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Camps-Vilaró A, Delgado-Jiménez JF, Farré N, Tizón-Marcos H, Álvarez-García J, Cinca J, Dégano IR, Marrugat J. Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. J Clin Med 2020; 9:E2089. [PMID: 32635219 PMCID: PMC7408645 DOI: 10.3390/jcm9072089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain. Our literature review identified epidemiological studies whose objective was to quantify the prevalence of HF and its comorbidities in Spain. We estimated the prevalence of HF with reduced EF, of New York Heart Association (NYHA) functional class II-IV, and with a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m². In this population, we analysed the prevalence of diabetes using data from the REDINSCOR (Spanish Network for Heart Failure) registry. Our estimations indicate there are 594,684 patients ≥45 years old with HF in Spain (2.6% of this population age group), of which 52.4%, 84.0%, and 93.9% have reduced EF, are NYHA II-IV, and have a GFR ≥ 30 mL/min/1.73 m², respectively. By our calculations, approximately 245,789 Spanish patients would meet the DAPA-HF patient profile, and therefore could benefit from the protective cardiovascular effects of dapagliflozin.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
| | - Juan F. Delgado-Jiménez
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Núria Farré
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Jesús Álvarez-García
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Juan Cinca
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
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Comparative analysis of heart failure management in two different media rural versus urban. (ALBAPIC Study). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:156-167. [PMID: 32307103 DOI: 10.1016/j.arteri.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/24/2019] [Accepted: 01/14/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To know the epidemiological, clinical and therapeutic characteristics of patients with a diagnosis of HF treated in primary care of 2Health Areas of Albacete, Zone 5 A (characteristics of the Urban Center) and Casas Ibañez (characteristics of the Rural Center) as well as to highlight The main differences between the two. METHOD Descriptive and cross-sectional study, corresponding to the first phase of the ALBAPIC study. All patients in the area who met the inclusion criteria have been registered: Having a diagnosis of HF in the TURRIANO program (consultation program in Primary Care of Castilla la Mancha). Demographic-anthropometric and clinical characteristics, analytical data, complementary diagnostic examinations, therapeutic guidelines and hospitalizations were recorded for 12 months prior to inclusion. A physical examination and electrocardiographic and biochemical controls were performed at the inclusion visit. RESULTS 384 patients diagnosed with HF in both Health Zone (161 in urban areas and 223 in rural areas) have participated. Average age 82.24±10.51 years (81.24±9.59 years in urban areas and 83.37±11 years in rural areas with significant differences P<.005, 54.3% are women (54% in urban areas and 54.7% in rural areas) We have an incidence of CI of 1% in urban areas and 1.8% in rural areas. The prevalence of CVRF has that hypertension above all and dyslipidemia are the most frequent, with differences depending on the environment in which they live. In the rural environment there are higher rates of heart disease. Patients with HF have a high number of concomitant chronic diseases, being between 4 and 6 more than 60% of cases in the urban environment and between 1 and 4 in the rural environment. Approximately 14% also have an oncological disease in the urban environment compared to 21% in the rural. According to the exploration and analytical data, the main variables are acceptably controlled, the lipid parameters in the rural center being worse controlled. The average number of drugs prescribed by each patient was 6.3 in rural and 7.2 urban. As for the treatments they are taking, it is observed that diuretics and statins. CONCLUSIONS There is an acceptable control of cardiovascular risk factors in both media, there being differences in the diagnostic methods and treatments used.
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Gómez-Martínez L, Orozco-Beltrán D, Quesada JA, Bertomeu-González V, Gil-Guillén VF, López-Pineda A, Carratalá-Munuera C. Tendencias de mortalidad prematura por insuficiencia cardiaca por comunidades autónomas en España, periodo 1999-2013. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Trends in Premature Mortality Due to Heart Failure by Autonomous Community in Spain: 1999 to 2013. ACTA ACUST UNITED AC 2018; 71:531-537. [PMID: 29331563 DOI: 10.1016/j.rec.2017.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major public health problem, and the prevalence increases with age. In Spain, there are considerable differences between autonomous communities. The aim of this study was to analyze trends in premature mortality due to HF between 1999 and 2013 in Spain by autonomous community. METHODS We analyzed data on mortality due to HF in Spanish residents aged 0 to 75 years by autonomous community between 1999 and 2013. Data were collected from files provided by the Spanish Statistics Office. Age-adjusted mortality rates were analyzed and the average annual percentage rate was estimated by Poisson models. RESULTS Mortality due to HF represented 10.9% of total mortality. In 2013, the national age-adjusted rate was 2.98 deaths in men and 1.29 deaths in women per 100 000 inhabitants, with an annual mean reduction of 2.27% and 4.53%, respectively. In men, average mortality showed the greatest reduction in Castile-La-Mancha (6.30%). In Cantabria, average mortality significantly increased (3.97%). In women, average mortality showed the greatest decrease in the Chartered Community of Navarre (15.17%). CONCLUSIONS During the study period, mortality due to HF showed an overall average decrease, both nationally and by autonomous community. This decrease was more pronounced in women than in men. Premature mortality significantly decreased in most-but not all-autonomous communities.
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Verdú-Rotellar JM, Frigola-Capell E, Alvarez-Pérez R, da Silva D, Enjuanes C, Domingo M, Mena A, Muñoz MA. Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study. Eur J Gen Pract 2017; 23:107-113. [PMID: 28376668 PMCID: PMC5774267 DOI: 10.1080/13814788.2017.1305104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration. OBJECTIVES To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors. METHODS A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014. RESULTS Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95-0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46-5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36-2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34-3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14-4.89). CONCLUSION Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis.
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Affiliation(s)
- Jose María Verdú-Rotellar
- a Centro de Atención Primaria Sant Martí de Provençals , Institut Català de la Salut , Barcelona , Spain
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
- c Departament de Medicina, Facultat de Medicina , Universitat Autónoma de Barcelona , Bellaterra , Spain
- d Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar , Servei Català de la Salut , Barcelona , Spain
| | - Eva Frigola-Capell
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Rosa Alvarez-Pérez
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Daniela da Silva
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
| | - Cristina Enjuanes
- d Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar , Servei Català de la Salut , Barcelona , Spain
- e Parc de Salut MAR, Servicio de Cardiologıa , Hospital del Mar , Barcelona , Spain
| | - Mar Domingo
- f Centro de Atención Primaria Sant Roc , Institut Català de la Salut , Badalona , Spain
| | - Amparo Mena
- g Centro de Atención Primaria Congres , Institut Català de la Salut , Barcelona , Spain
| | - Miguel-Angel Muñoz
- b Institut d'Investigació en Atenció Primaria IDIAP-Jordi Gol , Barcelona , Spain
- h Departament de Obstericia, Ginecologia i Medicina Preventiva, Facultat de Medicina , Universidad Autónoma de Barcelona , Bellaterra , Spain
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Martínez-Braña L, Mateo-Mosquera L, Bermúdez-Ramos M, Valcárcel García MDLÁ, Fernández Hernández L, Hermida Ameijeiras Á, Lado Lado FL. Clinical characteristics and prognosis of heart failure in elderly patients. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Clinical characteristics and prognosis of heart failure in elderly patients. Rev Port Cardiol 2015; 34:457-63. [DOI: 10.1016/j.repc.2015.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 11/20/2022] Open
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Epidemiology of heart failure in Spain over the last 20 years. ACTA ACUST UNITED AC 2013; 66:649-56. [PMID: 24776334 DOI: 10.1016/j.rec.2013.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 03/26/2013] [Indexed: 11/22/2022]
Abstract
Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines.
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Naveiro-Rilo JC, Diez-Juárez D, Flores-Zurutuza ML, Molina Mazo R, Alberte Pérez C, Arias Cobos V. [The appropriate use of pharmacological treatment in patients with chronic heart failure. A perspective from Primary Care]. Semergen 2013; 39:183-90. [PMID: 23726729 DOI: 10.1016/j.semerg.2012.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE The appropriate use of pharmacological treatment according to the indications in Clinical Guidelines reduces morbidity and mortality in patients with chronic heart failure (CHF). There are numerous studies regarding this in the hospital environment, but there are few studies done in Primary Care. The objective of this study is to evaluate the degree of compliance by Primary Care doctors to the Clinical Guidelines of the European Society of Cardiology in patients with CHF. METHODS A descriptive, observational study on the use of indication-prescription drugs was conducted. POPULATION AND SAMPLE Primary Care teams of the Leon Health Area (9 urban and 19 rural). The study population included patients with a diagnosis of New York Heart Association (NYHA) Grade II-IV chronic heart failure, from a register of 2047 with chronic heart failure patients treated by 97 Primary Care doctors. A proportional representative random sample of 474 patients from the urban and rural areas was studied. MAIN MEASUREMENTS Adherence to the drugs recommended in the Clinical Guidelines was evaluated using two indicators; one overall, and another for drugs with a higher level of evidence (A1: angiotensin converting enzyme inhibitors-angiotensin II receptor antagonists [ACE-I/ARA-II], β-blockers [BB] and spironolactone). RESULTS A total of 456 patients were studied, with a mean age of 78.4 years, and 53.1% females. Arterial hypertension (AHT) and ischaemic heart disease were present in 64.7% of patients. The mean comorbidity rate, excluding CHF, was 2.9. Around 40% were diagnosed a NYHA Grade 11-1V. The overall compliance rate (diuretics, ACE-I/ARA-II, β-blockers, spironolactone, digoxin, and oral anticoagulants) and rate of adherence to evidence-based ones was 55.2% and 44.6%, respectively. There was low compliance by 39.5%, and only 12.9% of patients showed perfect compliance with the drugs with a higher level of evidence, while to be less than 70 years-old, a history of ischaemia, AHT, and a hospital admission, were variables associated with better adherence to treatment. CONCLUSION There is a low use of the drugs recommended by the Clinical Guidelines for heart failure, particularly of those with better evidence for reducing morbidity and mortality.
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Callejo D, Guerra M, Hernández-Madrid A, Blasco JA. Economic assessment of cardiac resynchronization therapy. Rev Esp Cardiol 2011; 63:1235-43. [PMID: 21070719 DOI: 10.1016/s1885-5857(10)70248-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac resynchronization devices have been shown to be effective in treating heart failure. They reduce overall mortality, heart failure mortality and hospitalizations due to heart failure. The aim of this study was to compare the cost-effectiveness of cardiac resynchronization therapy (CRT) with that of optimal drug therapy (ODT) by carrying out an economic assessment in the Spanish healthcare setting. METHODS An existing model was adapted for use in the Spanish healthcare setting. The effectiveness of cardiac resynchronization therapy was determined from published systematic reviews. The costs of the various interventions were determined using a range of Spanish data sources. The model adopted the perspective of the public health system and the time horizon considered was the remainder of the patient's life. The outcome variables were life-years gained and quality-adjusted life-years (QALYs) gained. RESULTS Overall, ODT, CRT and CRT with a defibrillator resulted in gains of 2.11, 2.8 and 3.19 QALYs, respectively, at a cost of €11,722, €31,629 and €52,592, respectively. Consequently, each QALY gained with CRT relative to ODT involved the consumption of €28,612 of additional resources. Similarly, the use of CRT with a defibrillator cost an additional €53,547 per QALY relative to CRT without a defibrillator. CONCLUSIONS The use of CRT without a defibrillator could be a cost-effective alternative to ODT for treating heart failure in a carefully selected group of patients. The study results were sensitive to uncertainties in many of the variables used in the model.
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Affiliation(s)
- Daniel Callejo
- Unidad de Evaluación de Tecnologías Sanitarias (UETS), Agencia Laín Entralgo, Comunidad de Madrid, Madrid, España.
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Carmona M, García-Olmos LM, Alberquilla A, Muñoz A, García-Sagredo P, Somolinos R, Pascual-Carrasco M, Salvador CH, Monteagudo JL. Heart failure in the family practice: a study of the prevalence and co-morbidity. Fam Pract 2011; 28:128-33. [PMID: 20978242 DOI: 10.1093/fampra/cmq084] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a health problem that particularly affects the elderly population. Its onset is associated with other chronic diseases, a circumstance that makes it a challenge for health care services. The aim of this study is to quantify the prevalence of HF in family medicine offices and describe the chronic co-morbidity associated with it. METHODS A cross-sectional, observational descriptive study set in a health area of the Community of Madrid, Spain. The study was carried out in a population of 198,670 individuals over 14 years of age, attended to by 129 specialists in family medicine. The patient was considered to have HF when this diagnosis (ICPC code K77) appeared in his or her electronic medical record. The prevalence of HF was quantified and its association with another 25 chronic diseases was analysed. RESULTS The prevalence of HF was 6.9‰, 7.9‰ among women and 5.9‰ among men. Patients with HF had a high rate of chronic co-morbidity, with an average of 5.2 + 2.1 chronic diseases. Only 3% of the patients present with isolated HF and >60% have four or more additional chronic problems. Hypertension, cardiac arrhythmias, hyperlipidaemia, obesity and diabetes mellitus are the chronic diseases most frequently detected in HF patients. CONCLUSION Patients with HF frequently visit the offices of family physicians, presenting with a high rate of cardiac and non-cardiac co-morbidity that proves to be a challenge on the clinical level and in terms of the organization of health care services.
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Affiliation(s)
- Montserrat Carmona
- Unidad de Bioingeniería y Telemedicina, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
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Raposeiras-Roubín S, Rodiño-Janeiro BK, Grigorian-Shamagian L, Moure-González M, Seoane-Blanco A, Varela-Román A, Álvarez E, González-Juanatey JR. Productos de glicación avanzada: nuevo marcador de disfunción renal en pacientes con insuficiencia cardíaca crónica. Med Clin (Barc) 2011; 136:513-21. [DOI: 10.1016/j.medcli.2010.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/28/2010] [Accepted: 06/29/2010] [Indexed: 11/30/2022]
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López Castro J, Almazán Ortega R, Pérez De Juan Romero M, González Juanatey J. Factores pronósticos de mortalidad de la insuficiencia cardíaca en una cohorte del noroeste de España. Estudio EPICOUR. Rev Clin Esp 2010; 210:438-47. [DOI: 10.1016/j.rce.2010.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/23/2009] [Accepted: 02/19/2010] [Indexed: 11/29/2022]
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Méndez Bailón M, Muñoz Rivas N, Cano Arjona M. [Do we need multidisciplinary heart failure programmes in primary care?]. Aten Primaria 2010; 42:490-1. [PMID: 20138407 PMCID: PMC7024469 DOI: 10.1016/j.aprim.2009.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Nuria Muñoz Rivas
- Servicio de Medicina Interna, Hospital Infanta Leonor, Madrid, España
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Iturralde Iriso J. [Beta-blockers in the treatment of heart failure: when do we give them?]. Aten Primaria 2010; 42:141-2. [PMID: 19926359 PMCID: PMC7024405 DOI: 10.1016/j.aprim.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 11/24/2022] Open
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Barrio Ruiz C, Parellada Esquius N, Alvarado Montesdeoca C, Moll Casamitjana D, Muñoz Segura MD, Romero Menor C. [Heart failure: a view from primary care]. Aten Primaria 2010; 42:134-40. [PMID: 19818536 PMCID: PMC7024420 DOI: 10.1016/j.aprim.2009.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 06/22/2009] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Our aim was to find out the situation of heart failure (HF) in primary care. DESIGN Cross-sectional multicentre study. SETTING Four primary health care centres and a hospital in an urban area of Barcelona. PARTICIPANTS From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. MEASUREMENTS A standardised questionnaire was used to record demographic, clinical and treatment data. RESULTS There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%. CONCLUSIONS Patients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments.
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de Rivas Otero B, Permanyer-Miralda G, Brotons Cuixart C, Aznar Costa J, Sobreviela Blazquez E. Respuesta de los autores a: “Estudio INCA: ¿insuficiencia cardíaca o riesgo vascular?”. Aten Primaria 2009. [DOI: 10.1016/j.aprim.2009.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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[Clinical profile and management patterns in outpatients with heart failure in Spain: INCA study]. Aten Primaria 2009; 41:394-401. [PMID: 19427709 DOI: 10.1016/j.aprim.2008.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 10/20/2008] [Indexed: 11/24/2022] Open
Abstract
AIM To assess clinical characteristics and treatment management of out-patients with chronic heart failure (CHF) in Spain. DESIGN Cross-sectional study. LOCATION Primary care (PC) centres and cardiology out-patient clinics. PATIENTS CHF patients (all had an echocardiography performed). METHODS Data were collected from consecutive patients who attended clinics (93 cardiologist and 415 PC physicians) with a diagnosis of CHF during June 2006. RESULTS The study subjects were 2161 CHF patients (1412 PC; 749 Cardiology), with a mean age was 70.9+/-10.6 years and 55.62% were males. Patients followed up in cardiology were younger, the majority were male, had a better functional class, lower ejection fraction, and fewer co-morbidities than those followed up in PC. The most used treatments were drugs that block the renin-angiotensin system (ACEi or ARB) (89.4%) and diuretics (84.91%), followed by beta-blockers (43.96%). Blood pressure (< 130/80 mmHg) was controlled in 24.93% of the patients, and diabetes mellitus in 32.33% of the diabetics (HbA(1c)<6.5%). Both risk factors were significantly better in PC. CONCLUSIONS The INCA results show different clinical characteristics between patients followed up in the two health care levels. The pharmacological treatment has improved since previous studies and is closer to that recommended in chronic heart failure guidelines. Nevertheless, blood pressure and diabetes mellitus control are still insufficient.
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Vilches Moraga A, Rodríguez Pascual C. [Heart failure and geriatrics]. Rev Esp Geriatr Gerontol 2009; 44:57-60. [PMID: 19304345 DOI: 10.1016/j.regg.2008.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 12/09/2008] [Accepted: 12/10/2008] [Indexed: 05/27/2023]
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de Rivas B, Divisón J, Sobreviela E, Márquez-Contreras E, Luque M. Prevalencia y riesgo de desarrollar insuficiencia cardíaca en los hipertensos españoles atendidos en Atención Primaria. Estudio HICAP. Rev Clin Esp 2008; 208:513-6. [DOI: 10.1016/s0014-2565(08)76388-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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de Rivas B, Permanyer-Miralda G, Brotons C, Aznar J, Sobreviela E. Health-related quality of life in unselected outpatients with heart failure across Spain in two different health care levels. Magnitude and determinants of impairment: the INCA study. Qual Life Res 2008; 17:1229-38. [PMID: 18855125 DOI: 10.1007/s11136-008-9397-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
Abstract
AIMS To assess health-related quality of life (HRQL) in Spanish outpatients with chronic heart failure (CHF). METHODS Cross-sectional study carried out in a sample of CHF patients (echocardiography was performed in all of them) followed either in Primary Care (PC) centres or Cardiology outpatient clinics throughout Spain. HRQL was evaluated using the EuroQol 5D (EQ-5D) and Minnesota Living with Heart Failure (MLWHF) Questionnaire. RESULTS The study subjects were 2161 CHF patients (1412 PC; 749 Cardiology). Patients were older and had more severe disease in PC than in Cardiology settings. Their HRQL scores were likewise worse. After adjusting for clinical variables, the differences in global and physical MLWHF disappeared, but persisted to a smaller degree in EQ-5D and mental MLWHF. HRQL was worse than in a representative sample of the Spanish population and in other chronic conditions such as rheumatoid arthritis or type 2 diabetes, being only comparable to severe chronic obstructive pulmonary disease (COPD). CONCLUSION All domains of HRQL were significantly impaired in CHF patients. Differences found in HRQL between PC and Cardiology should possibly be attributed to a large extent to the different clinical characteristics of the patients attended. In spite of the differences between EQ-5D and MLWHF, our results suggest that both questionnaires adequately reflect the severity of the disease.
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Affiliation(s)
- Beatriz de Rivas
- Medical Department, AstraZeneca Farmacéutica Spain, S.A., Parque Norte, Edificio Roble, Serrano Galvache, 56, 28033, Madrid, Spain.
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González-Juanatey J, González Babarro E. ¿Qué ha cambiado en Cardiología en el último año? Implicaciones para la práctica clínica. Rev Clin Esp 2008. [DOI: 10.1016/s0014-2565(08)71782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JMA, del Alamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JMA, Varela-Román A, González-Juanatey JR. Morbidity and mortality among heart failure patients in Galicia, N.W. Spain: the GALICAP Study. Int J Cardiol 2008; 136:56-63. [PMID: 18617282 DOI: 10.1016/j.ijcard.2008.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 09/30/2007] [Accepted: 04/23/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Characterization of current morbidity and mortality among heart failure (HF) outpatients in Galicia (N.W. Spain), together with their main determinants. DESIGN Prospective multicentre study involving 149 primary care physicians. SETTING Primary care physicians selected randomly from among all (1959) primary care physicians in Galicia. PATIENTS Clinical and epidemiological information for 1195 outpatients with HF were collected in 2006, with a mean follow-up of 6.5+/-1.5 months. MAIN OUTCOME MEASURES Survival rates were calculated by Cox's proportional hazard model. RESULTS Mean patient age was 76 years, 48% were male, 82% had a history of arterial hypertension, and 32% ischaemic cardiopathy. Echocardiography had been performed in 67%, showing preserved systolic function in 61%. Ninety-two (8%) died during follow-up [74 (80%) of them from cardiac causes], and 313 (29%) were re-admitted to hospital [230 (73%) of them for cardiac reasons]. Multivariate analysis identified the following independent predictors of cardiovascular death and/or readmission: ischaemic cardiopathy [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.29-4.40], stroke (HR 1.79, CI 1.18-2.73), oedema (HR 1.49, CI 1.10-2.03), anaemia (HR 1.66, CI 1.21-2.27), deteriorated systolic function (HR 1.62, CI 1.19-2.20), and previous cardiovascular admissions (HR 2.33, CI 1.67-3.24). Residence in the Barbanza district was identified as an independent predictor of survival free from cardiovascular admission (HR 0.56, CI 0.37-0.86). CONCLUSION Morbidity and mortality are currently high among Galician HF patients, and their best single predictor is previous hospitalization for cardiovascular reasons.
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Delgado JF. Insuficiencia cardíaca con función sistólica normal: magnitud de un problema clínico. Med Clin (Barc) 2008; 131:171-2. [DOI: 10.1157/13124269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rodríguez Roca G, Barrios Alonso V, Llisterri Caro J, Alonso Moreno F. Réplica. Rev Clin Esp 2008. [DOI: 10.1157/13115215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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