[Clinical and socio-sanitary characteristics in adults older than 65 years attended in the Primary Care setting. The PYCAF study]. / Características clínicas y sociosanitarias en mayores de 65 años asistidos en atención primaria. Estudio PYCAF.

OBJECTIVE: To describe the clinical and socio-sanitary characteristics of adults older than 65 years attended in a Primary Care setting. MATERIAL AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a descriptive, cross-sectional and multicentre study, in which patients older than 65 years attended in clinical practice in Primary Care in Spain were consecutively included. RESULTS: A total of 2,461 patients (mean age 76.0±6.9 years, 57.9% women) were included in the study. The coexistence of cardiovascular risk factors and comorbidities was frequent, with arterial hypertension (73.7%) being the most prevalent, followed by dyslipidaemia (58.3%), arthrosis (56.4%), obesity (34.0%), and diabetes (28.9%). Some degree of cognitive impairment was observed in 13.4% of patients. Women had higher rates of frailty (61.0% vs. 51.8%; P<.001). Just under half (47.4%) of subjects were taking more than 6 drugs, with the prescription being higher in women (44.2% vs. 49.8%; P=.047). Just under half (49.5%) of patients made more than 10 visits to Primary Care, 25.9% of patients 4 or more visits to the specialist, and 22.3% of patients were admitted to hospital in the last year. CONCLUSIONS: The PYCAF study shows that elderly patients have a higher prevalence of chronic cardiovascular and non-cardiovascular diseases, which leads to high polypharmacy. The latter has consequences both on patient safety and on the direct and indirect costs of the National Health System that emanate from the care of patients over 65 years of age. Half the sample has fragility.

Grado de control y cumplimiento terapéutico de la anticoagulación con acenocumarol en Atención Primaria / Level of control and treatment adherence of anticoagulation with acenocoumarol in Primary Care

Objetivos. Determinar el grado de control y cumplimiento terapéutico en una muestra de pacientes tratados con acenocumarol asistidos en Atención Primaria. Material y métodos. Estudio descriptivo transversal realizado en pacientes diagnosticados de fibrilación auricular no valvular tratados con acenocumarol en Atención Primaria. Se recogieron los datos de los pacientes que disponían de los valores de la International Normalized Ratio (INR, «razón normalizada internacional») de los últimos 6 meses en la consulta del centro de salud. Se consideró control de INR inadecuado cuando el porcentaje de valores de INR dentro del rango terapéutico fue inferior al 60% en los últimos 6 meses. Se realizó valoración de cumplimiento por entrevista telefónica mediante el Test de Morisky-Green. Resultados. Se incluyeron 191 pacientes, 110 mujeres (57,6%), con una edad media de 76,5±9,4 años. Setenta y seis pacientes (39,8%) estaban en rango terapéutico (INR: 2-3) y 115 pacientes (60,2%) fuera de rango (por debajo de 2 el 20,9% y por encima de 3 el 39,3%). El 62,9% de los varones y el 58,2% delas mujeres estaban mal controlados (p<0,05). El mal control de INR aumentó hasta la edad de 85 años (<75 años: 57,8%; 75-85 años: 67,6%;>85 años: 61,5%). Respondieron al cuestionario de cumplimiento 90 pacientes (78,3%), siendo cumplidores 74 (82,2%) y no cumplidores 16 (17,8%). Conclusiones. Seis de cada 10 pacientes que están en tratamiento con acenocumarol están fuera de rango y casi 2 de cada 10 pacientes fuera de rango no cumple el tratamiento con acenocumarol. Llamamos la atención sobre la necesidad de evaluar sistemáticamente el cumplimiento terapéutico en los pacientes anticoagulados en Atención Primaria (AU)

Objectives. To determine the level of control in treatment compliance in a sample of patients who were treated with acenocoumarol attended in Primary Care settings. Material and methods. Cross-sectional study. Patients with non-valvular atrial fibrillation treated with acenocoumarol were included. The sample size was calculated based on previous studies. Data of patients who possessed International Normalized Ratio (INR) values in last 6 months in medical consult were collected. It was considered that the INR control was inadequate when the percentage of INR values within the therapeutic range was less than 60% in the last 6 months. Assessment of compliance by telephone interview was conducted by the Morisky-Green Test. Results. One hundred and ninety-one patients, 110 women (57.6%) with an average age of 76.5±9.4 years were included. Seventy-six patients (39.8%) were in therapeutic range (INR: 2-3) and 115 patients (60.2%) were out of range (below 2 the 20.9% and above 3 the 39.3%). Poor control of INR increased to the age of 85 years (<75 years: 57.8%; 75-85 years: 67.6%;>85 years: 61.5%). Ninety patients responded to the compliance questionnaire (78.3%), being compliant 74 (82.2%) and non-compliant 16 (17.8%). Conclusions. Six of 10 patients undergoing treatment with acenocoumarol are out of range and nearly 2 of each 10 patients out of range does not accomplish the treatment. We call attention to the need to make a systematically review of adherence in anticoagulated patients attended in Primary Care settings (AU)

[Level of control and treatment adherence of anticoagulation with acenocoumarol in Primary Care]. / Grado de control y cumplimiento terapéutico de la anticoagulación con acenocumarol en Atención Primaria.

