Seguimiento de indicadores de calidad de la prescripción tras infarto agudo de miocardio / Monitoring of quality indicators of prescriptions after acute myocardial infarction

Objetivos. La enfermedad cardiovascular constituye la principal causa de muerte en todo el mundo. Diferentes fármacos han mostrado su eficacia en el manejo de los pacientes con síndrome coronario agudo, incorporándose a las recomendaciones establecidas por diferentes sociedades científicas. El objetivo de este estudio es valorar el seguimiento de los estándares de calidad establecidos en Andalucía para el manejo de pacientes con infarto agudo de miocardio con elevación del segmento ST y analizar la fuente de variabilidad que aporta el facultativo prescriptor. Método. Estudio observacional, descriptivo, de indicación-prescripción, que analizó todas las prescripciones incluidas en los informes de alta hospitalaria de pacientes atendidos en un hospital de tercer nivel tras sufrir infarto agudo de miocardio con elevación del segmento ST, entre agosto de 2005 y julio de 2007. Resultados. El total de pacientes incluidos fue 287. La prescripción de antiagregantes se realizó en 99,3% de los pacientes, ácido acetilsalicílico en 95,8%. El porcentaje que recibió betabloqueantes fue 89,5%, inhibidores de la enzima de conversión de la angiotensina (IECA) 74,2%, indicándose ARA-II en 2,85%. El uso de estatinas fue de 84,6%. La indicación de nitroglicerina sublingual condicional fue 60,3%. El uso de IECA y nitroglicerina sublingual mostró diferencias estadísticamente significativas según el facultativo prescriptor. Conclusiones. La adecuación de las prescripciones a las recomendaciones establecidas en Andalucía es alta. La prescripción de nitroglicerina sublingual condicional es el indicador que más se desvía de los estándares de calidad marcados. Su uso, junto con la indicación de IECA, son las recomendaciones que presentan mayor desviación en función del facultativo prescriptor(AU)

Objectives. Cardiovascular disease is the primary cause of death in the world. Various drugs have shown their efficiency in the management of patients with acute coronary syndrome, along with the recommendations established by different Scientific Societies. The objective of this survey is to assess the monitoring of the quality standards established in Andalusia for the management of patients with myocardial infarction with evaluation of the ST segment and to analyse the source of variability of the prescription provided by the physician. Method. An observational descriptive survey, of indication-prescription, which analysed all the prescriptions included in the hospital discharge reports in patients treated in a tertiary hospital after having suffered acute myocardial infarction with ST segment elevation, between August 2005 and July 2007. Results. A total of 287 patients were included. Antiplatelets were prescribed in 99.3% of the patients, and acetylsalicylic acid in 95.8%. The percentage of beta-blockers received was 89.5%, angiotensin converting enzyme inhibitors (ACEI) in 74.2%, with ARA-II indicated in 2.85%. The use of statins was 84.6%. The indication of conditional sublingual nitroglycerin was 60.3%. The use of ACEI and sublingual nitroglycerin showed statistically significant differences according to the prescribing physician. Conclusions. The fitness of the prescriptions to the recommendations established in Andalusia is high. The prescription of conditional sublingual nitroglycerin is the indicator which varies most in the quality standards established. Its use in conjunction with the indication of ACEI, are the recommendations which show a higher deviation depending on the prescribing physician(AU)

[Monitoring of quality indicators of prescriptions after acute myocardial infarction]. / Seguimiento de indicadores de calidad de la prescripción tras infarto agudo de miocardio.

OBJECTIVES: Cardiovascular disease is the primary cause of death in the world. Various drugs have shown their efficiency in the management of patients with acute coronary syndrome, along with the recommendations established by different Scientific Societies. The objective of this survey is to assess the monitoring of the quality standards established in Andalusia for the management of patients with myocardial infarction with evaluation of the ST segment and to analyse the source of variability of the prescription provided by the physician. METHOD: An observational descriptive survey, of indication-prescription, which analysed all the prescriptions included in the hospital discharge reports in patients treated in a tertiary hospital after having suffered acute myocardial infarction with ST segment elevation, between August 2005 and July 2007. RESULTS: A total of 287 patients were included. Antiplatelets were prescribed in 99.3% of the patients, and acetylsalicylic acid in 95.8%. The percentage of beta-blockers received was 89.5%, angiotensin converting enzyme inhibitors (ACEI) in 74.2%, with ARA-II indicated in 2.85%. The use of statins was 84.6%. The indication of conditional sublingual nitroglycerin was 60.3%. The use of ACEI and sublingual nitroglycerin showed statistically significant differences according to the prescribing physician. CONCLUSIONS: The fitness of the prescriptions to the recommendations established in Andalusia is high. The prescription of conditional sublingual nitroglycerin is the indicator which varies most in the quality standards established. Its use in conjunction with the indication of ACEI, are the recommendations which show a higher deviation depending on the prescribing physician.

