Luis García Ortiz

Mortalidad a largo plazo y reingreso hospitalario tras infarto agudo de miocardio: un estudio de seguimiento de ocho años

INTRODUCTION AND OBJECTIVES Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. METHODS This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. RESULTS Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. CONCLUSIONS Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.

Eficacia de una intervención educativa grupal sobre cambios en los estilos de vida en hipertensos en atención primaria: un ensayo clínico aleatorio

Fundamentos: Los estilos de vida saludables se relacionan con un menor riesgo de enfermedades cardiovasculares. El objetivo del estudio es evaluar la eficacia de una estrategia educativa grupal en la modificacion de estilos de vida, control de factores de riesgo y riesgo cardiovascular (RCV) en personas hipertensas. Metodo: Ensayo clinico aleatorio en Atencion Primaria. Se seleccionaron por muestreo aleatorio 101 personas hipertensas de 35 a 74 anos, randomizando 51 al grupo de intervencion (GI)(64,5±9,7 anos, 56% mujeres) y 50 al control (GC) (65,4±8,4 anos, 68% mujeres). Se realizo una evaluacion basal, una intervencion educativa grupal sobre cambios de estilos de vida (seis sesiones durante un ano) y una evaluacion final. El efecto de la intervencion se evaluo con RCV (Framingham), presion arterial(PA), perfil lipidico, perimetro de cintura, indice de masa corporal(IMC), consumo de nutrientes con encuesta validada, ejercicio fisico con 7-PAR Day y calidad de vida con SF-36. Resultados: PA basal 136,8/82,7 mmHg en GI y 139,3/79,3 mmHg y en GC, RCV:11,1% (GI) y 12,3% (GC). La PA sistolica descendio 5,6±19,6 mmHg (p=0,07) en GI, y 7,1±16, mmHg (p=0,004) en GC, la diastolica 3,9±10,8 (p=0,02), y 2,7±11, mmHg (p=0,10) respectivamente. El IMC descendio 0,3±1,6 puntos en GI(p=0,17), y aumento 0,1±1,5 en GC(p=0,81). El RCV descendio 0,8±6,5 puntos en GI y aumento 0,2±6,8 en GC, el efecto de la intervencion fue un descenso de 1 punto (IC95%:-3,9-1,9) (p=0,48). La ingesta disminuyo en GI: 42,8±1141,2 Kcal/dia(p=0,14), y en GC: 278,9±1115,9 (p=0,62). El ejercicio (mets/hora/semana) aumento en ambos, 3,6±19 en GI(p=0,20) y 3,9±14,9 en GC(p=0,07). Conclusion: Encontramos mayor descenso del riesgo cardiovascular en el grupo de intervencion, sin existir diferencias estadisticamente significativas en los parametros evaluados entre ambos grupos.

Permanencia del efecto de una intervención de mejora de calidad en el seguimiento prolongado de pacientes hipertensos (CICLO-RISK STUDY)

OBJECTIVE To evaluate the durability of the effects achieved with a quality improvement intervention on cardiovascular risk factors and cardiovascular risk, as intermediate outcomes, in hypertensive patients on long-term follow-up long time primary health care. DESIGN Quasi-experimental study. SETTING Two urban primary care health centres. PARTICIPANTS The study included 419 and 430 hypertensive patients in the intervention (IG) and control group (CG), respectively. INTERVENTIONS Quality improvement intervention consisted of a combined program including, an audit, feedback, training sessions on the main cardiovascular risk factors clinical guidelines. MEASUREMENTS Evaluation of intermediate outcomes (blood pressure, LDL-cholesterol, HbA(1c), smoking, BMI and cardiovascular risk), were measured in both groups in March 2002, 2004 and 2006. RESULTS The mean of the durability effect (differences between IG and CG means) was: systolic blood pressure decreased from 8.9 to 4.3 and the diastolic from 3.9 to 2.3 mmHg (p<0.05). LDL-cholesterol decreased from 10 to 1.1mg/dl (p>0.05). Coronary risk fell from 2 to 1.2 percentage points and cardiovascular mortality risk from 0.6 to 0.4 percentage points (p<0.05). The percentage of patients with blood pressure<140/90 mmHg and BMI<30 lost statistical significance in the end evaluation and only remains in the percentage of patients with coronary risk less than 20% in the 2004 and 2006 results. CONCLUSIONS Quality improvement intervention was associated with reductions in cardiovascular risk factors and cardiovascular risk in post intervention evaluations with a tendency to decrease the effect achieved in the end evaluation.

Effectiveness of a quality improvement intervention in reducing cardiovascular risk in hypertensive patients

Introduction and objectives. To evaluate the effect of a quality improvement intervention on the reduction of cardiovascular risk in patients with hypertension. Patients and method. Quasi-experimental study involving two primary care centres. One centre was assigned to implement a quality improvement intervention (n = 482 patients), while at the other center «usual care» procedures were followed (control group, n = 360 patients). The quality improvement intervention consisted of a combined program designed for the medical staff and comprising audit, feedback, training sessions and implementation of clinical practice guidelines during 6 months. The main outcome measures were blood pressure, lipid levels, diabetes, smoking and cardiovascular risk. These values were compared before the intervention and after one year. Results. The baseline characteristics of the patients were similar in both groups. Absolute cardiovascular risk decreased from 15.85% to 14.36% (P 20% at 10 years) decreased in the intervention group from 30% to 25%, and increased in the control group from 28% to 30%. Relative cardiovascular risk decreased from 2.03 to 1.75 (P .05) in the control group. The intervention thus led to a 0.25 decrease in relative risk (95%CI: 0.14-0.35). Conclusions. Absolute and relative cardiovascular risk in patients with hypertension was reduced by a quality improvement intervention. The percentage of patients with high cardiovascular risk was also reduced.

Comments on the 2016 ESC/EAS Guidelines for the Management of Dyslipidemias☆

In the present article, we discuss the recently published guidelines for the treatment of dyslipidemia developed by the European Society of Cardiology (ESC) in conjunction with the European Atherosclerosis Society and with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation.1 To comment on these guidelines, the Guidelines Committee formed a task force composed of members of the Spanish Society of Cardiology (SEC). Thus, following the same order as the guidelines, the current article reviews the most important aspects of the various sections.

Diet and physical activity in people with intermediate cardiovascular risk and their relationship with the health-related quality of life: results from the MARK study

BackgroundTo analyze the interplay between diet, physical activity and health-related quality of life in a Spanish randomly selected sample of individuals attended in general practitioners offices with intermediate cardiovascular risk.MethodsThis study analyzed 314 subjects, aged 35–74 years (50.6% women), from the MARK study, conducted in Spain. Health related quality of life was measured by the SF-12 questionnaire. The assessment of the lifestyles included the diet quality index, the adherence to the Mediterranean diet and the leisure time physical activity practice.ResultsThe highest values of health related quality of life were obtained in the area of vitality (51.05 ± 11.13), while the lowest were found in the general health (39.89 ± 8.85). In the multiple linear regression analysis, after adjustment for age, gender and other confounders, for each point of increase in the Mediterranean diet adherence score, there was an increase of 1.177 points in the mental component value (p < 0.01). Similarly, for each point of increase in the Diet Quality Index Score, there was an increase in the mental component of 0.553 (p < 0.05). Likewise, the physical activity was positively associated with the physical function and vitality (β = 0.090 and 0.087, (p < 0.01 and p < 0.05), respectively).ConclusionsIn people with intermediate cardiovascular risk, better food habits and greater adherence to the Mediterranean diet are associated with higher scores on the mental component of quality of life. Likewise, increased physical activity is related with positive scores on the physical function.