Adherencia terapéutica de pacientes con riesgo cardiovascular en atención primaria. Proyecto REAAP / Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project

Objetivo Describir las percepciones y las experiencias cotidianas de los médicos de atención primaria (AP) en el abordaje de la falta de adherencia terapéutica en pacientes con riesgo cardiovascular, así como sus expectativas y las posibles áreas de mejora. Material y métodos Estudio cualitativo (en el marco del proyecto REAAP: Red de Expertos en Adherencia de Atención Primaria) realizado en varias comunidades autónomas de España a partir de un cuestionario de respuesta abierta completado por médicos de AP. Los escritos se analizaron mediante el método marco o Framework Analysis para orientar la codificación de los temas. Resultados Participaron 18 médicos, de cuyas respuestas se identificaron tres temas principales: abordaje de la adherencia durante la práctica clínica, barreras que dificultan una correcta adherencia e intervenciones para mejorar la adherencia. Las estrategias más señaladas para facilitar la adherencia terapéutica de los pacientes fueron: mejorar la comunicación médico-paciente y la continuidad asistencial, involucrar a las farmacias comunitarias y simplificar el tratamiento prescribiendo fármacos a combinaciones fijas. Conclusiones Los médicos asistenciales de AP apuntan a que no existe una estrategia ideal que por sí sola facilite la adherencia terapéutica, siendo necesario combinar varias intervenciones para optimizarla. Conocer la problemática y las herramientas disponibles y ausentes en la práctica habitual permitirá un mejor abordaje de la adherencia de los pacientes. En esta línea, iniciativas como el proyecto REAAP son un medio importante para que el personal sanitario, y el resto de actores implicados reconozcan la importancia que merece esta cuestión (AU)

Objective To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. Material and methods A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. Results Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients’ therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. Conclusions There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves (AU)

[Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project]. / Adherencia terapéutica de pacientes con riesgo cardiovascular en atención primaria. Proyecto REAAP.

OBJECTIVE: To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. MATERIAL AND METHODS: A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. RESULTS: Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients' therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. CONCLUSIONS: There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.

Home blood pressure self-measurement: “Current situation and new perspectives” / Automedidas domiciliarias de presión arterial: «situación actual y nuevas perspectivas»

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method.In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15–20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up.Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations. (AU)

El método utilizado habitualmente para el diagnóstico y seguimiento de los pacientes hipertensos ha sido la medida de la presión arterial en la consulta, pero es un hecho conocido que este método plantea problemas (sesgos del observador, no detecta reacción de alerta en consulta…) que afectan a su precisión como método diagnóstico.Las diferentes sociedades científicas internacionales, en los últimos años, recomiendan de forma insistente el uso de medidas de presión arterial fuera de la consulta (domiciliarias o ambulatorias) con aparatos automáticos validados para tomar decisiones. Datos de algunos estudios sugieren que si solo utilizamos las medidas de la consulta nos podemos equivocar en torno a un 15-20% de las veces que tomemos decisiones en el diagnóstico y seguimiento de los pacientes.Las medidas domiciliarias de presión arterial son un método sencillo y muy accesible que tienen una reproducibilidad y valor pronóstico similar al de las medidas ambulatorias, cuya disponibilidad actualmente e muy limitada, y que además tienen una utilidad importante que es la posibilidad de mejora del control de los hipertensos.Los profesionales sanitarios y los pacientes deben conocer la metodología de uso de la medida de presión arterial domiciliaria y sus utilidades y limitaciones. (AU)

Home blood pressure self-measurement: "Current situation and new perspectives".

