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1.
Artigo em Inglês | MEDLINE | ID: mdl-31694294

RESUMO

Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44-0.94) or death (HR = 0.55, 95% CI = 0.35-0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention.

2.
Clin Chem Lab Med ; 56(3): 403-412, 2018 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-29055937

RESUMO

BACKGROUND: There is no consensus in the literature about what analytes or values should be informed as critical results and how they should be communicated. The main aim of this project is to establish consensual standards of critical results for the laboratories participating in the study. Among the project's secondary objectives, establishing consensual procedures for communication can be highlighted. METHODS: Consensus was reached among all participating laboratories establishing the basis for the construction of the initial model put forward for consensus in conjunction with the clinicians. A real-time Delphi, methodology "health consensus" (HC), with motivating and participative questions was applied. The physician was expected to choose a numeric value within a scale designed for each analyte. RESULTS: The medians of critical results obtained represent the consensus on critical results for outpatient and inpatient care. Both in primary care and in hospital care a high degree of consensus was observed for critical values proposed in the analysis of creatinine, digoxin, phosphorus, glucose, international normalized ratio (INR), leukocytes, magnesium, neutrophils, chloride, sodium, calcium and lithium. For the rest of critical results the degree of consensus obtained was "medium high". The results obtained showed that in 72% of cases the consensual critical value coincided with the medians initially proposed by the laboratories. CONCLUSIONS: The real-time Delphi has allowed obtaining consensual standards for communication of critical results among the laboratories participating in the study, which can serve as a basis for other organizations.


Assuntos
Técnicas de Laboratório Clínico , Técnica Delfos , Inteligência , Consenso , Humanos , Coeficiente Internacional Normatizado
3.
Aten. prim. (Barc., Ed. impr.) ; 48(9): 596-603, nov. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-157680

RESUMO

Objetivo. Estimar la prevalencia de insuficiencia renal (IR) oculta en DM2, comparando 2 fórmulas de estimación de filtrado glomerular (EFG): Modification of Diet in Renal Disease 4 (MDRD-4) y Crockcoft-Gault (CG) y las variables clínicas asociadas. Diseño Analítico transversal multicéntrico. Emplazamiento. Dos áreas básicas de atención primaria a Terres de l’Ebre. Participantes. Un total de 493 DM2 con médico asignado en las áreas incluidas y edad >18 años. Pérdidas de 9 y 11 casos en cada fórmula debido a falta de variables necesarias para EFG. Mediciones principales. Estimación del filtrado glomerular mediante las 2 fórmulas, valores de creatinina plasmática, clasificación de pacientes con IR establecida, IR oculta y sin IR, posibles variables clinicopatológicas asociadas a la IR. Resultados. Un 45,2% fueron hombres, con una media de edad 70,4 años y un tiempo de evolución de diabetes de 7,5 años. La prevalencia de IR oculta con MDRD-4 fue del 18%, y del 22,6% con CG. Los casos detectados por CG y no por MDRD-4 fueron mayores y con peso menor. En ambas fórmulas, los pacientes con IR oculta presentaron más patologías crónicas, hipertensión y eventos cardiovasculares (CV) que los sin IR. Los factores de riesgo asociados a IR oculta fueron el ser mujer y el incremento de la edad y del colesterol LDL. Conclusiones. La prevalencia de IR oculta fue del 20% en DM2 e, independientemente de la fórmula, se observó un peor control de factores CV, lo que les hace ser un grupo de mayor riesgo de sufrir un evento (AU)


