Analysis of myocardial infarction incidence and case-fatality in the last three decades in the province of Girona.

INTRODUCTION AND OBJECTIVES: Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019). METHODS: The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression. RESULTS: MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women. CONCLUSIONS: In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.

New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis.

AIMS: To analyse differences in myocardial infarction incidence, mortality and hospitalization rates, 28-day case-fatality and two-year prognosis using two myocardial infarction case definitions: the classical World Health Organization definition (1994) and the European Society of Cardiology/American College of Cardiology definition (2000), which added cardiac troponin as a diagnostic biomarker. DESIGN: Population-based cohort of 4170 consecutive myocardial infarction patients aged 35-74 years from Girona (Spain) recruited between 2002 and 2009. METHODS: Incidence, mortality rates standardized to the European population and 28-day case-fatality were calculated. To estimate the association between case definition and prognosis, Cox models were fitted. RESULTS: Use of the 2000 European Society of Cardiology/American College of Cardiology definition significantly increased myocardial infarction incidence per 100,000 population (238.3 vs. 274.5 in men and 54.1 vs. 69.7 in women). Applying this definition decreased the 28-day case-fatality rate from 26.9% to 23.4% in men, and from 31.0% to 24.1% in women. In the acute phase, patients diagnosed only by increased troponins were significantly less treated with thrombolysis (34.4% vs. 2.0%), angiotensin-converting enzyme inhibitors (71.7% vs. 65.0%) and percutaneous coronary intervention (41.1% vs. 31.7%). Case-fatality at 28 days was significantly better in cases diagnosed only by troponin increase (0.2 % vs. 9.7%), but two-year cardiovascular mortality was higher (7.5% vs. 3.7%). CONCLUSIONS: Inclusion of cardiac troponins in myocardial infarction diagnosis increased annual incidence and decreased case-fatality. Diagnosis based only on increased troponins was associated with worse outcome. This group of patients at high risk of death should receive aggressive secondary prevention therapy.

Sex-related differences in prognosis after myocardial infarction: changes from 1978 to 2007.

Women with myocardial infarction (MI) have shown a 28-day survival disadvantage compared with men. However, results were less consistent when considering long-term mortality in 28-day survivors. The aim was to estimate the trends for sex-related differences in the three endpoints considered for this study: (1) 28-day mortality or severe ventricular dysfunction (acute pulmonary oedema or cardiogenic shock) during the hospital stay, (2) 28-day mortality and (3) two-year cardiovascular mortality or non-fatal MI in 28-day survivors after a first MI. A cohort of 3,982 consecutive patients with first Q-wave MI admitted to a university tertiary reference hospital between 1978 and 2007 was followed for 2 years. Short-term prognosis improved in women over the studied period; similar rates were observed in both sexes in the 2000s. After adjusting for age, co-morbidities and anterior location of MI, female sex had an odds ratio=1.71 (95% confidence interval [CI] 1.34-2.17) of short-term severe MI or death over the studied period. Overall, sex differences in long-term prognosis remained similar over the studied period (hazard ratio=1.40; 95% CI 1.02-1.91). In conclusion, short-term prognosis improved over the past 30 years for first Q-wave MI patients, becoming similar for both men and women in the most recent decade. Long-term prognosis did not improve in either men or women, indicating that secondary prevention should be reinforced to achieve consistent reductions in the number of cardiovascular events.

Tendencias en la práctica de actividad física en el tiempo libre en el periodo 1995-2005 en Girona / Trends in leisure time physical activity practice in the 1995-2005 period in Girona

