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Pedro-Botet J, Freixa R, Tamarit JJ, López-Miranda J, Fernández-Olmo R, Muñiz-Grijalvo O, Vázquez-García R, Guijarro C, Rodríguez-Padial L, Díaz-Díaz JL, Bravo-Amaro M, Hernández JL, Alarcón-Duque JA, Martin-Armas JA, García-López M, Cosín-Sales J. Strategies to improve cardiovascular health and treatment of dyslipidemia in Spain. Expert Insights Project. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(24)00087-1. [PMID: 39304407 DOI: 10.1016/j.arteri.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/06/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES To gather opinions, recommendations, and proposals for improvement from Spanish clinicians on cardiovascular (CV) health, with particular focus on dyslipidemia management. METHODS The Expert Insights project involved 8face-to-face sessions held throughout Spain, attended by 138 CV health experts. Clinicians answered to 25 questions survey related to CV health and dyslipidemia control. Each session included an analysis and a discussion on the perceived realities and areas for improvement. RESULTS 72% of centers have a standardized process for monitoring patients after a CV episode at discharge, but only 37% during their clinical follow-up. Patient care and management are dependent on the physician, with a lack of coordination between hospital specialties and primary care (PC). 95% of clinicians believe it is necessary to standarize treatment optimization. 65% of centers prescribe combined lipid-lowering treatment after a CV episode. Updating cLDL levels in the Therapeutic Positioning Report and standardizing and globalizing the prescription document would reduce iPCSK9 prescription barriers and lead to more equitable access. CONCLUSIONS In Spain, there are significant deficiencies in the management of dyslipidemia, with a great need for a consensus on standardizing management processes and optimizing patient treatment. The opinions, recommendations, and improvement proposals from Spanish clinicians on CV health are an important starting point to improve the situation.
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Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Román Freixa
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - Juan José Tamarit
- Servicio de Medicina Interna, Unidad de lípidos y riesgo cardiovascular, Hospital General Universitario de Valencia, Valencia, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | | | - Ovidio Muñiz-Grijalvo
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - Rafael Vázquez-García
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Grupo de investigación EM1 GADICOR, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Luis Rodríguez-Padial
- Unidad de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - José Luis Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Marisol Bravo-Amaro
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, España
| | - José Luís Hernández
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla-IDIVAL, Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España
| | - José Antonio Alarcón-Duque
- Unidad Rehabilitación Cardíaca/Prevención Secundaria, Hospital Universitario Donostia, Donostia, Guipuzkoa, España
| | - José Alfredo Martin-Armas
- Unidad de Lípidos y Riesgo Vascular, Hospital Universitario de Gran Canaria Dr. Negrín, Servicio de Medicina Interna, Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Martín García-López
- Servicio de Cardiología, Hospital Doctor José Molina Orosa, Las Palmas de Gran Canaria, Las Palmas, España
| | - Juan Cosín-Sales
- Servicio de Cardiología Hospital Arnau de Vilanova, Valencia, España; Facultad de Medicina, Departamento de Medicina y Cirugía, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, España.
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Raposeiras-Roubín S, Abu-Assi E, Pérez Rivera JÁ, Jorge Pérez P, Ayesta López A, Viana Tejedor A, Corbí Pascual MJ, Carrasquer A, Jiménez Méndez C, González Cambeiro C, Uribarri González A, Bonanad Lozano C, Marcos Mangas M, Merino-Merino A, Sánchez-Corral E, Santos-Sánchez I, Aguilar-Iglesias L, Alen A, Rozado Castaño J, Mínguez de la Guía E, López Vázquez M, Salmerón Martínez FM, Avivar Sáez Y, Villar Ruiz A, Panera de la Mano JA, García García MT, Pérez-Asensio A, Bompart D, Zaharia G, Ariza-Solé A. Efficacy and safety of bempedoic acid in acute coronary syndrome. Design of the clinical trial ES-BempeDACS. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00236-6. [PMID: 39059729 DOI: 10.1016/j.rec.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/08/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION AND OBJECTIVES Only about 1 out of every 3 patients with acute myocardial infarction (AMI) achieve low-density lipoprotein cholesterol (LDL-C) values <55mg/dL in the first year. The present study aims to evaluate the impact of early intensive therapy on lipid control after an AMI. METHODS An independent, prospective, pragmatic, controlled, randomized, open-label, evaluator-blinded clinical trial (PROBE design) will analyze the efficacy and safety of an oral lipid-lowering triple therapy: high-potency statin+bempedoic acid (BA) 180mg+ezetimibe (EZ) 10mg versus current European-based guidelines (high-potency statin±EZ 10mg), in AMI patients. LDL-C will be determined within the first 48hours. Patients with LDL-C ≥ 115mg/dL (without previous statin therapy), ≥ 100mg/dL (with previous low-potency or high-potency statin therapy at submaximal dose), or ≥ 70mg/dL (with previous high-potency statin therapy at high dose) will be randomly assigned 1:1 between 24 and 72hours post-AMI to the BA/EZ combination or to statin±EZ, without BA. The primary endpoint is the proportion of patients reaching LDL-C <55mg/dL at 8 weeks after treatment. RESULTS The results of this study will provide novel information for post-AMI LDL-C control by evaluating the usefulness of an early intensive lipid-lowering strategy based on triple oral therapy. CONCLUSIONS Early intensive lipid-lowering triple oral therapy vs the treatment recommended by current clinical practice guidelines could facilitate the achievement of optimal LDL-C levels in the first 2 months after AMI (a high-risk period). IDENTIFICATION NUMBER EudraCT 2021-006550-31.
