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1.
Neurología (Barc., Ed. impr.) ; 33(9): 561-569, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176001

RESUMO

INTRODUCCIÓN: La incidencia del ictus en nuestro medio ha sido evaluada en diferentes estudios con amplia variabilidad y no comparables. Tampoco hay estudios que analicen los cambios epidemiológicos en pacientes más jóvenes. MÉTODO: Estudio retrospectivo observacional. Conjunto Mínimo Básico de Datos. Se seleccionó a todos los pacientes mayores de 19 años hospitalizados por ictus (códigos ICD-9-CM 434.01, 434.11, 434.91, 430, 431, 432.9, 436 y 435) en el periodo 2002-2013. Análisis mediante el método de regresión lineal segmentada. RESULTADOS: Un total de 39.321 casos fueron identificados. El 47,25% mujeres. Un 3,73% tenía entre 20-44 años, el 6,29% entre 45-54, el 11,49% entre 55-64, el 23,89% entre 65-74 y un 54,60% más de 74 años. Se demuestra un incremento significativo en la tasa de hospitalización por ictus isquémico en varones de 45-54 años, +6,7% (IC del 95%: 3,3-10,2) y en mujeres de 20-44 y 45-54 años, +6,1% (IC del 95%: 0,8-11,7) y +5.7% (IC del 95%: 3,0-8,4), respectivamente. También se observa un incremento significativo de la tasa de hospitalización de ictus isquémico en varones mayores de 74 años, +4,2% (IC del 95%: 1,3-7,2). El análisis para los ataques isquémicos transitorios reproduce lo que ocurre en el ictus isquémico. El mismo análisis para el caso de la hemorragia confirma una estabilización en las tasas de hospitalización en el tiempo. CONCLUSIONES: Este estudio demuestra de una forma indirecta los cambios epidemiológicos que se están produciendo en el ictus. Existe suficiente evidencia que indica un cambio epidemiológico al aumentar la tasa de hospitalizaciones en adultos jóvenes


BACKGROUND: The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD: We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS: A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS: Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Isquemia Encefálica/epidemiologia , Hospitalização/tendências , Acidente Vascular Cerebral/epidemiologia , Espanha/epidemiologia , Estudos Retrospectivos
2.
Neurologia ; 33(9): 561-569, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27776958

RESUMO

BACKGROUND: The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD: We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS: A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS: Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults.


Assuntos
Isquemia Encefálica/epidemiologia , Hospitalização/tendências , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
3.
Diabetes Metab Syndr ; 11 Suppl 2: S777-S781, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28602847

RESUMO

BACKGROUND: Diabetic nephropathy traditionally produces significant proteinuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. The current study evaluated the impact of diabetes mellitus on the prevalence of renal disease in general population. METHODOLOGY: Data from of the HERMEX survey, an observational, cross sectional, population based study were used. The final sample included 2813 subjects (mean age 51.2 years, 53.5% female). Four hundred patients have diabetes. Urinary albumin excretion (UAE) rate was analyzed and glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. RESULTS: Among participants without diabetes, 2.9%(2.2-3.6) had a GFR < 60 ml/min. Prevalence of abnormal UAE in population without diabetes was 3.3% (2.6-4.0). The global prevalence of renal disease was 5.6%(4.8-6.6). Prevalence of GFR <60 ml/min in subjects with diabetes was 8.8%(6.4-11.9)(p<0.001,Chi-square test). Prevalence of abnormal UAE in population with diabetes was 14.1%(7.7-19.8)(p< 0.001,Chi-square test). CKD prevalence was 20.3%(16.6-24.6)(p<0.001,Chi-square test). The logistic regression analysis showed a positive independent association of CKD with age, high blood pressure and albuminuria. No significant relationship was found with diabetes mellitus CONCLUSIONS: CKD is more prevalent in population with diabetes. Nevertheless, most of patients with diabetes and CKD have no albuminuria. An increased cardiovascular burden seems to produce this clinical presentation.


Assuntos
Nefropatias Diabéticas/complicações , Insuficiência Renal Crônica/etiologia , Adulto , Idoso , Albuminúria/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
4.
J Nutr Health Aging ; 19(6): 688-92, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26054506

RESUMO

AIM: To evaluate the screening power of the HUGE formula for the detection of chronic kidney disease (CKD) in a Spanish population sample obtained from the HERMEX study, a survey of cardiovascular risk factors carried out in the region of Extremadura, stratified by age. DESIGN AND METHODS: This was an observational, cross-sectional, population-based study. The final sample included 2,813 subjects selected from Health Care System records. Anthropometric data and cardiovascular risk factors were recorded. Hematocrit, urea, creatinine and microalbuminuria were analyzed, after which the HUGE formula was applied. Renal function, assessed as eGFR based on serum creatinine, was estimated following the MDRD-4 formula. RESULTS: Using the HUGE formula, the estimated prevalence of CKD was 2.2% (men 2.2%, women 2.1%). The prevalence of CKD increased with age (5.0% in persons aged 60- 70 years and 9.6% in individuals over 70 years of age, p < 0.001) whereas with the MDRD formula the prevalence values were 9.8% and 15.5% respectively. The HUGE formula was seen to be highly specific (0.99). CKD was more common in persons >70 years, obese subjects, hypertensive patients, dyslipidemic subjects and those with microalbuminuria. Multivariate analysis revealed an independent negative association of CKD as the dependent variable with SBP, serum triglyceride levels and microalbuminuria. CONCLUSIONS: The HUGE formula allows the prediction of CKD in the general population to be honed without relying on serum creatinine levels. This method was found to have a higher specificity than the MDRD-4 formula. Moreover, it could reduce the excessively extensive diagnostic suspicion of CKD in women.


Assuntos
Hematócrito , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Caracteres Sexuais , Ureia/sangue , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Envelhecimento , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Antropometria , Doenças Cardiovasculares/etiologia , Creatinina/sangue , Estudos Transversais , Dislipidemias/epidemiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/epidemiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Triglicerídeos/sangue
5.
Rev. clín. esp. (Ed. impr.) ; 215(4): 195-203, mayo 2015. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-139156

RESUMO

Objetivos: Los ancianos con infarto agudo de miocardio constituyen una población que no está adecuadamente representada en ensayos clínicos ni en registros médicos. Nuestro objetivo fue comparar, entre pacientes menores y mayores de 75 años, las características clínicas, los tratamientos administrados y la mortalidad. Material y métodos: Estudio observacional y retrospectivo de pacientes ingresados por infarto agudo de miocardio en la década 2000-09. Se construyeron modelos multivariados para estimar mortalidad hospitalaria y tardía (mediana 4,6 años; RI 25-75: 2,1-7,3). Resultados: Se incluyeron 2.177 pacientes (hombres 995 [79%]) con una edad media de 70,8 años (DE: 12,6). Un total de 917 (42,0%) tenían 75 años o más. Estos enfermos comparados con los menores de 75 años presentaron mayor prevalencia de diabetes (38,3 vs. 32,5%; p<0,002), enfermedad pulmonar obstructiva crónica (15,6 vs. 11,2%; p<0,002), ictus (14,3 vs. 7,3%; p<0,001), insuficiencia renal crónica (11 vs. 3,9%; p<0,001), fibrilación auricular (15,9 vs. 6,9%; p<0,001), insuficiencia cardiaca (28 vs. 23,4%; p<0,008). Recibieron menos betabloqueantes (55,9 vs.71,2%; p<0,001) y estatinas (44,3 vs. 62,3%; p<0,001), se les realizaron menos coronariografías (17,9 vs. 48,5%; p<0,001) y angioplastias (10,8 vs. 29,1; p<0,001). Los mayores de 75 años mostraron una menor supervivencia (mortalidad 44,5 vs. 18,9%), HR 1,89 (IC 95%: 1,57-2,29), asociándose inversamente con la mortalidad tardía: betabloqueantes (HR=0,74; IC 95%: 0,62-0,89), estatinas (HR: 0,73; IC 95%: 0,58-0,91) y angioplastias (HR=0,42; IC 95%: 0,30-0,57). Conclusiones: Los pacientes mayores de 75 años con infarto agudo de miocardio tuvieron menor supervivencia y recibieron menos betabloqueantes, estatinas y angioplastias, indicaciones que se asocian a una menor mortalidad (AU)


Objectives: Elderly patients with acute myocardial infarction constitute a population that is not adequately represented in clinical trials or medical registries. Our objective was to compare the clinical characteristics, treatments administered and mortality among patients younger and older than 75 years. Material and methods: Observational retrospective study of patients hospitalized for acute myocardial infarction in the decade 2000-2009. Multivariate models were constructed to determine hospital and late mortality (median, 4.6 years; IQR 25-75: 2.1-7.3). Results: We included 2,177 patients (995 men [79%]), with a mean age of 70.8 years (SD, 12.6). A total of 917 (42.0%) of the patients were 75 years of age or older. When compared with the patients younger than 75 years, the older patients had a greater prevalence of diabetes (38.3% vs. 32.5%; P<.002), chronic obstructive pulmonary disease (15.6% vs. 11.2%; P<.002), stroke (14.3% vs. 7.3%; P<.001), chronic renal failure (11.0% vs. 3.9%; P<.001), atrial fibrillation (15.9% vs. 6.9%; P<.001), heart failure (28.0% vs. 23.4%; P<.008). The older patients were treated with fewer beta-blockers (55.9% vs. 71.2%; P<.001), statins (44.3% vs. 62.3%; P<.001), coronary angiographies (17.9% vs. 48.5%; P<.001) and angioplasties (10.8% vs. 29.1%; P<.001). The patients older than 75 years had lower survival (mortality, 44.5% vs. 18.9%; HR 1.89; 95% CI 1.57-2.29). The use of beta-blockers (HR, 0.74; 95% CI 0.62-0.89), statins (HR 0.73; 95% CI 0.58-0.91) and angioplasty (HR, 0.42; 95% CI 0.30-0.57) was inversely correlated with mortality. Conclusions: Patients older than 75 years with acute myocardial infarction had lower survival and were treated with fewer beta-blockers, statins and angioplasty, indications that are associated with lower mortality (AU)


Assuntos
Idoso de 80 Anos ou mais , Idoso , Humanos , Infarto do Miocárdio/epidemiologia , Doença Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Envelhecimento , Antagonistas Adrenérgicos beta/uso terapêutico , Angioplastia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
6.
Rev Clin Esp ; 215(4): 195-203, 2015 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25499670

RESUMO

OBJECTIVES: Elderly patients with acute myocardial infarction constitute a population that is not adequately represented in clinical trials or medical registries. Our objective was to compare the clinical characteristics, treatments administered and mortality among patients younger and older than 75 years. MATERIAL AND METHODS: Observational retrospective study of patients hospitalized for acute myocardial infarction in the decade 2000-2009. Multivariate models were constructed to determine hospital and late mortality (median, 4.6 years; IQR 25-75: 2.1-7.3). RESULTS: We included 2,177 patients (995 men [79%]), with a mean age of 70.8 years (SD, 12.6). A total of 917 (42.0%) of the patients were 75 years of age or older. When compared with the patients younger than 75 years, the older patients had a greater prevalence of diabetes (38.3% vs. 32.5%; P<.002), chronic obstructive pulmonary disease (15.6% vs. 11.2%; P<.002), stroke (14.3% vs. 7.3%; P<.001), chronic renal failure (11.0% vs. 3.9%; P<.001), atrial fibrillation (15.9% vs. 6.9%; P<.001), heart failure (28.0% vs. 23.4%; P<.008). The older patients were treated with fewer beta-blockers (55.9% vs. 71.2%; P<.001), statins (44.3% vs. 62.3%; P<.001), coronary angiographies (17.9% vs. 48.5%; P<.001) and angioplasties (10.8% vs. 29.1%; P<.001). The patients older than 75 years had lower survival (mortality, 44.5% vs. 18.9%; HR 1.89; 95% CI 1.57-2.29). The use of beta-blockers (HR, 0.74; 95% CI 0.62-0.89), statins (HR 0.73; 95% CI 0.58-0.91) and angioplasty (HR, 0.42; 95% CI 0.30-0.57) was inversely correlated with mortality. CONCLUSIONS: Patients older than 75 years with acute myocardial infarction had lower survival and were treated with fewer beta-blockers, statins and angioplasty, indications that are associated with lower mortality.

7.
Artigo em Espanhol | IBECS | ID: ibc-127636

RESUMO

Introducción. El incumplimiento farmacológico supone un importante problema que afecta el éxito terapéutico de los pacientes. El objetivo principal de esta investigación consistió en validar la llamada telefónica al domicilio del paciente como método de automedición del recuento de comprimidos simple como método alternativo al patrón oro del recuento simple en consulta sanitaria. Pacientes y métodos. Estudio de investigación observacional, multicéntrico, prospectivo, longitudinal, desarrollado por 25 investigadores en diferentes centros de salud de Extremadura que incluyeron 125 pacientes diagnosticados de hipertensión arterial no controlada de los cuales finalizaron 121. La inclusión de pacientes se realizó de forma consecutiva y a medida que el investigador detectaba un hipertenso no controlado. Se efectuaron 3 visitas, que incluían visita de inclusión, visita de seguimiento a las 4 semanas y visita final a las 8 semanas. Previamente a las visitas primera y final, se realizó la llamada telefónica al paciente para recordarle la visita correspondiente y recopilar en ese mismo momento información sobre el número de comprimidos que le quedaban. Resultados. Fueron incluidos 121 pacientes. En la visita final, el test de la llamada telefónica como método de medida del cumplimiento obtuvo: sensibilidad: 100%; especificidad: 86%; exactitud global: 86,8%; VPP: 30,4%; VPN: 100%; CP+: 7,13; CP−: 0,0 e índice kappa: 0,415 (p < 0,0001). El área bajo la curva ROC fue de 0,995 (IC95%: 0,985-1). Conclusiones. Concluimos que la llamada telefónica como método de medida del cumplimiento terapéutico puede ser una buena alternativa por su casi universalidad, coste reducido y sin la necesidad de desplazamiento de los pacientes a los centros sanitarios (AU)


Introduction. Pharmacological non-compliance is a significant problem that can affect patient health. The main aim of this investigation is to validate the telephone call to the patient’ home as a self-report method of counting the amount of tablets taken by the patient, as an alternative method to a simple tablet count in the clinic (gold standard). Patients and methods. An observational, multicentre, prospective, and longitudinal study was conducted by 25 researchers in different health centres in Extremadura, and which included 125 consecutively enrolled patients with uncontrolled arterial hypertension, 121 ended the study. Three visits were made, including enrollment visit, follow-up visit at 4 weeks, and final visit at 8 weeks. A telephone call was made prior to the enrollment and final visit to remind the patients of the next visit, and to ask at the same time about the number of tablets remaining. Results. A total of 121 patients completed the study. In the final visit, the phone-call method of compliance showed: 100% sensitivity, 86% specificity, 86.8% of overall accuracy, 30.4% PPV, 100% NPV, CP+ 7.13, CP− 0.0, and a kappa index of 0.415 (P < .0001). The area under the ROC curve was 0.995 (95% CI, 0.985-1). Conclusions. It was concluded that the telephone phone call, as a therapeutic compliance method, can be a good alternative due to being almost universal, easy to use, its reduced cost, and without the need of patients to go to the medical centres (AU)


Assuntos
Humanos , Masculino , Feminino , Entrevistas como Assunto/métodos , Entrevistas como Assunto , Cooperação do Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Farmacovigilância , Automedicação/métodos , Automedicação/estatística & dados numéricos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Monitoramento de Medicamentos/tendências
8.
Rev Clin Esp ; 214(9): 505-12, 2014 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25087090

RESUMO

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is the most common type of arrhythmia. The purpose of this study was to determine the prevalence of atrial fibrillation and its relationship with cardiovascular risk factors in Spain. METHODOLOGY: Cross-sectional study based on a grouped analysis of 17,291 randomized individuals recruited in 6 population studies. RESULTS: The prevalence of atrial fibrillation was 1.5% (95% CI:1.3-1.7%). Men had a greater prevalence of the disease than women (1.9 vs. 1.1%, respectively). The prevalence of atrial fibrillation progressively increased with age: 0.05% for patients younger than 45 years, 0.5% for those between 45-59 years of age, 2.3% for those between 60-74 years of age and 6.3% for those older than 75 years. The percentage of individuals who were underwent anticoagulant treatment was 74.3%. The risk factors significantly associated with arrhythmia were an age older than 60 years (odds ratio [OR]: 7.6; 95% CI: 5.1-11.2), the male sex (OR:1.8; 95% CI: 1.4-2.4), arterial hypertension (OR:1.6; 95% CI: 1.2-2.1), obesity (OR:1.5; 95% CI:1.2-2.1) and a history of coronary artery disease (OR:1.9; 95% CI: 1.3-3.0). CONCLUSION: Atrial fibrillation is a common disease in elderly individuals, while its prevalence is low in individuals younger than 60 years. Most individuals with atrial fibrillation were on anticoagulant treatment. The risk factors for this type of arrhythmia are age, the male sex, hypertension, obesity and a history of coronary artery disease.

9.
Semergen ; 40(7): 366-73, 2014 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-24838054

RESUMO

INTRODUCTION: Pharmacological non-compliance is a significant problem that can affect patient health. The main aim of this investigation is to validate the telephone call to the patient' home as a self-report method of counting the amount of tablets taken by the patient, as an alternative method to a simple tablet count in the clinic (gold standard). PATIENTS AND METHODS: An observational, multicentre, prospective, and longitudinal study was conducted by 25 researchers in different health centres in Extremadura, and which included 125 consecutively enrolled patients with uncontrolled arterial hypertension, 121 ended the study. Three visits were made, including enrollment visit, follow-up visit at 4 weeks, and final visit at 8 weeks. A telephone call was made prior to the enrollment and final visit to remind the patients of the next visit, and to ask at the same time about the number of tablets remaining. RESULTS: A total of 121 patients completed the study. In the final visit, the phone-call method of compliance showed: 100% sensitivity, 86% specificity, 86.8% of overall accuracy, 30.4% PPV, 100% NPV, CP+ 7.13, CP- 0.0, and a kappa index of 0.415 (P<.0001). The area under the ROC curve was 0.995 (95% CI, 0.985-1). CONCLUSIONS: It was concluded that the telephone phone call, as a therapeutic compliance method, can be a good alternative due to being almost universal, easy to use, its reduced cost, and without the need of patients to go to the medical centres.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adesão à Medicação , Telefone , Idoso , Anti-Hipertensivos/administração & dosagem , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Autorrelato , Sensibilidade e Especificidade , Espanha
10.
Rev. esp. patol. torac ; 25(3): 187-192, jul.-sept. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-117712

RESUMO

La proteína C reactiva (PCR) se ha propuesto como un marcador del riesgo cardiovascular. El síndrome de apneas e hipopneas durante el sueño (SAHS) se asocia a síndrome metabólico y al riesgo cardiovascular. Objetivos: Estudiar los niveles de PCR en pacientes con SAHS y compararlos con los de la población general. Estudiar la relación entre la severidad del SAHS y los niveles de PCR.Pacientes y método: Estudio de casos y controles (..) (AU)


C-reactive protein (CRP) has been proposed as cardiovascular risk marker. Obstructive Sleep Apnea (OSA) is associated to metabolic syndrome and major cardiovascular events.Objetives: To study CRP levels in OSA patients and compare them to healthy people, as the relationship between OSA (..) (AU)


Assuntos
Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/epidemiologia , Biomarcadores/análise , Fatores de Risco , Índice de Gravidade de Doença , Estudos de Casos e Controles
11.
Eur Rev Med Pharmacol Sci ; 17(14): 1889-93, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23877853

RESUMO

OBJECTIVES: To evaluate the relationship between chronic renal failure (CFR) defined through HUGE (hematocrit, urea and gender) formula score and the patient's cardiovascular risk measured through cardiovascular disease antecedents such as ischemic cardiopathy, cerebrovascular disease and peripheral arterial disease. DESIGN AND METHODS: The sample consisted of 2,831 subjects. Mean age was 51.2±14.7 years and 53.5% were female. Serum creatinine, urea, hematocrit and 24h proteinuria were analyzed. HUGE score was calculated from gender, urea and hematocrit. GFR was estimated from uncalibrated serum creatinine using the abbreviated Modification of Diet in Renal Disease equation (MDRD-4). UAE was measured in first morning urine sample. RESULTS: Using HUGE formula 2.2% (n = 61) of subjects had CRF. Of them, 12 (19.7%) had cardiovascular disease history. Among patients without CRF (n = 2770), 194 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Using the MDRD-4 formula 4.0% of subjects (n = 113) had a GFR < 60 ml/min. Of them, 18 (15.9%) had cardiovascular disease history. Among patients without CRF (n = 2718), 188 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Odd's ratio for cardiovascular diseases using HUGE definition of CRF was 3.25 (p = 0.001, Mantel-Haenszel test). CFR was associated to higher pulse pressure (PP) and increased urinary albumin excretion. CONCLUSIONS: A significant cardiovascular risk was associated to the diagnosis of CRF through HUGE formula. This relation was closer than the obtained using MDRD estimated GFR in spite of a bigger sample. HUGE formula seems to be a useful tool for diagnosing CRF and evaluate the cardiovascular risk of these patients.


Assuntos
Algoritmos , Doenças Cardiovasculares/epidemiologia , Hematócrito , Ureia/metabolismo , Adulto , Idoso , Albuminúria/urina , Arteriopatias Oclusivas/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Risco , Caracteres Sexuais
12.
Rev. clín. esp. (Ed. impr.) ; 213(4): 177-185, mayo 2013.
Artigo em Espanhol | IBECS | ID: ibc-112519