OBJECTIVES: To determine the level of control in treatment compliance in a sample of patients who were treated with acenocoumarol attended in Primary Care settings. MATERIAL AND METHODS: Cross-sectional study. Patients with non-valvular atrial fibrillation treated with acenocoumarol were included. The sample size was calculated based on previous studies. Data of patients who possessed International Normalized Ratio (INR) values in last 6 months in medical consult were collected. It was considered that the INR control was inadequate when the percentage of INR values within the therapeutic range was less than 60% in the last 6 months. Assessment of compliance by telephone interview was conducted by the Morisky-Green Test. RESULTS: One hundred and ninety-one patients, 110 women (57.6%) with an average age of 76.5±9.4 years were included. Seventy-six patients (39.8%) were in therapeutic range (INR: 2-3) and 115 patients (60.2%) were out of range (below 2 the 20.9% and above 3 the 39.3%). Poor control of INR increased to the age of 85 years (<75 years: 57.8%; 75-85 years: 67.6%;>85 years: 61.5%). Ninety patients responded to the compliance questionnaire (78.3%), being compliant 74 (82.2%) and non-compliant 16 (17.8%). CONCLUSIONS: Six of 10 patients undergoing treatment with acenocoumarol are out of range and nearly 2 of each 10 patients out of range does not accomplish the treatment. We call attention to the need to make a systematically review of adherence in anticoagulated patients attended in Primary Care settings.

Aspectos epidemiológicos y diagnósticos de la fibrilación auricular / Epidemiological and diagnostic features of atrial fibrillation

La fibrilación auricular (FA) es la arritmia cardíaca más frecuente y la que produce mayor número de ingresos hospitalarios. Se caracteriza por suplantar el ritmo normal del corazón, que pasa a ser irregular y descoordinado. La FA es un problema creciente de salud pública debido al progresivo envejecimiento de la población y a la mayor supervivencia de las enfermedades cardiovasculares. La prevalencia e incidencia aumentan, en ambos sexos, con la edad, llegándose a duplicar, aproximadamente, cada 10 años. En la población general afecta al 1%, alcanzando hasta el 16% en personas de 85 o más años de edad. Los principales factores de riesgo relacionados con el desarrollo de la FA son, además de la edad, hipertensión arterial, diabetes y cardiopatía isquémica. Es una enfermedad con una importante carga socioeconómica y sanitaria derivada de su alta morbimortalidad, aumentando el riesgo de muerte, insuficiencia cardíaca y fenómenos embólicos, incluido el accidente cerebrovascular. La FA es una enfermedad que altera notablemente la calidad de vida de los pacientes debido a su incapacidad para realizar las actividades diarias normales, siendo sus principales síntomas palpitaciones, dolor de pecho, disnea, fatiga o sensación de mareos. En la evaluación inicial de todo paciente con FA se debe clasificar adecuadamente la arritmia, valorar los síntomas, estimar el riesgo de ictus y realizar algunas pruebas complementarias al alcance del médico de atención primaria (AU)

Atrial fibrillation (AF) is the most common abnormal heart rhythm and is the arrhythmia that provokes the greatest number of hospital admissions. In AF the normal heart rhythm changes to one that is irregular and uncoordinated. AF is an increasing problem in public health due to progressive population aging and longer survival in persons with cardiovascular diseases. In both men and women, the incidence and prevalence of AF increase with age and approximately doubles every 10 years. This disorder affects 1% of the general population, rising to 16% among persons aged 85 years or more. In addition to age, the main risk factors for the development of AF are hypertension, diabetes, and ischemic heart disease. AF provokes a high socioeconomic and healthcare burden due to its high morbidity, which increases the risk of death, heart failure and embolic phenomena, including stroke. This disorder has a strong impact on patients’ quality of life due to their inability to perform normal daily activities. The main symptoms are palpitations, chest pain, shortness of breath, fatigue and dizziness. The initial evaluation of AF should always include classification of the arrhythmia, symptom evaluation, estimation of stroke risk and the performance of some complementary tests available in primary care (AU)