Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos / Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists

Introducción y objetivos Los programas de telemedicina entre clínico y paciente se han desarrollado con fuerza durante la pandemia de enfermedad por COVID-19, pero no hay datos de experiencias entre clínicos. Nuestro objetivo es analizar el impacto de la pandemia por COVID-19 en la actividad y resultados en salud de un programa de consulta electrónica universal (e-consulta) para todas las derivaciones de pacientes entre médicos de atención primaria y el Servicio de Cardiología de nuestra área. Métodos Analizamos mediante regresión logística a 25.121 pacientes con al menos una e-consulta entre 2018 y 2021 realizada con el Servicio de Cardiología de nuestra área sanitaria. También se realizó el análisis de regresión logística del impacto de la pandemia por COVID-19 sobre la resolución de la e-consulta y tiempo de espera de la atención, hospitalizaciones y mortalidad, tomando como referencia las consultas realizadas durante 2018. Resultados Observamos que una menor demora en la atención y resolución de la e-consulta (sin necesidad de atención presencial) se asociaba a un mejor pronóstico. Los períodos de pandemia COVID-19 presentaron similares resultados a los del 2018. Conclusiones Los resultados de nuestro estudio muestran una significativa reducción de las derivaciones a través de e-consulta durante el primer año de la pandemia por COVID-19 con recuperación posterior de la demanda asistencial sin que los períodos de pandemia se asociasen con peores resultados en salud. La reducción del tiempo de demora de resolución de la e-consulta y el grupo sin necesidad de consulta presencial se asociaron a un mejor pronóstico (AU)

Blackground and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes (AU)

[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]. / Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos.

Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists.

BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Efecto en la vida real sobre el control de los factores de riesgo asociado al inicio con polipíldora cardiovascular a partir de fármacos equipotentes / Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs

Objetivo: Analizar el impacto del inicio del tratamiento con la polipíldora-cardiovascular (CV) del Centro Nacional de Investigaciones Cardiovasculares (CNIC-Ferrer), en las cifras de presión arterial (PA) y colesterol ligado a lipoproteínas de baja densidad (LDL), de los pacientes de nuestra área sanitaria que previamente recibían dosis equipotentes de estatinas y antihipertensivos. Material y métodos: Se registraron todos los pacientes de nuestra área sanitaria (Santiago de Compostela) que a 31 de diciembre de 2019 tenían una prescripción activa de polipíldora-CV (CNIC-Ferrer), desde el 16 de enero de 2015. La fecha índice fue la fecha de inicio de prescripción de polipíldora-CV, y se analizaron los fármacos que previamente recibía el paciente para dislipemia e hipertensión arterial, clasificándose por equipotencias con atorvastatina y ramipril. Se analizó mediante la prueba t-Student para muestras apareadas las variaciones de colesterol LDL y PA. Resultados: Analizamos 547 pacientes con una edad media de 71,5±11,5 años y la mayoría varones (60,6%). Observamos un descenso del colesterol LDL (−10,6 [IC95%: −7,0, −14,3], p<0,001) en los pacientes (n=471) que iniciaron la polipíldora-CV con dosis previas equipotentes de atorvastatina. Documentamos una reducción de la PA sistólica (−3,7 [IC95%: −0,4, −6,9], p=0,029) en los pacientes (n=360) con inicio a partir de dosis equipotentes de ramipril. En 88 pacientes, el inicio de la polipíldora-CV se hizo a partir de dosis equipotentes de atorvastatina y ramipril observándose un descenso del colesterol LDL (−8,7 [IC95%: −3,8, −13,6], p=0,001) y de la PA sistólica (−3,6 [IC95%: −7,8, 0,5], p=0,085). Conclusiones: El inicio del tratamiento con la polipíldora-CV, en pacientes que previamente recibían tratamientos equipotentes de atorvastatina y ramipril, se asoció a una mayor reducción del colesterol LDL y la PA sistólica (AU)

Objective: This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)’s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives. Material and methods: All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples. Results: We analyzed 547 patients with a mean age of 71.5±11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (−10.6 [95% CI: −7.0, −14.3], p<.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n=471). We documented a reduction in systolic BP (−3.7 [95% CI: −0.4, −6.9], p=.029) in patients who had previously taken equally potent doses of ramipril (n=360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (−8.7 [95% CI: −3.8, −13.6], p=.001) and systolic BP (−3.6 [95% CI: −7.8, 0.5], p=.085). Conclusions: The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP (AU)