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals. Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review

Background: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. Objective: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). Material and methods: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. Results: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55% (AU)

Antecedentes: La eficacia y la seguridad de la profilaxis con ácido acetilsalicílico (AAS) para la prevención primaria de la enfermedad cardiovascular arteriosclerótica (ECVA) siguen siendo controvertidas en personas con diabetes (DM) sin ECVA, ya que el posible aumento del riesgo de hemorragias graves podría superar la posible disminución del riesgo de mortalidad y de los principales episodios adversos cardiovasculares (MACE) considerados individualmente o en conjunto. Objetivo: Evaluar el riesgo-beneficio de la profilaxis con AAS en prevención primaria en personas con DM y comparar las recomendaciones de las guías de práctica clínica con los resultados de los metaanálisis (MA) y revisiones sistemáticas (RS). Material y métodos: Se realizaron búsquedas en Medline, Google Scholar, Embase y Biblioteca Cochrane de RS y MA publicados desde 2009 hasta 2020 que compararan los efectos de AAS versus placebo o control en seguimiento durante al menos un año en personas con DM sin ECVA. Se valoraron la heterogeneidad entre los ensayos clínicos aleatorizados (ECA) incluidos en las RS y MA. Se mostraron los resultados cardiovasculares de eficacia (muerte por cualquier causa [MCC], muerte cardiovascular [MCV], infarto de miocardio [IM], ictus y MACE) y de seguridad (episodios hemorrágicos importantes [EHI], episodios hemorrágicos gastrointestinales importantes [EHGI], hemorragias intracraneales y extracraneales). Resultados: Se valoraron las recomendaciones de 12 guías de práctica clínica. Se evaluaron los resultados de 25 RS y MA que incluyeron un total de 20ECA. Ningún MA ni RS mostró que la profilaxis con AAS disminuyera el riesgo de MCC, MCV o IM. Solo dos de los 19 SR y MA que evaluaron el ictus isquémico mostraron una disminución en el riesgo de ictus (media 20,0% [DE±5,7]), rozando la significación estadística (AU)

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

[Skills perceived by general practitioners for providing care to immigrant patients]. / Aptitudes percibidas por el médico de familia en la atención a pacientes inmigrantes.

OBJECTIVE: To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS: A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS: The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture.

Prevalence of hypotension in hypertensive treated patients within the Primary Care setting. The PRESCAP 2010 study.

OBJECTIVE: To determine the prevalence of hypotension and associated factors in hypertensive patients treated in the Primary Care setting. MATERIALS AND METHODS: A cross-sectional, descriptive, and multicentre study was conducted with a total of 2635 general practitioners consecutively including 12,961 hypertensive patients treated in a Primary Care setting in Spain. An analysis was performed on the variables of age, gender, weight, height, body mass index, waist circumference, cardiovascular risk factors (diabetes, dyslipidaemia, smoking, obesity, sedentary lifestyle), fasting plasma glucose, complete lipid profile, as well as the presence of target organ damage (left ventricular hypertrophy, microalbuminuria, carotid atherosclerosis) and associated clinical conditions. Hypotension was defined as a systolic blood pressure less than 110mmHg or a diastolic blood pressure less than 70mmHg. A multivariate analysis was performed to determine the variables associated with the presence of hypotension. RESULTS: The mean age was 66.2 years, and 51.7% of patients were women. The mean time of onset of hypertension was 9.1 years. A total of 13.1% of patients (95% confidence interval 12.4-13.6%) had hypotension, 95% of whom had low diastolic blood pressure. The prevalence of hypotension was higher in elderly patients (25.7%) and in those individuals with coronary heart disease (22.6%). The variables associated with the presence of hypotension included a history of cardiovascular disease, being treated with at least 3 antihypertensive drugs, diabetes, and age. CONCLUSIONS: One out of 4-5 elderly patients, or those with cardiovascular disease, had hypotension. General practitioners should identify these patients in order to determine the causes and adjust treatment to avoid complications.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]. / Medidas antropométricas de obesidad general y central y capacidad discriminativa sobre el riesgo cardiovascular: estudio RICARTO.

INTRODUCTION AND OBJECTIVES: Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). MATERIAL AND METHODS: Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points. RESULTS: The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m2) and men (26.99kg/m2). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other. CONCLUSIONS: The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

[Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. / Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.

[Baseline spirometry parameters that can influence the bronchodilation test]. / Parámetros basales de la espirometría que pueden influir en la prueba de broncodilatación.