Introducción y objetivos. Determinar la distribución de la práctica de actividad física y la prevalencia de sedentarismo, su tendencia y las variables asociadas en la población de 35-74 años de Girona en el periodo 1995-2005. Métodos. Análisis de tres estudios transversales independientes de la población de 35-74 años de Girona realizados en 1995 (n=1.419), 2000 (n=2.499) y 2005 (n=5.628). La actividad física se recogió mediante el cuestionario de actividad física en el tiempo libre de Minnesota. Se definió el sedentarismo como: gasto energético en actividad física moderada (4-5,5 MET) < 675kcal/semana o < 420kcal/semana en actividad física intensa (≥ 6 MET). Para determinar las variables asociadas al sedentarismo, se utilizó un modelo de regresión logística. Resultados. Las prevalencias de sedentarismo estandarizadas por edad fueron del 53,8, el 39,5 y el 32,6% en 1995, 2000 y 2005 respectivamente. La prevalencia de sedentarismo ha disminuido durante el periodo, especialmente en mujeres de más de 50 años residentes en áreas urbanas. Se observó un incremento de la actividad física ligera y moderada en los varones mayores de 50 años y de la actividad física ligera en las mujeres mayores de 50 años. Las variables asociadas a mayor prevalencia de sedentarismo fueron: el sexo femenino, la edad, el consumo de tabaco y el menor nivel de estudios. Conclusiones. La prevalencia de sedentarismo ha disminuido, especialmente entre las mujeres del área urbana, pero continúa siendo elevada. La promoción de actividad física debe ser un elemento importante de las campañas de prevención y debe tener en cuenta las desigualdades sociales y de sexo existentes (AU)

Introduction and objectives. The aims of the study were: to describe the distribution of physical activity practice; to determine the prevalence and trends of sedentary lifestyle in the population aged 35 to 74 years of Girona in the 1995-2005 period; and to identify the variables associated to sedentary lifestyle at the population level. Methods. Data from three independent population-based cross-sectional studies undertaken in 1995 (n=1419), 2000 (n=2499), and 2005 (n=5628) were analyzed. Physical activity was measured using the Minnesota Leisure Time Physical Activity questionnaire. Sedentary lifestyle was defined as an energy expenditure in moderate physical activity (4-5.5 METs) <675 kcal/week or <420 kcal/week in intense physical activity (≥6 METs). Logistic regression was used to determine the variables associated with sedentary lifestyle. Results. The age-standardized prevalence of sedentary lifestyle was 53.8%, 39.5%, and 32.6% in 1995, 2000, and 2005 respectively. The prevalence of sedentary lifestyle has decreased especially in women older than 50 years living in the urban areas. An increase in light and moderate physical activity practice in men older than 50 years and in light physical activity practice in women older than 50 years was observed. Female gender, age, smoking and lower educational level were associated with a higher prevalence of sedentary lifestyle. Conclusions. Prevalence of sedentary lifestyle has decreased in the 1995-2005 period in Girona, especially in women, but is still high. Health promotion programs should include physical activity practice as a key element and should take into account gender and social inequalities (AU)

[Trends in leisure time physical activity practice in the 1995-2005 period in Girona]. / Tendencias en la práctica de actividad física en el tiempo libre en el periodo 1995-2005 en Girona.

INTRODUCTION AND OBJECTIVES: The aims of the study were: to describe the distribution of physical activity practice; to determine the prevalence and trends of sedentary lifestyle in the population aged 35 to 74 years of Girona in the 1995-2005 period; and to identify the variables associated to sedentary lifestyle at the population level. METHODS: Data from three independent population-based cross-sectional studies undertaken in 1995 (n=1419), 2000 (n=2499), and 2005 (n=5628) were analyzed. Physical activity was measured using the Minnesota Leisure Time Physical Activity questionnaire. Sedentary lifestyle was defined as an energy expenditure in moderate physical activity (4-5.5 METs) <675 kcal/week or <420 kcal/week in intense PA (≥ 6 METs). Logistic regression was used to determine the variables associated with sedentary lifestyle. RESULTS: The age-standardized prevalence of sedentary lifestyle was 53.8%, 39.5%, and 32.6% in 1995, 2000, and 2005 respectively. The prevalence of sedentary lifestyle has decreased especially in women older than 50 years living in the urban areas. An increase in light and moderate physical activity practice in men older than 50 years and in light physical activity practice in women older than 50 years was observed. Female gender, age, smoking and lower educational level were associated with a higher prevalence of sedentary lifestyle. CONCLUSIONS: Prevalence of sedentary lifestyle has decreased in the 1995-2005 period in Girona, especially in women, but is still high. Health promotion programs should include physical activity practice as a key element and should take into account gender and social inequalities.

