[Influence of morbidity, metabolic control, and use of resources in subjects with cardiovascular risk in the primary care setting]. / Influencia de la morbilidad, control metabólico y uso de recursos de los sujetos en situación de riesgo cardiovascular en el ámbito de la atención primaria de salud.

OBJECTIVE: To determine the comorbidity, the therapeutic objectives, and economic impact in subjects with cardiovascular risk in primary care (PC). DESIGN: Multicentre, cross-sectional study. SETTING: Five urban PC centres, Spain. PARTICIPANTS: Patients over 55 years seen during the year 2006. Compared according to the presence/absence of a cardiovascular event (CVE). MEASUREMENTS: Demographics, cardiovascular/general comorbidity (adjusted clinical groups), Charlson index, clinical parameters, multiple drugs and semi-fixed direct costs (operational) and variables (tests, referrals, drugs). A logistical regression and ANCOVA analysis was performed to correct the models. SPSSWIN Program (P< .05). RESULTS: Of 24 410 patients, 15.4% (CI, 14.9-15.9) had a CVE. The subjects with a CVE showed a higher mortality (4.0% vs 1.8%) and general morbidity (8.1 vs 6.4 episodes) (P< .001). The CVE had an independent association in males (OR=2.7), Charlson index (OR=2.1), dyslipaemia (OR=1.5), depression (OR=1.4), age (OR=1.3), arterial hypertension (OR=1.2) and diabetes (OR=1.1) (P< .005). In primary prevention worse average cholesterols were obtained (211.6 vs 192.4 mg/dL), while in secondary prevention blood glucose was worse (111.3 vs 104.2 mg/dL; P< .001). The average corrected direct costs were euro1543.55 versus euro1027.65, respectively (P< .001). These differences were maintained in all the cost components. CONCLUSIONS: The presence of a CVE is associated with higher comorbidity, causing an increase in costs. The achievement of therapeutic control objectives could be improved, in primary prevention as well as in secondary. Intervention strategies should be increased to modify life styles in these patients.

Influencia de la morbilidad, control metabólico y uso de recursos de los sujetos en situación de riesgo cardiovascular en el ámbito de la atención primaria de salud / Influence of morbidity, metabolic control, and use of resources in subjects with cardiovascular risk in the primary care setting

Objetivo. Determinar la comorbilidad, los objetivos terapéuticos y el impacto económico de sujetos en situación de riesgo cardiovascular en atención primaria (AP). Diseño. Estudio multicéntrico y transversal. Emplazamiento. Cinco centros de AP urbanos. Participantes. Pacientes mayores de 55 años atendidos durante el año 2006, comparados en función de la presencia/ausencia de episodios cardiovasculares (ECV). Mediciones. Demográficas, comorbilidad cardiovascular/general (Adjusted Clinical Groups), índice de Charlson, parámetros clínicos, polifarmacia y costes directos semifijos (funcionamiento) y variables (pruebas, derivaciones, fármacos). Se efectuó un análisis de regresión logística y de ANCOVA para la corrección de los modelos con el programa SPSSWIN (p < 0,05). Resultados. Se incluyeron en el estudio 24.410 pacientes. Un 15,4% (intervalo de confianza [IC], 14,9-15,9) presentaron algún ECV. Los sujetos con ECV presentaron una mortalidad (el 4,0 frente al 1,8%) y una morbilidad general (8,1 frente a 6,4 episodios) superiores (p < 0,001). El ECV tuvo una relación independiente en varones (odds ratio [OR] = 2,7), índice de Charlson (OR = 2,1), dislipemia (OR = 1,5), depresión (OR = 1,4), edad (OR = 1,3), hipertensión arterial (OR = 1,2) y diabetes (OR = 1,1) (p < 0,005). En prevención primaria se obtuvieron unos peores promedios de colesterol (211,6 frente a 192,4 mg/dl), mientras que en prevención secundaria fueron los de glucemia (111,3 frente a 104,2 mg/dl; p < 0,001). El promedio de los costes directos corregidos fue de 1.543,55 frente a 1.027,65 €, respectivamente (p < 0,001). Estas diferencias se mantuvieron en todos los componentes del coste. Conclusiones. La presencia de ECV se asocia con una mayor comorbilidad, lo que ocasiona un incremento de los costes. La consecución de los objetivos terapéuticos de control debería mejorarse, tanto en el ámbito de la prevención primaria como en el de la secundaria. Se deberían potenciar estrategias de intervención sobre la modificación de los estilos de vida en estos pacientes

Objective. To determine the comorbidity, the therapeutic objectives, and economic impact in subjects with cardiovascular risk in primary care (PC). Design. Multicentre, cross-sectional study. Setting. Five urban PC centres, Spain. Participants. Patients over 55 years seen during the year 2006. Compared according to the presence/absence of a cardiovascular event (CVE). Measurements. Demographics, cardiovascular/general comorbidity (adjusted clinical groups), Charlson index, clinical parameters, multiple drugs and semi-fixed direct costs (operational) and variables (tests, referrals, drugs). A logistical regression and ANCOVA analysis was performed to correct the models. SPSSWIN Program (P<.05). Results. Of 24 410 patients, 15.4% (CI, 14.9-15.9) had a CVE. The subjects with a CVE showed a higher mortality (4.0% vs 1.8%) and general morbidity (8.1 vs 6.4 episodes) (P<.001). The CVE had an independent association in males (OR=2.7), Charlson index (OR=2.1), dyslipaemia (OR=1.5), depression (OR=1.4), age (OR=1.3), arterial hypertension (OR=1.2) and diabetes (OR=1.1) (P<.005). In primary prevention worse average cholesterols were obtained (211.6 vs 192.4 mg/dL), while in secondary prevention blood glucose was worse (111.3 vs 104.2 mg/dL; P<.001). The average corrected direct costs were €1543.55 versus €1027.65, respectively (P<.001). These differences were maintained in all the cost components. Conclusions. The presence of a CVE is associated with higher comorbidity, causing an increase in costs. The achievement of therapeutic control objectives could be improved, in primary prevention as well as in secondary. Intervention strategies should be increased to modify life styles in these patients

Evaluación clínica y económica según el grado de riesgo cardiovascular en sujetos pertenecientes a un ámbito poblacional español / No disponible

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