Tendencias en el uso de estatinas tras un ictus isquémico. ¿Hemos cambiado nuestra práctica clínica? / Trends in the use of statins after ischaemic stroke: Have clinical practices changed?

Introducción: El papel de las estatinas tras el ictus isquémico cambió con la publicación del estudio SPARCL en 2006. Nos planteamos valorar cómo ha influido en la prescripción de estatinas en esta población.MétodoEstudio retrospectivo de las altas por ictus isquémico en los hospitales Virgen Macarena, Virgen del Rocío y Valme de Sevilla durante dos periodos: 1999-2001 y 2014-2016.ResultadoIncluimos 1.575 pacientes, 661 (42%) mujeres, edad media 69 (± 10) años. Comparando los dos períodos, los pacientes del grupo post-SPARCL tienen mayor edad (68 ± 10 vs. 71 ± 11, p = 0,0001), mayor proporción de mujeres y mayor frecuencia de dislipidemia, hipertensión y diabetes. Al alta se utilizaron estatinas en el 18,7% frente al 86,9% (p = 0,0001), y estatinas de alta intensidad en el 11,1% frente al 54,4% (p = 0,0001), respectivamente. En ambos períodos la atorvastatina fue la estatina más recetada (80 mg, 6% vs. 42,7%; 40 mg, 5,1% vs. 11,1%). En el primer grupo, el uso de estatinas y de estatinas de alta intensidad se correlacionó con la hipercolesterolemia, y de forma inversa con la edad. En el segundo grupo, el uso de estatinas se correlacionó con la hipertensión y la hipercolesterolemia, y el de estatinas de alta intensidad, con la cardiopatía isquémica y, de forma inversa, con la edad.ConclusiónExiste un cambio evidente en la prescripción de estatinas al alta en pacientes con ictus isquémico. No obstante, muchos pacientes siguen infratratados y es preciso optimizar su uso. (AU)

Introduction: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population.MethodsWe conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016.ResultsThe study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P = .0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P = .0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P = .0001). In both periods, atorvastatin was the most commonly prescribed statin (80 mg: 6% vs 42.7%; 40 mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age.ConclusionThere has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised. (AU)

Trends in the use of statins after ischaemic stroke: Have clinical practices changed?

INTRODUCTION: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS: We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS: The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P = .0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P = .0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P = .0001). In both periods, atorvastatin was the most commonly prescribed statin (80 mg: 6% vs 42.7%; 40 mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION: There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.

Trends in the use of statins after ischaemic stroke: Have clinical practices changed? / Tendencias en el uso de estatinas tras un ictus isquémico. ¿Hemos cambiado nuestra práctica clínica?

INTRODUCTION: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS: We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS: The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P=.0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P=.0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P=.0001). In both periods, atorvastatin was the most commonly prescribed statin (80mg: 6% vs 42.7%; 40mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION: There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.

Pulmonary embolism in very elderly patients. A diagnostic challenge. / Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico.

BACKGROUND: Diagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). OBJECTIVE: The aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. METHOD: We conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. RESULTS: The study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88±2.55 vs. 2.89±2.85; P=.0001). CONCLUSION: Thirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients.

[Neurological complications of tick-borne relapsing fever]. / Complicaciones neurologicas de la fiebre recurrente transmitida por garrapatas.

INTRODUCTION: Tick-borne relapsing fever (TBRF) can cause neurological complications. There are hardly any studies in Spain on this subject. AIM: To study the prevalence and clinical characteristics of neurological complications of patients with TBRF. PATIENTS AND METHODS: We retrospectively reviewed all the patients attended with TBRF over 12 years (2004-2015) in a hospital in a rural area of southern Spain. RESULTS: We included 75 patients, 42 males (56%). Mean age: 33 years (range: 14-72 years). Tick bites were observed in 9 patients (12%). The most common symptoms were: fever in 64 (85.3 %) patients, headache in 41 (54.6%) patients, and vomits in 26 (34.6%) patients. Manifestations suggesting meningeal involvement were noted in 9 (12%) of the patients, and 3 patients (4%) had clear meningeal signs on admission. All these patients underwent lumbar puncture. None of the patients presented facial palsy or other neurologic manifestation. Cerebrospinal fluid abnormalities were found in the three patients with meningismus. In one case Borrelia were found in the cerebrospinal fluid. In those cases with neurologic involvement the treatment used was penicillin G in one case and ceftriaxone in two patients. All patients recovered completely. CONCLUSIONS: TBRF is one of the less severe forms of borreliosis and less than 5% of patients present neurological complications. However, physicians should know that Borrelia can cause meningitis in subjects exposed to ticks in endemic regions of TBRF.

TITLE: Complicaciones neurologicas de la fiebre recurrente transmitida por garrapatas.Introduccion. La fiebre recurrente transmitida por garrapatas (FRTG) puede producir complicaciones neurologicas. No existen apenas estudios en España sobre el tema. Objetivo. Estudiar la prevalencia y las caracteristicas clinicas de las complicaciones neurologicas de los pacientes con FRTG. Pacientes y metodos. Estudio retrospectivo de los pacientes atendidos con FRTG durante 12 años (2004-2015) en un hospital de una zona rural del sur de España. Resultados. Se incluyeron 75 pacientes, 42 varones (56%), con una edad media de 33 años (rango: 14-72 años). Se observaron picaduras de garrapatas en nueve pacientes (12%). Los sintomas mas frecuentes fueron: fiebre en 64 pacientes (85,3%), cefalea en 41 (54,6%) y vomitos en 26 (34,6%). Se sospecho afectacion meningea en nueve pacientes (12%), de los que tres (4%) tenian signos meningeos en el momento del ingreso. A todos ellos se les realizo una puncion lumbar. Ninguno presento paralisis facial ni otra manifestacion neurologica. Se encontraron alteraciones del liquido cefalorraquideo en los tres pacientes con meningismo. En uno de los casos se visualizo Borrelia en el liquido cefalorraquideo. En los pacientes con afectacion neurologica, el tratamiento utilizado fue penicilina G en un caso y ceftriaxona en dos. Todos los pacientes se recuperaron completamente. Conclusiones. La FRTG es una de las formas menos graves de borreliosis, y menos del 5% de los pacientes presenta complicaciones neurologicas. Sin embargo, los medicos deben saber que Borrelia puede causar meningitis en los sujetos expuestos a garrapatas en regiones endemicas de FRTG.