Modelo de intervención coronaria percutánea primaria en Cataluña / The primary percutaneous coronary intervention program in Catalonia

El Código Infarto de Cataluña se inició en junio de 2009 con el fin de implantar el tratamiento de reperfusión en red, basado en la intervención coronaria percutánea primaria, a los pacientes con infarto de miocardio y elevación del segmento ST, siguiendo las recomendaciones de las Guías de la Sociedad Europea de Cardiología. El protocolo, único para toda Cataluña, fue impulsado por la Sociedad Catalana de Cardiología y fue desarrollado conjuntamente con el Departamento de Salud, el CatSalut y el Servicio de Emergencias Médicas (SEM). El protocolo de actuación se basa en la sectorización de Cataluña alrededor de cinco centros con atención permanente, la participación de otros cinco centros con intervencionismo durante su horario laboral y la activa participación del SEM, que realiza el diagnóstico de infarto, decide el tipo de tratamiento en función de las isocronas, realiza el traslado del paciente directamente a las salas de hemodinámica y asegura su retorno a la unidad coronaria más próxima al domicilio del paciente. Otros aspectos importantes son la obligatoriedad de aceptar a los pacientes por parte de los hospitales, tanto en el traslado primario como en el retorno, y de realizar un registro por internet de los datos de todos los pacientes atendidos. Desde el inicio del programa, el número de intervenciones coronarias percutáneas primarias se ha duplicado, con una media de 250 al mes, y los tiempos de actuación se han reducido entre un 20 y un 40%, especialmente entre los pacientes atendidos inicialmente por el SEM (AU)

A myocardial infarction code of practice was introduced in Catalonia, Spain, in June 2009. Its aim was to establish a treatment network for reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) based on the use of primary percutaneous coronary interventions and implemented in accordance with the recommendations of European Society of Cardiology guidelines. The protocol for the code of practice, the only one used in Catalonia, was proposed by the Catalan Society of Cardiology and developed jointly with the Catalan Department of Health, the CatSalut and local Medical Emergency Services. The operating protocol was based on the division of Catalonia into five sectors arranged around centers operating on a 24-hour basis, the participation of five other centers where catheterization facilities were available during normal working hours, and the active participation of the Medical Emergency Services, who usually diagnose the myocardial infarction, decide on the type of treatment that can be given in the time available, transport the patient directly to the catheterization laboratory, and ensure that patients are subsequently transferred to the coronary care unit closest to their home. Other important factors are the hospital’s obligation to accept patients, both on first admission and subsequent transfer, and the establishment of an on-line data register of all patients treated. Since the start of the program, the number of primary percutaneous coronary interventions has doubled, with 250 procedures being performed each month on average, and operating delays have decreased by 20-40%, especially among patients who are first seen by the Medical Emergency Services (AU)

Socioeconomic status and risk of acute myocardial infarction. Population-based case-control study.

INTRODUCTION AND OBJECTIVES: Socioeconomic status is associated with cardiovascular mortality. The aims of this study were to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI), and to determine whether any association found is independent of the presence of cardiovascular risk factors (CVRFs). METHODS: Study cases were matched with controls by age, sex and year of recruitment. Cases were recruited from a hospital register and controls from cross-sectional studies of the general population. The socioeconomic status was determined from educational level and social class, as indicated by occupation. Self-reported data were collected on the presence of CVRFs. RESULTS: The study included 1369 cases and controls. Both educational level and social class influenced AMI risk. Among non-manual workers, there was an inverse linear relationship between educational level and AMI risk independent of CVRFs: compared with university educated individuals, the odds ratio (OR) for an AMI among those with a high school education was 1.63 (95% confidence interval [CI], 1.16-2.3), and among those with an elementary school education, 3.88 (95% CI, 2.79-5.39). No association between educational level and AMI risk was observed in manual workers. However, the AMI risk was higher in manual workers than non-manual university educated workers: in those with an elementary school education, the increased risk (OR=2.09; 95% CI, 1.59-2.75) was independent of CVRFs. CONCLUSIONS: An association was found between socioeconomic status and AMI risk. The AMI risk was greatest in individuals with only an elementary school education, irrespective of CVRFs and social class, as indicated by occupation.

