Actualización y validación del riesgo cardiovascular de por vida en España: IBERLIFERISK2 / Update and validation of the lifetime cardiovascular risk in Spain: IBERLIFERISK2

Introducción: La función para estimar el riesgo cardiovascular de por vida en España –IBERLIFERISK– en población laboral obtuvo una discriminación satisfactoria; se registró una ligera sobreestimación del riesgo en hombres y una infraestimación del riesgo en mujeres. Objetivo: Recalibrar la ecuación de riesgo de por vida actual tras alargar 3 años el seguimiento. Métodos: Estudio de cohortes retrospectivo. Se incluyeron 762.058 trabajadores que realizaron un examen de salud laboral entre los años 2004 y 2007. Se evaluaron todos los episodios de incapacidad temporal y mortalidad cardiovascular hasta diciembre de 2017. Se combinaron los modelos de regresión para tener en cuenta la presencia de riesgos competitivos en la estimación del riesgo cardiovascular en una cohorte de derivación. La calibración se realizó representando gráficamente la proporción de eventos esperados y observados a los 10 años de seguimiento en la cohorte de validación estratificando por deciles de riesgo y calculando el estadístico Z de Spiegelhalter. La discriminación se evaluó de forma gráfica mediante la curva Receiver Operating Curve (ROC) y calculando el índice C de Harrell. Resultados: La media de edad fue de 35,48 años (DE 10,56). El 71,14% eran hombres. El índice C de Harrell fue de 0,78 (IC 95% 0,76-0,79) en hombres y de 0,73 (IC 95% 0,69-0,77) en mujeres. En general, se registró un ligero grado de infraestimación en mujeres y de sobreestimación en hombres en el último decil de riesgo, aunque el estadístico Z de Spiegelhalter no resultó estadísticamente significativo en ambos sexos (p>0,05). Conclusiones: El modelo actualizado continúa discriminando satisfactoriamente, aunque la calibración del modelo no ha mejorado sustancialmente con la nueva actualización.(AU)

Introduction: The function to estimate lifetime cardiovascular risk –IBERLIFERISK– in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women. Objective: To recalibrate the current lifetime risk equation after extending the follow-up by 3 years. Methods: Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index. Results: The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05). Conclusions: The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update.(AU)

Update and validation of the lifetime cardiovascular risk in Spain: IBERLIFERISK2. / Actualización y validación del riesgo cardiovascular de por vida en España: IBERLIFERISK2.

INTRODUCTION: The function to estimate lifetime cardiovascular risk -IBERLIFERISK- in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women. OBJECTIVE: To recalibrate the current lifetime risk equation after extending the follow-up by 3 years. METHODS: Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index. RESULTS: The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05). CONCLUSIONS: The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update.

PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study.

Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.

Efectos a largo plazo de una intervención intensiva sobre cambios en los estilos de vida en pacientes con hiperfibrinogenemia y riesgo cardiovascular moderado-alto / Long-term effects of intensive intervention on changes in lifestyle in patients with hyperfibrinogenaemia and moderate-high cardiovascular risk

OBJETIVOS: Evaluar si persiste el beneficio sobre los factores de riesgo cardiovascular (FRCV) a los 5 años de una intervención intensiva en estilos de vida (EV) que duró 2 años, en pacientes con hiperfibrinogenemia y riesgo cardiovascular moderado o alto. DISEÑO: Estudio observacional prospectivo multicéntrico. Emplazamiento: Trece Centros de Atención Primaria de Barcelona y Baix Llobregat. PARTICIPANTES: Un total de 300 pacientes que finalizaron el estudio EFAP (146 del grupo intervención y 154 del control). INTERVENCIONES: El estudio EFAP, realizado con pacientes con cifras de colesterol normal y fibrinógeno elevado, mostró que las intervenciones sobre el estilo de vida son eficaces en la reducción de FRCV. Finalizado el estudio EFAP, los 2 grupos siguieron los controles habituales. Pasados 5 años evaluamos los 2 grupos. Mediciones principales: Edad, sexo, FRCV (diabetes, dislipidemia, hipertensión arterial, obesidad), analítica (fibrinógeno, glucosa, hemograma, colesterol, triglicéridos), presión arterial, peso, talla, índice de masa corporal (IMC), hábitos tóxicos (tabaco y alcohol), REGICOR. RESULTADOS: A los 5 años, el grupo intervención presentó respecto al control menor perímetro abdominal (98 y 101 cm, respectivamente; p = 0,043), menor peso (76,30 y 75,04kg, respectivamente; p < 0,001) e IMC (29,5 y 30, 97 kg/m2; p = 0,018). El nivel de fibrinógeno fue inferior en el grupo intervención (330,33 y 320,27 mg/dl respectivamente; p < 0,001), y riesgo REGICOR también fue inferior en el grupo intervención (5,65 y 5,59 respectivamente; p < 0,06). CONCLUSIÓN: El beneficio de una intervención intensiva en EV durante 2 años para reducir los FRCV persiste a los 5 años, pero disminuye su intensidad con el tiempo. Se recomienda repetir periódicamente las intervenciones para mantener el efecto beneficioso sobre los EV

