groups of patients with syncope of unknown origin.

AIMS: To assess the diagnostic yield of the head-up tilt test and electrophysiology in different groups of patients with syncope of unknown origin established according to simple clinical criteria. METHODS AND RESULTS: Six hundred consecutive patients with syncope of unknown origin submitted to a tilt test. Two hundred and forty seven of them also underwent electrophysiology. Patients were divided into groups according to age at the time of first syncope, ECG findings and the presence of organic heart disease. Positive responses to the tilt test were more common in patients who had suffered their first syncope at an age equal to or below 65 years (group I) than in older patients (group II) (47% vs 33%, P<0.05, OR 1.8, CI 1.2-2.78), and in patients with a normal ECG and without organic heart disease than in the other subgroups of patients (47% vs 37%, P<0.008, OR 1.6). The lowest rate of positive response was observed in older patients with an abnormal ECG and organic heart disease. Electrophysiology disclosed abnormal findings in group II more often than in group I (23% vs 7%, P<0.001, OR 3.7, CI 1.7-9.2). The diagnostic yield from electrophysiology was higher in patients with an abnormal ECG than in those with a normal ECG (22% vs 3.7%, P<0.0005, OR 7.1), and it was especially low in patients with a normal ECG and without organic heart disease (2.6%). CONCLUSION: The diagnostic yield of the tilt test and electrophysiology differs in groups of patients with syncope of unknown origin, established according to simple clinical criteria. These findings have a bearing on selecting the most appropriate test in a particular patient.

[Therapeutic control and quality of life in coronary artery bypass surgery patients]. / Control terapéutico de los factores de riesgo y calidad de vida en los pacientes tratados mediante derivación aortocoronaria.

BACKGROUND: Description of measures of secondary prevention and of health related quality of life one year after the intervention in patients undergoing coronary artery bypass surgery. PATIENTS AND METHOD: One year follow up prospective study in patients undergoing first coronary bypass surgery without associated procedures and aged less than 80 in public and private hospitals in Cataluña, Spain. RESULTS: 710 patients were included, 85.4% were men, and mean age was of 63 years. When compared women and men, 74.8 vs 48.7% patients were diagnosed of hypertension, 70.2 vs 55% of hypercholesterolemia, and 42.3 vs 28.7% of diabetes (p < 0.01); on the other hand, 31.2% of men and 2.9% of women were active smokers (p < 0.01). After a year of follow-up, 7% of the total population remained smokers; a significant reduction of anti-anginal treatments and a significant improvement in health related quality of life were observed. Cholesterol lowering treatment in patients previously diagnosed of hypercholesterolemia increased significantly between hospital admission and one year after hospital discharged (from 44% at the beginning to a 58% at the year of follow up; p < 0.01). CONCLUSIONS: Patients undergoing coronary artery bypass surgery clinically improved one year after the intervention, improving also their health related quality of life. However, the percentage of smokers and the level of antihypertensive and lowering cholesterol treatment at the end of follow up suggest a suboptimal control of risk factor

[Pericardial effusion in the elderly: A different disease?]. / Derrame pericárdico en el paciente anciano: una enfermedad diferente?

INTRODUCTION AND OBJECTIVES: The aim of the present study was to assess possible differences in etiologic spectrum and clinical course of pericardial effusion in elderly patients, as has been previously suggested, and therefore determine whether clinical, management should be based on patient age. METHODS: All echocardiograms performed in our hospital from 1990 to 1996 were screened for pericardial effusion, and those with moderate or large effusions were selected. Patients under 66 years of age were included in group I, and those above 65 years were assigned to group II. RESULTS: We selected 322 patients with moderate (122) or with large (200) effusions. 221 patients being included in group I (aged 15-65, mean 47) and 101 in group II (aged 66-88, mean 72.5). Effusion was large in 60% of group I and in 66% of group II (p = NS), and tamponade occurred in 36% and 38.6%, respectively (p = NS). Specific pericardial infections (tuberculous and purulent pericarditis) were more frequent in group I (5.9 versus 0.9%; p < 0.05). No significant differences were found in incidence of idiopathic (33 vs 38%) or neoplastic (14.4 vs 10.8%) etiologies. During follow-up (96% of the patients, median time of 11 months, range 1-58 months) the mortality (24 vs 30%) and evolution to cardiac constriction (4 vs 2%) were similar in the two groups, but persistence of effusion was more common in group II (6.3 vs 14%; p < 0.05). CONCLUSIONS: Our study suggests that etiology, clinical course and prognosis of moderate and large pericardial effusion are, in general, similar in elderly and younger patients. Thus, management should be similar in the different age groups, and no etiologic form of pericardial disease should be ruled out because of patient's age when considering the differential diagnosis.

Clinical clues to the causes of large pericardial effusions.