RESUMO

Antecedentes y objetivos. La mortalidad por ictus isquémico es elevada en nuestro entorno, aunque desconocemos su magnitud y evolución en una década reciente. Por ello hemos analizado la mortalidad global hospitalaria y al cabo de un año de los enfermos con ictus isquémico atendidos en un hospital comarcal y sus factores pronósticos. Pacientes y métodos. Estudio de cohorte histórica, con seguimiento de un año, de los pacientes ingresados en el Hospital Don Benito-Villanueva de la Serena (Badajoz) con el diagnóstico de ictus isquémico (1 de enero 2000 al 31 de diciembre 2009). Se recogieron datos epidemiológicos y clínicos, y los fallecimientos por cualquier causa. Resultados. Se incluyeron 2.228 pacientes (50,8% varones), con una edad media de 71 (DE: 10) años. La mortalidad hospitalaria fue del 15,3% y al cabo de un año del 16,9%, sin cambios relevantes en los 10 años del estudio. Los factores asociados a una mayor mortalidad hospitalaria fueron: edad, insuficiencia cardiaca y renal, y la no realización de pruebas diagnósticas, y al año fueron: edad, demencia, enfermedad pulmonar obstructiva crónica, infarto de miocardio, fibrilación auricular y la no realización de pruebas diagnósticas. Durante el estudio se incrementaron la realización de pruebas diagnósticas y el tratamiento al alta con estatinas, heparina y antihipertensivos. Conclusiones. Los pacientes ingresados por ictus isquémico en un hospital comarcal presentaron una mortalidad global al cabo de un año del 29,6%. No asistimos a una mejoría en esta tendencia durante 10 años. La mortalidad se asoció a la mayor edad, comorbilidades y no realización de pruebas diagnósticas(AU)


Background and objectives. Mortality due to stroke is high in our setting. However, we do not know its magnitude and course in a recent decade. Thus, we have assessed the global inhospital mortality and that at 1 year of stroke in patients seen in a regional hospital as well as its prognostic factors. Material and methods. A one-year follow-up historical cohort study was performed of patients admitted at Don Benito-Villanueva de la Serena Regional Hospital (Badajoz) with diagnosis of ischemic stroke (1 January 2000 to 31 December 2009). Epidemiological, clinical data all cause death information were collected. Results. A total of 2.228 patients (50.8% male), mean age 71 (SD 10) years were recruited. In-hospital mortality rate was 15.3% and mortality rate at 1 year was 16.9%, with no significant changes during the 10-year study period. Risk factors for greater in-hospital mortality were age, previous renal and heart failure and not performing diagnostic tests. Factors associated with 1-year all-cause mortality were age, dementia, chronic obstructive pulmonary disease, myocardial infarction, atrial fibrillation and also not performing diagnostic tests. During the study, use of diagnostic tests and treatment with statin, heparin and antihypertensive medication on discharge increased. Conclusions. Patients admitted due to ischemic stroke, in a regional hospital presented a 1 year mortality rate of 29.6%. This tendency did not improve during the 10-year study period. Mortality was associated to greater age, comorbidities and not performing diagnostic tests(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Risco , Mortalidade Hospitalar/tendências , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/fisiopatologia , Prognóstico , Infarto Cerebral/complicações , Infarto Cerebral/mortalidade , Acidente Vascular Cerebral , Estudos de Coortes , Anti-Hipertensivos/uso terapêutico , Comorbidade , Estudos Retrospectivos
13.
Rev Clin Esp (Barc) ; 213(4): 177-85, 2013 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23477597

RESUMO

BACKGROUND AND OBJECTIVES: Mortality due to stroke is high in our setting. However, we do not know its magnitude and course in a recent decade. Thus, we have assessed the global inhospital mortality and that at 1 year of stroke in patients seen in a regional hospital as well as its prognostic factors. MATERIAL AND METHODS: A one-year follow-up historical cohort study was performed of patients admitted at Don Benito-Villanueva de la Serena Regional Hospital (Badajoz) with diagnosis of ischemic stroke (1 January 2000 to 31 December 2009). Epidemiological, clinical data all cause death information were collected. RESULTS: A total of 2.228 patients (50.8% male), mean age 71 (SD 10) years were recruited. In-hospital mortality rate was 15.3% and mortality rate at 1 year was 16.9%, with no significant changes during the 10-year study period. Risk factors for greater in-hospital mortality were age, previous renal and heart failure and not performing diagnostic tests. Factors associated with 1-year all-cause mortality were age, dementia, chronic obstructive pulmonary disease, myocardial infarction, atrial fibrillation and also not performing diagnostic tests. During the study, use of diagnostic tests and treatment with statin, heparin and antihypertensive medication on discharge increased. CONCLUSIONS: Patients admitted due to ischemic stroke, in a regional hospital presented a 1 year mortality rate of 29.6%. This tendency did not improve during the 10-year study period. Mortality was associated to greater age, comorbidities and not performing diagnostic tests.


