Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2.

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Obesity is an independent risk factor for heart failure: Zona Franca Cohort study.

BACKGROUND: Heart failure (HF) is a major problem in developed countries. However, its relationship with obesity remains unclear, especially in low-risk populations. The objective of the study was to analyze the relationship between obesity and HF in a low-risk Mediterranean population. HYPOTHESIS: Obesity is an independent predictor for HF. METHODS: A prospective community-based population cohort study with 10 years' follow-up was conducted at 2 healthcare centers in the city of Barcelona, Spain. From a registered population of 35 275, the study included 932 randomly selected patients without HF, age 35-84 years. Obesity was defined as body mass index (BMI) ≥30 and HF according to European Society of Cardiology guidelines, confirmed by echocardiography. Cox proportional hazards regression was used to examine the association between obesity and heart failure. RESULTS: The difference in HF incidence between obese subjects (4.7%) and nonobese subjects (1.6%) was 3.1% (95% confidence interval [CI]: 0.7-5.5). In the unadjusted model, incident HF was significantly associated with BMI: the hazard ratio [HR] was 1.09 for every 1 kg/m² increase (95% CI: 1.05-1.14) and 3.01 for BMI ≥30 (95% CI: 1.34-6.77). After adjusting for age, sex, hypertension, ischemic heart disease, and diabetes mellitus, the results were similar: HR 1.06 (95% CI: 1.01-1.10) and HR 2.45 for BMI ≥30 (95% CI: 1.02-5.61). Overweight was not associated with HF in any of the models. The population-attributable risk of HF due to obesity was 43.0% (95% CI: 13.9-74.9). CONCLUSIONS: High rate differences, HRs, and attributable risk indicate that obesity is an important risk factor for incident HF.

The epidemiology of cardiovascular disease in primary care. the Zona Franca Cohort study in Barcelona, Spain.

INTRODUCTION AND OBJECTIVES: Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. METHODS: A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. RESULTS: The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P< .001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. CONCLUSIONS: The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition.

Epidemiología de las enfermedades cardiovasculares en atención primaria. Estudio cohorte zona franca de barcelona / The epidemiology of cardiovascular disease in primary care. The zona franca cohort study in Barcelona, Spain

Introducción y objetivos. La incidencia de las enfermedades cardiovasculares no se conoce suficientemente en España, sobre todo en enfermedades emergentes como la arteriopatía periférica y la insuficiencia cardiaca. El objetivo es estudiar la incidencia de estas enfermedades en atención primaria. Métodos. Estudio prospectivo de cohortes de base poblacional, realizado en dos centros de salud de Barcelona (España). Se incluyó a 931 sujetos entre 35 y 84 años, sin enfermedades cardiovasculares, seleccionados aleatoriamente y seguidos 10 años. Se estudió la incidencia de cardiopatía isquémica (infarto agudo de miocardio y angina), enfermedad cerebrovascular (ictus y accidente isquémico transitorio), arteriopatía periférica de extremidades inferiores e insuficiencia cardiaca. Resultados. La enfermedad más frecuente fue la cardiopatía isquémica (incidencia acumulada, 6,1%), seguida de la enfermedad cerebrovascular (4,3%), la insuficiencia cardiaca (3%) y la arteriopatía periférica (1,9%). Fueron más frecuentes en mayores de 65 años (incidencias acumuladas, 9,6, 8,9, 4,6 y 3,1% respectivamente). La superposición más frecuente fue entre cardiopatía isquémica y enfermedad cerebrovascular. La incidencia de infarto agudo de miocardio fue superior en varones (p < 0,001), sin diferencias significativas en otras enfermedades. Las tasas ajustadas (población europea) cada 100.000 habitantes/año en varones y mujeres respectivamente fueron: infarto agudo de miocardio, 605 y 115; angina, 238 y 220; ictus, 200 y 327; accidente isquémico transitorio, 125 y 115; arteriopatía periférica, 136 y 178, e insuficiencia cardiaca, 219 y 267. Conclusiones. La incidencia de enfermedades cardiovasculares es inferior que en otros países desarrollados y son especialmente frecuentes en mayores de 65 años. La cardiopatía isquémica sigue siendo la más frecuente y destaca la insuficiencia cardiaca como enfermedad emergente (AU)

Introduction and objectives. Knowledge about the incidence of cardiovascular disease in Spain is limited, particularly about emergent conditions such as peripheral arterial disease and heart failure. The objective of this study was to determine the incidence of these conditions in a primary care setting. Methods. A prospective population-based cohort study was carried out in two health centers in Barcelona, Spain. It included 931 randomly selected individuals, aged 35 to 84 years, without cardiovascular disease who were followed for 10 years. We assessed the incidence of ischemic heart disease (i.e. myocardial infarction and angina), cerebrovascular disease (i.e. stroke and transient ischemic attack), peripheral arterial disease of the lower extremities, and heart failure. Results. The most frequently occurring condition was ischemic heart disease (cumulative incidence, 6.1%), followed by cerebrovascular disease (4.3%), heart failure (3.0%), and peripheral arterial disease (1.9%). These conditions were more frequent in patients aged >65 years (cumulative incidence, 9.6%, 8.9%, 4.6% and 3.1%, respectively). The most frequent comorbid conditions were ischemic heart disease and cerebrovascular disease. The incidence of acute myocardial infarction was greater in men (P<.001), but there was no significant difference for other conditions. The adjusted incidence (European population) per 100,000 inhabitants per year in men and women, respectively, was: 605 and 115 for acute myocardial infarction; 238 and 220 for angina; 300 and 327 for stroke; 125 and 115 for transient ischemic attack; 136 and 178 for peripheral arterial disease; and 219 and 267 for heart failure. Conclusions. The incidence of cardiovascular disease was lower than in other developed countries. Disease occurred more frequently in patients aged >65 years. Ischemic heart disease remained the most common, with heart failure being a notable emergent condition (AU)