Posición socioeconómica e infarto agudo de miocardio. Estudio caso-control de base poblacional / Socioeconomic status and risk of acute myocardial infarction. Population-based case-control study

Introducción y objetivos. La posición socioeconómica se relaciona con la mortalidad cardiovascular. El objetivo de este estudio fue analizar la relación entre la posición socioeconómica y sus diferentes indicadores y el riesgo de infarto agudo de miocardio (IAM), y determinar si ésta era independiente de los factores de riesgo cardiovascular (FRCV). Métodos. Estudio caso-control apareado por edad, sexo y año de reclutamiento. Los casos se obtuvieron de un registro hospitalario y los controles, de estudios transversales de base poblacional. La posición socioeconómica se determinó por el nivel de estudios y la clase social basada en ocupación. Se recogió información autodeclarada sobre los FRCV. Resultados. Se incluyó a 1.369 casos y controles. Hubo interacción entre nivel de estudios y clase social: en los trabajadores no manuales el nivel de estudios se asoció de forma lineal, inversa e independiente de los FRCV con el riesgo de IAM (estudios secundarios, odds ratio [OR] = 1,63; intervalo de confianza [IC] del 95%, 1,16-2,3; estudios primarios, OR = 3,88; IC del 95%, 2,79-5,39) respecto a universitarios; en los trabajadores manuales no se observó una asociación entre nivel de estudios y riesgo de IAM. Los trabajadores manuales presentaban un exceso de riesgo de IAM respecto a los no manuales universitarios, este exceso de riesgo era independiente de los FRCV en el grupo con estudios primarios (OR = 2,09; IC del 95%, 1,59-2,75). Conclusiones. Hay relación entre la posición socioeconómica y el riesgo de IAM. El grupo de la población con nivel de estudios primarios presenta mayor riesgo de IAM que es independiente de los FRCV y de la clase social basada en la ocupación (AU)

Introduction and objectives. Socioeconomic status is associated with cardiovascular mortality. The aims of this study were to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI), and to determine whether any association found is independent of the presence of cardiovascular risk factors (CVRFs). Methods. Study cases were matched with controls by age, sex and year of recruitment. Cases were recruited from a hospital register and controls from cross-sectional studies of the general population. The socioeconomic status was determined from educational level and social class, as indicated by occupation. Self-reported data were collected on the presence of CVRFs. Results. The study included 1369 cases and controls. Both educational level and social class influenced AMI risk. Among non-manual workers, there was an inverse linear relationship between educational level and AMI risk independent of CVRFs: compared with university educated individuals, the odds ratio (OR) for an AMI among those with a high school education was 1.63 (95% confidence interval [CI], 1.16-2.3), and among those with an elementary school education, 3.88 (95% CI, 2.79-5.39). No association between educational level and AMI risk was observed in manual workers. However, the AMI risk was higher in manual workers than non-manual university educated workers: in those with an elementary school education, the increased risk (OR=2.09; 95% CI, 1.59-2.75) was independent of CVRFs. Conclusions. An association was found between socioeconomic status and AMI risk. The AMI risk was greatest in individuals with only an elementary school education, irrespective of CVRFs and social class, as indicated by occupation (AU)

Why should population attributable fractions be periodically recalculated? An example from cardiovascular risk estimation in southern Europe.

OBJECTIVE: To determine the effect of age and study period on coronary heart disease (CHD) risk attributable to cardiovascular risk factors. METHODS: A cohort of cardiovascular disease (CVD)-free randomly participants from Girona (Spain) aged 35-74 years recruited in 1995 and 2000 and followed for an average of 6.9 years. A survey conducted in the same area in 2005 was also used for the analysis. Smoking, hypertension, diabetes, sedentary lifestyle, obesity, total cholesterol > or = 240 mg/dl, low-density lipoprotein (LDL) cholesterol > or = 160 mg/dl, and high-density lipoprotein cholesterol <40 mg/dl were the risk factors considered. The composite end-point included myocardial infarction, angina pectoris, and CHD death. RESULTS: LDL cholesterol had the highest potential for CHD prevention between 35 and 74 years [42% (95% Confidence Interval: 23,58)]. The age-stratified analysis showed that the population attributable risk (PAF) for smoking was 64% (30,80) in subjects < 55 years; for those > or = 55 years, the PAF for hypertension was 34% (1,61). The decrease observed between 1995 and 2005 in the population's mean LDL cholesterol level reduced that PAF in all age groups. CONCLUSION: Overall, LDL cholesterol levels had the highest potential for CHD prevention. Periodic PAF recalculation in different age groups may be required to adequately monitor population trends.

