Resumen ejecutivo sobre la optimización del abordaje multidisciplinar e integrado de la polimialgia reumática y la arteritis de células gigantes en la Comunidad de Madrid / Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region

La polimialgia reumática y la arteritis de células gigantes pueden suponer una emergencia médica en la que el retraso en su correcto diagnóstico y manejo terapéutico pueden asociar complicaciones graves. Con el objetivo de mejorar la atención de los pacientes con estas patologías en el entorno de la Comunidad de Madrid, se diseñó un estudio para identificar las causas y las posibles soluciones para hacer frente los problemas relacionados con el diagnóstico de estas patologías. Tras un análisis preliminar, se identificaron 11 áreas de mejora relacionadas con cuatro aspectos diferenciados del proceso asistencial: coordinación y protocolos, equipamientos, formación y concienciación sobre las patologías y experiencia del paciente. De todas ellas, se priorizó resolver aquellas relacionadas con la generación de protocolos de abordaje integral de las patologías y que contemplen todas las especialidades y niveles asistenciales implicados. Otro aspecto crucial es el incremento del grado de sospecha clínica de estas patologías. (AU)

Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies. (AU)

Resumen ejecutivo sobre la optimización del abordaje multidisciplinar e integrado de la polimialgia reumática y la arteritis de células gigantes en la Comunidad de Madrid / Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region

La polimialgia reumática y la arteritis de células gigantes pueden suponer una emergencia médica en la que el retraso en su correcto diagnóstico y manejo terapéutico pueden asociar complicaciones graves. Con el objetivo de mejorar la atención de los pacientes con estas patologías en el entorno de la Comunidad de Madrid, se diseñó un estudio para identificar las causas y las posibles soluciones para hacer frente los problemas relacionados con el diagnóstico de estas patologías. Tras un análisis preliminar, se identificaron 11 áreas de mejora relacionadas con cuatro aspectos diferenciados del proceso asistencial: coordinación y protocolos, equipamientos, formación y concienciación sobre las patologías y experiencia del paciente. De todas ellas, se priorizó resolver aquellas relacionadas con la generación de protocolos de abordaje integral de las patologías y que contemplen todas las especialidades y niveles asistenciales implicados. Otro aspecto crucial es el incremento del grado de sospecha clínica de estas patologías. (AU)

Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies. (AU)

Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region.

Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies.

[Knowledge of chronic venous disease among healthcare professionals in Spain]. / Conocimiento de la enfermedad venosa crónica en los profesionales sanitarios en España.

INTRODUCTION: Chronic venous disease (CVD) is classified as the most prevalent vascular disease in humans. It has been associated with an increased incidence of cardiovascular diseases and is a strong predictor of all-cause mortality, representing a public health problem of the first magnitude. The objective of this study was to analyze the actions in the management of CVD in the daily clinical practice of health professionals in Spain. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection through an opinion survey of 22 questions completed electronically through a Google® form for professionals involved in chronic venous disease care. Three hundred surveys were analyzed. The quantitative variables were represented with means and standard deviation and the qualitative ones with percentages and confidence intervals. RESULTS: Three hundred surveys analyzed. 65.3% were women. The most participatory age group was over 55 years of age. 85% of those surveyed considered that CVD is an underdiagnosed and undertreated disease, with an added negative impact in terms of follow-up during the Covid-19 pandemic, since 91.7% considered that it had not been adequate. 47% of the participants did not know the CEAP classification and 56.3% did not know the venous clinical severity scale (VCSS). 92.7% of physicians prescribed compression stockings and 74.7% phlebotonic drugs. Hidrosmine was the best known and most prescribed venoactive drug (51.7%). 73% of the doctors recognized that they did not use any algorithm or protocol for the diagnosis, treatment and monitoring of CVD in their usual clinical practice and 91% stated that they were not trained in their workplaces. 54.3% of the physicians believed that one of the main limitations that made follow-up of the disease difficult was the lack of coordination with the vascular surgeons. CONCLUSIONS: Updating and responding to the training needs of professionals regarding CVD is essential to guarantee quality care continuity in the care of our patients.

