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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.

4.
Medicine (Baltimore) ; 97(3): e9578, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29504981

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke 4 to 5-fold. The first choice of anticoagulant therapy (AT) is the vitamin K antagonist (VKA). Contraindication to VKA or poor control of the International Normalized Ratio leads to the administration of direct-acting oral anticoagulants. There is a trend toward inadequate AT in nonvalvular AF (NVAF) patients. AIM: To evaluate the impact of the implementation of a decision support tool linked to the digital clinical history on the adequacy of AT, the incidence of complications, and the mortality in patients with NVAF in primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: Randomized clinical trial in 287 PCCs, formed by 2 groups (intervention and control). POPULATION: patients controlled in PCCs, diagnosed with NVAF 1 year before the implementation of the decision support tool and with VKA treatment over a minimum of 1 year. A simple randomization method will be performed at a sector level. The decision support tool will be available for 1 year. The time in therapeutic range (TTR) will be available in the digital clinical history only to professionals of the intervention group. The information system for primary care research development database will be used for the data extraction. Statistical analysis will be done at 3 time points: before the implementation of the tool, at 1 year, and at 2 years after the beginning of the intervention. Multilevel (patient and professional levels) logistic regression models will be used to estimate the effect of the intervention. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethical Committee of Clinical Investigation of the Institut Universitari d'Investigació en Atenció Primària Jordi Gol (code P17/091). Articles will be published in scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT03367325.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Sistemas de Apoio a Decisões Clínicas , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Humanos , Incidência , Atenção Primária à Saúde , Melhoria de Qualidade , Projetos de Pesquisa , Acidente Vascular Cerebral/epidemiologia
11.
Rev. esp. cardiol. (Ed. impr.) ; 54(6): 715-734, jun. 2001.
Artigo em Espanhol | IBECS | ID: ibc-2080

RESUMO

Introducción y objetivos. Se han elaborado unas recomendaciones de tratamiento de la insuficiencia cardíaca a partir de la revisión sistemática de la evidencia disponible sobre los distintos tratamientos farmacológicos. Material y métodos. La revisión se ha centrado en el tratamiento de la insuficiencia cardíaca crónica y sistólica. Se identificaron todos los estudios publicados en inglés sobre los tratamientos farmacológicos de la insuficiencia cardíaca. Para cada tratamiento se clasificaron las evidencias en función de: a) variables de eficacia (reducción de la mortalidad y de los ingresos hospitalarios, mejoría de la clase funcional, fracción de eyección y de la tolerancia al ejercicio), y b) nivel de calidad de la evidencia según una escala de evaluación. También se revisaron las evidencias sobre las comparaciones y las combinaciones de los tratamientos, y sobre su toxicidad y costes. Resultados. Las pautas de tratamiento han sido definidas en función de la clase funcional de la NYHA y se han clasificado en las categorías A, B o C según el nivel de calidad de la evidencia disponible. Las evidencias de mortalidad se han considerado las más importantes. Se han tenido en cuenta los fármacos de primera elección, las alternativas y otros posibles tratamientos. Conclusiones. Se dispone de suficiente información para elaborar recomendaciones terapéuticas en todas las fases de la insuficiencia cardíaca basadas en evidencias sobre variables, como la reducción de la mortalidad o de los ingresos hospitalarios. Esto pone de manifiesto el interés y la prioridad de utilizarlas en el proceso de evaluación y mejora de resultados en este proceso patológico (AU)


Assuntos
Humanos , Medicina Baseada em Evidências , Espironolactona , Vasodilatadores , Antiarrítmicos , Inibidores da Enzima Conversora de Angiotensina , Anticoagulantes , Bloqueadores dos Canais de Cálcio , Cardiotônicos , Análise Custo-Benefício , Diuréticos , Digoxina , Antagonistas Adrenérgicos beta , Insuficiência Cardíaca , Digoxina
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