OBJECTIVES: To determine whether the benefit on cardiovascular risk factors (CVRF) persists 5 years after an intensive intervention in lifestyle (LS) that lasted 2 years, in patients with hyperfibrinogenaemia and moderate or high cardiovascular risk. DESIGN: multicentre prospective observational study. LOCATION: 13 Primary Care Centres in Barcelona and Baix Llobregat. PARTICIPANTS: A total of 300 patients who completed the EFAP study (146 intervention group, 154 control group). INTERVENTIONS: The EFAP study, conducted on patients with normal cholesterol and elevated fibrinogen showed that lifestyle interventions are effective in reducing CVRF. After the EFAP study, the 2 groups followed the usual controls, and re-assessed after 5 years. MAIN MEASUREMENTS: Age, gender, cardiovascular diseases (CVD) (diabetes, dyslipidaemia, hypertension, obesity), laboratory parameters (fibrinogen, glucose, full blood count, cholesterol, triglycerides), blood pressure, weight, height, body mass index (BMI), tobacco and alcohol use, REGICOR. RESULTS: At 5 years, the intervention group had a lower abdominal circumference (98 and 101cm, respectively, P = .043), a lower weight (76.30 and 75.04 kg, respectively, P < .001), and BMI (29.5 and 30.97 kg/m2, P = .018). Fibrinogen level was lower in the intervention group (330.33 and 320.27 mg/dl respectively, P < .001), and REGICOR risk was also lower in the intervention group (5.65 and 5.59 respectively, P < .06). CONCLUSION: The benefit of an intensive intervention in LS for 2 years to reduce CVRF persists at 5 years, but decreases its intensity over time. It is recommended to repeat the interventions periodically to maintain the beneficial effect on LS

[Long-term effects of intensive intervention on changes in lifestyle in patients with hyperfibrinogenaemia and moderate-high cardiovascular risk]. / Efectos a largo plazo de una intervención intensiva sobre cambios en los estilos de vida en pacientes con hiperfibrinogenemia y riesgo cardiovascular moderado-alto.

OBJECTIVES: To determine whether the benefit on cardiovascular risk factors (CVRF) persists 5 years after an intensive intervention in lifestyle (LS) that lasted 2 years, in patients with hyperfibrinogenaemia and moderate or high cardiovascular risk. DESIGN: multicentre prospective observational study. LOCATION: 13 Primary Care Centres in Barcelona and Baix Llobregat. PARTICIPANTS: A total of 300 patients who completed the EFAP study (146 intervention group, 154 control group). INTERVENTIONS: The EFAP study, conducted on patients with normal cholesterol and elevated fibrinogen showed that lifestyle interventions are effective in reducing CVRF. After the EFAP study, the 2 groups followed the usual controls, and re-assessed after 5 years. MAIN MEASUREMENTS: Age, gender, cardiovascular diseases (CVD) (diabetes, dyslipidaemia, hypertension, obesity), laboratory parameters (fibrinogen, glucose, full blood count, cholesterol, triglycerides), blood pressure, weight, height, body mass index (BMI), tobacco and alcohol use, REGICOR. RESULTS: At 5 years, the intervention group had a lower abdominal circumference (98 and 101cm, respectively, P=.043), a lower weight (76.30 and 75.04kg, respectively, P<.001), and BMI (29.5 and 30.97kg/m2, P=.018). Fibrinogen level was lower in the intervention group (330.33 and 320.27 mg/dl respectively, P < .001), and REGICOR risk was also lower in the intervention group (5.65 and 5.59 respectively, P < .06). CONCLUSION: The benefit of an intensive intervention in LS for 2 years to reduce CVRF persists at 5 years, but decreases its intensity over time. It is recommended to repeat the interventions periodically to maintain the beneficial effect on LS.