Superando las barreras en el abordaje del paciente crónico / Overcoming the barriers in the approach of the chronic patient

Al menos uno de cada 3 adultos tiene múltiples enfermedades crónicas. La asistencia a estos pacientes es imprescindible, y constituye una de las labores principales en atención primaria. El abordaje de estos pacientes supone un reto, ya que existen barreras a múltiples niveles (sistema sanitario, trabajadores sanitarios, paciente). Además, la pandemia por COVID-19 no ha hecho sino empeorar aún más esta situación. En consecuencia, se hace necesario tomar medidas que intenten mejorar esta situación. Para ello, con el objetivo de definir soluciones/recomendaciones que ayuden a un mejor diagnóstico, tratamiento y seguimiento de los pacientes con enfermedades crónicas, un grupo de expertos de SEMERGEN ha tratado de identificar los problemas en la atención de estos pacientes, buscando posibles soluciones y áreas de mejora. En concreto, el presente documento se ha centrado en 4 de las enfermedades crónicas más prevalentes en atención primaria: dislipemia, hipertensión arterial, enfermedad venosa crónica y depresión (AU)

At least one in three adults has multiple chronic conditions. The assistance of patients with chronic conditions is mandatory. This is one of the main tasks of the primary care physicians. The approach in these patients is challenging, as there are many barriers at different levels (sanitary system, healthcare professionals and patients). In addition, COVID-19 pandemic has worsened this situation even more. Therefore, it is necessary to take actions that try to improve this state. For this purpose, with the aim to find solutions/recommendations that may be helpful to attain a better diagnosis, treatment and follow-up of patients with chronic diseases, a group of experts of SEMERGEN have tried to identify the problems in the attention to these patients, searching for potential solutions and areas of improvement. The present document has specifically focused on four prevalent chronic conditions in primary care: dyslipidemia, arterial hypertension, chronic venous disease and depression (AU)

[Overcoming the barriers in the approach of the chronic patient]. / Superando las barreras en el abordaje del paciente crónico.

At least one in three adults has multiple chronic conditions. The assistance of patients with chronic conditions is mandatory. This is one of the main tasks of the primary care physicians. The approach in these patients is challenging, as there are many barriers at different levels (sanitary system, healthcare professionals and patients). In addition, COVID-19 pandemic has worsened this situation even more. Therefore, it is necessary to take actions that try to improve this state. For this purpose, with the aim to find solutions/recommendations that may be helpful to attain a better diagnosis, treatment and follow-up of patients with chronic diseases, a group of experts of SEMERGEN have tried to identify the problems in the attention to these patients, searching for potential solutions and areas of improvement. The present document has specifically focused on four prevalent chronic conditions in primary care: dyslipidemia, arterial hypertension, chronic venous disease and depression.

Enfermedad venosa crónica en los nuevos tiempos. Propuesta Venocheck / Chronic Venous Disease in the new times. Venocheck Proposal

La enfermedad venosa crónica (EVC) es la enfermedad vascular más frecuente en el ser humano y sigue siendo infradiagnosticada e infratratada en todos los niveles asistenciales. Los nuevos tiempos que vivimos suponen un aumento de la incertidumbre entre los pacientes crónicos sobre su diagnóstico, tratamiento y seguimiento por parte de los médicos de familia y especialmente en la EVC. Con el fin de abordar estos nuevos tiempos, el Grupo de Vasculopatías de Semergen ha diseñado el cuestionario Venocheck, que valora aspectos etiológicos, clínicos (clasificación CEAP), de severidad y calidad de vida, terapéuticos, presencia de complicaciones y criterios de derivación (AU)

Chronic venous disease (CVD) is the most common vascular disease in humans and continues to be underdiagnosed and undertreated at all levels of care. The new times we live in have led to an increase in uncertainty among chronic patients about their diagnosis, treatment and follow-up by family doctors and especially in CVD. In order to analyze these new times, the Semergen Vasculopathies Group has created the Venocheck questionnaire, which assesses aetiological, clinical (CEAP classification), severity and quality of life, therapeutic aspects, presence of complications and referral criteria (AU)

[Chronic Venous Disease in the new times. Venocheck Proposal]. / Enfermedad venosa crónica en los nuevos tiempos. Propuesta Venocheck.

