Perfil clínico y patrones de manejo en los pacientes con insuficiencia cardíaca atendidos ambulatoriamente en España: estudio INCA (Estudio Insuficiencia Cardíaca) / Clinical profile and management patterns in outpatients with heart failure in Spain: INCA study

ObjetivosConocer las características clínicas y el manejo terapéutico de pacientes con insuficiencia cardíaca crónica atendidos ambulatoriamente en España.DiseñoEstudio transversal y multicéntrico.EmplazamientoAtencion primaria (AP) y consultas ambulatorias de cardiología.ParticipantesPacientes con insuficiencia cardíaca crónica (con ecocardiograma realizado en todos ellos).MétodosRecogida de datos demográficos, clínicos y relativos al tratamiento de pacientes consecutivos que acudieron a la consulta (93 cardiólogos y 415 médicos de AP) con el diagnóstico de insuficiencia cardíaca en junio de 2006.ResultadosDatos válidos de 2.161 pacientes (1.412 de AP; 749 de cardiología). La media de edad era 70,9±10,6 años; el 55,62% eran varones. Entre los pacientes atendidos en cardiología había más varones y eran más jóvenes, con mejor grado funcional, menor fracción de eyección y menos comorbilidades que entre los atendidos en AP. Los fármacos más utilizados para tratar la insuficiencia cardíaca eran los fármacos que bloquean el sistema renina-angiotensina (IECA o ARA-II) (89,4%) y los diuréticos (84,91%), seguidos de los bloqueadores beta (43,96%). La presión arterial estaba controlada (< 130/80mmHg) en el 24,93% de los pacientes, y la diabetes mellitus en el 32,33% de los diabéticos (HbA1c<6,5%). El control de ambas era significativamente mejor en AP.ConclusionesNuestros resultados indican que existen diferencias en las características de los pacientes atendidos en ambos ámbitos asistenciales, y que se ha producido una mejora en la adecuación del tratamiento farmacológico en comparación con estudios previos y se aproximan más a lo recomendado por las guías de insuficiencia cardíaca crónica. A pesar de ello, el control de la presión arterial y la diabetes mellitus es insuficiente(AU)

AimTo assess clinical characteristics and treatment management of out-patients with chronic heart failure (CHF) in Spain.DesignCross-sectional study.LocationPrimary care (PC) centres and cardiology out-patient clinics.PatientsCHF patients (all had an echocardiography performed).MethodsData were collected from consecutive patients who attended clinics (93 cardiologist and 415 PC physicians) with a diagnosis of CHF during June 2006.ResultsThe 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 (< 130/80mmHg) was controlled in 24.93% of the patients, and diabetes mellitus in 32.33% of the diabetics (HbA1c<6.5%). Both risk factors were significantly better in PC.ConclusionsThe 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(AU)

[Knowledge and implementation of cardiovascular risk clinical practice guidelines by general practitioners and specialists]. / Conocimiento y aplicación de las guías de práctica clínica sobre riesgo cardiovascular en las consultas generales y especializadas.

INTRODUCTION AND OBJECTIVES: Patients at a high risk of cardiovascular disease rarely achieve the preventive targets stipulated by the clinical practice guidelines published by professional bodies. The aims of the ACORISC registry were to determine the level of compliance with guidelines on prevention by general practitioners and specialists and to assess the findings in terms of risk factors. METHODS: The study included 5849 consecutive patients (mean age 65 years) with type 2 diabetes or chronic ischemic heart disease who were seen as outpatients. In addition, 384 participating physicians were questioned on their knowledge and use of practice guidelines. RESULTS: Overall, 91% of patients also had hypertension. Physicians tended to have better knowledge of and to implement guidelines published by the closest related professional bodies. Some 14% of treatment provided was inappropriate, half of which involved oral antidiabetics. Conversely, 48% of patients for whom guidelines recommended an angiotensin inhibitor did not receive one. The target figures for blood pressure, body mass index, and cholesterol were achieved in only 13%, 21% and 39% of patients, respectively. CONCLUSIONS: Overall, 75% of risk factors in patients with diabetes or chronic ischemic heart disease were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines. The inappropriate use of oral antidiabetics was particularly common.

Conocimiento y aplicación de las guías de práctica clínica sobre riesgo cardiovascular en las consultas generales y especializadas / Knowledge and Implementation of Cardiovascular Risk Clinical Practice Guidelines by General Practitioners and Specialists

Introducción y objetivos. Los pacientes de alto riesgo vascular alcanzan en escasa cuantía los objetivos de prevención que se indican en las directrices de las entidades profesionales. El objetivo del registro ACORISC fue analizar el grado de adecuación a las directrices de prevención por parte de un grupo de médicos de atención primaria y especialistas, así como sus resultados en los parámetros de riesgo. Métodos. Se registran de manera consecutiva los da- tos de 5.849 pacientes (65 años) con diabetes mellitus de tipo 2 o cardiopatía isquémica crónica visitados ambulatoriamente. Se encuestó a los 384 médicos participantes acerca de su conocimiento y aplicación de las directrices. Resultados. El 91% de los pacientes tenía, además, hipertensión arterial. Los médicos conocían y aplicaban prioritariamente las directrices dictadas por las sociedades profesionales más afines. El 14% de los tratamientos aplicados era incorrecto, la mitad de ellos antidiabéticos orales. En cambio, el 48% de los pacientes que precisarían un inhibidor de la enzima de conversión de la angiotensina según las guías no lo tomaba. Las cifras de control recomendadas de presión arterial, índice de masa corporal y colesterol se alcanzaron sólo en el 13, el 21 y el 39% de los pacientes, respectivamente. Conclusiones. El 75% de los parámetros de riesgo en pacientes diabéticos o con cardiopatía isquémica no están adecuadamente controlados por los médicos de atención primaria y los especialistas de acuerdo con las guías de práctica clínica vigentes. Es llamativamente alto el uso inadecuado de antidiabéticos orales (AU)

Introduction and objectives. Patients at a high risk of cardiovascular disease rarely achieve the preventive targets stipulated by the clinical practice guidelines published by professional bodies. The aims of the ACORISC registry were to determine the level of compliance with guidelines on prevention by general practitioners and specialists and to assess the findings in terms of risk factors. Methods. The study included 5849 consecutive patients (mean age 65 years) with type 2 diabetes or chronic ischemic heart disease who were seen as outpatients. In addition, 384 participating physicians were questioned on their knowledge and use of practice guidelines. Results. Overall, 91% of patients also had hypertension. Physicians tended to have better knowledge of and to implement guidelines published by the closest related professional bodies. Some 14% of treatment provided was inappropriate, half of which involved oral antidiabetics. Conversely, 48% of patients for whom guidelines recommended an angiotensin inhibitor did not receive one. The target figures for blood pressure, body mass index, and cholesterol were achieved in only 13%, 21% and 39% of patients, respectively. Conclusions. Overall, 75% of risk factors in patients with diabetes or chronic ischemic heart disease were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines. The inappropriate use of oral antidiabetics was particularly common (AU)