Prevalence of cardiovascular risk factors in men with stable coronary heart disease in France and Spain.

BACKGROUND: Cigarette smoking, raised blood pressure, unfavourable lipid concentrations, diabetes and - more indirectly - obesity, are responsible for most coronary heart disease events in developed and developing countries. AIMS: The objective of our study was to compare prevalence, treatment and control of cardiovascular risk factors in two samples of men with stable coronary heart disease, recruited in France and Spain. METHODS: Standardized measurements of body mass index, systolic and diastolic blood pressures, plasma lipids, glycaemia, and smoking were collected and drug use was registered. Cross-sectional comparisons were made between French and Spanish samples. RESULTS: Data from 982 individuals were analysed (420 French and 562 Spanish men). Current smoking was more frequent in Spain (p<0.001), whereas hypertension and uncontrolled blood pressure were more frequent in France (p<0.001). Mean concentrations of low-density lipoprotein cholesterol and triglycerides were significantly higher in France (p<0.001). No significant differences were observed regarding obesity, high-density lipoprotein cholesterol and diabetes. More than 97% of participants presented with at least one of the following conditions: hypertension, dyslipidaemia, diabetes, obesity or smoking. Antiplatelet agents, calcium inhibitors, diuretics and hypoglycaemic drugs were used more frequently in France, whereas angiotensin-converting enzyme inhibitors and lipid-lowering treatments were used more frequently in Spain. CONCLUSION: Prevalence of cardiovascular risk factors is high among French and Spanish patients with stable coronary heart disease, with differences between countries regarding the distribution of the various risk factors. A great proportion of patients do not reach the recommended levels for risk factor control.

Waist circumference and impaired fasting glucose screening in a Mediterranean population.

We evaluate the merits of routine waist circumference measurements for screening of impaired fasting glucose (IFG). Waist circumference and body mass index showed a strong association with the risk of IFG. The present data indicate the need for routine anthropometric measurements in clinical practice screening for IFG.

De tot (el) cor : volúmen 1

Publicación compuesta por 4 volúmenes cuyo objetivo es prevenir las enfermedades del corazón y ayudar a los enfermos que las padecen. Incluye: conceptos básicos, los factores de riesgo, el ejercicio físico, las relaciones sexuales y los sentimientos y las emociones.

Hypertension confirmation and blood pressure control rates in epidemiological surveys.

BACKGROUND: Scarce knowledge about hypertension confirmation and control after a single blood pressure (BP) measurement is available. The objective of this study was to evaluate hypertension confirmation and control rates after 6-year follow-up in a population-based cohort. METHODS: A cohort of 1748 participants representative of a Spanish population received standardized BP measurements. Systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg was found in 617 participants. Three hundred and thirty-four of them had no history of hypertension and the remaining 283 had been previously diagnosed or received antihypertensive treatment. All were advised to consult their physicians. We discarded for follow-up 109 participants with already well-controlled hypertension (27.8% of all hypertensive participants). We followed 583 participants (94.5% of the cohort) for 6 years (14 died and 20 were lost to follow-up). RESULTS: The diagnosis of hypertension was confirmed during follow-up in 139 (44.4%) of those with no previously known hypertension, making the overall prevalence for the cohort equal to 30.4% (n=531). The hypertension control rate at the end of follow-up was 50.1%, whereas it was 27.9% at baseline. Diabetes was the only factor to be independently associated with good control of hypertension. CONCLUSION: Six years after a single-occasion blood pressure measurement, hypertension was confirmed in almost half of the participants with systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg and no history of hypertension. Hypertension control achieved with this screening procedure is almost double that observed in the baseline examination, and is highest among diabetic participants.

[Analysis of trends in myocardial infarction case-fatality, incidence and mortality rates in Girona, Spain, 1990-1999]. / Análisis de la tendencia en la letalidad, incidencia y mortalidad por infarto de miocardio en Girona entre 1990 y 1999.

