[Study of patients with gout: clinical features in the last 2 years of monitoring]. / Estudio de pacientes con gota: características clínicas en los últimos 2 años de seguimiento.

OBJECTIVE: to analyze the clinical characteristics of gout patients with < 3 attacks and ≥ 3 acute attacks per year. METHODS: retrospective observational study carried out at 6-primary care (AP) and 2 hospitals. We included patient's ≥ 18 years during the years 2003-2007 inclusive. The study groups were: patients with 1-2 and ≥ 3 attacks/acute recurrences.The main variables: demographic, metabolic syndrome (MS), clinical features and treatment. STATISTICAL ANALYSIS: logistic regression model, p < 0.05. RESULTS: 3,130 patients were included. The mean age was 55.8 years and 81.1% were male:31.6% have ≥ 3 attacks per year. The prevalence of MS was 28.8% (CI: 27.2-30.4%) in patients with 1-2 attacks. Subjects with ≥ 3 acute attacks were associated with: MS (OR: 6.2; CI: 4.6-8.3; 65.8 vs. 11.8%), obesity (OR: 2.1; CI: 1.7-2.5;63.5 vs. 33.8%) and hypertension (OR: 1.6; CI: 1.3-1.9; 58.3 vs. 36.9%), p < 0.001; 58.4% continued to take allopurinol(50.3 vs. 62.2%; p < 0.001). CONCLUSIONS: patients with ≥ 3 attacks per year have a more severe disease with acute poly-articular, tophi and higher number of co-morbidities. It is important to control uric acid to reduce the recurrence of attacks in these patients.

Gender differences in antithrombotic treatment in patients with atrial fibrillation from Spain versus the rest of Western Europe. GLORIA-AF Program.

BACKGROUND AND OBJECTIVE: Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF. METHODS: GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs≥1 (2014-2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE. RESULTS: This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d=-0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%). CONCLUSIONS: OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701).

[The reporting of observational studies: analysis using the STROBE statement]. / Comunicación de los resultados de la investigación observacional: análisis mediante la guía STROBE.

BACKGROUND: Deficiencies detected in biomedical studies publication different Guidelines to improve. The objective of the study is to assess the communication of observational studies of Cardiovascular and Metabolism therapeutic area (CVM) published in 6 Spanish journals in 2009 using the STROBE statement. METHODS: Cross-sectional analysis of articles related to CVM therapeutic area, published during 2009 in 6 Spanish journals applying the 34 items of the STROBE statement. Descriptive analysis of the results for qualitative variables was performed using a frequency analysis. Quantitative variables were analyzed by sample estimates and dispersion. A comparative analysis of journals was performed using ANOVA with a statistical significance of p<0.05. RESULTS: Throughout 2009, 74 CVM observational studies were published in the evaluated journals. The most frequent design were cohorts 45 (60.8%) and cross-sectional 28 (37.8%). The study main objective was on pathology 55 (74.3%), followed by drug and non-pharmacological interventions 15 (20.3%) and diagnosis 4 (5.4%). The mean of complied items was 20 on 34 (DE±3.7), with a maximum of 24 (DE±2) in Gaceta Sanitaria and a minimum of 19 (DE±2.8) in Hipertensión. CONCLUSIONS: Evaluated papers comply with slightly more than a half items (58%) of the STROBE recommendations. The Methods and Results sections showed more deficiencies.

[Influence of compliance on the incidence of cardiovascular events and health costs when using single-pill fixed-dose combinations for the treatment of hypertension]. / Influencia del cumplimiento asociado a la incidencia de eventos cardiovasculares y los costes en combinaciones a dosis fijas en el tratamiento de la hipertensión arterial.

BACKGROUND AND OBJECTIVE: To determine the incidence of cardiovascular events (CVE) and health care costs in relation to compliance, persistence and level of blood pressure control when comparing patients treated with single-pill combinations (SPC) or free combinations (FC) for the treatment of hypertension. PATIENTS AND METHODS: Observational, multicenter study that included patients>30 years old, from six primary care teams and two hospitals, who started pharmacological treatment for hypertension during 2006. Two study groups were established: SPC (ACEIs/diuretics; ARBs/diuretics) and FC (ACEIs+DIU; ARB+DIU, separately). Main variables studied were sociodemographic data, comorbidity, Charlson-index, compliance, persistence and achievement of therapeutic goals (ESH-ESC criteria). The cumulative incidence of CVE and a total-cost model were determined (differentiating: health/direct; non-health/indirect). Patients were followed for two years. Statistical analysis included logistic regression, Cox proportional hazards model and analysis of covariance. Statistical signification: p<0.05. RESULTS: 1,605 patients were recruited, 1,112 (69.3%) receiving SPC and 493 (30.7%) receiving FC, p<0.001; mean age: 69.4 (12.2) years; women: 55.5%. FC treatments were associated with ischaemic heart disease (OR=1.4; 95% CI: 1.1-2.0) and organ failure (OR=1.5; 95% CI: 1.2-2.1), p<0.031. Patients on SPC showed better therapeutic compliance (77.6% vs 71.9%; p<0.001) and longer persistence of treatment (62.1% on-treatment at 24-months [95% CI: 56.3-67.9] vs 49.7% [95% CI: 38.5-60.9]; p<0.001). Optimal control of blood pressure was higher in SPC (48.9% [95% CI: 43.0-54.8] vs 46.7% [95% CI: 35.6-57.8]; p<0.001). Cumulative incidence of cerebrovascular accidents in FC was 4.6% vs 2.4% in SPC; p=0.041. The total health care costs were lower in SPC (1,650.7 € vs 1,674.8 €; p<0.001), including lower specialized care costs (316.1 € vs 382.9 €; p<0.001), fewer hospital admissions and less loss of labour productivity (44.5 € vs 88.4 €; p<0.001). CONCLUSIONS: Better compliance and persistence with antihypertensive fixed-dose combinations improves therapeutic control, leading to a significant reduction of cerebrovascular accidents and total health care costs.