Objective. To estimate the prevalence of occult renal failure (RF) in DM2, by comparing two formulas for estimating glomerular filtration rate (GFR): Modification of Diet in Renal Disease 4 (MDRD-4) and Cockcroft-Gault (CG), as well as their associated clinical variables. Design. Multicentre analytical cross-sectional. Location. Two basic Primary Care areas in Terres de l’Ebre, in North-Eastern Spain. Participants. A total of 493 DM2 patients with age >18 years with an assigned doctor in the areas studied. There was a loss of 9 and 11 cases in each formula due to lack of variables necessary for the GFR. Main measurements. Estimated GFR using the two formulas, plasma creatinine values, classification of patients with established RF, occult RF and without RF, and possible clinical-pathological variables associated with RF. Results. Of the total, 45.2% were men, the mean age was 70.4 years, and mean time since onset of diabetes of 7.5 years. The prevalence of occult RF with MDRD-4 was 18%, and 22.6% with CG. The cases detected by GC and not by MDRD-4 were higher, and with lower weight. In both formulas, occult RF patients had more chronic diseases, hypertension, and cardiovascular events (CV) than those without RF. Risk factors associated with occult RF were female, increasing age, and LDL cholesterol. Conclusions. The prevalence of occult RF was 20% in DM2, independently of the formula. A poorer control of cardiovascular risk factors was observed, which makes them a group at higher risk of suffering a CV event (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Creatinina/análise , Fatores de Risco , Barreira de Filtração Glomerular , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Estudos Transversais/métodos
4.
Rev. neurol. (Ed. impr.) ; 62(9): 385-395, 1 mayo, 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-151859

RESUMO

Objetivo. Conocer la incidencia poblacional de la hemorragia intracerebral y su incidencia evitable, factores de riesgo asociados y pronóstico de muerte y discapacidad. Sujetos y métodos. Muestra de 240 pacientes consecutivos con un primer episodio de hemorragia intracerebral entre el 1 de abril de 2006 y el 30 de junio de 2015. Las variables principales son: escala NIHSS, comorbilidad, información farmacológica, índice de Barthel, escala de Rankin, tiempo en rango terapéutico, pronóstico y destino al alta hospitalaria. Se aplicó la clasificación ‘mortalidad innecesariamente prematura y sanitariamente evitable’ (MIPSE) para definir los casos como ’incidencia evitable’. Resultados. La tasa de incidencia poblacional de enfermedad cerebrovascular hemorrágica fue de 23,5 casos por 100.000 habitantes/año; se produjo un incremento exponencial a partir de los 55 años en hombres y 75 años en mujeres. La razón de tasas fue de 0,682. La incidencia evitable significaría el 66,6% de todos los casos en los menores de 75 años y el 22,7% en aquellos con 75 o más años. La probabilidad de supervivencia y la autonomía funcional fueron significativamente inferiores en las mujeres, y la edad, el tratamiento anticoagulante, la presencia de polimedicación y el tratamiento con antidepresivos inhibidores de la recaptación de serotonina fueron factores independientes del pronóstico. Conclusiones. No parece que se modifique la incidencia de enfermedad cerebrovascular hemorrágica en el período, pero sí los factores asociados según sexo y edad. Según la clasificación MIPSE, la evitabilidad de la enfermedad cerebrovascular hemorrágica sería de hasta un 36% (AU)


Aim. To determine the population incidence of intracerebral haemorrhage and its preventable incidence, associated risk factors and prognosis of death and disability. Subjects and methods. We examined a sample of 240 consecutive patients with a first episode of intracerebral haemorrhage between 1st April 2006 and 30th June 2015. The main variables are: NIHSS scale, comorbidity, pharmacological information, Barthel index, Rankin scale, time within therapeutic window, prognosis and destination on hospital discharge. The ‘unnecessarily premature and sanitarily avoidable mortality’ (MIPSE) classification was applied to define the cases as ‘preventable incidence’. Results. The rate of population incidence of haemorrhagic cerebrovascular disease was 23.5 cases per 100,000 inhabitants/year; an exponential increase occurred from the age of 55 years in males and 75 years in females. The rate ratio was 0.682. The preventable incidence would account for 66.6% of all the cases in those under 75 years of age and 22.7% in those aged 75 or over. The chances of survival and functional autonomy were significantly lower in females, and age, anticoagulant treatment, the presence of polymedication and treatment with serotonin reuptake inhibitor antidepressants were factors that were independent of the prognosis. Conclusions. The incidence of haemorrhagic cerebrovascular disease does not appear to be modified within the period, but just the opposite occurs with the factors associated according to sex and age. According to the MIPSE classification, the preventability of haemorrhagic cerebrovascular disease could be as high as 36% (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/complicações , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/patologia , Incidência , Comorbidade/tendências , Fatores de Risco , Prognóstico , Mortalidade Prematura , Envelhecimento/metabolismo , Envelhecimento/patologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Estudos de Coortes , Estudo Observacional , Estudos Longitudinais , Estudos Retrospectivos , Espanha/epidemiologia
5.
Aten Primaria ; 48(9): 596-603, 2016 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-26993245