INTRODUCTION AND OBJECTIVES: The incidence of myocardial infarction in Spain is low, and mortality has been decreasing over the last few decades. The objective of this study was to analyze trends in myocardial infarction mortality, incidence, attack rates, and 28-day case-fatality attack rates between 1990 and 1999 in the general population aged 35-74 years in Girona, Spain. METHODS: The study included all myocardial infarction cases in Girona classified according to the MONICA algorithm. Attack, incidence, mortality rates and case-fatality were calculated. In addition, the annual percentage change in each of these indicators during the study period was also calculated. RESULTS: The mean attack rate per 100,000 inhabitants was 258 (95% CI, 249-267) in men and 55 (95% CI, 51-59) in women. The mean mortality rate per 100,000 was 99 (95% CI, 93-104) in men and 25 (95% CI, 22-28) in women. Significant reductions in attack, incidence and recurrence rates were observed in men aged 35-64 years during the period 1990-1999, but not in men aged 65-74 years, nor in women. CONCLUSIONS: Myocardial infarction incidence and mortality rates were low in the general population aged 35-64 years. Rates improved in men aged 35-64 years during the period 1990-1999, but not in those aged 65-74 years, which indicates that a combination of primary and secondary prevention has increased the age at which a myocardial infarction or its recurrence is observed. Rates in woman were lower and did not change during the study period.

Análisis de la tendencia en la letalidad, incidencia y mortalidad por infarto de miocardio en Girona entre 1990 y 1999 / Analysis of trends in myocardial infarction case-fatality, incidence and mortality rates in Girona, Spain, 1990-1999

Introducción y objetivos. La incidencia por infarto de miocardio en España es baja y la mortalidad está disminuyendo en las últimas décadas. Hemos analizado las tendencias en las tasas de mortalidad, incidencia y ataque, y en la letalidad a 28 días por infarto de miocardio entre 1990 y 1999 en la población de 35 a 74 años de Girona. Métodos. Se incluyeron todos los casos de infarto de miocardio de Girona clasificados según el algoritmo MONICA. Se calcularon las tasas de ataque, incidencia y mortalidad, y la letalidad, así como el porcentaje de cambio anual en cada uno de los indicadores durante el período analizado. Resultados. La tasa anual media de ataque fue de 258 (intervalo de confianza [IC] del 95%, 249-267) y 55 (IC del 95%, 51-59) por 100.000 habitantes para varones y mujeres, respectivamente, y la de mortalidad de 99 (IC del 95%, 93-104) por 100.000 en varones y de 25 (IC del 95%, 22-28) por 100.000 en mujeres. Las tasas de ataque, incidencia y recurrencia disminuyeron significativamente en varones de 35 a 64 años durante el período 1990-1999, pero no en los de 65 a 74 años ni en las mujeres. Conclusiones. La incidencia y la mortalidad por IAM fueron bajas en la población de 35 a 64 años, y mejoraron en los varones de 35 a 64 años durante el período 1990-1999, pero no en los de 65 a 74 años, lo que indica que la combinación de prevención primaria y secundaria ha retrasado la edad de aparición del infarto de miocardio o de las recurrencias. Las tasas en mujeres fueron inferiores y no cambiaron durante el período estudiado (AU)

Introduction and objectives. The incidence of myocardial infarction in Spain is low, and mortality has been decreasing over the last few decades. The objective of this study was to analyze trends in myocardial infarction mortality, incidence, attack rates, and 28-day case-fatality attack rates between 1990 and 1999 in the general population aged 35-74 years in Girona, Spain. Methods. The study included all myocardial infarction cases in Girona classified according to the MONICA algorithm. Attack, incidence, mortality rates and case-fatality were calculated. In addition, the annual percentage change in each of these indicators during the study period was also calculated. Results. The mean attack rate per 100,000 inhabitants was 258 (95% CI, 249-267) in men and 55 (95% CI, 51-59) in women. The mean mortality rate per 100,000 was 99 (95% CI, 93-104) in men and 25 (95% CI, 22-28) in women. Significant reductions in attack, incidence and recurrence rates were observed in men aged 35-64 years during the period 1990-1999, but not in men aged 65-74 years, nor in women. Conclusions. Myocardial infarction incidence and mortality rates were low in the general population aged 35-64 years. Rates improved in men aged 35-64 years during the period 1990-1999, but not in those aged 65-74 years, which indicates that a combination of primary and secondary prevention has increased the age at which a myocardial infarction or its recurrence is observed. Rates in woman were lower and did not change during the study period (AU)

Enfermedad de Kawasaki con afección coronaria en el adulto / Kawasaki disease with coronary artery lesions in adults

No disponible

[Effect of reactions to symptoms onset on early mortality from myocardial infarction]. / Impacto de la actitud frente a los síntomas en la mortalidad temprana por infarto de miocardio.