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Affiliation(s)
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Pablo Jorge Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Ana Ayesta López
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | | | - Anna Carrasquer
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | | | | | | | - Marta Marcos Mangas
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Merino-Merino
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | | | - Alberto Alen
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Rozado Castaño
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | | | | | - Ylènia Avivar Sáez
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Alberto Villar Ruiz
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | - Ana Pérez-Asensio
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Daznia Bompart
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain
| | - Georgiana Zaharia
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Escobar C, Barrios V, Cequier A, Cosin-Sales J, Seijas J, Doblas JJG, Arrarte V, Tuñon J, Banach M. Impact of the Spanish consensus for improving lipid control on patients admitted for an acute coronary syndrome. J Clin Lipidol 2023; 17:756-764. [PMID: 37838521 DOI: 10.1016/j.jacl.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION In 2020, the Spanish Society of Cardiology published a consensus to improve lipid control in secondary prevention patients. This study was aimed to assess the impact of the implementation of this consensus in clinical practice. METHODS Non-interventional, national and multicenter study, with a prospective and retrospective design in two cohorts. Implementation of the consensus was performed on the prospective cohort. Prospective cohort included patients with acute coronary syndrome (ACS) from December 2020 to March 2022 and were followed-up for 3 months. Retrospective cohort included patients with ACS in the same hospital, matched for main baseline clinical characteristics, between August 2019 to February 2020, with a follow-up of 3 months. Additionally, patients were included if they had previously received lipid-lowering therapy and LDL cholesterol (LDL-C) was >55 mg/dL. RESULTS A total of 516 patients were included (245 in the prospective cohort and 271 in the retrospective cohort). Overall, mean age was 67.9 ± 11.4 years, 73.8 % were men, and 35.8 % had diabetes. At discharge, 98.4 % and 98.9 %, respectively (P = 0.71) were taking statins (90.6% vs 88.9 %; P = 0.564 high intensity statins), 58.4% vs 33.2 %; P<0.001 ezetimibe, 1.2% vs 0.4 %; P = 0.35 PCSK9 inhibitors. During the follow-up, the dose of statins was increased in 11.4% vs 3.3 % (P<0.001), and ezetimibe was added in 25.7% vs 25.8 % (P = 0.976). At study end, significantly more patients achieved LDL-C <55 mg/dL in the prospective cohort (45.6% vs 33.5 %; P = 0.013). CONCLUSIONS The implementation of the Spanish lipid consensus was associated with a significant improvement of LDL-C control after only 3 months.
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Affiliation(s)
| | | | - Angel Cequier
- University Hospital of Bellvitge, Barcelona, Spain (Dr Cequier)
| | - Juan Cosin-Sales
- Hospital Arnau de Vilanova, Cardiology, Valencia, Spain (Dr Cosin-Sales)
| | - Jose Seijas
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain (Dr Seijas)
| | | | | | - Jose Tuñon
- Fundacion Jimenez Diaz, Madrid, Spain (Dr Tuñon)
| | - Maciej Banach
- Polish Mother's Memorial Hospital Research institute (PMMHRI), Lodz, Poland (Dr Banach)
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Puche JE, Iturregui-Guevara M, Vázquez R. [Prognostic impact of cardiovascular risk factors in patients admitted for acute coronary syndrome]. HIPERTENSION Y RIESGO VASCULAR 2023; 40:110-118. [PMID: 36273980 DOI: 10.1016/j.hipert.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome. PATIENTS AND METHODS Epidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated. RESULTS The patients admitted for acute coronary syndrome were predominantly men, with body mass index>25Kg/m2, smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis. CONCLUSION There is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential.
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Affiliation(s)
- J E Puche
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, España; Servicio de Cardiología, Hospital Costa del Sol, Marbella, España.
| | - M Iturregui-Guevara
- Servicio de Endocrinología, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, España
| | - R Vázquez
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, España
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Fernández MS, Silva Melchor L, Martínez-Sellés M, Viana Tejedor A, Aguilar R, Lopez de Sa Areses E, Martín Asenjo R. Early approach to LDL-related risk after acute coronary syndrome: The OPTA Project. Expert Rev Cardiovasc Ther 2023:1-6. [PMID: 37144281 DOI: 10.1080/14779072.2023.2211266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients. AREAS COVERED The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids. EXPERT OPINION Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets "the lower, the better" and "the earlier, the better".