Prevención primaria de la enfermedad cardiovascular con aspirina: ¿qué dicen las guías de práctica clínica? / Primary prevention of cardiovascular disease with aspirin: what do the guidelines say?

Objetivo: Evaluar las recomendaciones de las guías sobre el uso de aspirina en prevención primaria de la enfermedad cardiovascular.DiseñoRevisión sistemática. Búsqueda realizada por enfermedades, tratamiento y tipo de prevención.Fuentes de datosScience Citation Index, SCOPUS, PubMed, Ministerio de Sanidad y Consumo, Organización Mundial de la Salud, páginas web de sociedades científicas nacionales e internacionales.Extracción de datosRevisión independiente por parte de 2 evaluadores. Los aspectos evaluados fueron los siguientes: a) uso de antiagregantes en prevención primaria; b) identificación de población diana; c) identificación de dosis diaria recomendada; d) identificación de criterios de aplicación; e) publicaciones en inglés o en español, y f) difusión a nivel internacional y nacional (España).ResultadosSe revisaron 9 guías en prevención primaria y 5 guías en diabetes.ResultadosLa mayoría recomiendan dosis bajas de aspirina con un rango entre 75–325mg/día. Las guías recomiendan un determinado nivel de riesgo coronario para definir la población por tratar, pues existe una gran variabilidad en las tablas utilizadas para el cálculo del riesgo y en el umbral de riesgo para recomendar el tratamiento. Las guías para diabetes no definen ningún nivel de riesgo. Tres guías recomiendan que el uso de aspirina se haga cuando la presión arterial esté bien controlada.ConclusionesExiste una alta variabilidad entre las guías respecto al nivel de riesgo a partir del cual se deberían tratar los pacientes y en las dosis recomendadas. La mayoría de las guías recomiendan aspirina en prevención primaria en pacientes diabéticos, aunque existen discrepancias entre grupos internacionales e incluso en diferentes documentos de una misma sociedad(AU)

Objective: To review the guideline recommendations on aspirin use in primary prevention of cardiovascular diseases.DesignSystematic review. The search was made by condition, treatment and type of prevention.Data sourcesScience Citation Index, SCOPUS, PubMed, Spanish Ministry of Health, World Health Organisation, web sites of national and international scientific societies.Data extractionTwo investigators independently reviewed all the guidelines. Specific topics assessed: a) use of antiplatelet treatment in primary prevention b) identification of target population c) identification of recommended dosage, d) identification of criteria of aspirin use, e) publications in English and/or Spanish, f) dissemination at national (Spain) or international level.ResultsNine guidelines on primary prevention and 5 guidelines on diabetes were reviewed. Most of them recommended low dose aspirin ranging between 75mg and 325mg per day. All the guidelines recommend a specifc level of coronary risk to define the target population to be treated, showing high variability in risk tables used and in the level of risk which should be used to recommend treatment. The diabetes guidelines do not define any level of risk. Three guidelines recommend the use of aspirin when blood pressure is well controlled.ConclusionsThere is high variability among guidelines in terms of the level of risk from which patients should be treated, and also in dosages. Most of the guidelines recommend the use aspirin in diabetics, although some discrepancies exist among international panels, and even in different documents of the same scientific society(AU)

[Primary prevention of cardiovascular disease with aspirin: what do the guidelines say?]. / Prevención primaria de la enfermedad cardiovascular con aspirina: ¿qué dicen las guías de práctica clínica?