Assuntos
Isquemia Encefálica/mortalidade , Acidente Vascular Cerebral/mortalidade , Idoso , Isquemia Encefálica/complicações , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Mortalidade/tendências , Prognóstico , Estudos Retrospectivos , Espanha/epidemiologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
14.
Rev. clín. esp. (Ed. impr.) ; 213(1): 16-24, ene.-feb. 2013.
Artigo em Espanhol | IBECS | ID: ibc-109828

RESUMO

Antecedentes y objetivos. La insuficiencia cardiaca es la causante del mayor gasto sanitario en hospitalización y la tercera causa de mortalidad cardiovascular. Fue nuestro objetivo determinar la evolución de las características clínicas, y los factores relacionados con el pronóstico en pacientes ingresados por insuficiencia cardiaca en un área de salud de Extremadura durante 10 años. Pacientes y métodos. Estudio observacional, retrospectivo y unicéntrico en pacientes consecutivos ingresados por insuficiencia cardiaca descompensada en un Hospital General de la provincia de Badajoz en el período 2000/2009. Resultados. Se incluyeron 2.220 pacientes con una edad media de 76,3 (DE±10,1) años, 54% mujeres. Estratificados en 4 períodos de 30 meses, se observó: un significativo incremento de los pacientes mayores de 75 años (55 al 71%; p<0,001) y al alta una mayor prescripción de bloqueadores beta (12 al 34%; p<0,001), estatinas (8 al 31%; p<0,001), y anticoagulantes orales (13 al 25%; p<0,001). La mortalidad intrahospitalaria disminuyó del 13 al 8% (p<0,01) y al año del 30 al 23% (p<0,01). Fueron predictores independientes de mortalidad al año la edad (HR=1,04 [IC del 95%: 1,02-1,05]), la diabetes (HR=1,35 [IC del 95%: 1,11-1,66]) y la insuficiencia renal (HR=1,49 [IC del 95%: 1,18-1,87]). Conclusiones. La mortalidad ha disminuido significativamente en la década a pesar del incremento de la edad. La edad, la diabetes y la insuficiencia renal crónica resultaron predictores independientes de mortalidad al año. La anticoagulación resultó protectora(AU)


Background and objectives. Heart failure is responsible for a major part of hospital health expenditure and the third cause of cardiovascular death. To describe the evolution of clinical features, and factors related to prognosis of patients admitted due to decompensated heart failure in a region of Extremadura during a period 10 years. Patients and methods. Observational, retrospective and single centre study of consecutive patients admitted due to decompensated heart failure in a general hospital in the province of Badajoz, during the period 2000/2009. Results. A total of 2220 patients with mean age of 76.3 (SD±10.1), being 54% female were included in the study. Stratified into four periods (30 months each), a significant increase in patients over 75 years was observed (55 vs. 71%; P<.001), as well as an increase in the prescription of beta blockers at discharge (12 vs. 34%, P<.001), statins (8 vs. 31%; P<.001), and oral anticoagulants (13 vs. 25%; P<.001). Hospital mortality significantly decreased from 13 to 8% (P<.01), and from 30 to 23% (P<.01) at one year follow-up. Age (HR per year=1.04 [95% CI: 1.02 to 1.05]), diabetes (HR=1.35 [95% CI: 1.11 to 1.66]) and chronic renal failure (HR=1.49 [95% CI: 1.18 to 1.87]) were identified as independent predictors of all-cause mortality at one year of follow-up. Conclusions. Total mortality in patients with decompensated heart failure has declined significantly over the last decade, despite the increasing age. Age, diabetes and chronic renal failure were independent predictors of total mortality at one year. Oral anticoagulation was a protective factor(AU)


Assuntos
Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Prognóstico , Anticoagulantes/uso terapêutico , Insuficiência Cardíaca/epidemiologia , Estudos Retrospectivos , Mortalidade Hospitalar/tendências , Controle de Qualidade
15.
Int Urol Nephrol ; 45(2): 553-60, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23355028

RESUMO

OBJECTIVES: HERMEX is a population-based study, which tries to evaluate the prevalence of cardiovascular risk factors in the population of Extremadura, Spain. This report provides the data concerning albuminuria in the elderly people recruited in the survey. DESIGN AND METHODS: 3,402 subjects were randomly selected from the database of the Health Care System of Extremadura. The final sample included 2,813 subjects (mean age 51.2 years, 53.5 % female). Urinary albumin excretion rate (UAER) in the first morning urine sample was analyzed. Albuminuria was diagnosed when UAER (albumin-to-creatinine ratio) was ≥ 22 mg/g in men or ≥ 31 mg/g in women. RESULTS: The prevalence of abnormal UAER in the elderly population was 10.9 % (microalbuminuria: 8.9 %; overt proteinuria: 1.8 %). The younger subjects showed a lower prevalence of microalbuminuria (3.4 %, p < 0.001). Elderly patients showed a higher prevalence of cardiovascular risk factors than the younger ones. The elderly had higher systolic blood pressure and pulse pressure than the younger ones. Furthermore, the elderly subjects had lower plasma levels of HDL cholesterol, but higher triglycerides, glucose, creatinine, and glycosylated hemoglobin; no differences were found for total and LDL cholesterol. When the prevalence of causes of microalbuminuria was compared between age groups, we found a sharp increase in diabetic and, especially, hypertensive patients in the elderly group. The multivariate analysis showed an independent association of microalbuminuria with systolic blood pressure and plasma creatinine. CONCLUSIONS: A high prevalence of abnormal UAER in elderly people was detected in a randomly selected sample of Spanish general population. In most elderly patients, microalbuminuria was associated with high blood pressure and, less frequently, with diabetes mellitus.


Assuntos
Albuminúria/epidemiologia , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia
16.
Rev Clin Esp (Barc) ; 213(1): 16-24, 2013.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22981991

RESUMO

BACKGROUND AND OBJECTIVES: Heart failure is responsible for a major part of hospital health expenditure and the third cause of cardiovascular death. To describe the evolution of clinical features, and factors related to prognosis of patients admitted due to decompensated heart failure in a region of Extremadura during a period 10 years. PATIENTS AND METHODS: Observational, retrospective and single centre study of consecutive patients admitted due to decompensated heart failure in a general hospital in the province of Badajoz, during the period 2000/2009. RESULTS: A total of 2220 patients with mean age of 76.3 (SD±10.1), being 54% female were included in the study. Stratified into four periods (30 months each), a significant increase in patients over 75 years was observed (55 vs. 71%; P<.001), as well as an increase in the prescription of beta blockers at discharge (12 vs. 34%, P<.001), statins (8 vs. 31%; P<.001), and oral anticoagulants (13 vs. 25%; P<.001). Hospital mortality significantly decreased from 13 to 8% (P<.01), and from 30 to 23% (P<.01) at one year follow-up. Age (HR per year=1.04 [95% CI: 1.02 to 1.05]), diabetes (HR=1.35 [95% CI: 1.11 to 1.66]) and chronic renal failure (HR=1.49 [95% CI: 1.18 to 1.87]) were identified as independent predictors of all-cause mortality at one year of follow-up. CONCLUSIONS: Total mortality in patients with decompensated heart failure has declined significantly over the last decade, despite the increasing age. Age, diabetes and chronic renal failure were independent predictors of total mortality at one year. Oral anticoagulation was a protective factor.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
19.
Int J Cardiol ; 146(2): 219-24, 2011 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-20439123

RESUMO

BACKGROUND: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. METHODS: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, P-selectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. RESULTS: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30- and 360-day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. CONCLUSIONS: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.


Assuntos
Angina Instável/diagnóstico , Angina Instável/mortalidade , Morte Súbita Cardíaca/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco
20.
Emergencias (St. Vicenç dels Horts) ; 15(5): 298-300, oct. 2003. ilus
Artigo em Espanhol | IBECS | ID: ibc-28675

RESUMO

El síndrome de Brugada es una enfermedad caracterizada por la presencia de un bloqueo de rama derecha atípico con corazón estructuralmente sano y riesgo de muerte súbita. Se ha alertado acerca de su riesgo y la necesidad de estudios diagnósticos no invasivos e invasivos precoces. La única terapéutica conocida, y muy eficaz, es la colocación de un desfibrilador automático implantable. Presentamos el caso de un paciente joven que consulta por dolor precordial que responde a los nitritos y que su ECG muestra alteraciones típicas compatibles con esta entidad (AU)


Assuntos
Adulto , Masculino , Humanos , Bloqueio Cardíaco/diagnóstico , Morte Súbita Cardíaca/etiologia , Infarto do Miocárdio/diagnóstico , Bloqueio de Ramo/diagnóstico , Bloqueio Cardíaco/tratamento farmacológico , Bloqueio Cardíaco/terapia , Flecainida/farmacologia , Isoproterenol/farmacologia , Diagnóstico Diferencial , Nitritos/farmacologia , Nitritos/administração & dosagem , Bloqueio de Ramo/tratamento farmacológico , Tratamento de Emergência/métodos , Desfibriladores Implantáveis
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