INTRODUCTION AND OBJECTIVES: A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. PATIENTS AND METHOD: Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. RESULTS: Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). CONCLUSIONS: In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients.

Impacto de la actitud frente a los síntomas en la mortalidad temprana por infarto de miocardio / Effect of reactions to symptom onset on early mortality from myocardial infarction

Introducción y objetivos. El entorno y las circunstancias del paciente en el inicio de los síntomas del infarto agudo de miocardio (IAM) pueden condicionar su supervivencia. El objetivo es estudiar los aspectos relativos a la convivencia, las características y el retraso en las primeras acciones tomadas por los pacientes con IAM que sobrevivieron más de 1 h y analizar su relación con la mortalidad en distintos períodos.Pacientes y método. Se ha realizado un estudio de cohortes de base poblacional entre 1997 y 1998. La principal fuente de información ha sido el Registre Gironí del Cor (REGICOR) y, para los fallecidos antes de acceder a monitorización, los boletines estadísticos de defunción. Se estudiaron las características demográficas, los hábitos y los antecedentes, los síntomas, las alteraciones electrocardiográficas, el valor de las enzimas miocárdicas y los procedimientos terapéuticos y diagnósticos. Se analizó la mortalidad prehospitalaria, intrahospitalaria y global a los 28 días. Resultados. Se analizaron 1.097 casos: 652 (59,4%) supervivientes a 28 días, 171 muertes en hospitales (15,58%) y 274 muertes prehospitalarias (24,97%). Los pacientes que fueron directamente al hospital presentaron menor mortalidad (odds ratio [OR] = 0,32; intervalo de confianza [IC] del 95%, 0,17-0,59). Hubo mayor mortalidad a los 28 días entre los que tenían síntomas atípicos (OR = 5,52; IC del 95%, 2,90-10,50) y/o vivían institucionalizados (OR = 9,47; IC del 95%,1,05-84,9). Conclusiones. En ausencia de un servicio de ambulancias medicalizadas, los pacientes con un IAM que se dirigen directamente a un hospital y/o presentan síntomas típicos sobreviven en mayor proporción a los 28 días y en la fase prehospitalaria de la enfermedad, y los institucionalizados presentan una mayor mortalidad a los 28 días

Introduction and objectives. A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. Patients and method. Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. Results. Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). Conclusions. In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36)

Objetivo: El cuestionario de salud SF-36 puede ser autoaplicado o utilizado en entrevistas personales o telefónicas. El objetivo principal de este trabajo fue comparar la aplicación telefónica del cuestionario y la versión autoaplicada en una población de Girona (España). Métodos: Diseño cruzado y aleatorizado para la aplicación de las dos formas del cuestionario. Se asignaron dos órdenes de aplicación de las encuestas (telefónica-autoaplicada y autoaplicada-telefónica). Un total de 261 personas completaron los cuestionarios. Las comparaciones entre modos de aplicación se realizaron mediante la prueba de la t de Student para datos apareados. La consistencia interna y la concordancia entre modos de aplicación se analizaron mediante los coeficientes * de Chronbach y de correlación intraclase, respectivamente. Su utilizó un modelo lineal general para medidas repetidas para evaluar el efecto del orden de la aplicación de los cuestionarios. Resultados: Cuando se utilizó primero el cuestionario autoaplicado, las escalas de función física, rol físico y función social resultaron en una menor puntuación. Todos los coeficientes * de Chronbach fueron superiores a 0,70, excepto para la escala de función social en la modalidad autoaplicada cuando se aplicó primero la encuesta telefónica. El rango de los coeficientes de correlación intraclase fue de 0,41 a 0,83 en la modalidad telefónica-autoaplicada y de 0,32 a 0,73 en la modalidad autoaplicada-telefónica. No se observó un efecto relevante del orden de aplicación. Conclusiones: Los resultados de este estudio indican que la aplicación de la encuesta telefónica es equivalente e tan válida como la encuesta autoaplicada

Objective: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). Methods: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. Results: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. Conclusions: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode