Juan José Gómez-Doblas

Prevalence of Atrial Fibrillation in Spain. OFRECE Study Results

INTRODUCTION AND OBJECTIVES Atrial fibrillation 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 estimate the prevalence of atrial fibrillation in Spain. METHODS A cross-sectional study was conducted in the general Spanish population older than 40 years. Two-stage random sampling was used, in which first-stage units were primary care physicians randomly selected in every Spanish province and second-stage units were 20 randomly selected persons drawn from each participating physicians assigned population. The reported prevalence was standardized for the age and sex distribution of the Spanish population. The electrocardiogram recordings were read centrally. RESULTS Overall, 8343 individuals were evaluated. The mean age was 59.2 years (95% confidence interval, 58.6-59.8 years), and 52.4% of the participants were female. The overall age-adjusted prevalence of atrial fibrillation was 4.4% (95% confidence interval, 3.8-5.1). Prevalence was similar in both sexes, men 4.4% (3.6-5.2) and women 4.5% (3.6-5.3), rising with increasing age older than 60 years. In patients older than 80 years, the prevalence was 17.7% (14.1-21.3). In 10% of patients an unknown atrial fibrillation was diagnosed. CONCLUSIONS The prevalence of atrial fibrillation in the general Spanish population older than 40 years is high, at 4.4%. The prevalence is similar in both sexes and rises steeply above 60 years of age. It is estimated that there are over 1 million patients with atrial fibrillation in the Spanish population, of whom over 90,000 are undiagnosed.

Evolución de las hospitalizaciones por insuficiencia cardíaca en Andalucía en la última década

Resumen Fundamento y objetivos Las hospitalizaciones ocasionan la mayor parte del gasto sanitario por insuficiencia cardiaca. Nuestro objetivo es analizar las tendencias de estas hospitalizaciones en Andalucia en el periodo 1990-2000. Material y metodo Los datos sobre hospitalizaciones en Andalucia (rubrica 428 de la novena revision de la Clasificacion Internacional de Enfermedades) se tomaron de la Encuesta Nacional de Morbilidad Hospitalaria del Instituto Nacional de Estadistica. Mediante el metodo de estandarizacion directa se calcularon las tasas, estandarizadas por edad y sexo, de ingreso por insuficiencia cardiaca. Resultados El numero absoluto de hospitalizaciones por insuficiencia cardiaca en mayores de 45 anos paso de 4.345 en 1990 a 10.153 en el ano 2000, lo que representa un crecimiento relativo de un 230% y correspondio al 14,2% de los ingresos en Espana en el ano 2000. El aumento se centro en mayores de 65 anos y las tasas estandarizadas fueron ligeramente superiores en mujeres que en hombres. Conclusiones El numero de hospitalizaciones por insuficiencia cardiaca en Andalucia en la decada de los noventa crecio de forma importante, y esto se produjo fundamentalmente en mayores de 65 anos, tanto en mujeres como en hombres.Background and objectives The cost of hospitalization represents the greatest proportion of total expenditure due to heart failure. Our objective was to analyze the trends of morbidity of chronic heart failure in Andalusia between 1990-2000.

Mortalidad por insuficiencia cardíaca en España: ¿existe una paradoja andaluza?

La mortalidad actual por insuficiencia cardiaca es alta como demuestran los resultados de los ensayos clinicos y estudios observacionales. Andalucia constituye uno de los paradigmas de la cultura mediterranea; sin embargo, presenta una prevalencia de enfermedad coronaria y una tasa ajustada de mortalidad por insuficiencia cardiaca mayor que otras Comunidades de Espana. Asi, la tasa de mortalidad por insuficiencia cardiaca en Espana en el ano 2000 por 100.000 habitantes fue de 27,3 en hombres y 28,88 en mujeres, mientras que Andalucia presento una tasa media de 38,19 en hombres y 41,13 en mujeres, y cada una de las 8 provincias andaluzas presentaron mayores tasas que la media nacional, tanto en hombres como en mujeres. Por tanto, incluso en paises con baja prevalencia de enfermedad coronaria como Espana la mortalidad por insuficiencia cardiaca es mayor en las Comunidades como Andalucia, con tasas mayores de enfermedad coronaria.

Proyecto de estudio sobre la situación de la enfermedad cardiovascular de la mujer en España: conclusiones y recomendaciones finales

En este articulo se presentan las conclusiones y las recomendaciones finales del estudio sobre la enfermedad cardiovascular de la mujer en Espana, realizado por la Sociedad Espanola de Cardiologia. Hay diferencias notables entre mujeres y varones respecto a las caracteristicas clinicas, el perfil de riesgo, la realizacion de pruebas diagnosticas, las medidas terapeuticas y el pronostico en la mayor parte de las enfermedades estudiadas, sobre todo en el sindrome coronario agudo, la insuficiencia cardiaca y la hipertension arterial. Las diferencias en el manejo diagnostico y terapeutico son, en general, desfavorables para las mujeres. No existe informacion adecuada respecto a la fibrilacion auricular y las enfermedades valvulares, por lo que es preciso realizar estudios especificos de estas afecciones. Son necesarias campanas de informacion y educacion para concienciar tanto a la sociedad en general como a los profesionales sanitarios sobre estas desigualdades, asi como adoptar medidas que contribuyan a mejorar la atencion de las enfermedades cardiovasculares en las mujeres.

Influencia de la angina en la semana previa al primer infarto agudo de miocardio sobre su pronóstico intrahospitalario y a medio plazo

Introduccion y objetivos Existe controversia sobre elefecto de la angina de reciente comienzo en el pronosticode los pacientes que presentan un infarto agudo de miocardio.El objetivo de este estudio fue determinar si estaangina confiere proteccion respecto a las complicacionesintrahospitalarias y en el seguimiento a medio plazo enpacientes con un primer infarto agudo de miocardio Pacientes y metodo Estudiamos a un total de 290 pacientesconsecutivos ingresados con un primer infarto,107 con angina de reciente comienzo en la semana previay 183 sin ella, excluyendo a aquellos con antecedentesde cardiopatia isquemica de mas de una semana deevolucion o cardiopatia estructural de base. Estudiamossu pronostico intrahospitalario y en el seguimiento a medioplazo (muerte e insuficiencia cardiaca) Resultados Los pacientes con angina de reciente comienzoprevio al infarto presentaron un menor numerode muertes (3,7 frente a 11,5%), insuficiencia cardiaca(4,6 frente a 15,8%) y su combinacion (7,5 frente a21,3%) (p = 0,002). Esta asociacion se confirma en el seguimiento(4,1 frente a 13,2%; p = 0,03). En el analisismultivariado, la angina de reciente comienzo preinfartoconstituia un factor predictor de presentar un menor numerode muertes y de desarrollar insuficiencia cardiacaen la fase hospitalaria y en el seguimiento Conclusiones La presencia de angina de reciente comienzoprevia al primer infarto agudo de miocardio seasocia a una disminucion del numero de pacientes quemueren o presentan insuficiencia cardiaca, tanto en lafase hospitalaria como en el seguimiento a medio plazo

Type 2 diabetes is associated with decreased PGC1α expression in epicardial adipose tissue of patients with coronary artery disease

BackgroundAlthough recent studies indicate that epicardial adipose tissue expresses brown fat-like genes, such as PGC1α, UCP1 and PRDM16, the association of these genes with type 2 diabetes mellitus (DM2) in coronary artery disease (CAD) remains unknown.MethodsPGC1α, UCP1, and PRDM16 mRNAs expression levels were measured by real-time PCR in epicardial and thoracic subcutaneous adipose tissue from 44 CAD patients (22 with DM2 [CAD-DM2] and 22 without DM2 [CAD-NDM2]) and 23 non-CAD patients (NCAD).ResultsThe CAD-DM2 patients had significantly lower PGC1α and UCP1 expression in epicardial adipose tissue than the CAD-NDM2 and NCAD patients. However, PGC1α and UCP1 mRNA trended upward in subcutaneous adipose tissue from CAD-DM2 patients. At multiple regression analysis, age, body mass index, left ventricular ejection fraction, UCP1 expression of epicardial adipose tissue and diabetes came out to be independent predictors of PGC1α levels. Epicardial adipose tissue PGC1α expression was dependent on the number of injured coronary arteries and logistic regression analysis showed that PGC1α expression in epicardial adipose tissue could exert a protective effect against coronary lesions.ConclusionsDM2 is associated with decreased expression of PGC1α and UCP1 mRNA in epicardial adipose tissue of patients with CAD, likely reflecting a loss of brown-like fat features. Decreased expression of PGC1α in human epicardial adipose tissue is associated with higher prevalence of coronary lesions.

