Prevención cardiovascular estancada: tendencias alarmantes y barreras socioeconómicas persistentes

[Accomplishment of preventive activities proposed by resident doctors of Family Medicine in Primary Care and its relationship with communication skills]

OBJECTIVE

To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities.

DESIGN

A descriptive multicentre study assessing medical consultations video recording.

LOCATION

Eight Primary Healthcare centres in Jaen (Andalucia).

PARTICIPANTS

Seventy-three resident physicians (4th year) filmed and observed with patients.

PRINCIPAL MEASUREMENTS

Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed.

RESULTS

Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10).

CONCLUSIONS

Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer.

The burden of behavioral risk factors for cardiovascular disease in Europe. A significant prevention deficit

OBJECTIVE

The study objective was to assess the burden of major cardiovascular disease (CVD) behavioral risk factors (BRFs) (i.e., smoking, excess body weight, physical inactivity, risky alcohol consumption) among individuals in the community with and without CVD history.

METHODS

For the current study, a subset of the data from the Survey of Health, Ageing and Retirement in Europe (SHARE) was analyzed, which were collected from 26,743 individuals aged 50+ years old, during the 1st wave of SHARE in 2004/05 in eleven European countries.

RESULTS

Among those with CVD, there is a statistically significant higher percentage of inactive individuals (81.4% vs. 69.5 among those without CVD), and of individuals with excess body weight (64.3%) or obese (21.6%). Patients with CVD had a lower prevalence of smoking and risky alcohol consumption in most countries, whereas the prevalence of high body weight and physical inactivity was higher in CVD patients compared to individuals without CVD in almost all countries. More than half of the population has at least two BRFs, with a significantly higher prevalence of multiple BRFs among those diagnosed with CVD.

CONCLUSION

Study findings suggest that a significant burden of behavioral risk factors for CVD remains in the population overall but also among patients diagnosed with CVD. Given the significant prevalence of BRFs, the prevention benefits would be immense for all stakeholders involved and negligence would be perilous.

[Management of time used to treat the chronic patient: a new approach to improve quality of health care]

OBJECTIVE

Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time.

MATERIAL AND METHODS

Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test.

RESULTS

In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]).

CONCLUSIONS

Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.

[Cardiovascular risk of immigrants living in Spain according to origin and years of stay]

OBJECTIVE

To assess whether there are differences in the immigrant population in terms of the years since their arrival in Spain and their geographical area of origin.

DESIGN

A cross-sectional study was conducted in three immigrant groups.

PARTICIPANTS

The groups selected were: a group of Latin American immigrants (298), a group of North African immigrants (130) and a group from Eastern Europe (114). A control group of 100 from a Spanish population of similar age and sex was also included.

METHODS

Anthropometric variables were measured, including biochemical inflammatory markers, blood pressure and cardiovascular risk estimation according to the tables of the European Societies of Hypertension and Cardiology.

RESULTS

The cardiovascular risk of the three groups of immigrants is similar between them (added cardiovascular risk high or very high at 5.5% in Latin Americans, 4.3% in North Africans, and 1.6% in immigrants from eastern countries), but significantly lower than the Spanish control group (28%). After 8 years in Spain, cardiovascular risk increases in the three groups of immigrants, with those from North Africa and eastern countries being comparable to the Spanish group (added cardiovascular risk high or very high of 18.5% in North Africans, and 20% in group from eastern countries). This cardiovascular risk was higher than the other groups, including the Spanish control group (Latin American immigrants 48.7% vs 28% in Spanish group).

CONCLUSIONS

The cardiovascular risk of immigrants increases over the years in Spain, with this increase being higher if they come from Latin America. This increase becomes clinically significant after the 8 years of stay in Spain.

Overcoming barriers in the management of hypertension: the experience of the cardiovascular health program in chilean primary health care centers

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.

Identification of pharmacogenetic predictors of lipid-lowering response to atorvastatin in Chilean subjects with hypercholesterolemia

BACKGROUND

Statins are normally the first-line therapy for hypercholesterolemia (HC); however, the lipid-lowering response shows high interindividual variation. We investigated the effect of four polymorphisms in CYP3A4, CYP3A5 and ABCB1 genes on response to atorvastatin and CYP3A4 activity in Chilean subjects with HC.

METHODS

A total of 142 hypercholesterolemic individuals underwent atorvastatin therapy (10mg/day/1month). Serum lipid levels before and after treatment were measured. Genetic variants in CYP3A4 (-290A>G, rs2740574), CYP3A5 (6986A>G, rs776746) and ABCB1 (2677G>A/T, rs2032582 and 3435C>T, rs1045642) were analyzed by PCR-RFLP. CYP3A4 enzyme activity in urine samples was assessed through determination of 6β-hydroxycortisol/cortisol free ratio (6βOHC/FC).

RESULTS

After 4weeks of therapy, a significant reduction in total cholesterol (TC) and LDL-c was observed (P<0.001). The G allele for -290A>G polymorphism was related to higher percentage of variation in TC and LDL-c (P<0.001). Moreover, same allele was associated with higher HDL-c variation (P=0.017). In addition, CYP3A4 enzyme activity was lower in subjects carrying this polymorphism (P=0.009). No differences were observed for CYP3A5 and ABCB1 variants.

CONCLUSION

Our results suggest that presence of G allele for -290A>G polymorphism determines a better response to atorvastatin, being also associated with lower CYP3A4 activity in vivo, causing an increased atorvastatin activity.