PURPOSE: To examine whether the size of the effusion, the presence of tamponade, and inflammatory signs are useful in determining the causes of moderate or severe pericardial effusions. SUBJECTS AND METHODS: All echocardiograms performed at a general hospital between January 1990 and April 1996 were screened for pericardial effusion. Patients with moderate (echo-free space of 10 to 20 mm during diastole) or severe (echo-free space >20 mm) effusions were studied. RESULTS: We identified 322 patients (166 [52%] men, mean [+/- SD] age 56 +/- 17 years [range 15 to 88 years]), 132 (41%) with moderate and 190 (59%) with severe pericardial effusion. The most frequent etiologic diagnoses were acute idiopathic pericarditis (n = 66 [20%]), iatrogenic effusions (n = 50 [16%]), cancer (n = 43 [13%]), and chronic idiopathic pericardial effusion (n = 29 [9%]). In 192 (60%) of the patients, the cause of the effusion was a known medical condition. In the 130 other patients, inflammatory signs were associated with acute idiopathic pericarditis (likelihood ratio = 5. 4, P < 0.001), severe effusions without inflammatory signs or tamponade were associated with chronic idiopathic pericardial effusion (likelihood ratio = 20, P < 0.001), and tamponade without inflammatory signs was associated with malignant effusions (likelihood ratio = 2.9, P < 0.01). CONCLUSIONS: In many patients, pericardial effusions are due to a known underlying disease or condition. In patients without underlying diseases, inflammatory signs, the size of effusion, and the presence or absence of cardiac tamponade can be helpful in establishing cause.

Strategy for optimal aortic regurgitation quantification by Doppler echocardiography: agreement among different methods.

BACKGROUND: Although different Doppler methods have been validated for aortic regurgitation quantification, the benefit of combining information from different methods has not been defined. METHODS: Our study included 2 phases. In the initial phase (60 patients), Doppler parameters (jet width, short-axis jet area, apical jet area, regurgitant fraction from pulmonary and mitral flow, and deceleration slope) were correlated with angiography; range values for each severity grade were defined and intraobserver and interobserver and intermachine variability were studied. In the validation phase (158 patients), defined value ranges were prospectively tested and a strategy based on considering as the definitive severity grade that in which the two best methods agreed was tested. RESULTS: Jet width had the best correlation with angiography (r = 0.91), and its ratio with the left ventricular outflow diameter did not improve the correlation (r = 0.85) and decreased reproducibility. Apical jet area and regurgitant fraction from pulmonary flow permitted acceptable quantification (r = 0.87 and 0.86, respectively) but with worse reproducibility. The other methods were not assessable in 20% to 30% of studies. Concordance with angiography decreased in jet width when the jet was eccentric (90% vs 77%, P <.01), in apical jet area when mitral valve disease was present (84% vs 65%, P <.02), and in short-axis jet area and regurgitant fraction from pulmonary flow with concomitant aortic stenosis (77% vs 44%, P <.002 and 77% vs 53%, P <.02, respectively). Agreement with angiography was very high (94 [95%] of 99) when severity grade coincided in both jet width and apical jet area. In 59 cases without concordance, regurgitant fraction from pulmonary flow was used as a third method. Overall, this strategy permitted concordance with angiography in 146 patients (92%). CONCLUSIONS: Jet width is the best predictor in aortic regurgitation quantification by Doppler echocardiography. However, better results were obtained when a strategy based on concordance between jet width and another Doppler method was established, particularly when the jet was eccentric.

[Adaptation of the MacNew QLMI quality of life questionnaire after myocardial infarction to be used in the Spanish population]. / Adaptación del cuestionario de calidad de vida postinfarto MacNew QLMI para su uso en la población española.

BACKGROUND: The advantage of specific quality of life instruments is its ability to evaluate specific issues related to the illness of interest. The aim of the present study is to develope a Spanish version of the self-administered questionnaire MacNew QLMI, specific for patients after myocardial infarction (MI). MATERIAL AND METHOD: Forward and back-translation method by bilinguals was performed; once the test for feasibility and comprehension was carried out. 143 patients with a first MI completed the Spanish version of the MacNew QLMI and principal components factor analysis was performed. Reliability was assessed in 50 patients with stable MI that completed twice the questionnaire (with an interval of two weeks), measuring reproducibility and internal consistency with Student t test, intraclass correlation and Cronbach's alpha. RESULTS: Factor analysis showed a similar three dimensional structure as the original version. Intraclass correlation coeficient were 0.83, 0.87 and 0.83, and Cronbach's alpha coeficients were 0.85, 0.88 and 0.83 for the emotional, physical and social dimensions respectively. CONCLUSIONS: The Spanish version of the MacNew QLMI questionnaire has a good equivalence with the original version, a good internal consistency and a good reproducibility; it can be used in the Spanish population to study its validity.