Diseño general del proyecto de estudio sobre la situación de la enfermedad cardiovascular de la mujer en España

Las enfermedades cardiovasculares son la causa principal de mortalidad de varones y mujeres en los paises de nuestro entorno. Sin embargo, el riesgo de la enfermedad cardiovascular en la mujer se subestima frecuentemente, debido a la percepcion de que las mujeres estan «protegidas» contra la cardiopatia isquemica. Ademas, las manifestaciones clinicas de la enfermedad coronaria en las mujeres pueden ser distintas de las observadas en los varones. Estos factores pueden llevar a una peor atencion a las mujeres que sufren enfermedades cardiovasculares, no solo cardiopatia isquemica, y a un peor pronostico. En este articulo se discuten algunos aspectos relacionados con las diferencias en los factores de riesgo cardiovascular, las caracteristicas clinicas, el tratamiento y el pronostico relacionados con el sexo, y se detalla la metodologia general del proyecto de estudio sobre la situacion en Espana de la enfermedad cardiovascular en la mujer.

Frequency of different electrocardiographic abnormalities in a large cohort of Spanish workers

Aims Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. Methods and results Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16-74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study. All tracings were classified by the same cardiologist, according to the Minnesota Code criteria. The mean age of the sample was 40 years, and 73.4% were male. Frequencies of complete right bundle branch block, complete left bundle branch block, and left ventricular hypertrophy were 1.1, 0.2, and 3.6%, respectively. Major Q wave abnormalities were observed in 1.7% of the subjects, T wave abnormalities in 0.7%, early repolarization in 2.4%, and other ST segment abnormalities in 0.2%. Atrial fibrillation was present in 0.08% of the workers and atrial flutter in 0.02%. Frequencies of the Wolff-Parkinson-White pattern, Brugada pattern, long QT pattern, and short QT pattern were 0.2, 0.068, 0.038, and 0.015%, respectively. Conclusion This study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low.

New data about atrial fibrillation, comment to the OFRECE study: response

1which provides us with an opportunity to present some interesting additional information not included in the article itself. We agree on the importance of knowing the thromboembolic risk of the population included in the OFRECE study, both for patients with a diagnosis of atrial fibrillation and for the general population. In our study, the mean (standard deviation) CHADS2 and CHAD2DS2-VASc of patients with atrial fibrillation was 2.3 (1.3) and 3.8 (1.6), respectively. In the general population, the mean (standard deviation) CHADS2 and CHAD2DS2-VASc of patients with atrial fibrillation was 0.8 (1) and 1.8 (1.5), respectively. The distribution of both scales is in agreement with that of the Val-FAAP and AFABE studies, 2, 3 although the similarity is greater in the 2 population-based studies (Figure). These data are, we believe, relevant because they show that the level of risk in the population with atrial fibrillation is very similar to that of the populations included in clinical trials with new oral anticoagulants. In addition, an increasing body of evidence suggests that thromboembolic risk, as measured with these scales in the population without a diagnosis of atrial fibrillation, is associated with the onset of events. 4 Figure. Prevalences by thromboembolic risk scales in the OFRECE, AFABE, and Val-FAAP studies.

Significant mitral regurgitation worsens the prognosis and favors the decision of conservative treatment in octogenarians with severe symptomatic aortic stenosis

INTRODUCTION The coexistence of significant mitral regurgitation (MR) and severe aortic stenosis is prevalent, has a prognostic impact and makes treatment in the elderly population a complex issue. The aim of this study is to determine the prevalence of significant MR among a population of octogenarians and its influence on treatment and prognosis. METHODS We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario), a prospective registry that consecutively included 928 patients aged ≥80 years with severe symptomatic aortic stenosis. RESULTS The prevalence of significant MR was 8.5% (79 patients) and independently associated with the decision to treat conservatively (odds ratio = 2.28, 95% confidence interval: 1.31-3.95, p = 0.003). The group of patients with significant MR had higher overall mortality at 12 months follow-up (51.9% vs 25%, p < 0.001), which remained on division into subgroups based on the presence of comorbidities (Charlson<5: 49.2% vs 21.9%, p < 0.001; and Charlson ≥5: 62.5% vs 41.7%, p = 0.07). Within the group of patients in whom conservative treatment was performed, those with significant MR had higher mortality at one year (62.7% vs 35%, p < 0.001). MR was a significant independent predictor of overall mortality at 12-month follow-up (hazard ratio = 1.87, 95% confidence interval: 1.09-3.18, p = 0.022). CONCLUSIONS Significant MR has a high prevalence and worsens the prognosis of octogenarian patients with severe symptomatic aortic stenosis, especially in patients with conservative treatment, independently of the existence of comorbidities.