Factores de riesgo en una población anciana: escalas de valoración para la prevención de fracturas de cadera / Factors of risk in an elderly population: evaluation scales for the prevention of hip fractures

Objetivos: Describir y cuantificar factores de riesgo (FR) en una población hospitalizada por fractura de cadera (FC), utilizar escalas de valoración en pacientes susceptibles de tenerla y establecer las recomendaciones para su prevención. Metodología: Estudio descriptivo transversal en 87 pacientes mayores de 64 años, con una edad media de 83 años, ingresados por FC. El 77% fueron mujeres. Se cuantificó y se evaluó los FR en esta población. El 81,6% tuvo caídas y el 42,5% fracturas después de los 50 años. Todas las FC fueron por caídas desde bipedestación. Metodología: Se realizó una charla educacional farmaceuticomédica al ingreso y un repaso completo al alta hospitalaria. Las variables analizadas fueron edad, sexo, FR, motivo de la FC, antecedentes genéticos y mortalidad intrahospitalaria, entre otras. En todos los pacientes se aplicó la escala Black y en 75 la escala FRAX® (fracture risk assessment tool). Resultados: El 42,5% señaló antecedentes hereditarios. El 98,9% consumía productos lácteos. El 48,3% presentó efecciones osteoarticulares aunque sólo el 8% recibía tratamiento. El 75% esperó al menos 5 días para su intervención. El 12,6% falleció durante la hospitalización. Según la escala de Black, el 85,1% presentó alto riesgo de tener una nueva FC y, según la escala FRAX, el 12% tiene probabilidad de que esto ocurra en los siguientes 10 años. Conclusión: La mayoría de los pacientes mostraron un alto número de FR de FC previo al ingreso hospitalario que no se detectaron a tiempo. Las escalas de Black y FRAX son herramientas útiles para valorar pacientes susceptibles de tener una FC. Una educación preventiva centrada en los FR disminuiría las FC (AU)

Objective: Describe and quantify risk factors (RF) present in a population hospitalized for hip fracture (HF), apply evaluation scales in patients susceptible to HF and conclude recommendations to prevent them. Methods: Descriptive cross-sectional study in 87 patients over 64 yrs old admitted for HF. RF were quantified and evaluated in this population. A pharmaceutical-medical education was given at admission and a full reviewed at discharge. The 87 patients studied (77.0% female) had mean age of 83 yrs. 81.6% suffered falls; 42.5% had previous fractures since the age of 50 yrs. All HF were for falls from standing Methods Variables: age, sex, RF, HF cause, genetic history, hospital mortality, among others. The index Black was applied to all patients and the scale FRAX to 75 patients. Results: The 42.5% of the patients reported genetic background. 98.9% consumed milk products. The 48.3% presented osteoarticular diseases and only 8.0% received treatment. The 75% waited at least 5 days to undergo surgery. Hospital mortality was 12.6%. According to index Black, 85.1% had a high risk of a new HF. According to SF, 12% were likely to suffer a new HF in the following 10 yrs. Conclusion: Most patients showed a high number of RF for HF prior hospitalization that was not detected in time. Index Black and Scale Frax are useful tools to detect patients susceptible to HF. Preventive education, particularly focussed on RF, would decrease HF (AU)

[Impact of hospitalization on patients with nutrition status evaluation at admission]. / Influencia de la hospitalización en los pacientes evaluados nutricionalmente al ingreso.