OBJECTIVE: To determine whether the baseline parameters of forced spirometry can influence the positivity of the bronchodilation test (BDT), and whether this could have an influence in future positivity criteria. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted in a Primary Care setting. It included all patients referred by their family doctor to perform a forced spirometry test due to smoking, respiratory symptoms, or follow-up of respiratory diseases, between the months of June 2015 and February 2017. All of them were subjected to a forced spirometry with a BDT. RESULTS: A total of 295 patients were included, with a mean age 53.4±15.5 years, and 62% were male.An obstructive pattern was obtained in 20% of the spirometries, with 67.5% presenting with a mild obstruction, 18% a moderate, 9.6% moderate to severe, and 4.8% very severe. The BDT was positive in 8.8% of the spirometries, with 11.2% only positive in volume, and 17.6% were only positive in percentage. It was observed that the patients with a BDT positive in percentage had a lower base forced expiry volume in the first second (1.66 L/sec vs. 2.74 L/sec; P<.001), and a lower forced vital capacity (2.85 l vs.3.73 l; P<.001). The patients with a positive BDT in volume had a lower forced expiry volume in the first second (2.59 l/sec vs. 2. 62 l/sec; P<.001), and a higher forced vital capacity (3.89 l vs. 3.58 l; P<.001). CONCLUSIONS: The baseline forced expiry volume in the first second and forced vital capacity have an influence in the positivity of the BDT. This circumstance should be assessed when establishing the positivity of the BDT.

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

[Reliability study on the interpretation of electrocardiograms by general practitioners and trainees]. / Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes.

OBJECTIVE: To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. MATERIAL AND METHODS: An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. RESULTS: The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). CONCLUSIONS: Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist.

[Control of anticoagulation in patients with non-valvular atrial fibrillation in a primary care clinical practice setting in the different autonomous communities. PAULA study]. / Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA.

AIMS: To determine the differences between regions in the level of control of patients with non-valvular atrial fibrillation treated with vitamin K antagonists, included in the PAULA study. METHODS: Observational, and coss-sectional/retrospective study, including 139 Primary Care physicians from 99 Health Care centres in all autonomous communities (except La Rioja). Anticoagulation control was defined as the time in therapeutic range assessed by either the direct method (poor control <60%), or the Rosendaal method (poor control <65%). RESULTS: A total of 1,524 patients were included. Small differences in baseline characteristics of the patients were observed. Differences in the percentage of time in therapeutic range were observed, according to the Rosendaal method (mean 69.0±17.7%), from 78.1%±16.6 (Basque Country) to 61.5±14% (Balearic Islands), by the direct method (mean 63.2±17.9%) from 73.6%±16.6 (Basque Country) to 57.5±15.7% (Extremadura). When comparing regions, in those where the Primary Care physicians assumed full control without restrictions on prescription, the percentage of time in therapeutic range by the direct method was 63.89 vs. 60.95% in those with restrictions (p=.006), by Rosendaal method, 69.39% compared with 67.68% (p=.1036). CONCLUSIONS: There are significant differences in the level of control between some regions are still inadequate. Regions in which the Primary Care physicians assumed the management of anticoagulation and without restrictions, time in therapeutic range was somewhat higher, and showed a favourable trend for better control. These findings may have clinical implications, and deserve consideration and specific analysis.

[Resistant arterial hypertension in Primary Care patients in Spain. PRESCAP Study 2010]. / Hipertensión arterial resistente en pacientes hipertensos atendidos en Atención Primaria de España. Estudio PRESCAP 2010.

OBJECTIVE: To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. PATIENTS AND METHODS: A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. RESULTS: Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P<.001), had a higher prevalence of obesity (55.2 vs. 38.6%, P<.001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P<.001), and a higher prevalence of DM (48.3 vs. 29.5%, P<.001). The prevalence of target organ damage (73.0 vs. 61.4%, P<.001) and cardiovascular disease (46.7 vs. 26.8%, P<.001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. CONCLUSIONS: The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease.

[Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010]. / Control de la presión arterial en una población hipertensa diabética asistida en atención primaria: Estudio PRESCAP-Diabetes 2010.

OBJECTIVES: To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. MATERIAL AND METHODS: A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90mmHg was considered as good control of arterial hypertension. The percentages of patients with<130/80mmHg PA, 140/80mmHg, and 140/85mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. RESULTS: A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (<140/90mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. CONCLUSIONS: The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP.

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.