Validity of the Polar V800 monitor for measuring heart rate variability in mountain running route conditions.

PURPOSE: This study was conducted to test, in mountain running route conditions, the accuracy of the Polar V800™ monitor as a suitable device for monitoring the heart rate variability (HRV) of runners. METHOD: Eighteen healthy subjects ran a route that included a range of running slopes such as those encountered in trail and ultra-trail races. The comparative study of a V800 and a Holter SEER 12 ECG Recorder™ included the analysis of RR time series and short-term HRV analysis. A correction algorithm was designed to obtain the corrected Polar RR intervals. Six 5-min segments related to different running slopes were considered for each subject. RESULTS: The correlation between corrected V800 RR intervals and Holter RR intervals was very high (r = 0.99, p < 0.001), and the bias was less than 1 ms. The limits of agreement (LoA) obtained for SDNN and RMSSD were (- 0.25 to 0.32 ms) and (- 0.90 to 1.08 ms), respectively. The effect size (ES) obtained in the time domain HRV parameters was considered small (ES < 0.2). Frequency domain HRV parameters did not differ (p > 0.05) and were well correlated (r ≥ 0.96, p < 0.001). CONCLUSION: Narrow limits of agreement, high correlations and small effect size suggest that the Polar V800 is a valid tool for the analysis of heart rate variability in athletes while running high endurance events such as marathon, trail, and ultra-trail races.

Intraventricular hemorrhage after dural fistula embolization / Hemorragia intraventricular após embolização de fístula dural

Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Resumo Justificativa e objetivos: Fístulas arteriovenosas durais (FAVD) são comunicações anômalas entre os canais venosos e arteriais da dura-máter cujo centro está localizado entre os folhetos da dura-máter. Para as circunstâncias nas quais o tratamento invasivo é obrigatório, as técnicas endovasculares se tornaram os pilares da prática, escolha atribuível a relatos de sua segurança e eficácia. Descrevemos o caso único e raro de uma FAVD tratada por embolização transarterial (ETA) e complicada por uma hemorragia intraventricular (HIV). Nosso objetivo foi destacar alguns aspectos centrais do manejo perioperatório desses pacientes para ajudar a melhorar uma futura abordagem de casos semelhantes. Relato de caso: Paciente do sexo feminino, 59 anos, com diagnóstico prévio de FAVD tipo IV (Cognard), apresentou-se para ETA, realizada fora da sala de cirurgia soBanestesia venosa total. O procedimento transcorreu sem complicações, e a angiografia intraoperatória revelou obliteração completa da fístula. No período pós-operatório imediato, a paciente apresentou sinais clínicos de aumento da pressão intracraniana (PIC) atribuíveis a uma HIV posteriormente diagnosticada, o que condicionou a colocação de um dreno ventricular, internação em Unidade de Terapia Intensiva (UTI), vasoespasmo cerebral e internação hospitalar prolongada. Durante todo o período perioperatório, não houve alterações na oximetria cerebral. A paciente recebeu alta sem sequelas neurológicas. Conclusão: HIV pode ser uma complicação grave após o tratamento endovascular de FAVD. A observação e o monitoramento cuidadosos no pós-operatório permitem o diagnóstico precoce e o tratamento que aumenta as chances de um resultado melhor.

Intraventricular hemorrhage after dural fistula embolization.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

[Intraventricular hemorrhage after dural fistula embolization]. / Hemorragia intraventricular após embolização de fístula dural.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Efficacy of memory training in healthy community-dwelling older people: study protocol for a randomized controlled trial.