RESUMO

OBJECTIVE: To estimate the prevalence of occult renal failure (RF) in DM2, by comparing two formulas for estimating glomerular filtration rate (GFR): Modification of Diet in Renal Disease 4 (MDRD-4) and Cockcroft-Gault (CG), as well as their associated clinical variables. DESIGN: Multicentre analytical cross-sectional. LOCATION: Two basic Primary Care areas in Terres de l'Ebre, in North-Eastern Spain. PARTICIPANTS: A total of 493 DM2 patients with age >18years with an assigned doctor in the areas studied. There was a loss of 9 and 11 cases in each formula due to lack of variables necessary for the GFR. MAIN MEASUREMENTS: Estimated GFR using the two formulas, plasma creatinine values, classification of patients with established RF, occult RF and without RF, and possible clinical-pathological variables associated with RF. RESULTS: Of the total, 45.2% were men, the mean age was 70.4 years, and mean time since onset of diabetes of 7.5 years. The prevalence of occult RF with MDRD-4 was 18%, and 22.6% with CG. The cases detected by GC and not by MDRD-4 were higher, and with lower weight. In both formulas, occult RF patients had more chronic diseases, hypertension, and cardiovascular events (CV) than those without RF. Risk factors associated with occult RF were female, increasing age, and LDL cholesterol. CONCLUSIONS: The prevalence of occult RF was 20% in DM2, independently of the formula. A poorer control of cardiovascular risk factors was observed, which makes them a group at higher risk of suffering a CV event.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Insuficiência Renal/etiologia , Idoso , Creatinina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Prevalência , Fatores de Risco , Espanha
6.
Rev. senol. patol. mamar. (Ed. impr.) ; 29(1): 13-18, ene.-mar. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-149866

RESUMO

Objetivo. Comparar la supervivencia del cáncer de mama en mujeres que han sido cribadas en el programa de Detección Precoz del Cáncer de Mama (DPCM) y en las que no han participado en él. Pacientes y métodos. Es un estudio descriptivo y longitudinal en el que se han estudiado todos los cánceres de mama registrados en el servicio de Anatomía Patológica del Hospital de Tortosa Verge de la Cinta (Tarragona) de mujeres de 50-65 años, que se habían detectado la enfermedad ellas mismas o que la había detectado el programa DPCM, desde junio de 1999 hasta junio de 2003. Se registraron 101 pacientes con cáncer de mama, de las que en 84 se pudieron recoger todos los datos relativos al tumor, la cirugía y el tratamiento. En el 2014, tras un seguimiento de 11,6 ± 1,8 años, se anotó el estado actual. Resultados. No hay diferencia estadísticamente significativa en la supervivencia de los 2 grupos. Pacientes con carcinoma in situ y sin ganglios metastásicos se encuentran entre las fallecidas, mientras que ninguna paciente con carcinoma bien diferenciado falleció. Conclusiones. En nuestro estudio, el cribado del cáncer de mama no mejora la supervivencia y determinados factores en los que se apoyan los programas de cribado, como la detección de carcinomas no infiltrantes y/o de ganglios no metastásicos, no aseguran la curación (AU)