Programa de consulta electrónica universal (e-consulta) de un servicio de cardiología. Resultados a largo plazo / Universal electronic consultation (e-consultation) program of a cardiology service. Long-term results

Introducción y objetivos: Muchos sistemas sanitarios han iniciado programas de consulta electrónica, aunque poco se conoce de su impacto en acceso, seguridad y satisfacción. El objetivo de este estudio es evaluar el impacto clínico de la puesta en marcha de un modelo de atención ambulatoria que incluye una consulta electrónica (e-consulta) inicial comparándolo con un modelo presencial de acto único. Métodos: Se seleccionó a pacientes con al menos 1 consulta al servicio de cardiología entre 2010 y 2019. Mediante un modelo de regresión de series temporales interrumpidas, se analizó el impacto de la incorporación de la e-consulta en el modelo asistencial (iniciado en 2013), evaluando: tiempo de espera de la atención, asistencias a urgencias, ingresos hospitalarios y mortalidad. Resultados: Se analizó a 47.377 pacientes: el 61,9% de ellos atendidos incorporando la e-consulta y el 38,1% en el modelo de consulta presencial de acto único. La mediana [intervalo intercuartílico] de la demora a la atención en el modelo de e-consulta, 7 [5-13] días, fue menor que en el modelo presencial: 33 [14-81] días (p<0,001). El modelo de regresión para series temporales interrumpidas mostró que la incorporación de la e-consulta aporta una disminución muy importante en la demora de la atención, que se mantiene en torno a los 9 días, aunque con ligeras oscilaciones. Los pacientes valorados vía e-consulta tuvieron menos ingresos hospitalarios (el 0,9 frente al 1,2%; p=0,0017) y mortalidad (el 2,5 frente al 3,9%; p<0,001). Conclusiones: Un programa de atención ambulatoria que incluye una e-consulta ha mostrado importantes reducciones en los tiempos de espera y es un modelo seguro, con menores tasas de ingresos hospitalarios y mortalidad en el primer año (AU)

Introduction and objectives: Many health systems have initiated electronic consultation (e-consultation) programs, although little is known about their impact on accessibility, safety, and satisfaction. The aim of this study was to assess the clinical impact of the implementation of an outpatient care model that includes an initial e-consultation and to compare it with a one-time face-to-face consultation model. Methods: We selected patients who visited the cardiology service at least once between 2010 and 2019. Using an interrupted time series regression model, we analyzed the impact of incorporating e-consultation into the health care model (started in 2013), and evaluated waiting times, emergency services, hospital admissions, and mortality. Results: We analyzed 47 377 patients: 61.9% were attended in e-consultation and 38.1% in one-time face-to-face consultations. The waiting time for care was shorter in the e-consultation model (median [IQR]: 7 [5-13] days) than in the face-to-face model (median [IQR]: 33 [14-81] days), P<.001. The interrupted time series regression model showed that the introduction of e-consultation substantially decreased waiting times, which held steady at around 9 days, although with slight oscillations. Patients evaluated via e-consultation had fewer hospital admissions (0.9% vs 1.2%, P=.0017) and lower mortality (2.5% vs 3.9%, P<.001). Conclusions: An outpatient care program that includes an e-consultation reduced waiting times significantly and was safe, with a lower rate of hospital admissions and mortality in the first year (AU)

Real-life effect on the control of risk factors associated with initiation of the cardiovascular polypill created from equipotent drugs.

OBJECTIVE: This work aims to analyze the impact of Spain's National Center for Cardiovascular Research (CNIC-Ferrer)'s cardiovascular (CV)-polypill on blood pressure (BP) and low-density lipoprotein cholesterol (cLDL) levels in patients in our healthcare area who previously took equipotent doses of statins and antihypertensives. MATERIAL AND METHODS: All patients in our healthcare area (Santiago de Compostela, Spain) who, as of December 31, 2019, had an active prescription for the CV-polypill (CNIC-Ferrer) since January 16, 2015 were registered. The index date was the start date of the CV-polypill prescription. The drugs the patient had previously received for dyslipidemia and hypertension were analyzed, classifying them by their equivalent potency to atorvastatin and ramipril. Changes in cLDL and BP were analyzed by means of Student's t-test for paired samples. RESULTS: We analyzed 547 patients with a mean age of 71.5 ± 11.5 years. The majority were men (60.6%). We observed a decrease in cLDL (-10.6 [95% CI: -7.0, -14.3], p < 0.001) in patients who started taking the CV-polypill who had previously taken equally potent doses of atorvastatin (n = 471). We documented a reduction in systolic BP (-3.7 [95% CI: -0.4, -6.9], p = 0.029) in patients who had previously taken equally potent doses of ramipril (n = 360). In 88 patients, the CV-polypill was started via equally potent doses of atorvastatin and ramipril, with a decrease in cLDL (-8.7 [95% CI: -3.8, -13.6], p = 0.001) and systolic BP (-3.6 [95% CI: -7.8, 0.5], p = 0.085). CONCLUSIONS: The initiation of treatment with the CV-polypill in patients who previously received equally potent treatment with atorvastatin and ramipril was associated with a greater reduction in cLDL and systolic BP.