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Affiliation(s)
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda-Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rio Aguilar
- Department of Cardiology. Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain
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Barrios V, Escobar C. Which patients could benefit from the use of bempedoic acid in clinical practice? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:847-848. [PMID: 35662522 DOI: 10.1016/j.rec.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
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Seijas-Amigo J, Gayoso-Rey M, Mauriz-Montero MJ, Suarez-Artime P, Casas-Martinez A, Dominguez-Guerra M, Gonzalez-Freire L, Estany-Gestal A, Codero-Fort A, Rodriguez-Mañero M, Gonzalez-Juanatey JR. Impact of the COVID-19 pandemic in the lipid control of the patients that start PCSK9 inhibitors. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:245-252. [PMID: 35287972 PMCID: PMC8810305 DOI: 10.1016/j.arteri.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/30/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control; (2) descriptive analysis; (3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab; (4) communicate PCSK9i safety. MATERIAL AND METHODS It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time. RESULTS 89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148mg/dL and the follow-up value was 71mg/dL. The baseline value of patients treated with alirocumab (N=43) was 144mg/dL and 73mg/dL in the follow-up. With evolocumab (N=46) was 151mg/dL in basaline and 69mg/dL in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70mg/dL in six month time; 19.4% between 69mg/dl and 55mg/dL and 37.5% <55mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (N=2), myalgias (N=1), flu-like symptoms (N=1) and neurocognitive worsening (N=1). CONCLUSIONS (1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (<55mg/dL and/or reduction>50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (P=.972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed.
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Affiliation(s)
- Jose Seijas-Amigo
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España.
| | | | | | - Pedro Suarez-Artime
- Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | - María Dominguez-Guerra
- Servicio de Farmacia, Hospital Universitario de Ourense, Ourense, España h Servicio de Farmacia, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | | | - Ana Estany-Gestal
- FIDIS-Unidad de Epidemiología e Investigación Clínica, Santiago de Compostela, Santiago de Compostela, España
| | - Alberto Codero-Fort
- Hospital Universitario de San Juan de Alicante, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Moisés Rodriguez-Mañero
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Jose Ramón Gonzalez-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
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Impact of a virtual lipid clinic on lipid-lowering therapy, LDL cholesterol levels, and outcomes in patients with acute coronary syndrome. J Clin Lipidol 2022; 16:635-642. [DOI: 10.1016/j.jacl.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 01/05/2023]
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Barrios V, Escobar C. ¿Qué pacientes pueden beneficiarse del ácido bempedoico en la práctica clínica? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vázquez García R, Puche García JE, Mialdea Salmerón D, Bartolomé Mateos D, Delgado Nava W. Virtual lipid clinic after acute coronary syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:91-92. [PMID: 34417151 DOI: 10.1016/j.rec.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Rafael Vázquez García
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Juan Enrique Puche García
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Diego Mialdea Salmerón
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Daniel Bartolomé Mateos
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - William Delgado Nava
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
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Barrios V, Escobar C, Arrarte V, Bravo M, Del Campo A, Hidalgo R, Recasens L, Cequier Á. Analysis of the prescription process of PCSK9 inhibitors in the cardiology departments of Spanish hospitals and optimization proposal. The IKIGAI study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2021; 33:296-305. [PMID: 34315626 DOI: 10.1016/j.arteri.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
AIMS To ascertain the formalities and procedures required for the prescription of PCSK9 inhibitors in the cardiology departments of Spanish hospitals, making proposals for improvement to optimize the prescription process. METHODS A first phase of collecting information about the variables and administrative procedures required for the prescription of PCK9 inhibitors and the elaboration of a specific questionnaire and a second phase of collecting data with an online self-administered questionnaire. RESULTS A total of 88 hospitals participated in the study (mean number of beds 625; mean number of cardiologists 18 ± 10; 78% university hospitals). There was underuse of PCSK9 inhibitors (real prescription of 30 treatments/year; potential prescription of 80), mainly because of not fulfilling the therapeutic positioning report (52%) and application refusal (31%). Beyond the requirements of the therapeutic positioning report, 1.2 ± 0.4 applications are required with 8.5 ± 4.2 variables. Only 21% of hospitals did not require a previous authorization process and in the remaining hospitals, approval from a committee was necessary. The accumulated time of the prescription process was 6 weeks. Discontinuation rates during follow-up were 9% ± 12%. CONCLUSIONS Treatment with PCSK9 inhibitors is clearly underused in Spain. This is mainly due to both inappropriate identification of patients, and complex administrative procedures that could inhibit/discourage prescription by cardiologists and consequently, limit their use. In addition, there is a substantial delay from drug approval tadministration.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Vicente Arrarte
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, España
| | - Marisol Bravo
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Pontevedra, España
| | - Alfredo Del Campo
- Sociología y Comunicación, Gabinete de estudios sociosanitarios, Madrid, España
| | - Rafael Hidalgo
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Lluís Recasens
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, España
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