Chronic venous disease (CVD) is the most common vascular disease in humans and continues to be underdiagnosed and undertreated at all levels of care. The new times we live in have led to an increase in uncertainty among chronic patients about their diagnosis, treatment and follow-up by family doctors and especially in CVD. In order to analyze these new times, the Semergen Vasculopathies Group has created the Venocheck questionnaire, which assesses aetiological, clinical (CEAP classification), severity and quality of life, therapeutic aspects, presence of complications and referral criteria.

[Giant Cell Arteritis. Recommendations in Primary Care]. / Arteritis de las células gigantes. Recomendaciones en Atención Primaria.

Giant cell arteritis is a systemic vasculitis with significant intra and extracranial involvement that, with early diagnosis and treatment in primary care, can improve its prognosis as it is a medical emergency. Our working group on vascular diseases of the Spanish Society of Primary Care Physicians (SEMERGEN) proposes a series of recommendations based on current scientific evidence for a multidisciplinary approach and follow-up in primary care.

[Knowledge of thromboprophylaxis-COVID-19 in healthcare professionals in Spain]. / Conocimiento de la tromboprofilaxis-COVID-19 en los profesionales sanitarios en España.

INTRODUCTION: Patients suffering from coronavirus infection have an increased risk of venous thromboembolic disease (VTE) associated with COVID-19, which confers a higher risk of mortality. For this reason, it is necessary to analyze the knowledge and the different actions in the management of thromboprophylaxis in work environments. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection through a Google® form with 19 questions for professionals involved in the care of COVID-19. 414 surveys were received. The quantitative variables were represented with means and standard deviation and the qualitative variables with percentages and confidence intervals. RESULTS: 414 surveys analyzed. 58.2% were women. The most participatory age group was 56-65 years. 95.2% stated that COVID-19 patients had a higher risk of VTE and peripheral arterial microthrombosis. 93.6% considered that outpatient COVID-19 patients should receive thromboprophylaxis. 60.5% of the physicians did not know any protocol for the evaluation of thrombotic risk in these patients. Low molecular weight heparin was considered the main treatment for thromboprophylaxis. CONCLUSIONS: The majority of doctors consider that COVID-19 patients have a higher risk of suffering VTE and peripheral arterial microthrombosis than the general population, however more than a third do not assess the thrombotic risk and a significant percentage claim not to know protocols to evaluate said risk. The survey highlights the training needs of our professionals in thromboprophylaxis so that our patients receive healthcare with the highest possible quality.

[COVID-19 and thromboprophylaxis: Recommendations for our clinical practice in Primary Care]. / COVID-19 y tromboprofilaxis: recomendaciones para nuestra práctica clínica en Atención Primaria.

The new coronavirus (SARS-CoV-2) is responsible for a severe acute respiratory syndrome. Among its manifestations, it can develop a thrombotic disease, both venous and arterial, due to excessive inflammation that affects the vascular system, with platelet activation and endothelial dysfunction, among other mechanisms. Thrombosis is associated with SARS-CoV-2 infection, increasing its severity and conferring a worse prognosis. Our performance as Family Physicians can contribute important actions in the management and control of this severe complication. Considering that many of our patients already receive antithrombotic or anticoagulant therapy, the fact that they may develop a COVID-19 infection will have implications for the choice, dosage and control of their treatment. In this document we review, with the information currently available, the relationship between disease caused by SARS-CoV-2 and thrombosis, as well as its management with a focus on Primary Care.

COVID-19 y tromboprofilaxis: recomendaciones para nuestra práctica clínica en Atención Primaria / COVID-19 and thromboprophylaxis: recommendations for our clinical practice in Primary Care

El nuevo coronavirus (SARS-CoV-2) es el responsable de un síndrome respiratorio agudo severo (SARS). Entre sus manifestaciones puede desarrollar una enfermedad trombótica, tanto venosa como arterial, debido a la inflamación excesiva que afecta al sistema vascular, con activación plaquetaria y disfunción endotelial, entre otros mecanismos. La trombosis se asocia a la infección producida por el SARS- CoV-2, aumentando su gravedad y confiriendo un peor pronóstico. Nuestra actuación como Médicos de Familia puede aportar acciones importantes en el manejo y control de esta severa complicación. Teniendo en cuenta que muchos de nuestros pacientes ya reciben terapia antitrombótica o anticoagulante, el hecho de que puedan desarrollar una infección por COVID-19 tendrá implicaciones para la elección, la dosificación y el control en su tratamiento. En este documento, revisamos, con la información actualmente disponible, la relación entre enfermedad producida por el SARS-CoV-2 y trombosis, así como su manejo con un enfoque centrado en Atención Primaria