Objective. To compare survival in breast cancer between women diagnosed in an early breast cancer detection programme and those not attending this programme. Patients and methods. We conducted a descriptive and longitudinal study that analysed all types of breast cancer registered in the Pathology Service of the Hospital de Tortosa Verge de la Cinta (Tarragona, Spain). Tumour samples were obtained from 50-65-year-old women who had detected alterations on self-examination and from those attending the early breast cancer detection programme from June 1999 to June 2003. All the information relating to the tumour, surgery or treatment was registered. In 2014, after a follow-up of 11.6 ± 1.8 years, the current status of each patient was recorded. Results. There was no significant statistical difference in survival between the two groups of patients. Non-survivors included patients with in situ carcinoma and without lymph node metastases. Survival was 100% in patients with well differentiated carcinoma. Conclusions. Breast cancer screening did not improve survival in our study. The elements on which screening programs are based, such as non-invasive carcinoma detection and/or non- metastatic lymph nodes, do not ensure recovery (AU)


Assuntos
Humanos , Feminino , Adulto , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Programas de Rastreamento/classificação , Programas de Rastreamento/métodos , Linfonodos/metabolismo , Espanha/etnologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/terapia , Intervalo Livre de Doença , Programas de Rastreamento/normas , Programas de Rastreamento , Linfonodos/anormalidades , Biópsia de Linfonodo Sentinela/normas
7.
Cerebrovasc Dis Extra ; 5(3): 95-102, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26648964

RESUMO

BACKGROUND: A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences. We sought to examine the relationship between sex and outcome after thrombolysis. METHODS: This was a prospective cohort study including 1,272 incident ischemic strokes (597 in women) from April 1, 2006 to December 31, 2014. Statistical approaches were used for analyzing survival outcomes and their relationship with thrombolysis therapy. RESULTS: The death rates were lower (p = 0.003) in the thrombolysis therapy group with an incidence ratio of 0.57 (95% CI 0.39-0.83). 113 (8.8%) patients (53 women) received thrombolysis. They were significantly younger (69.2 ± 12.7 vs. 73.9 ± 12.5 years; p < 0.001), had higher NIHSS score (12.7 ± 6.3 vs. 7.3 ± 7.0; p < 0.001), spent more days in hospital (10.4 ± 8.3 vs. 8.3 ± 7.9; p < 0.001), and had a higher average Barthel score at discharge (85.5 ± 24.4 vs. 79.2 ± 28.6; p = 0.023). The male/female incidence ratio showed a significant decrease (p = 0.01) in the incidence of mortality in women and a better Barthel score. The thrombolysis improved the survival in the overall group with thrombolysis versus without thrombolysis (p = 0.028), in women versus in men with thrombolysis (p = 0.023), and in women with thrombolysis versus in those without thrombolysis (p < 0.001) but not in men with thrombolysis versus in those without thrombolysis (p = 0.743). The protective factors as regards mortality were thrombolysis therapy (95% CI 0.37-0.80; p = 0.002), Barthel score ≥ 60 (95% CI 0.81-0.94; p = 0.002), and cardiovascular secondary prevention 1 year after stroke (0.13, 95% CI 0.06-0.28). CONCLUSIONS: The stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting. The overall benefit on survival of the patients treated with thrombolysis might be explained by the beneficial effect of the thrombolysis on the women.


Assuntos
Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica/métodos , Administração Intravenosa , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
8.
Biomed Res Int ; 2015: 134756, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26229954

RESUMO

OBJECTIVE: This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. METHOD: A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. RESULTS: The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC ≥ 2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC < 2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. CONCLUSIONS: The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7-36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Sistema de Registros , Vitamina K/antagonistas & inibidores , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Espanha/epidemiologia , Análise de Sobrevida
9.
Aten. prim. (Barc., Ed. impr.) ; 47(2): 108-116, feb. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-133653

RESUMO

Objetivo: Investigar la relación entre género y supervivencia después de un episodio de ictus tratado con fibrinólisis.Diseño: Estudio de cohortes. Emplazamiento: Atención primaria. Participantes: Los casos tratados con fibrinólisis por un ictus agudo desde el 1 de abril de 2006 al 13 de septiembre de 2013. Intervenciones: Seguimiento del estado vital. Mediciones principales: Riesgos vasculares: escala Framingham, REGICOR, CHA2DS2-VASc, Essen, NIHSS, índice Barthel; densidad de incidencia; análisis de supervivencia por Kaplan-Meier; bivariado entre supervivientes y fallecidos; y multivariante de Cox. Resultados: Noventa y un pacientes con edad media 68,02 ± 11,9 años. Los hombres tienen mayor riesgo cardiovascular basal. El tiempo medio de seguimiento fue de 2,95 ± 2,33 años. La razón de tasa de incidencias mostró un mayor riesgo en los hombres respecto a las mujeres IR = 3,2 (IC 95%: 1,2-8,0). Los fallecidos en relación con los supervivientes son mayores (p = 0,032); mayor riesgo cardiovascular basal (p = 0,040) y de recidiva de ictus (p < 0,001); mayor severidad del episodio (p = 0,002); y una mayor caída en la puntuación Barthel un año después del ictus (p = 0,016). El porcentaje de muertes es significativamente más alto cuando el paciente es derivado a centros de agudos o de larga estancia (p = 0,006) que cuando se deriva al domicilio, pero solo el género (HR: 1,12; IC 95%: 1,05-1,20) y la prevención cardiovascular secundaria (HR: 0,13; IC 95%: 0,06-0,28) se asociaron con la mortalidad de los pacientes. Conclusiones: Después de un episodio de ictus tratado con fibrinólisis los hombres tienen un 12% más de riesgo de morir que las mujeres, y la ausencia de prevención cardiovascular secundaria aumenta 7,7 veces el riesgo de mortalidad (AU)


Objective: To seek if there is gender survival difference among patients treated with thrombolytic therapy. Design: Cohort study. Location: Community based register. Participants: 91 subjects with an episode of stroke collected since April 2006 up to September 2013 and treated with thrombolytic therapy.Interventions: Monitoring of vital status. Measurements: We collected baseline characteristics in Framingham, Regicor, CHA2DS2-VASc, Essen, NIHSS, Barthel scales and outcomes according to gender; person-time incidence rate; survival analysis by Kaplan-Meier's curves, bivariate analysis between survivors and deaths, and Cox multivariate. Results: 91 patients with middle age 68.02 ± 11.9 years. The men have higher cardiovascular basal risk. The average time of follow-up was 2.95 ± 2.33 years. Incidence rate ratio (IR) shown higher risk in men than in women IR = 3.2 (CI 95% 1.2-8.0). The dead cases were older (P = .032); with higher cardiovascular basal risk (P = .040) and more risk of stroke recurrence (P = < .001), with cardiovascular pathology before the stroke (P = .005); more stroke severity (P = .002); and a major fall in the score Barthel one year after the episode (P = .016). The percentage of deaths is significantly higher when the patient is referred by complications to other centres (P = .006) in relation to those referred to home, but just the gender (HR: 1,12; IC 95%: 1,05-1,20) and secondary cardiovascular prevention (HR: 0,13; IC 95%: 0,06-0,28) were associated with higher risk of mortality. Conclusions: After stroke episode treated with thrombolytic therapy, men have 12% higher risk of dying than women and don’t be treated with secondary cardiovascular prevention rise 7.7 times the mortality risk (AU)


Assuntos
Humanos , Masculino , Feminino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fibrinólise/genética , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/métodos , Gênero e Saúde , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Fibrinólise/fisiologia , Atenção Primária à Saúde/normas , Atenção Primária à Saúde
10.
Aten Primaria ; 47(2): 108-16, 2015 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24953174

RESUMO

OBJECTIVE: To seek if there is gender survival difference among patients treated with thrombolytic therapy. DESIGN: Cohort study. LOCATION: Community based register. PARTICIPANTS: 91 subjects with an episode of stroke collected since April 2006 up to September 2013 and treated with thrombolytic therapy. INTERVENTIONS: Monitoring of vital status. MEASUREMENTS: We collected baseline characteristics in Framingham, Regicor, CHA2DS2-VASc, Essen, NIHSS, Barthel scales and outcomes according to gender; person-time incidence rate; survival analysis by Kaplan-Meier's curves, bivariate analysis between survivors and deaths, and Cox multivariate. RESULTS: 91 patients with middle age 68.02±11.9 years. The men have higher cardiovascular basal risk. The average time of follow-up was 2.95±2.33 years. Incidence rate ratio (IR) shown higher risk in men than in women IR=3.2 (CI 95% 1.2-8.0). The dead cases were older (P=.032); with higher cardiovascular basal risk (P=.040) and more risk of stroke recurrence (P=<.001), with cardiovascular pathology before the stroke (P=.005); more stroke severity (P=.002); and a major fall in the score Barthel one year after the episode (P=.016). The percentage of deaths is significantly higher when the patient is referred by complications to other centres (P=.006) in relation to those referred to home, but just the gender (HR: 1,12; IC 95%: 1,05-1,20) and secondary cardiovascular prevention (HR: 0,13; IC 95%: 0,06-0,28) were associated with higher risk of mortality. CONCLUSIONS: After stroke episode treated with thrombolytic therapy, men have 12% higher risk of dying than women and don't be treated with secondary cardiovascular prevention rise 7.7 times the mortality risk.


Assuntos
Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Taxa de Sobrevida
11.
Aten. prim. (Barc., Ed. impr.) ; 46(2): 58-67, feb. 2014. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-119023

RESUMO

Objetivo: Conocer el circuito asistencial de la fibrilación auricular (FA): diagnóstico, tratamiento y seguimiento en el contexto asistencial del sistema sanitario público. Diseño: AFABE es un estudio observacional, multicéntrico y descriptivo, con datos retrospectivos relacionados con el diagnóstico, tratamiento y seguimiento de una cohorte de pacientes ambulatorios con FA en el contexto de la atención primaria, servicios de urgencias y cardiología referentes. Emplazamiento: Atención primaria y especializada. Comarca del Baix Ebre. Tarragona. España. Participantes: Muestra representativa de pacientes con FA > 60 años, seleccionados aleatoriamente entre los pacientes registrados en los 22 centros de atención primaria existentes en el territorio del estudio. Mediciones principales: Datos demográficos, comorbilidades, valor CHA2DS2-VASc y HAS_BLED, y patrones asistenciales resultantes entre la atención primaria y servicios referentes. Resultados: Se incluyeron 182 pacientes, de 78,5; DE:7,3 años, y el 50% mujeres. En atención primaria (AP) se realizó el primer contacto en el 68,3% (IC 95% 60,3-76,3) de los casos de FA, de los que un 56,3% (IC 95% 45,2-66,0) fueron enviados al servicio de urgencias del hospital referente. El 72,7% (IC 95% 63,5-79,0) de los tratamientos anticoagulantes orales y el 58,44% (IC 95% 49,4-66,9) de los tratamientos antiarrítmicos se iniciaron en el servicio de urgencias referente. Un 55,9% (IC 95% 47,2-64,7) de los pacientes son seguidos por el servicio de cardiología referente. Conclusiones: El médico de AP realiza el primer contacto de la mayoría de FA y deriva el 55% de los casos al servicio de urgencias hospitalario donde se inician la mayoría de tratamientos específicos de la FA (AU)


Aim: To provide insights into the characteristics and management of outpatients when their atrial fibrillation (AF) was first detected: diagnosis, treatment and follow-up in the context of the public health system. Design: AFABE is an observational, multicentre descriptive study with retrospective data collection relating to the practice patterns, management and initial strategies of treatment of patients with diagnosed AF in the context of primary care, emergency and cardiologists of the public health system. Setting: Primary and Specialist care. Baix Ebre region. Tarragona. Spain. Subjects: A representative sample of 182 subjects > 60-year-old with AF who have been randomized, recruited among the registered patients with AF in 22 primary care centres in the area of the study. Mesurements: Demographic data, comorbidities (AF), CHA2DS2-VASc and HAS BLED scores, and practice patterns results between Primary Care and referral services. Results: A total of 182 patients were included (mean age 78.5 SD: 7.3 years; 50% women). Most patients (68.3% 95%CI; 60.3-76.3) had the first contact in Primary Care, of which 56.3% (95%CI;45.2-66.0) were sent to Hospital Emergency Department where 72.7% (95%CI: 63.5-79.0) of the oral anticoagulation and 58.4% (95%CI: 49.4-66.9) of antiarrhytmic treatments were started. More than half (55.9%:95%CI; 47.2-64.7, of patients with permanent AF were followed-up by the Cardiology department. Conclusions: Most patients with newly diagnosed AF made a first contact with Primary Care, but around half were sent to Hospital Emergency departments, where they were treated with an antiarrhythmic and/or oral anticoagulation (AU)


Assuntos
Humanos , Fibrilação Atrial/epidemiologia , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial/organização & administração , Especialização/tendências , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Fatores de Risco , Doenças Cardiovasculares/epidemiologia
12.
Aten Primaria ; 46(2): 58-67, 2014 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24042075

RESUMO

AIM: To provide insights into the characteristics and management of outpatients when their atrial fibrillation (AF) was first detected: diagnosis, treatment and follow-up in the context of the public health system. DESIGN: AFABE is an observational, multicentre descriptive study with retrospective data collection relating to the practice patterns, management and initial strategies of treatment of patients with diagnosed AF in the context of primary care, emergency and cardiologists of the public health system. SETTING: Primary and Specialist care. Baix Ebre region. Tarragona. Spain. SUBJECTS: A representative sample of 182 subjects > 60-year-old with AF who have been randomized, recruited among the registered patients with AF in 22 primary care centres in the area of the study. MESUREMENTS: Demographic data, comorbidities (AF), CHA2DS2-VASc and HAS_BLED scores, and practice patterns results between Primary Care and referral services. RESULTS: A total of 182 patients were included (mean age 78.5 SD:7.3 years; 50% women). Most patients (68.3% 95%CI; 60.3-76.3) had the first contact in Primary Care, of which 56.3% (95%CI; 45.2-66.0) were sent to Hospital Emergency Department where 72.7% (95%CI: 63.5-79.0) of the oral anticoagulation and 58.4% (95%CI: 49.4-66.9) of antiarrhytmic treatments were started. More than half (55.9%:95%CI; 47.2-64.7, of patients with permanent AF were followed-up by the Cardiology department. CONCLUSIONS: Most patients with newly diagnosed AF made a first contact with Primary Care, but around half were sent to Hospital Emergency departments, where they were treated with an antiarrhythmic and/or oral anticoagulation.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Idoso , Assistência Ambulatorial , Procedimentos Clínicos , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos
13.
Cardiol Res ; 5(1): 12-22, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28392870

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival. METHODS: It is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA2DS2-VASc and HAS_BLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank. RESULTS: The average following time was 6.2 ± 3.7 years (0.2-20.4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0.86 ± DE 0.03 among men and 0.90 ± DE 0.04 among women without differences. Thirty-six point eight percent (95% CI: 30.8 - 42.7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24.2%) and ischemic stroke (23.2%) the most frequent. The mortality is higher (P < 0.036) among those who suffered ≥ 3 vascular complications and significantly lower among those treated with statins (P = 0.032). After AF diagnosis, the most frequent was the cardiac heart failure (46.7%), significantly higher among women (P = 0.037). The mortality is significantly lower in those treated with OAC (P = 0.003). CONCLUSIONS: AF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia.

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