OBJECTIVE: To review the guideline recommendations on aspirin use in primary prevention of cardiovascular diseases. DESIGN: Systematic review. The search was made by condition, treatment and type of prevention. DATA SOURCES: Science Citation Index, SCOPUS, PubMed, Spanish Ministry of Health, World Health Organisation, web sites of national and international scientific societies. DATA EXTRACTION: Two investigators independently reviewed all the guidelines. Specific topics assessed: a) use of antiplatelet treatment in primary prevention b) identification of target population c) identification of recommended dosage, d) identification of criteria of aspirin use, e) publications in English and/or Spanish, f) dissemination at national (Spain) or international level. RESULTS: Nine guidelines on primary prevention and 5 guidelines on diabetes were reviewed. Most of them recommended low dose aspirin ranging between 75mg and 325mg per day. All the guidelines recommend a specifc level of coronary risk to define the target population to be treated, showing high variability in risk tables used and in the level of risk which should be used to recommend treatment. The diabetes guidelines do not define any level of risk. Three guidelines recommend the use of aspirin when blood pressure is well controlled. CONCLUSIONS: There is high variability among guidelines in terms of the level of risk from which patients should be treated, and also in dosages. Most of the guidelines recommend the use aspirin in diabetics, although some discrepancies exist among international panels, and even in different documents of the same scientific society.

[Randomized clinical trial on the efficacy of global geriatric assessment in primary care]. / Ensayo clínico aleatorizado sobre la eficacia de la valoración geriátrica integral seguida de intervención en atención primaria.

OBJECTIVE: the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed. MATERIAL AND METHODS: a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG. RESULTS: there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P< .001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64). CONCLUSIONS: the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention.

Ensayo clínico aleatorizado sobre la eficacia de la valoración geriátrica integral seguida de intervención en atención primaria / Randomized clinical trial on the efficacy of global geriatric assessment followed by intervention in primary care

Objetivo: el médico de familia es el primer profesional de salud que puede actuar preventivamente sobre la población anciana de riesgo. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial tras la valoración geriátrica integral (VGI) en términos de morbimortalidad. Material y métodos: ensayo clínico aleatorizado, con grupo control (GC), en personas mayores de 75 años visitadas en las consultas de un centro de atención primaria durante un período de 18 meses. Según la VGI, se clasificó al anciano como frágil o no; en el grupo de intervención (GI) los pacientes frágiles recibieron una intervención personalizada, mientras que a los no frágiles se les ofreció participar en una sesión grupal. Resultados: participaron en el estudio 620 sujetos, el 49,7% aleatorizados al GI y el 50,3% al GC. Realizaron la visita de seguimiento 430 (69,4%) pacientes. En la visita final, los pacientes del GC mostraron un riesgo significativamente superior de depresión (Yesavage) que el GI (p = 0,048). Durante el seguimiento, el 13% del GI modificó su estado inicial de frágiles a no frágiles frente al 5% del GC, mientras que el 11% del GI pasó a ser nuevos pacientes frágiles frente al 22% del GC (p < 0,001). Se registró un 15% de eventos (ingreso en residencia, atención domiciliaria o defunción) en el GI frente a un 17% en el GC (p = 0,64). Conclusiones: la intervención se mostró efectiva al contener el número de pacientes frágiles de nuevo diagnóstico y al aumentar el número de pacientes que revirtieron el proceso en el GI durante el seguimiento. La VGI resulta efectiva si se asocia a una intervención

Objective: the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed. Material and methods: a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG. Results: there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P<.001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64). Conclusions: the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention

[Evaluative study of medical-care costs in primary care]. / Estudio evaluativo de los costes asistenciales en atención primaria.