The new coronavirus (SARS-CoV-2) is responsible for a severe acute respiratory syndrome. Among its manifestations, it can develop a thrombotic disease, both venous and arterial, due to excessive inflammation that affects the vascular system, with platelet activation and endothelial dysfunction, among other mechanisms. Thrombosis is associated with SARS-CoV-2 infection, increasing its severity and conferring a worse prognosis. Our performance as Family Physicians can contribute important actions in the management and control of this severe complication. Considering that many of our patients already receive antithrombotic or anticoagulant therapy, the fact that they may develop a COVID-19 infection will have implications for the choice, dosage and control of their treatment. In this document we review, with the information currently available, the relationship between disease caused by SARS-CoV-2 and thrombosis, as well as its management with a focus on Primary Care

Tratamiento hipolipemiante en la era COVID-19 / Lipid treatment in the period COVID-19

ANTECEDENTES Y OBJETIVOS: La pandemia por COVID-19 ha puesto de manifiesto que las enfermedades cardiovasculares conllevan mayor riesgo de mortalidad. Han surgido dudas en cuanto a la terapia lipídica en estos pacientes. Nuestro objetivo en esta revisión es analizar la eficacia y la seguridad de la terapia hipolipemiante en los pacientes con COVID-19. MATERIAL Y MÉTODOS: Se realizó una revisión de la literatura científica en PubMed, informes CDC, NIH y NCBI SARS-CoV-2 utilizando las palabras clave: COVID-19, statins, ezetimibe, PCSK9 inhibitors, hypercholesterolemia and hypolipidemic drugs. RESULTADOS: Las estatinas se deben seguir utilizando en los pacientes con COVID-19 en base a su eficacia, seguridad, efectos inmunosupresores, antiinflamatorios, disponibilidad y accesibilidad. En función de los niveles de riesgo cardiovascular de estos pacientes puede ser necesario el empleo de estatinas de alta potencia y/o ezetimiba y/o inhibidores de la proproteína convertasa subtilisina (iPCSK9) en pacientes de alto y muy alto riesgo cardiovascular. Los pacientes tratados con iPCSK9 deben seguir con el tratamiento por sus efectos beneficiosos sobre la prevención de la enfermedad cardiovascular. Los pacientes con hipercolesterolemia familiar y COVID-19 son especialmente vulnerables a la enfermedad cardiovascular precoz y deben seguir recibiendo el tratamiento hipolipemiante intensivo. CONCLUSIONES: En los pacientes con COVID-19 la mayoría de las enfermedades cardiovasculares basales son de origen aterosclerótico, con peor pronóstico para los pacientes con alto riesgo y muy alto riesgo de enfermedad cardiovascular. En estos pacientes el tratamiento intensivo con estatinas y/o combinación fija con ezetimiba y/o iPCSK9 juega un papel fundamental

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has shown that cardiovascular diseases carry a higher risk of mortality. Doubts have been raised regarding lipid therapy in these patients. The objectives are to analyze the efficacy and safety of lipid lowering therapy in patients with COVID-19. MATERIAL AND METHODS: A review of the scientific literature was conducted in PubMed, CDC Reports, NIH, and NCBI SARS-CoV-2 using the keywords: COVID-2, statins, ezetimibe, PCSK9 inhibitors, hypercholesterolemia, and hypolipidemic drugs. RESULTS: The statins should continue to use patients with COVID-19 based on their efficacy, safety, immunosuppressive effects, anti-inflammatory availability and accessibility. Depending on the cardiovascular risk levels of these patients, the use of high potency statins and/or ezetimibe and/or iPCSK9 may be necessary in patients with high and very high cardiovascular risk. Patients treated with iPCSK9 should continue treatment for its beneficial effects in preventing cardiovascular disease. Patients with familial hypercholesterolemia and COVID-19 are especially vulnerable to cardiovascular disease and should continue to receive severe lipid lowering therapy. CONCLUSIONS: In patients with COVID-19, the majority of baseline CVDs are of atherosclerotic origin, with the worst prediction for patients with high risk and very high risk of CVD. In these patients, intensive treatment with statins and/or fixed combination with ezetimibe and/or iPCSK9 plays a fundamental role