BACKGROUND: There is limited evidence on the efficacy and social utility of cognitive training. To address this, we have designed a randomized controlled trial to assess the effectiveness of memory training workshops for healthy older people in terms of their short- and long-term impact on cognitive function, health-related quality of life, and functionality. METHODS/DESIGN: A randomized controlled trial will be performed in health care centers in Barcelona (Spain) through comparison of a group of individuals participating in memory training workshops (experimental group) with another group with similar characteristics not participating in the workshops (control group). The intervention will consist of twelve 90-minute group sessions imparted once a week by a psychologist specialized in memory training. The groups will each comprise approximately 15 people, for a total number of 230 patients involved in the study. Each session has its own objectives, materials and activities. The content of the intervention is based on memory training from different perspectives, including cognitive and emotional aspects and social and individual skills. Data will be collected at baseline, at 3-4 months and at 6 months. To assess the efficacy of the intervention on cognitive function, health-related quality of life and functionality, a statistical analysis will be performed by fitting a repeated-measures mixed effects model for each main outcome: Self-perceived memory, measured by a Subjective Self-reported Memory Score (from 0 to 10) and by the Memory Failures in Everyday life questionnaire (MFE); Everyday memory, measured using the Rivermead Behavioural Memory Test-3 (RBMT-3) and Executive control abilities, measured in terms of visual-perceptual ability, working memory and task-switching ability with the Trail Making Test (TMT) and with the digit span scale of the Wechsler Adult Intelligence Scale III (WAIS III). DISCUSSION: The results of this study will be highly useful for social and public health policies related to older people. Given the continuous increase in the prevalence of older people, a large number of interventions targeting memory loss are funded by public resources. To ensure transparency and effective prioritization, research such as the present study is needed to provide evidence of the effectiveness and usefulness of these interventions. TRIAL REGISTRATION: Number: NCT02431182 .

Impact of using different SCORE tables for estimating cardiovascular risk.

INTRODUCTION AND OBJECTIVES: In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. METHODS: In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. RESULTS: Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. CONCLUSIONS: The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting.

Impacto de la utilización de las diferentes tablas SCORE en el cálculo del riesgo cardiovascular / Impact of using different SCORE tables for estimating cardiovascular risk

Introducción y objetivos. En España disponemos de tablas SCORE para el cálculo del riesgo cardiovascular en países de bajo riesgo, tablas calibradas para la población española, y unas tablas que permiten incluir el colesterol unido a lipoproteínas de alta densidad. Este estudio pretende evaluar el impacto de la utilización de una u otra tabla de riesgo en la práctica clínica. Métodos. Estudio transversal realizado en dos centros de salud. Se seleccionó a sujetos de entre 40 y 65 años de edad que contaran con un registro de presión arterial y colesterol total entre marzo de 2010 y marzo de 2012. Se excluyó a los sujetos con antecedente de diabetes mellitus o enfermedad cardiovascular. Se calculó el riesgo utilizando las tablas SCORE para países de bajo riesgo, tablas SCORE con colesterol unido a lipoproteínas de alta densidad y tablas SCORE calibrado. Resultados. Se calculó el riesgo cardiovascular a 3.716 pacientes. Los pacientes de alto o muy alto riesgo fueron el 1,24% con SCORE con colesterol unido a lipoproteínas de alta densidad, el 4,73% con SCORE para países de bajo riesgo y el 15,44% con SCORE calibrado (p < 0,01). Utilizando el SCORE calibrado, deberíamos tratar con hipolipemiantes al 10,23% de los pacientes; con el SCORE para países de bajo riesgo, al 3,12%, y con el SCORE con colesterol unido a lipoproteínas de alta densidad, al 0,67%. Conclusiones. La tabla SCORE calibrado identifica a más pacientes de alto riesgo que las del SCORE de bajo riesgo y el SCORE con colesterol unido a lipoproteínas de alta densidad, por lo que su utilización implicaría tratar a más pacientes con estatinas. Son necesarios estudios de validación del SCORE para valorar la tabla más adecuada en nuestro medio (AU)

Introduction and objectives. In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. Methods. In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. Results. Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. Conclusions. The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting (AU)

Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012 / Prevention in primary care. The example of the Program for Prevention and Health Promotion. SESPAS Report 2012

Objetivos: El Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS), que la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) puso en marcha a finales de la década de 1980, tiene como objetivo la integración de las actividades preventivas y de promoción de la salud en el seno de las tareas desarrolladas en las consultas de atención primaria. Se pretende conocer el grado de cumplimentación del PAPPS en atención primaria. Métodos: Se ha realizado una búsqueda bibliográfica de las publicaciones relacionadas con el PAPPS con el fin de evaluar su implementación y el impacto sus programas. Resultados: Las evaluaciones periódicas que se han ido realizando desde su inicio muestran que tanto el cumplimiento como el registro de las actividades preventivas han ido mejorando progresivamente hasta las últimas evaluaciones. El PAPPS es evaluado de forma positiva tanto por los profesionales como por los pacientes. En España, el médico de familia realiza actividades de prevención y promoción de la salud en un mayor porcentaje que el global de Europa. Conclusiones: El PAPPS sigue vigente 24 años después de su puesta en marcha, aunque es necesario un proceso de adaptación al actual escenario sanitario español. Las propuestas de cambio se centran en mejorar la accesibilidad y en ofrecer respuestas más ágiles a los usuarios. En los pacientes ancianos es importante valorar la esperanza de vida y priorizar las intervenciones preventivas basándose en ésta (AU)

The Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP.MethodsWe performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program.ResultsThe distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians.ConclusionsThe PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly (AU)

[Prevention in primary care. The example of the Program for Prevention and Health Promotion. SESPAS Report 2012]. / Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012.

OBJECTIVES: The Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP. METHODS: We performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program. RESULTS: The distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians. CONCLUSIONS: The PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly.

Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study.

INTRODUCTION AND OBJECTIVES: To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice. METHODS: A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. RESULTS: In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5-34.8%) in the intervention group and 25.6% (22.3-29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3-11.3%) in the intervention group and 11% (7.4-16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97-101.91 cm) and 102.58 cm (95% CI, 100.96-104.21 cm), respectively (P=.07). Overall, 20.9% (15.6-27.7%) of patients in the intervention group and 29.6% (23.9-36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4-37.9%) in the intervention group and 41.4% (35.8-47.3%) in the control group had depression (P=.02). CONCLUSIONS: A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced.

Ensayo clínico aleatorizado para evaluar la eficacia de un programa integral de prevención secundaria de las enfermedades cardiovasculares en atención primaria: estudio PREseAP / Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study

Introducción y objetivos. Evaluar la eficacia de un programa integral de prevención secundaria de las enfermedades cardiovasculares en atención primaria. Métodos.Ensayo clínico aleatorizado, pragmático, por conglomerados realizado en atención primaria. Eran pacientes elegibles varones y mujeres menores de 86 años, diagnosticados de cardiopatía isquémica, accidente cerebrovascular o enfermedad arterial periférica entre enero de 2004 y mayo de 2005. Participaron en el estudio pacientes visitados en 42 centros de salud de todo el estado español. La variable de resultado fue la combinación de la mortalidad total y los reingresos hospitalarios por causa cardiovascular a los 3 años de seguimiento. Resultados. Se reclutó a 1.224 pacientes, 624 en el grupo intervención y 600 en el grupo control. La variable principal de resultado se observó en el 29,9% (intervalo de confianza del 95%, 25,5-34,8) en el grupo intervención y en el 25,6% (22,3-29,2) en el grupo control (p=0,15). Al final del seguimiento un 8,5% (6,3-11,3) del grupo intervención y un 11% (7,4-16) del grupo control eran fumadores (p=0,07). El perímetro abdominal del grupo intervención fue 100,44 (98,97-101,91) cm y el del grupo control, 102,58 (100,96-104,21) cm (p=0,07). El 20,9% (15,6-27,7) de los pacientes del grupo intervención y el 29,6% de los pacientes del grupo control (23,9-36,1) tenían ansiedad (p=0,05), y el 29,6% (22,4-37,9) del grupo intervención y el 41,4% (35,8-47,3) del grupo control tenían depresión (p=0,02). Conclusiones. Un programa integral de prevención secundaria no es eficaz para reducir la morbimortalidad cardiovascular, pero sí en mejorar algunos aspectos relacionados con los hábitos saludables y en reducir la ansiedad y la depresión (AU)

Introduction and objectives: To assess the efficacy of a comprehensive programof secondary prevention of cardiovascular disease in general practice. Methods: A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. Results: In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5–34.8%) in the intervention group and 25.6% (22.3–29.2%) in the control group (P = .15). At the end of follow-up, 8.5% (6.3–11.3%) in the intervention group and 11% (7.4–16%) in the control group were smokers (P = .07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97–101.91 cm) and 102.58 cm (95% CI, 100.96–104.21 cm), respectively (P = .07). Overall, 20.9% (15.6–27.7%) of patients in the intervention group and 29.6% (23.9–36.1%) in the control group suffered from anxiety (P = .05), and 29.6% (22.4–37.9%) in the intervention group and 41.4% (35.8–47.3%) in the control group had depression (P = .02). Conclusions: A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced (AU)

Improvements in health-related quality of life of patients admitted for heart failure. The HF-QoL study.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is associated with a poor prognosis, both in terms of survival and ongoing symptoms. The objectives of this study were to investigate trends in the health-related quality of life (HRQoL) of a heterogeneous group of HF patients, with a focus on subgroups of particular clinical interest, and to identify determinants of mortality. METHODS: Prospective study of 883 HF patients discharged from 50 Spanish hospitals and followed for 1 year, during which six HRQoL assessments were carried out using the generic Short Form-36 (SF-36) questionnaire and the specific Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS: A marked change was noted at the beginning of the study on all dimensions of the SF-36, in its physical (mean 34.1) and mental (mean 40.1) component summary scores, and in the MLHFQ score (mean 37.5). There was a clear improvement in the first month, which subsequently remained unchanged, except in younger patients aged under 40 years whose HRQoL continued to improve progressively. The following predictors of mortality were identified: age, functional class, co-morbidity and baseline HRQoL. CONCLUSIONS: In patients with HF, HRQoL showed a clear improvement during the first month after hospital discharge but subsequently remained unchanged, except in younger patients, whose HRQoL continued to improve progressively.

Determinantes de mal control de los factores de riesgo en pacientes coronarios en la atención primaria / Determinants of poor control of risk factors in coronary patients in primary care

Introducción: La prevención secundaria de las enfermedades cardiovasculares tiene como objetivo reducir el riesgo de un nuevo episodio cardiovascular y mejorar la supervivencia. Los pacientes en prevención secundaria representan la primera prioridad en la prevención de las enfermedades cardiovasculares, por tratarse de pacientes de riesgo muy alto. El objetivo de este estudio es evaluar cuáles son los determinantes del mal control de los factores de riesgo en pacientes coronarios atendidos en la atención primaria. Métodos: Estudio multicéntrico evaluativo y retrospectivo mediante revisión de las historias clínicas y llamada telefónica a los pacientes diagnosticados de enfermedad coronaria y controlados en 5 centros de atención primaria de la provincia de Barcelona y Girona. Resultados: Participaron 736 pacientes, con una edad media de 72,11 años, de los cuales el 71,4% eran varones. Se identificaron como determinantes de mal control de la presión arterial (PA > 140/90 mmHg o PA > 130/80 mmHg para pacientes con diabetes mellitus o insuficiencia renal): a) no estar diagnosticado de infarto de miocardio (odds ratio (..) (AU)

Introduction: The objective of secondary prevention of cardiovascular disease is to reduce the risk of a new cardiovascular event and increase survival. Patients in secondary prevention are at very high risk and represent the first priority in the prevention of cardiovascular disease. The aim of this study was to identify the determinants of poor control of risk factors in coronary patients attended in primary care. Methods: We performed a retrospective multicenter evaluation study with review of medical records and telephone calls to patients diagnosed with coronary heart disease attended in five primary care centers in the provinces of Barcelona and Gerona. Results: A total of 736 patients were studied, with a mean age of 72.11 years (71.4% were male). The following determinants of uncontrolled blood pressure (BP >140/90 mmHg orBP > 130/80 mmHg in patients with diabetes mellitus or renal insufficiency) were identified: 1. Not being diagnosed with myocardial infarction (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.07-2.43); 2. Having a diagnosis of diabetes mellitus (OR = 4.26;95% CI, 2.76-6.57): 3. Having a diagnosis of hypertension (OR = 2.67; 95% CI, 1.71-4.17),and 4. Not being diagnosed with chronic obstructive pulmonary disease (OR = 1.98; 95%CI, 1.01-3.89). The following determinants of poor lipid control (low-density (..) (AU)

Patient registries of acute coronary syndrome: assessing or biasing the clinical real world data?

BACKGROUND: The risk of selection bias in registries and its consequences are relatively unexplored. We sought to assess selection bias in a recent registry about acute coronary syndrome and to explore the way of conducting and reporting patient registries of acute coronary syndrome. METHODS AND RESULTS: We analyzed data from patients of a national acute coronary syndrome registry undergoing an audit about the comprehensiveness of the recruitment/inclusion. Patients initially included by hospital investigators (n=3265) were compared to eligible nonincluded (missed) patients (n=1439). We assessed, for 25 exposure variables, the deviation of the in-hospital mortality relative risks calculated in the initial sample from the actual relative risks. Missed patients were of higher risk and received less recommended therapies than the included patients. In-hospital mortality was almost 3 times higher in the missed population (9.34% [95% CI, 7.84 to 10.85] versus 3.9% [95% CI, 2.89 to 4.92]). Initial relative risks diverged from the actual relative risks more than expected by chance (P<0.05) in 21 variables, being higher than 10% in 17 variables. This deviation persisted on a smaller degree on multivariable analysis. Additionally, we reviewed a sample of 129 patient registries focused on acute coronary syndrome published in thirteen journals, collecting information on good registry performance items. Only in 38 (29.4%) and 48 (37.2%) registries was any audit of recruitment/inclusion and data abstraction, respectively, mentioned. Only 4 (3.1%) authors acknowledged potential selection bias because of incomplete recruitment. CONCLUSIONS: Irregular inclusion can introduce substantial systematic bias in registries. This problem has not been explicitly addressed in a substantial number of them.

[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.

[Factors affecting the control of blood pressure and lipid levels in patients with cardiovascular disease: the PREseAP Study]. / Determinantes del control de la presión arterial y los lípidos en pacientes con enfermedad cardiovascular (estudio PREseAP).

The aim of this observational study was to identify factors influencing the control of blood pressure (i.e., <140/90 mmHg, or <130/80 mmHg in diabetic patients) and low-density lipoprotein (LDL) cholesterol level (<100 mg/dL) in 1223 patients with cardiovascular disease. Overall, 70.2% of patients were men, and their mean age was 66.4 years. Blood pressure was poorly controlled in 50.9% (95% confidence interval [CI], 46.9%-54.8%) and the LDL cholesterol level was poorly controlled in 60.1% (95% CI, 56.3%-63.9%). Determinants of poor blood pressure control were diabetes, hypertension, no previous diagnosis of heart failure, previous diagnosis of peripheral artery disease or stroke, obesity, and no lipid-lowering treatment. Determinants of poor LDL cholesterol control were no lipid-lowering treatment, no previous diagnosis of ischemic heart disease, no antihypertensive treatment, and dyslipidemia. The factors affecting blood pressure control were different from those affecting LDL cholesterol control, an observation that should be taken into account when implementing treatment recommendations for achieving therapeutic objectives in secondary prevention.

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

Determinantes del control de la presión arterial y los lípidos en pacientes con enfermedad cardiovascular (estudio PREseAP) / Factors affecting the control of blood pressure and lipid levels in patients with cardiovascular disease: the PREseAP study

Estudio observacional para identificar los determinantes del control de la presión arterial (< 140/90 o < 130/80 mmHg si diabetes) y el colesterol de las lipoproteínas de baja densidad (cLDL < 100 mg/dl) en 1.223 pacientes diagnosticados de enfermedad cardiovascular. El 70,2% eran varones con una media de edad de 66,4 años. El 50,9% (intervalo de confianza [IC] del 95%, 46,9%-54,8%) mostró mal control de la presión arterial y el 60,1% (IC del 95%, 56,3%-63,9%), del cLDL. Determinantes de mal control de la presión arterial fueron: diabetes, hipertensión arterial, no tener diagnóstico previo de insuficiencia cardiaca, diagnóstico de enfermedad arterial periférica o ictus, obeso y no recibir tratamiento hipolipemiante. Determinantes de mal control del cLDL fueron: no recibir tratamiento hipolipemiante, no tener diagnóstico de cardiopatía isquémica, no recibir tratamiento antihipertensivo y dislipemia. Los determinantes de mal control de presión arterial difieren de los del cLDL, resultado que considerar al aplicar las recomendaciones para alcanzar los objetivos terapéuticos en prevención secundaria

The aim of this observational study was to identify factors influencing the control of blood pressure (i.e., <140/90 mmHg, or <130/80 mmHg in diabetic patients) and low-density lipoprotein (LDL) cholesterol level (<100 mg/dL) in 1223 patients with cardiovascular disease. Overall, 70.2% of patients were men, and their mean age was 66.4 years. Blood pressure was poorly controlled in 50.9% (95% confidence interval [CI], 46.9%­54.8%) and the LDL cholesterol level was poorly controlled in 60.1% (95% CI, 56.3%­63.9%). Determinants of poor blood pressure control were diabetes, hypertension, no previous diagnosis of heart failure, previous diagnosis of peripheral artery disease or stroke, obesity, and no lipid-lowering treatment. Determinants of poor LDL cholesterol control were no lipid-lowering treatment, no previous diagnosis of ischemic heart disease, no antihypertensive treatment, and dyslipidemia. The factors affecting blood pressure control were different from those affecting LDL cholesterol control, an observation that should be taken into account when implementing treatment recommendations for achieving therapeutic objectives in secondary prevention

[Baseline characteristics and determinants of outcome in a patient population admitted for heart failure to a general hospital]. / Características basales y determinantes de la evolución en pacientes ingresados por insuficiencia cardíaca en un hospital general.

INTRODUCTION AND OBJECTIVES: To assess baseline characteristics, management patterns, and clinical outcomes after 18 months in patients diagnosed as heart failure in a tertiary hospital in Catalonia, Spain. METHODS: The records of all 265 patients admitted to the Hospital General Vall d'Hebron from July through December 1998 with a diagnosis of heart failure who met study criteria were identified and analyzed. Patients were interviewed by telephone 18 months later. RESULTS: The mean age of the study population was 75 12 years, 42% were male, 19% were admitted for causes other than heart failure, and 62% had significant comorbidity. Ventricular function was assessed in 68% (preferentially patients with a better prognosis), and was considered normal in 41%. Angiotensin-converting enzyme inhibitors or angiotensin II antagonists were used in 54%, and beta-blockers in 4%. The 18-month mortality was 46% (77% cardiac mortality). Multivariate predictors of death were older age, severe or previous heart failure, and serious comorbidity. At 18 months, 69% of survivors were in functional classes I or II. CONCLUSIONS: 1) As in other geographic areas, patients in this study were an older population with poor survival; 2) local patterns of care definitely need improvement; 3) comorbidity is important for prognosis, and 4) a significant proportion of survivors enjoy an acceptable quality of life long after discharge.

Características basales y determinantes de la evolución en pacientes ingresados por insuficiencia cardíaca en un hospital general / Baseline characteristics and determinants of outcome in a patient population admitted for heart failure to a general hospital

Introducción y objetivos. Analizar las características basales, los patrones de manejo y los resultados clínicos a los 18 meses del ingreso en pacientes diagnosticados de insuficiencia cardíaca en un hospital terciario de Cataluña. Métodos. Se identificaron y analizaron las historias clínicas de los 256 pacientes ingresados en el Hospital General Vall d'Hebron desde julio a diciembre de 1998, diagnosticados de insuficiencia cardíaca y que cumplieran los criterios del estudio. Se entrevistó a los pacientes telefónicamente 18 meses después. Resultados. La edad media de los pacientes era de 75 ñ 12 años, el 42 por ciento correspondía a varones, el 19 por ciento había ingresado por enfermedades distintas de la insuficiencia cardíaca y el 62 por ciento tenía comorbilidad significativa. Se estudió la función ventricular en el 68 por ciento (básicamente en pacientes con mejor pronóstico), y se consideró normal en un 41 por ciento. Se administraron inhibidores de la enzima conversiva o antagonistas de la angiotensina II en un 54 por ciento y bloqueadores beta en un 4 por ciento. La mortalidad a los 18 meses fue del 46 por ciento, siendo de causa cardíaca en el 77 por ciento de éstos. Los predictores independientes de mortalidad fueron la edad avanzada, la insuficiencia cardíaca grave o antigua y la comorbilidad. A los 18 meses, un 69 por ciento de los supervivientes se hallaba en clase funcional I o II. Conclusiones. 1) Al igual que sucede en otras áreas geográficas, los pacientes de este estudio constituyen, como media, una población anciana y con pobre supervivencia; 2) los patrones de manejo registrados son claramente mejorables; 3) la comorbilidad afecta significativamente al pronóstico, y 4) la calidad de vida después del alta es aceptable en una llamativa proporción de supervivientes. (AU)