[Effectiveness of the clinical assistant in the control of hypertensive and diabetic patients in primary care]. / Efectividad del asistente clínico en el control de pacientes hipertensos y diabéticos en atención primaria.

OBJECTIVE: To evaluate the effectiveness of the incorporation of the clinical assistant in improving the control of type 2 diabetes mellitus and hypertension in a primary care center. DESIGN: Quasi-experimental study (pre-post), with a control group, with a 1-year follow-up. SETTING: Primary care center. PARTICIPANTS: Patients between the ages of 18 and 85 with a diagnosis of diabetes type 2 and/or hypertension were selected. INTERVENTION: Incorporation of the figure of the clinical assistant, previously trained. The latter contacted the patient to explain their role and obtain informed consent, assessed compliance with the protocols, and when they were incomplete and/or detected warning signs, referred the patient directly to medicine and/or nursing. RESULTS: Three thousand and sixty-four patients participated, 30.74% assigned to the intervention group. Fifty percent were women. The mean age was 68.5 years (SD 11.07). 93.59% of diabetic patients in the intervention group had at least one determination of glycosylated hemoglobin compared to 86.83% in the control group (p=0.003). Fundus and diabetic foot screening was significantly higher in the intervention group (94.31% and 85.41% vs. 83.49% and 72.38%). 88.43% of the patients in the intervention group had registered blood pressure figures compared to 62.06% of the patients in the control group (p<0.05). There were not statistically significant differences in the control of blood pressure between the patients with recorded measures (p=0.478). CONCLUSIONS: Clinical assistants can facilitate the implementation and compliance with chronic diseases protocols, and in the long run improve the degree of control of these patients and the quality of care.

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.

[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. / Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022.

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.