Current functioning of cardio-oncology units in Spain.

PURPOSE: The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS: All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS: We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS: The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.

Hacia un manejo integral del paciente con diabetes y obesidad. Posicionamiento de la SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC / Position statement of the SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC

La obesidad y el sobrepeso constituyen la principal causa modificable de diabetes tipo 2 (DM2). En el momento del diagnóstico de la diabetes tipo 2 se debe establecer el grado de obesidad según el índice de masa corporal y, en los pacientes con sobrepeso, determinar el perímetro de la cintura. El adecuado tratamiento de la DM2 requiere un abordaje simultáneo del sobrepeso/obesidad y el resto de factores de riesgo cardiovascular, como la hipertensión, la dislipemia o el tabaquismo. Las intervenciones no farmacológicas (dieta, ejercicio) con beneficio demostrado en la prevención y tratamiento del paciente con DM2 y sobrepeso/obesidad deben seguir un enfoque individualizado y multidisciplinario, con programas estructurados dotados de recursos específicos. La ganancia de peso asociada al tratamiento antidiabético puede dificultar el control glucémico, comprometer la adherencia al tratamiento, empeorar el perfil de riesgo vascular de los pacientes y limitar los beneficios cardiovasculares del tratamiento. Por ello, es importante evitarla; una medida que resulta coste-efectiva. Los fármacos antidiabéticos con beneficios sobre el peso corporal también han demostrado su beneficio en pacientes con un índice de masa corporal<30kg/m2. Globalmente, el tratamiento del paciente con DM2 y obesidad dependerá tanto del grado de obesidad como de la comorbilidad asociada. Los ensayos clínicos de intervención en DM2 deben contemplar objetivos combinados que incluyan no solo el control glucémico, sino otras variables como el riesgo de hipoglucemia y el efecto del tratamiento sobre el peso corporal (AU)

Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight (AU)

Position statement of the SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC.

Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight.

Analysis of small bubbles in glass by glow discharge--time-of-flight mass spectrometry.

The chemical reactions occurring during the glass manufacturing processes can give rise to small bubbles, damaging the required glass properties. To avoid eventual bubbles formation, the chemical composition of the bubbles should be known to trace back the gas sources and take appropriate corrective actions. Mass spectrometry is a most adequate detection technique for such purpose due to its ability to provide the required information in a short time. Analysis of these small bubbles in glass requires a system incorporating a very small volume (for a fast evacuation of the entire line and low dilution of the analytes) and a fast mass analyser allowing the quasi-simultaneous detection of the whole spectral interval of interest, such as a time-of-flight mass spectrometer (TOFMS). In this work, the analytical potential of a radiofrequency glow discharge (rf-GD) coupled to a TOFMS was evaluated for the first time for the analysis of bubbles in glasses. The operating conditions of the rf-GD (pressure and applied power) were optimized by introducing into the system known volumes of air. Detection limits in the order of nL were obtained for molecular nitrogen, oxygen and carbon dioxide. Finally, a stainless steel bellows valve was modified to serve as glass breaker for the sampling process. This valve was connected on-line to the mass spectrometer inlet line and proved to be most appropriate for the analysis of the gaseous content of bubbles (with diameters below 0.5mm) entrapped in industrial glasses.

Additive value of diabetes and peripheral arterial disease in the risk stratification of patients admitted after an acute coronary syndrome: a subanalysis of the PAMISCA Study.

BACKGROUND: There is an increasing interest in the use of non-invasive methods for the detection of subclinical atherosclerosis to better identify patients with high risk of cardiovascular events The presence of diabetes mellitus (DM) and peripheral arterial disease (PAD) is associated with increased risk of events but their value in the acute coronary syndrome (ACS) patient has not been ascertained. METHODS: We performed a subanalysis of the PAMISCA study, designed to investigate the prevalence of PAD in patients admitted to Spanish hospitals with a diagnosis of an ACS. RESULTS: A total of 1410 patients were analysed (71.4% men, age 66 +/- 11.9 years, 35% DM). The prevalence of PAD was higher in DM vs. no-DM (41.5% vs. 30.6% respectively, p < 0.001). Patients with PAD and DM had more in-hospital cardiac complications such as atrial fibrillation/flutter, recurrent myocardial ischaemia and heart failure and a trend towards higher in-hospital mortality (p = 0.08). Non-DM patients with PAD and DM without PAD shared similar cardiac complications and the group without neither PAD nor DM had the best prognosis. In patients without PAD, DM was an independent predictor of three-vessel coronary disease (OR 1.6; 95% CI: 1.1-2.5, p < 0.05) after adjustment by age, sex, low density lipoproteins (LDL), smoking and the previous myocardial infarction. However, in PAD patients, DM failed to be an independent risk factor in the multivariate analysis (OR 1.0; 95% CI 0.6-1.6, p < 0.05). CONCLUSIONS: The concurrence of DM and PAD helps identify patients with an adverse risk profile.

Control de los factores de riesgo cardiovascular en el paciente hipertenso con disfunción cardíaca: Atención Primaria frente a Especializada / Cardiovascular risk factors control in hypertensive patients with cardiac dysfunction: Primary or Specialized Care

Introducción. El objetivo del estudio es conocer el grado de control tensional y de los diferentes factores de riesgo cardiovascular en el paciente hipertenso con disfunción cardíaca en función del ámbito asistencial, sea Atención Primaria o Especializada, en España. Material y métodos. Se han reclutado de manera consecutiva 3.984 pacientes hipertensos con disfunción cardíaca (23,2 % desde Atención Primaria). Se han recogido parámetros demográficos y antropométricos, antecedentes cardiovasculares, factores de riesgo, presión arterial, electrocardiograma y ecocardiograma, datos analíticos y tratamiento. Resultados. Los pacientes reclutados desde Atención Primaria tenían una significativa mayor edad (71,46 frente a 68,51 años; p < 0,0001), así como un mayor índice de masa corporal (29,78 frente a 29,46 kg/m2; p < 0,05). En el análisis multivariante se observó un manejo terapéutico diferente entre ambas poblaciones, con un mayor empleo de betabloqueantes, antagonistas del calcio e inhibidores del eje renina-angiotensina en Atención Especializada. En ésta se observó una significativa mayor proporción de pacientes con colesterol HDL < 40 mg/dl, triglicéridos > 150 mg/dl, glucemias elevadas y microalbuminuria. No hubo diferencias en el control de las cifras de presión arterial, con un alto porcentaje de pacientes con valores > 130/80 mmHg (83,7 % en Atención Primaria frente a 85,9 % en Atención Especializada). Conclusiones. El manejo terapéutico del paciente hipertenso con disfunción cardíaca es diferente según el ámbito asistencial analizado. El control de las cifras de presión arterial y sobrepeso en esta población es subóptimo en ambos entornos

Introduction. This study aims to evaluate the degree of blood pressure (BP) and the control of different cardiovascular risk factors in hypertensive patients with cardiac dysfunction, according to the type of health care setting in Spain: Primary or Specialized Care. Material and methods. A total of 3,984 hypertensive patients with cardiac dysfunction were recruited consecutively (23.2 % from Primary Care). Demographic and anthropometric parameters, cardiovascular events, risk factors, BP, electrocardiogram, echocardiogram, laboratory analysis data and treatment were collected. Results. Patients from Primary Care were significantly older (71.46 vs 68.51 years; p < 0.0001), and had higher body mass index (29.78 vs 29.46 kg/m2; p < 0.05). The multivariate analysis showed differences between both groups regarding therapeutic management: beta blockers, calcium channel blockers and renin-angiotensin inhibitors were used more in specialized care vs. Primary Care setting. Patients recruited from specialized care settings showed significantly higher proportion of plasma HDL-cholesterol level < 40 mg/dl, plasma triglyceride level > 150 mg/dl, hyperglycemia and microalbuminuria. There were no differences in BP control between groups, with a very high percentage of patients with values of BP > 130/80 mmHg (83.7 % in Primary Care versus 85.9 % in Specialized Care). Conclusion. Therapeutic management of hypertensive patients with cardiac dysfunction differs according to the health-care setting analyzed. In this population analyzed, both BP and overweight control is suboptimal in both groups

Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function.

OBJECTIVE: To investigate the prevalence of anaemia and its influence on mortality among hospitalised patients with congestive heart failure (CHF) with preserved left ventricular systolic function (LVSF). METHOD AND RESULTS: 210 patients with preserved LVSF admitted to the cardiology department of a tertiary hospital for CHF between 1 January 2000 and 31 December 2002 were analysed. Anaemic patients, who constituted 46% of the whole group, were older (75 v 72 years, p = 0.036); were in hospital longer (mean (SD) 13 v 11 days, p = 0.007); had a higher prevalence of ischaemic heart disease (54% v 35%, p = 0.009), left bundle branch block (12% v 4%, p = 0.018), and kidney failure (56% v 34%, p = 0.003); and had faster erythrocyte sedimentation rates (mean (SD) 50 v 26 mm in the first hour, p < 0.001), a tendency to lower serum cholesterol concentration (mean (SD) 4.65 v 5.22 mmol/l, p = 0.073), and smaller body mass index (mean (SD) 27 v 29 kg/m2, p = 0.126) than their non-anaemic counterparts. Kaplan-Meier analysis showed the anaemic group to have significantly poorer survival (p = 0.0001), with a one year survival rate of 72.2% versus 90.5% in the non-anaemic group. Multivariate analysis showed anaemia to be the most powerful independent predictor of mortality, increasing the risk of death by a factor of 2.7 (p = 0.007). CONCLUSION: Anaemia is a very prevalent condition in hospitalised patients with CHF with preserved LVSF and is independently associated with higher mortality. Appropriately designed randomised studies are needed to determine whether the prevention or treatment of anaemia can improve survival of these patients.

Características clínicas y pronóstico de la insuficiencia cardíaca de origen isquémico e hipertensivo / Clinical characteristics and prognoses of ischemic and hypertensive heart failure

Objetivos. Nos propusimos evaluar las características clínicas y la supervivencia de pacientes con insuficiencia cardíaca de origen isquémico o hipertensivo que requirieron ingreso hospitalario. Métodos. Analizamos las características clínicas de 229 pacientes con insuficiencia cardíaca en clase III-IV debida a cardiopatía isquémica o hipertensión arterial (en este grupo se excluyeron los hipertensos con lesiones coronarias o manifestaciones clínicas de cardiopatía isquémica, así como los casos debidos a otras cardiopatías) que requirieron ingreso hospitalario entre el 1 de enero de 1991 y el 31 de diciembre de 1994. Su situación vital se evaluó mediante consulta o contacto telefónico en los meses de abril y mayo de 1998, con un período medio de seguimiento de 4 años. Se obtuvieron datos de 144 pacientes con insuficiencia cardíaca de origen isquémico y 69 pacientes de etiología hipertensiva. La edad media del grupo total era de 70 ñ 11 años, 70 ñ 9 de los 69 pacientes incluidos en el grupo hipertenso y 69 ñ 11 años en el isquémico. Resultados. El 49 por ciento de los isquémicos era también hipertenso. El 72 por ciento de los hipertensos y el 73 por ciento de los isquémicos se encontraban en clase IV en el ingreso hospitalario. La presencia de edema (periférico y pulmonar) era significativamente más frecuente en los pacientes con insuficiencia cardíaca hipertensiva, 49 por ciento frente al 20 por ciento; p = 0,0001, así como la existencia de cardiomegalia en radiografía de tórax: 97 por ciento frente al 84 por ciento, p = 0,01. También la hipertrofia ventricular izquierda en ECG (58 por ciento frente al 31 por ciento; p = 0,0001) y la fibrilación auricular (47 por ciento frente al 19 por ciento; p = 0,0001) eran significativamente más frecuentes en el grupo hipertenso. La disfunción sistólica de ventrículo izquierdo (FE < 50 por ciento) fue más frecuente, aunque no de forma significativa, en los pacientes que tenían cardiopatía isquémica (82 por ciento frente al 68 por ciento; p = 0,057). No se observaron diferencias en la supervivencia de ambos grupos con una supervivencia a 3 años del 58,5 por ciento y 58,6 por ciento de los pacientes incluidos en el grupo hipertenso e isquémico y a los 5 años del 47,7 por ciento y 45,9 por ciento, respectivamente. Conclusiones. El grupo de pacientes con insuficiencia cardíaca de etiología isquémica ingresados en nuestro hospital presenta, a largo plazo una elevada mortalidad similar a la del grupo hipertensivo, siendo la supervivencia a cinco años menor del 50 por ciento en ambos grupos (AU)