[Lipid treatment in the period COVID-19]. / Tratamiento hipolipemiante en la era COVID-19.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has shown that cardiovascular diseases carry a higher risk of mortality. Doubts have been raised regarding lipid therapy in these patients. The objectives are to analyze the efficacy and safety of lipid lowering therapy in patients with COVID-19. MATERIAL AND METHODS: A review of the scientific literature was conducted in PubMed, CDC Reports, NIH, and NCBI SARS-CoV-2 using the keywords: COVID-2, statins, ezetimibe, PCSK9 inhibitors, hypercholesterolemia, and hypolipidemic drugs. RESULTS: The statins should continue to use patients with COVID-19 based on their efficacy, safety, immunosuppressive effects, anti-inflammatory availability and accessibility. Depending on the cardiovascular risk levels of these patients, the use of high potency statins and/or ezetimibe and/or iPCSK9 may be necessary in patients with high and very high cardiovascular risk. Patients treated with iPCSK9 should continue treatment for its beneficial effects in preventing cardiovascular disease. Patients with familial hypercholesterolemia and COVID-19 are especially vulnerable to cardiovascular disease and should continue to receive severe lipid lowering therapy. CONCLUSIONS: In patients with COVID-19, the majority of baseline CVDs are of atherosclerotic origin, with the worst prediction for patients with high risk and very high risk of CVD. In these patients, intensive treatment with statins and/or fixed combination with ezetimibe and/or iPCSK9 plays a fundamental role.

Documento de consenso de la Sociedad Española de Médicos de Atención Primaria y Capítulo Español de Flebología y Linfología de la Sociedad Española de Angiología y Cirugía Vascular: trombosis venosa superficial de miembros inferiores en Atención Primaria / Consensus document of the Spanish Society of Primary Care Physicians and the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery: Superficial vein thrombosis of the lower limbs in Primary Care

La trombosis venosa superficial de miembros inferiores se venía considerando como una patología de naturaleza benigna con un curso clínico autolimitado, actualmente se conoce que sus potenciales complicaciones pueden ser graves o incluso mortales como pueden ser la trombosis venosa profunda o el tromboembolismo pulmonar. Existen diferentes formas de presentación clínica, factores de riesgo y diferentes tratamientos para su abordaje principalmente en Atención Primaria. Nuestro grupo de trabajo de vasculopatías de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) ha elaborado esta actualización con la evidencia científica actual de forma conjunta con el Capítulo Español de Flebología y Linfología de la Sociedad Española de Angiología y Cirugía Vascular

Superficial vein thrombosis of the lower limbs used to be considered a benign condition with a self-limiting clinical course. It is now known that its potential complications can be serious or even fatal, such as deep vein thrombosis or pulmonary thromboembolism. There are different forms of clinical presentation, risk factors and different treatments for its approach, mainly in Primary Care. The Vascular Diseases Working Group of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update using current scientific evidence and jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery

[Consensus document of the Spanish Society of Primary Care Physicians and the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery: Superficial vein thrombosis of the lower limbs in Primary Care]. / Documento de consenso de la Sociedad Española de Médicos de Atención Primaria y Capítulo Español de Flebología y Linfología de la Sociedad Española de Angiología y Cirugía Vascular: trombosis venosa superficial de miembros inferiores en Atención Primaria.

Superficial vein thrombosis of the lower limbs used to be considered a benign condition with a self-limiting clinical course. It is now known that its potential complications can be serious or even fatal, such as deep vein thrombosis or pulmonary thromboembolism. There are different forms of clinical presentation, risk factors and different treatments for its approach, mainly in Primary Care. The Vascular Diseases Working Group of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update using current scientific evidence and jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery.