Núria Soriano

Validación de la versión española del Minnesota Living with Heart Failure Questionnaire

Introduccion y objetivos El Minnesota Living with Heart Failure Questionnaire (MLHFQ) es el instrumento mas utilizado para la evaluacion de la calidad de vida en pacientes con insuficiencia cardiaca. Contiene 21 items y dos dimensiones: fisica y emocional. El objetivo de este estudio es evaluar las propiedades metricas de la version espanola del MLHFQ. Metodos Se aplico, 1 y 2 meses despues del alta, el MLHFQ y el SF-36 a 677 pacientes ingresados por insuficiencia cardiaca. A partir de la clasificacion NYHA y otras 3 variables de capacidad funcional, se definio a los pacientes como estables (n = 245) o con cambio (n = 103). De la fiabilidad, se estudio: la consistencia interna (alfa de Cronbach) y la reproducibilidad (coeficiente de correlacion intraclase [CCI]). La validez se estudio con las puntuaciones segun la clase funcional y las correlaciones con las dimensiones del SF-36. La sensibilidad al cambio se evaluo por el tamano del efecto. Resultados El alfa de Cronbach fue ≥0,8 en las tres puntuaciones, y el CCI tambien fue elevado (0,74-0,83). Las puntuaciones del MLHFQ mostraron diferencias segun la clase funcional (p Conclusiones La version espanola del MLHFQ ha mostrado unas adecuadas propiedades metricas, igual que la original. Estos resultados respaldan el uso del MLHFQ en pacientes espanoles con insuficiencia cardiaca, aunque seria recomendable reevaluar su sensibilidad al cambio.

Características basales y determinantes de la evolución en pacientes ingresados por insuficiencia cardíaca en un hospital general

Introduccion y objetivos Analizar las caracteristicas basales, los patrones de manejo y los resultados clinicos a los 18 meses del ingreso en pacientes diagnosticados de insuficiencia cardiaca en un hospital terciario de Cataluna. Metodos Se identificaron y analizaron las historias clinicas de los 256 pacientes ingresados en el Hospital General Vall d’Hebron desde julio a diciembre de 1998, diagnosticados de insuficiencia cardiaca y que cumplieran los criterios del estudio. Se entrevisto a los pacientes telefonicamente 18 meses despues. Resultados La edad media de los pacientes era de 75 ± 12 anos, el 42% correspondia a varones, el 19% habia ingresado por enfermedades distintas de la insuficiencia cardiaca y el 62% tenia comorbilidad significativa. Se estudio la funcion ventricular en el 68% (basicamente en pacientes con mejor pronostico), y se considero normal en un 41%. Se administraron inhibidores de la enzima conversiva o antagonistas de la angiotensina II en un 54% y bloqueadores beta en un 4%. La mortalidad a los 18 meses fue del 46%, siendo de causa cardiaca en el 77% de estos. Los predictores independientes de mortalidad fueron la edad avanzada, la insuficiencia cardiaca grave o antigua y la comorbilidad. A los 18 meses, un 69% de los supervivientes se hallaba en clase funcional I o II. Conclusiones 1) Al igual que sucede en otras areas geograficas, los pacientes de este estudio constituyen, como media, una poblacion anciana y con pobre supervivencia; 2) los patrones de manejo registrados son claramente mejorables; 3) la comorbilidad afecta significativamente al pronostico, y 4) la calidad de vida despues del alta es aceptable en una llamativa proporcion de supervivientes.

Patient Registries of Acute Coronary Syndrome Assessing or Biasing the Clinical Real World Data

Background—The risk of selection bias in registries and its consequences are relatively unexplored. We sought to assess selection bias in a recent registry about acute coronary syndrome and to explore the way of conducting and reporting patient registries of acute coronary syndrome. Methods and Results—We analyzed data from patients of a national acute coronary syndrome registry undergoing an audit about the comprehensiveness of the recruitment/inclusion. Patients initially included by hospital investigators (n=3265) were compared to eligible nonincluded (missed) patients (n=1439). We assessed, for 25 exposure variables, the deviation of the in-hospital mortality relative risks calculated in the initial sample from the actual relative risks. Missed patients were of higher risk and received less recommended therapies than the included patients. In-hospital mortality was almost 3 times higher in the missed population (9.34% [95% CI, 7.84 to 10.85] versus 3.9% [95% CI, 2.89 to 4.92]). Initial relative risks diverged from the actual relative risks more than expected by chance (P<0.05) in 21 variables, being higher than 10% in 17 variables. This deviation persisted on a smaller degree on multivariable analysis. Additionally, we reviewed a sample of 129 patient registries focused on acute coronary syndrome published in thirteen journals, collecting information on good registry performance items. Only in 38 (29.4%) and 48 (37.2%) registries was any audit of recruitment/inclusion and data abstraction, respectively, mentioned. Only 4 (3.1%) authors acknowledged potential selection bias because of incomplete recruitment. Conclusions—Irregular inclusion can introduce substantial systematic bias in registries. This problem has not been explicitly addressed in a substantial number of them.

Determinantes del control de la presión arterial y los lípidos en pacientes con enfermedad cardiovascular (estudio PREseAP)

Estudio observacional para identificar los determinantes del control de la presion arterial ( El 70,2% eran varones con una media de edad de 66,4 anos. El 50,9% (intervalo de confianza [IC] del 95%, 46,9%–54,8%) mostro mal control de la presion arterial y el 60,1% (IC del 95%, 56,3%–63,9%), del cLDL. Determinantes de mal control de la presion arterial fueron: diabetes, hipertension arterial, no tener diagnostico previo de insuficiencia cardiaca, diagnostico de enfermedad arterial periferica o ictus, obeso y no recibir tratamiento hipolipemiante. Determinantes de mal control del cLDL fueron: no recibir tratamiento hipolipemiante, no tener diagnostico de cardiopatia isquemica, no recibir tratamiento antihipertensivo y dislipemia. Los determinantes de mal control de presion arterial difieren de los del cLDL, resultado que considerar al aplicar las recomendaciones para alcanzar los objetivos terapeuticos en prevencion secundaria.

Validation of the Spanish Version of the Minnesota Living With Heart Failure Questionnaire

INTRODUCTION AND OBJECTIVES The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most commonly used instrument for evaluating quality of life in patients with heart failure. It comprises 21 items and two dimensions: the physical and the emotional. The aim of this study was to assess the psychometric properties of the Spanish version of the MLHFQ. METHODS The MLHFQ and the 36-item short form (SF-36) questionnaire were administered one and two months after discharge to 677 patients who had been hospitalized for heart failure. Patients were classified as either stable (n=245) or unstable (n=103) on the basis of New York Heart Association (NYHA) functional class and three other functional capacity variables. Reliability was evaluated using measures of internal consistency (Cronbachs alpha) and reproducibility (the intraclass correlation coefficient [ICC]). Validity was assessed by looking at the scores by NYHA class, and at correlations between scores on MLHFQ and SF-36 dimensions. Responsiveness to change was evaluated using the effect size. RESULTS Cronbachs alpha was > OR =0.8 for the three MLHFQ scores, and the ICC was also large (0.74-0.83). In addition, MLHFQ scores varied significantly with functional class (P< .001), and there were intermediate-to-high correlations with the assumed corresponding SF-36 dimensions (0.74-0.52). The observed effect sizes were small or intermediate (0.09-0.44). CONCLUSIONS The Spanish version of the MLHFQ demonstrated adequate metric properties, comparable to the original. These results support the use of the MLHFQ in Spanish heart failure patients, although it would be advisable to re-evaluate its responsiveness to change.

Ensayo clínico aleatorizado para evaluar la eficacia de un programa integral de prevención secundaria de las enfermedades cardiovasculares en atención primaria: estudio PREseAP

INTRODUCTION AND OBJECTIVES To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice. METHODS A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. RESULTS In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5-34.8%) in the intervention group and 25.6% (22.3-29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3-11.3%) in the intervention group and 11% (7.4-16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97-101.91 cm) and 102.58 cm (95% CI, 100.96-104.21 cm), respectively (P=.07). Overall, 20.9% (15.6-27.7%) of patients in the intervention group and 29.6% (23.9-36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4-37.9%) in the intervention group and 41.4% (35.8-47.3%) in the control group had depression (P=.02). CONCLUSIONS A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced.

Evolución de la calidad de vida relacionada con la salud en pacientes ingresados por insuficiencia cardiaca. Estudio IC-QoL

Introduccion y objetivos. La insuficiencia cardiaca conlleva un mal pronostico tanto en la supervivencia como en el estado sintomatico. El objetivo de este estudio es evaluar en una poblacion heterogenea de pacientes con insuficiencia cardiaca los patrones de evolucion de la calidad de vida relacionada con la salud (CVRS), especialmente en subgrupos de interes clinico, asi como los determinantes de la mortalidad. Metodos. Estudio prospectivo de 1 ano de seguimiento con seis evaluaciones de la CVRS mediante un cuestionario generico (SF-36) y un cuestionario especifico (MLHFQ) a 883 pacientes dados de alta del hospital por insuficiencia cardiaca de 50 hospitales del territorio espanol. Resultados. Se observo una importante alteracion inicial de todas las dimensiones y de los componentes sumario fisico (CSF) (media, 34,1) y mental (CSM) (media, 40,1), del SF-36 y del MLHFQ (media, 37,5), y una clara mejora en el primer mes, que se mantuvo estable posteriormente, excepto en los menores de 40 anos, que mostraron una mejora progresiva de la CVRS. Se identificaron como predictores de mortalidad la edad, el grado funcional, la comorbilidad y los valores iniciales de CVRS. Conclusiones. La evolucion de la CVRS de los pacientes con insuficiencia cardiaca mejora durante el primer mes tras el alta hospitalaria, pero despues se mantiene estable, excepto en los pacientes mas jovenes, en los que se observa una mejora persistente

Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012

OBJECTIVES The Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP. METHODS We performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program. RESULTS The distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians. CONCLUSIONS The PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly.

Factors Affecting the Control of Blood Pressure and Lipid Levels in Patients With Cardiovascular Disease: The PREseAP Study

The aim of this observational study was to identify factors influencing the control of blood pressure (i.e., <140/90 mmHg, or <130/80 mmHg in diabetic patients) and low-density lipoprotein (LDL) cholesterol level (<100 mg/dL) in 1223 patients with cardiovascular disease. Overall, 70.2% of patients were men, and their mean age was 66.4 years. Blood pressure was poorly controlled in 50.9% (95% confidence interval [CI], 46.9%-54.8%) and the LDL cholesterol level was poorly controlled in 60.1% (95% CI, 56.3%-63.9%). Determinants of poor blood pressure control were diabetes, hypertension, no previous diagnosis of heart failure, previous diagnosis of peripheral artery disease or stroke, obesity, and no lipid-lowering treatment. Determinants of poor LDL cholesterol control were no lipid-lowering treatment, no previous diagnosis of ischemic heart disease, no antihypertensive treatment, and dyslipidemia. The factors affecting blood pressure control were different from those affecting LDL cholesterol control, an observation that should be taken into account when implementing treatment recommendations for achieving therapeutic objectives in secondary prevention.

Improvements in Health-Related Quality of Life of Patients Admitted for Heart Failure. The HF-QoL Study

INTRODUCTION AND OBJECTIVES Heart failure (HF) is associated with a poor prognosis, both in terms of survival and ongoing symptoms. The objectives of this study were to investigate trends in the health-related quality of life (HRQoL) of a heterogeneous group of HF patients, with a focus on subgroups of particular clinical interest, and to identify determinants of mortality. METHODS Prospective study of 883 HF patients discharged from 50 Spanish hospitals and followed for 1 year, during which six HRQoL assessments were carried out using the generic Short Form-36 (SF-36) questionnaire and the specific Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS A marked change was noted at the beginning of the study on all dimensions of the SF-36, in its physical (mean 34.1) and mental (mean 40.1) component summary scores, and in the MLHFQ score (mean 37.5). There was a clear improvement in the first month, which subsequently remained unchanged, except in younger patients aged under 40 years whose HRQoL continued to improve progressively. The following predictors of mortality were identified: age, functional class, co-morbidity and baseline HRQoL. CONCLUSIONS In patients with HF, HRQoL showed a clear improvement during the first month after hospital discharge but subsequently remained unchanged, except in younger patients, whose HRQoL continued to improve progressively.