[Validation of the Spanish version of the Minnesota Living with Heart Failure Questionnaire]. / Validación de la versión española del Minnesota Living with Heart Failure Questionnaire.

INTRODUCTION AND OBJECTIVES: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most commonly used instrument for evaluating quality of life in patients with heart failure. It comprises 21 items and two dimensions: the physical and the emotional. The aim of this study was to assess the psychometric properties of the Spanish version of the MLHFQ. METHODS: The MLHFQ and the 36-item short form (SF-36) questionnaire were administered one and two months after discharge to 677 patients who had been hospitalized for heart failure. Patients were classified as either stable (n=245) or unstable (n=103) on the basis of New York Heart Association (NYHA) functional class and three other functional capacity variables. Reliability was evaluated using measures of internal consistency (Cronbach's alpha) and reproducibility (the intraclass correlation coefficient [ICC]). Validity was assessed by looking at the scores by NYHA class, and at correlations between scores on MLHFQ and SF-36 dimensions. Responsiveness to change was evaluated using the effect size. RESULTS: Cronbach's alpha was > OR =0.8 for the three MLHFQ scores, and the ICC was also large (0.74-0.83). In addition, MLHFQ scores varied significantly with functional class (P< .001), and there were intermediate-to-high correlations with the assumed corresponding SF-36 dimensions (0.74-0.52). The observed effect sizes were small or intermediate (0.09-0.44). CONCLUSIONS: The Spanish version of the MLHFQ demonstrated adequate metric properties, comparable to the original. These results support the use of the MLHFQ in Spanish heart failure patients, although it would be advisable to re-evaluate its responsiveness to change.

Validación de la versión española del Minnesota Living with Heart Failure Questionnaire / Validation of the Spanish Version of the Minnesota Living with Heart Failure Questionnaire

Introducción y objetivos. El Minnesota Living with Heart Failure Questionnaire (MLHFQ) es el instrumento más utilizado para la evaluación de la calidad de vida en pacientes con insuficiencia cardiaca. Contiene 21 ítems y dos dimensiones: física y emocional. El objetivo de este estudio es evaluar las propiedades métricas de la versión española del MLHFQ. Métodos. Se aplicó, 1 y 2 meses después del alta, el MLHFQ y el SF-36 a 677 pacientes ingresados por insuficiencia cardiaca. A partir de la clasificación NYHA y otras 3 variables de capacidad funcional, se definió a los pacientes como estables (n = 245) o con cambio (n = 103). De la fiabilidad, se estudió: la consistencia interna (alfa de Cronbach) y la reproducibilidad (coeficiente de correlación intraclase [CCI]). La validez se estudió con las puntuaciones según la clase funcional y las correlaciones con las dimensiones del SF-36. La sensibilidad al cambio se evaluó por el tamaño del efecto. Resultados. El alfa de Cronbach fue ≥ 0,8 en las tres puntuaciones, y el CCI también fue elevado (0,74-0,83). Las puntuaciones del MLHFQ mostraron diferencias según la clase funcional (p < 0,001), así como correlaciones moderadas-altas con las dimensiones del SF-36 planteadas a priori (0,74-0,52). Los cambios observados fueron pequeños o moderados (0,09-0,44). Conclusiones. La versión española del MLHFQ ha mostrado unas adecuadas propiedades métricas, igual que la original. Estos resultados respaldan el uso del MLHFQ en pacientes españoles con insuficiencia cardiaca, aunque sería recomendable reevaluar su sensibilidad al cambio

Introduction and objectives. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most commonly used instrument for evaluating quality of life in patients with heart failure. It comprises 21 items and two dimensions: the physical and the emotional. The aim of this study was to assess the psychometric properties of the Spanish version of the MLHFQ. Methods. The MLHFQ and the 36-item short form (SF-36) questionnaire were administered one and two months after discharge to 677 patients who had been hospitalized for heart failure. Patients were classified as either stable (n=245) or unstable (n=103) on the basis of New York Heart Association (NYHA) functional class and three other functional capacity variables. Reliability was evaluated using measures of internal consistency (Cronbach's alpha) and reproducibility (the intraclass correlation coefficient [ICC]). Validity was assessed by looking at the scores by NYHA class, and at correlations between scores on MLHFQ and SF-36 dimensions. Responsiveness to change was evaluated using the effect size. Results. Cronbach's alpha was ≥0.8 for the three MLHFQ scores, and the ICC was also large (0.74­0.83). In addition, MLHFQ scores varied significantly with functional class (P<.001), and there were intermediate-to-high correlations with the assumed corresponding SF-36 dimensions (0.74­0.52). The observed effect sizes were small or intermediate (0.09­0.44). Conclusions. The Spanish version of the MLHFQ demonstrated adequate metric properties, comparable to the original. These results support the use of the MLHFQ in Spanish heart failure patients, although it would be advisable to re-evaluate its responsiveness to change

[Usefulness of coronary risk assessment using the equation of the Framingham study: a case control study]. / Utilidad de la medición del riesgo coronario a partir de la ecuación del estudio de Framingham: estudio de casos y controles.

BACKGROUND AND OBJECTIVE: During the last decade, recommendations for coronary heart disease prevention have emphasized the need of an assessment of coronary risk. The objective of this study was to assess the usefulness of the Framingham risk function for the estimation of coronary risk in our population, assessing the accuracy of the coronary risk as a diagnostic test (assuming that a coronary risk >20% is a positive diagnosis test of coronary disease). PATIENTS AND METHOD: Prospective case-control study, carried out in a public tertiary hospital. RESULTS: 138 cases were identified and matched, according to age and sex, with 223 controls. The level of risk > or =20% was the one which better classified the patients (70% of patients correctly classified as cases and controls) with an area under the ROC curve of 73.5% (moderate accuracy). Patients with a coronary risk >20% had a six times higher probability of being a case than a control (OR=6.09; 95% CI, 3.30-11.22). CONCLUSIONS: The utilization of the Framingham function for the prediction of coronary disease is a useful method to identify high risk patients. It is recommended to use it in clinical practice until we have our own model derived from populations with a baseline risk similar to ours allowing to predict the risk with higher accuracy.

Utilidad de la medición del riesgo coronario a partir de la ecuación del estudio de Framingham: estudio de casos y controles / Usefulness of coronary risk assessment using the equation of the Framingham study: a case control study

FUNDAMENTO Y OBJETIVO: Durante la última década el cálculo del riesgo cardiovascular se ha convertido en la piedra angular de las guías de práctica clínica de prevención cardiovascular. El objetivo de este estudio es evaluar la utilidad del cálculo del riesgo coronario basado en la ecuación del estudio de Framingham en nuestro entorno, evaluando la eficacia diagnóstica del riesgo coronario (asumiendo que el riesgo coronario superior al 20 por ciento fuera una prueba diagnóstica positiva de enfermedad coronaria). PACIENTES Y MÉTODO: Estudio de casos y controles prospectivo realizado en un hospital público terciario. RESULTADOS: Se seleccionaron 138 casos y se emparejaron por edad y sexo con 223 controles. El nivel de riesgo igual o superior al 20 por ciento fue el que mejor clasificó a los pacientes (un 70 por ciento de los pacientes clasificados correctamente como casos y como controles), siendo el área bajo la curva ROC del 73,5 por ciento, lo que representa una exactitud moderada. Los pacientes con riesgo coronario superior al 20 por ciento tienen una probabilidad 6 veces mayor de pertenecer al grupo de los casos que al grupo de los controles (odds ratio = 6,09; intervalo de confianza del 95 por ciento, 3,3011,22). CONCLUSIONES: La utilización del modelo de Framingham para la predicción de la enfermedad coronaria es un método útil para identificar a los pacientes de riesgo. Se recomienda su uso en la práctica clínica mientras no se disponga de un modelo genuino o basado en poblaciones con riesgo basal de enfermedad coronaria semejante al nuestro que prediga el riesgo con mayor exactitud (AU)

Prophylactic treatment after myocardial infarction in primary care: how far can we go?

BACKGROUND: Despite best practice, it may not be achievable in some patients to reach the optimal goals of secondary prevention recommendations for various reasons, such as co-morbidity, contraindications for some drugs or side effects. OBJECTIVE: Our aim was to estimate the achievable standards for audit purposes in primary care for prophylactic treatment of secondary prevention of myocardial infarction. METHODS: We conducted a survey of consecutive patients with a hospital diagnosis of first acute myocardial infarction during 1997 who were identified from discharge books from four hospitals and interviewed at their primary health centre 2 years after admission. The achievable standard for a prophylactic drug was then defined as the proportion of patients that could benefit from the treatment excluding those that for one justified reason or another were off medication. RESULTS: Three hundred and sixty-nine patients were interviewed in the follow-up. Aspirin or another antiplatelet regimen was prescribed in 86.9 patients, beta-blockers in 50.2%, angiotensin-converting enzyme (ACE) inhibitors in 32.5% and lipid-lowering drugs in 52%. The estimated achievable standards for those prescribed drugs were 94.5, 71,8, 50.5 and 69.8%, respectively. CONCLUSIONS: There is an underuse of prophylactic drug therapies after myocardial infarction. The standards established in this study for secondary preventive drug treatment might be achieved through a reasonable effort by GPs working in primary care committed to improving the quality of care.

[Cardiac surgery in elderly patients]. / Cirugía cardíaca en el anciano.

OBJECTIVE: The morbimortality of elderly patients, (age 70 years or older), who underwent surgery for valvular and coronary artery disease in the last 17 years was analyzed. PATIENTS AND METHOD: A total of 1,305 patients (654 valvular, 531 coronary and 120 combined) operated from January 1985 to December 2000 were retrospectively studied. Mean age was 73.7 years. We analyzed the progression of the pathology, comorbidity, and results. A second retrospective analysis was made of patients who underwent surgery in the last three years (436 patients) to determine the relation between preoperative comorbidity and postoperative evolution. RESULTS: The mean hospital mortality was 16% (18% valvular, 11% coronary artery, and 23% combined). In the last three years this mortality was reduced to 11% (15.17, 6.26, and 16.18%, respectively) despite an increase in comorbidity. Comorbidity and complications increased with age (p < 0.05). Mean hospital stay was 15.5 days and the stay in intensive/semi-intensive care was 5 days. Independent risk factors of postoperative complications were creatinine levels > 2 mg/dl, combined surgery, and prior surgery. Predictors of death were prior surgery, valvular surgery, and combined surgery, with a clear tendency in the case of obesity. The presence of any complication in the postoperative period (renal or respiratory failure, infections, or myocardial infarction) was an independent predictor of mortality. Off-pump coronary surgery reduced mortality. In recent years, the mortality of patients operated without extracorporeal circulation has decreased from 5.71% to 4% for those who underwent extracorporeal circulation. CONCLUSIONS: Nowadays, cardiac surgery in older patients accounts for more than 30% of our surgical activity. Mortality is being controlled although comorbidity is increasing. The difference with respect to younger people is due to comorbidity (creatinine > 2 mg/dl, combined surgery, and previous surgery) and the higher probability of complications (infections, renal, and respiratory complications), which worsens prognosis. We believe that off-pump coronary surgery helps to improve results.