Javier Muñiz García

Prevalencia de la insuficiencia cardiaca en la población general española mayor de 45 años. Estudio PRICE

Introduccion y objetivos La insuficiencia cardiaca congestiva (ICC) tiene elevadas incidencia, morbilidad y mortalidad y una gran prevalencia. Sin embargo, no hay datos directos sobre este aspecto en nuestro pais. El objetivo de nuestro estudio es evaluar la prevalencia de ICC en Espana. Metodos Se diseno un estudio poblacional en el que participaron 15 centros repartidos por toda Espana. Se selecciono de forma aleatoria una muestra de la poblacion de 45 o mas anos de edad atendida en cada area de salud, que fue estudiada por sus medicos de atencion primaria. Se utilizaron los criterios de Framingham para el diagnostico. Las personas con criterios de ICC fueron remitidas a una consulta de cardiologia para confirmacion diagnostica y realizacion de ecocardiograma. Resultados Se evaluo a 1.776 personas, con una media ± desviacion estandar (intervalo) de edad de 64 ± 12 (45-100) anos; eran varones el 44%. Se remitio a cardiologia a 242 pacientes. La prevalencia ponderada de ICC fue del 6,8% (intervalo de confianza [IC] del 95%, 4%- 8,7%). La prevalencia fue similar en varones (6,5%; IC del 95%, 4,7%-8,4%) y en mujeres (7%; IC del 95%, 4,4%-9,6%). Por edades, la prevalencia fue del 1,3% (0,4%-2,1%) entre los 45 y 54 anos; el 5,5% (2,4%-8,5%) entre 55 y 64 anos; el 8% (4,2%-11,8%) entre 65 y 74 anos, y el 16,1% (11%-21,1%) en personas de 75 o mas anos. Conclusiones La prevalencia de ICC en Espana es alta, en torno a un 7-8%. La prevalencia es similar varones y mujeres, y parece aumentar con la edad.

Prevalence of Heart Failure in the Spanish General Population Aged Over 45 Years. The PRICE Study

INTRODUCTION AND OBJECTIVES Congestive heart failure is associated with substantial morbidity and mortality and both its incidence and prevalence are high. Nevertheless, comprehensive data on this condition in Spain are lacking. The aim of this study was to determine the prevalence of congestive heart failure in Spain. METHODS A demographic study which involved the participation of 15 healthcare centers throughout Spain was carried out. In each health area, a random sample was taken of the population aged 45 years or more. These individuals were examined by their primary care physicians, who made their diagnoses using Framingham criteria. Individuals who satisfied criteria for congestive heart failure were referred to a cardiologist for confirmation of the diagnosis and for echocardiography. RESULTS Overall, 1776 individuals were evaluated. Their mean age was 64+/-12 years (range, 45-100 years) and 44% were male. Of these, 242 were referred to a cardiologist. The weighted prevalence of congestive heart failure was 6.8% (95% confidence interval [CI] 4%-8.7%). The prevalence was similar in men (6.5%, 95% CI 4.7%-8.4%) and women (7%, 95% CI 4.4%-9.6%). When analyzed by age, the prevalence was 1.3% (0.4%-2.1%) in those aged 45-54 years, 5.5% (2.4%-8.5%) in those aged 55-64 years, 8% (4.2%-11.8%) in those aged 65-74 years, and 16.1% (11%-21.1%) in those aged over 74 years. CONCLUSIONS Prevalence of congestive heart failure in Spain is high, at about 7%-8%. The prevalence was similar in males and females, and appeared to increase with age.

Effect of a Simple Educational Program for Physicians on Adherence to Secondary Prevention Measures After Discharge Following Acute Coronary Syndrome. The CAM Project

Introduction and objectives Adherence to established guidelines for patients discharged from the hospital after acute coronary syndrome is known to be suboptimal. The aim of this study was to assess the efficacy of a program for physicians centered on the treatment of acute coronary syndrome. Patients and method 39 hospitals participated. Intervention: a set of measures was developed by consensus for the creation and distribution of educational materials. Outcomes of interest: proportion of patients in whom ejection fraction and residual ischemia were evaluated, treatment at discharge, and health and dietary recommendations to patients (smoking, diet, exercise, etc.) referred to all patients in whom these measures or treatments should have been used (“ideal patients”). Changes were assessed with four cross-sectional surveys. Results A total of 1157, 1162, 1149, and 1158 patients were included. There were no relevant differences between these groups in baseline characteristics. In general, there was improvement in all variables between the first and the last survey. The proportion of patients who were weighed and measured increased (from 33.5% to 53.4%; P Conclusions The educational intervention seems to have had a positive effect on improving the appropriateness of procedures and treatments for patients discharged after acute coronary syndrome.

Efecto de un programa sencillo de educación de los profesionales en el cumplimiento de medidas de prevención secundaria en el momento del alta hospitalaria tras un síndrome coronario agudo. Proyecto CAM

Introduccion y objetivos El cumplimiento de las recomendaciones establecidas como eficaces en el momento del alta en los pacientes hospitalizados por un sindrome coronario agudo es suboptimo. El objetivo de este estudio es evaluar la eficacia de un programa de intervencion centrado en el abordaje y tratamiento del sindrome coronario agudo. Pacientes y metodo Participaron en el proyecto 39 hospitales. La intervencion realizada consistio en el desarrollo consensuado de acuerdos de minimos y la elaboracion y difusion de materiales educativos. Entre las medidas de interes cabe destacar la proporcion de pacientes en la que se evaluaron la fraccion de eyeccion, la isquemia residual y los tratamientos y recomendaciones higienico-dieteticas en el momento del alta (tabaco, dieta, ejercicio, etc.) del total de pacientes en los que se deben determinar segun el acuerdo de minimos («pacientes ideales»). Asimismo, se valoraron los cambios en 4 cortes transversales. Resultados Se incluyo a 1.157, 1.162, 1.149 y 1.158 pacientes, respectivamente. No habia diferencias en las caracteristicas basales de pacientes analizados en cada corte. En general, se aprecia una mejoria entre el primer y el ultimo corte en todas las variables analizadas. Mejoro especialmente la proporcion de pacientes en los que se determinaron el peso y la talla (del 33,5 al 53,4%; p Conclusiones La intervencion educativa parece que tiene un efecto positivo en la mejora de la adecuacion de los procedimientos realizados y en los tratamientos prescritos en el momento del alta tras un sindrome coronario agudo.

Insuficiencia cardiaca en España. Epidemiología e importancia del grado de adecuación a las guías de práctica clínica

En el presente articulo se abordan aspectos de la magnitud de la insuficiencia cardiaca, con especial mencion a la carga que supone la enfermedad en nuestro medio. Se discuten, asimismo, los problemas para estimar esta magnitud debidos al propio caracter de sindrome de esta condicion y a constituir un sendero comun final a multiples enfermedades. En un segundo apartado se presentan algunas reflexiones acerca del valor de las guias de practica clinica y de los problemas para que las intervenciones que han demostrado su eficacia en el entorno controlado de un ensayo clinico se generalicen en la practica clinica cotidiana, a fin de aprovechar al maximo su potencial beneficio. Finalmente, se sugieren algunos puntos para mejorar tanto la adhesion de los profesionales a las guias de practica clinica como la de los pacientes al tratamiento que se les indique.

Análisis del uso adecuado de los bloqueadores beta en el postinfarto

Introduction. The use of β-blockers in patients with acute myocardial infarction has shown to improve the survival and reduce the risk of a new reinfarction. Aim. To quantify the use of β-blockers in patients with acute myocardial infarction in Galicia, Spain. Methods. We used the database of the RIGA study (Registry of Infarctions in Galicia) including 655 consecutive patients admitted to any hospital of Galicia for acute myocardial infarction from February to July, 1995. An extensive review of the literature was previously made to establish therapeutic criteria for the use of β-blockers in patients with acute myocardial infarction. The survey of the RIGA database was compared with the criteria established to determine the definition of appropriate usage. Results. 210 out of 655 patients (32%) received β-blockers. Interestingly, treatment (or lack of treatment) with βblockers was deemed appropriated in 51.4% of the patients. This inadequacy was related to the use of ACE inhibitors, calcium antagonists and thrombolysis. Conclusion. The use of β-blockers in Galicia in patients admitted with acute myocardial infarction was markedly lower than that established by standard criteria and the use of ACE inhibitors, calcium channel blockers and thrombolysis was related to less appropriate use.

El estudio Manresa: un estímulo para el desarrollo de la epidemiología cardiovascular en España

Entre los diferentes tipos de estudios de caracter ob-servacional de que se dispone en epidemiologia, losestudios longitudinales son los que, en general, apor-tan informacion de mas valor para establecer la rela-cion entre una exposicion determinada (o varias) yuna enfermedad. Estos estudios de cohortes puedenusarse para estimar los riesgos, las tasas o el momentoen que suceden los eventos de interes

The Manresa Study: a Stimulus for the Development of Cardiovascular Epidemiology in Spain

22 Of the different types of observational studies available in epidemiology, longitudinal studies are generally considered to provide the most valuable information regarding the association between exposure and disease. These cohort studies can be used to estimate risks, and rates or time of occurrence of events of interest. 1 One of the many advantages of longitudinal studies is the ability to describe the natural history of a disease from the time of exposure and to calculate its incidence. Nevertheless, longitudinal studies are not exempt from inconveniences, especially when they are undertaken in the general population. These inconveniences include their lack of efficiency in the case of rare diseases, important logistic problems related with the usually prolonged duration of the study,