OBJECTIVE: To estimate the real costs of medical care by diagnostic groups at a primary care centre. DESIGN: Descriptive, retrospective study, based on the review of computerized medical records. SETTING: Urban primary care centre (PCC). PARTICIPANTS: All patients who attended the PCC during 2005. MAIN MEASUREMENTS: Mean medical care cost per visit in euros, broken down for health professionals, diagnostic procedures and drugs costs, and stratified by diagnostic groups. RESULTS: The most frequent visits were for pulmonary, locomotor, cardiovascular, and gastro-intestinal conditions. The mean number of visits per patient attended was 8.7 (SD, 9.4); and per patient registered at the centre, 5.9 (8.7). The highest costs were for cardiovascular (18.96%; 95% CI, 18.93%-18.99%), locomotor (11.21%; 95% CI, 11.18%-11.23%), psychological (10.69%, 95% CI, 10.66%-10.71%), pulmonary (10.20%; 95% CI, 10.17%-10.22%) and endocrinal-nutritional (9.61%; 95% CI, 9.58%-9.63%) problems. Drugs expenditure accounted for 65% of the total cost; visits to health professionals, for 33%; and procedures, for 2%. Overall cost per inhabitant was 239.1 (493.6) euros, and per patient attended was 349.5 (563.5). CONCLUSIONS: Cardiovascular disease conditions are much the most costly ones in terms of overall medical cost. Psychological conditions are located in second place in terms of pharmaceutical cost; and in third place, in terms of overall medical-care cost.

Control terapéutico de los factores de riesgo y calidad de vida en los pacientes tratados mediante derivación aortocoronaria / Therapeutic control and quality of life in coronary artery bypass surgery patients

FUNDAMENTO: Describir las medidas de prevención secundaria en los pacientes intervenidos de derivación aortocoronaria en nuestro medio y la calidad de vida relacionada con la salud al año de la intervención. PACIENTES Y MÉTODO: Estudio prospectivo de un año de seguimiento, realizado en hospitales públicos y privados de Cataluña. RESULTADOS: Se incluyeron 710 pacientes cuya edad media era de 63 años. El 74,8 por ciento de las mujeres y el 48,7 por ciento de los varones eran hipertensos, el 70,2 por ciento de las mujeres y el 55 por ciento de los varones tenían hipercolesterolemia, el 42,3 por ciento de las mujeres y el 28,7 por ciento de los varones eran diabéticos y el 31,2 por ciento de los varones y el 2,9 por ciento de las mujeres eran fumadores (p < 0,01). Al año de seguimiento seguían fumando un 7 por ciento de la población, y se observó una reducción significativa de todos los fármacos antianginosos y una mejora significativa de la calidad de vida relacionada con la salud. Entre el ingreso y al año del alta hospitalaria se apreció un aumento significativo de los fármacos hipolipemiantes en los pacientes diagnosticados basalmente de hipercolesterolemia (de un 44 a un 58 por ciento; p < 0,01). CONCLUSIONES: Los pacientes intervenidos de cirugía aortocoronaria mejoran clínicamente al cabo de un año de la intervención, mejorando también la calidad de vida relacionada con la salud. Tanto el porcentaje de fumadores como el grado de tratamiento antihipertensivo e hipolipemiante al final del seguimiento indican un grado de control subóptimo de la prevención secundaria en pacientes de alto riesgo (AU)

Adaptación del cuestionario de calidad de vida postinfarto MacNew QLMI para su uso en la población española / Adaptation of the MacNew QLMI quality of life questionnaire after myocardial infarction to be used in the Spanish population

Fundamento: Los cuestionarios de calidad de vida específicos tienen la ventaja de evaluar aspectos concretos propios de la enfermedad analizada. El objetivo del presente estudio es elaborar una versión española del cuestionario autoadministrado MacNew QLMI para los pacientes que han presentado un infarto de miocardio. Material y método: Se realizaron la traducción y retrotraducción del cuestionario original y se evaluaron su comprensibilidad y facilidad de administración. Posteriormente se llevó a cabo un análisis factorial de componentes principales en 143 pacientes que habían sido dados de alta por un primer infarto de miocardio. Para el estudio de fiabilidad se administró el cuestionario a 50 pacientes con infarto de miocardio en situación estable y se evaluó la reproducibilidad mediante la t de Student y la correlación intraclase, y la consistencia interna mediante el alfa de Cronbach. Resultados: El análisis factorial demostró una estructura de los ítems en tres dimensiones similar a la versión original. Los coeficientes de correlación intraclase fueron de 0,83, 0,87 y 0,83, y las alfas de Cronbach de 0,85, 0,88 y 0,83 para las tres dimensiones: emocional, física y social, respectivamente. Conclusiones: La versión española del cuestionario MacNew QLMI presenta una buena equivalencia con la versión original, buena consistencia interna y buena reproducibilidad, de modo que puede utilizarse en la población española para estudiar su validez. (AU)