Malnutrition (MN) continues to be an unacknowledged and underestimated problem in hospitals. It affects patients, by increasing complications, mean hospital stay (HS) and health-related risks. Such MN tends to be aggravated by hospitalization. Our purpose was to analyze the influence of hospitalization on the nutritional status of the patients studied. The following data were collected from 134 patients previously assessed for malnutrition risk between the 3rd and 5th day after admission: 1) during admission: type of diet, no of days with an absolute diet, use of protein supplements and artificial nutrients, onset of large-scale and small-scale complications, duration of HS, no of subsequent admissions and death; and 2) on discharge: serum albumin (SA) g/dl, total lymphocytes (TL)/ml. A statistical analysis was carried out using the chi 2 test, a Correlation test and ANOVA for a significance level of p < 0.05. It was possible to review 71.64% of the case histories and 61.45% were assessed. The following findings were reached: 1) the patients with weight loss on admission (WLA) had lower SA figures on discharge (p < 0.01) and a higher mortality rate (p < 0.001). 2) Absolute diet during HS led to a lengthening of admission time (p < 0.001). 3) Those patients with a severe risk of MN were the same ones who only received nutritional support (p < 0.001). 4) Patients who were re-admitted presented a worse nutritional status on discharge (p < 0.001). 5) An increase of 3.7 days in the HS in medical cases and 7.9 days more in surgical services, for those patients at risk of MN. 1. Low SA, TL and WLA figures are prognostic factors for hospital death. 2. Nutritional support was only used at severe levels of MN risk, so the HS was longer in these cases. 3. Patients with MN should be detected on arrival in order to avoid inherent health risks during hospitalization.

Influencia de la hospitalización en los pacientes evaluados nutricionalmente al ingreso / Influence of hospitalization on patients following nutritional assessment on admission

La malnutrición (MN) continúa siendo un problema no reconocido en los hospitales e infravalorado. Incide en los enfermos, aumentando las complicaciones, la estancia hospitalaria (EH) y los riesgos sanitarios. Esta MN suele agravarse durante la hospitalización.Nuestro objetivo fue analizar la influencia que puede tener la hospitalización sobre el estado nutricional de los pacientes estudiados.De 134 pacientes previamente valorados para el riesgo de malnutrición entre el 3.º y 5.º día de su ingreso, se recogieron los siguientes datos: 1) durante su ingreso: tipo de dieta, número de días con dieta absoluta, utilización de suplementos proteicos y nutrición artificial, aparición de complicaciones mayores y menores, duración de la EH, número de reingresos y de exitus, y 2) al alta: albúmina sérica (AS) g/dl, linfocitos totales (LT)/ml. Se realiza análisis estadístico del test de 2, test de correlación y ANOVA para una significación p < 0,05. Se pudieron revisar el 71,64 por ciento de las historias clínicas, y se evaluaron el 61,45 por ciento. Se encontró: 1) los pacientes con pérdida de peso al ingreso (PPI) tuvieron cifras más bajas de AS al alta (p < 0,01) y mayor índice de mortalidad (p < 0,001). 2) La dieta absoluta durante la EH condicionó un alargamiento de la misma (p < 0,001). 3) Los pacientes con riesgo grave de MN fueron los que únicamente recibieron soporte nutricional (p < 0,001). 4) Los pacientes con reingresos presentaron peor estado nutricional al alta (p < 0,001). 5) un incremento de la EH de 3,7 días en los servicios médicos y de 7,9 en los quirúrgicos, para los pacientes con riesgo de MN.1. Cifras bajas de AS, LT y PPI son factores pronósticos de muerte hospitalaria. (AU)

Malnutrition (MN) continues to be an unacknowledged and underestimated problem in hospitals. It affects patients, by increasing complications, mean hospital stay (HS) and health-related risks. Such MN tends to be aggravated by hospitalization. Our purpose was to analyze the influence of hospitalization on the nutritional status of the patients studied. The following data were collected from 134 patients previously assessed for malnutrition risk between the 3rd and 5th day after admission: 1) during admission: type of diet, no of days with an absolute diet, use of protein supplements and artificial nutrients, onset of large-scale and small-scale complications, duration of HS, no of subsequent admissions and death; and 2) on discharge: serum albumin (SA) g/dl, total lymphocytes (TL)/ml. A statistical analysis was carried out using the x2 test, a Correlation test and ANOVA for a significance level of p < 0.05. It was possible to review 71.64% of the case histories and 61.45% were assessed. The following findings were reached: 1) the patients with weight loss on admission (WLA) had lower SA figures on discharge (p < 0.01) and a higher mortality rate (p < 0.001). 2) Absolute diet during HS led to a lengthening of admission time (p < 0.001). 3) Those patients with a severe risk of MN were the same ones who only received nutritional support (p < 0.001). 4) Patients who were re-admitted presented a worse nutritional status on discharge (p < 0.001). 5) An increase of 3.7 days in the HS in medical cases and 7.9 days more in surgical services, for those patients at risk of MN. 1. Low SA, TL and WLA figures are prognostic factors for hospital death. 2. Nutritional support was only used at severe levels of MN risk, so the HS was longer in these cases. 3. Patients with MN should be detected on arrival in order to avoid inherent health risks during hospitalization (AU)

[Assessment of nutritional status at hospital admission: identification of patients with risk for malnutrition]. / Evaluación del estado nutricional al ingreso hospitalario: identificación de pacientes con riesgo de malnutrición.

Various studies of prevalence in our hospitals have detected large percentages of under-nourished patients in both medical and surgical wards. These groups of patients are not detected in clinical practice and are therefore untreated, leading to nutritional deterioration. The present paper studies the prevalence of the risk of malnutrition, using the Cardona risk assessment sheet as modified by Mager, in 134 patients between the 3rd and 5th day after admission to hospital. A chi-squared test was applied to allow comparison of quantitative and qualitative variables. We found 56.70% of patients risked under-nourishment (60% in medical wards and 50% in surgical wards). The variables which showed the best correlation with the risk of malnutrition were albumen (p < 0.01), weight loss (p < 0.001) and age (p < 0.005). The Hospital's Clinical Nutrition Committee must define the standard to be achieved regarding nutritional risk in order to ensure the quality offered to our patients in this regard.

Evaluación del estado nutricional al ingreso hospitalario: identificación de pacientes con riesgo de malnutrición / Assessment of nutritional status on admission to hospital: identification of patients at risk of malnutrition

En distintos estudios de prevalencia en nuestros hospitales, se detectan importantes porcentajes de pacientes malnutridos tanto en áreas médicas como en quirúrgicas. Estos grupos de pacientes en la práctica clínica no se detectan y por tanto no son tratados, conduciendo al deterioro nutrional de los mismos. En el presente trabajo se realiza un estudio sobre prevalencia del riesgo de malnutrición, utilizando la hoja de valoración de riesgo de Cardona modificada de Nager, sobre 134 pacientes entre el 3.° y 5.° día del ingreso hospitalario. Se aplicó un test del CHI 2 para comparar variables cuantitativas y un ANOVA para comparar variables cuantitativas con cualitativas. Encontramos el 56,70 por ciento de pacientes con riesgo de malnutrición (60 por ciento áreas médicas y 50 por ciento áreas quirúrgicas). Tanto la albúmina (p < 0,01), como la pérdida de peso (p < 0,001) y la edad (p < 0,005), fueron las variables que mejor se correlacionaron con el riesgo de malnutrición. Se debería definir en la Comisión de Nutrición Clínica Hospitalaria, el estándar a alcanzar sobre riesgo nutricional, que garantizase en esta materia la calidad prestada a nuestros pacientes (AU)

Various studies of prevalence in our hospitals have detected large percentages of under-nourished patients in both medical and surgical wards. These groups of patients are not detected in clinical practice and are therefore untreated, leading to nutritional deterioration. The present paper studies the prevalence of the risk of malnutrition, using the Cardona risk assessment she-et as modified by Mager, in 134 patients between the 3rd and 5th day after admission to hospital. A chi-squared test was applied to allow comparison of quantitative and qualitative variables. We found 56.70% of patients risked under-nourishment (60% in medical wards and 50% in surgical wards). The variables which showed the best correlation with the risk of malnutrition were albumen (p < 0.01), weight loss (p < 0.001) and age (p < 0.005). The Hospital's Clinical Nutrition Committee must define the standard to be achieved regarding nutritional risk in order to ensure the quality offered to our patients in this regard (AU)