Perspectiva de género en el estudio OFRECE: diferencias en la atención entre pacientes que consultan por dolor torácico o por palpitaciones / The gender perspective within the OFRECE study: differences in health care among patients consulting for chest pain and/or palpitations

Introducción y objetivos: En un estudio de base poblacional, se analizaron las posibles diferencias en función del sexo en la atención al dolor torácico o las palpitaciones como motivo de consulta. Métodos: El estudio OFRECE incluyó una muestra aleatoria de la población española de 8.400 participantes de edad ≥ 40 años, de los que 1.132 (13,5%) tenían antecedentes de consulta por dolor en el pecho y 1.267 (15,1%), por palpitaciones y se incluyen en este estudio. Se calculó la odds ratio (OR) de que se practicaran determinadas pruebas y se comunicaran los resultados de las consultas en relación con el hecho de ser mujer, tanto brutas como ajustadas por los factores de riesgo cardiovascular clásicos, antecedentes de enfermedad cardiovascular y diagnóstico de angina estable o fibrilación auricular confirmado en este estudio en cada caso. Resultados: No se observaron diferencias en los antecedentes de consulta por dolor torácico entre mujeres y varones (el 13 y el 14,1%; p=0,159) y sí en las consultas por palpitaciones (el 19,0 y el 10,4% respectivamente; p <0,001). A las mujeres con antecedentes de consulta por dolor torácico, en comparación con los varones, se les realizaron menos ecocardiogramas (el 32,5 y el 45,3%; p <0,001), se las remitió con menor frecuencia al cardiólogo (el 49,1 y el 60,1%; p <0,001), ingresaron menos (el 20,1 y el 39,4%; p <0,001) y se alcanzó un diagnóstico en menor proporción de casos (el 60,9 y el 71,9%; p <0,001). Al ajustar, disminuyen las diferencias y dejan de ser significativas en todos los casos: para ecocardiogramas, OR ajustada=0,81 (IC95%, 0,60-1,09); para remisión al cardiólogo, OR ajustada=0,86 (IC95%, 0,63-1,16), y para ingreso, OR ajustada=0,76 (IC95%, 0,54-1,09). En el caso de las palpitaciones, las diferencias no ajustadas son menores y todas desaparecen al ajustar. Conclusiones: Este trabajo no confirma un sesgo en razón del sexo en la atención a estos síntomas, aunque no es descartable completamente un sesgo de género en el diagnóstico confirmado en el estudio que limite su capacidad para identificar diferencias en la atención a las pacientes

Introduction and objectives: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. Methods: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. Results: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. Conclusions: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care

The Gender Perspective Within the OFRECE Study: Differences in Health Care Among Patients Consulting for Chest Pain and/or Palpitations.

INTRODUCTION AND OBJECTIVES: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. CONCLUSIONS: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.

Validación externa de la escala EAHFE-3D para la evaluación del pronóstico en insuficiencia cardiaca aguda / External validity of a prognostic score for acute heart failure based on the Epidemiology of Acute Heart Failure in Emergency Departments registry: the EAHFE-3D scale

Objetivo. Validar la escala pronóstica EAHFE-3D en una cohorte externa de pacientes atendidos por insuficiencia cardiaca aguda (ICA). Método. Estudio de cohortes multipropósito que incluyó pacientes con ICA en 3 centros hospitalarios del País Vasco entre 2011 y 2013. Se recogieron los datos demográficos (edad), clase funcional basal (New York Heart Association), clínicos (presión arterial sistólica y saturación de oxígeno basal), analíticos (natremia) y terapéuticos (ventilación mecá- nica no invasiva e inotrópicos y vasopresores) en el servicio de urgencias (SU) necesarios para el cálculo de la escala EAHFE-3D. La variable de resultado principal fue la mortalidad a tres días de la llegada al SU. Resultados. Analizamos 717 pacientes con información completa. El intercepto β el modelo fue 0,5 (IC95%: -2,7- 3,7) y la pendiente α fue de 1,3 (IC95%: 0,4-2,2). El área bajo la curva AUC (ROC) fue 0,76 (IC95%: 0,58-0,94). Conclusiones. La escala EAHFE-3D presentó una buena capacidad predictiva en nuestra muestra, no diferente a la obtenida por los autores originales, aunque no ha mostrado buena calibración. Se recomienda continuar con el proceso de validación antes de ser implementada en la práctica clínica (AU)

Objective. To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure. Methods. Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department. Results. The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94). Conclusions. The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice (AU)

External validity of a prognostic score for acute heart failure based on the Epidemiology of Acute Heart Failure in Emergency Departments registry: the EAHFE-3D scale. / Validación externa de la escala EAHFE-3D para la evaluación del pronóstico en insuficiencia cardiaca aguda.

OBJECTIVES: To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure. MATERIAL AND METHODS: Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department. RESULTS: The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94). CONCLUSION: The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice.

OBJETIVO: Validar la escala pronóstica EAHFE-3D en una cohorte externa de pacientes atendidos por insuficiencia cardiaca aguda (ICA). METODO: Estudio de cohortes multipropósito que incluyó pacientes con ICA en 3 centros hospitalarios del País Vasco entre 2011 y 2013. Se recogieron los datos demográficos (edad), clase funcional basal (New York Heart Association), clínicos (presión arterial sistólica y saturación de oxígeno basal), analíticos (natremia) y terapéuticos (ventilación mecánica no invasiva e inotrópicos y vasopresores) en el servicio de urgencias (SU) necesarios para el cálculo de la escala EAHFE-3D. La variable de resultado principal fue la mortalidad a tres días de la llegada al SU. RESULTADOS: Analizamos 717 pacientes con información completa. El intercepto ß el modelo fue 0,5 (IC95%: ­2,7- 3,7) y la pendiente α fue de 1,3 (IC95%: 0,4-2,2). El área bajo la curva AUC (ROC) fue 0,76 (IC95%: 0,58-0,94). CONCLUSIONES: La escala EAHFE-3D presentó una buena capacidad predictiva en nuestra muestra, no diferente a la obtenida por los autores originales, aunque no ha mostrado buena calibración. Se recomienda continuar con el proceso de validación antes de ser implementada en la práctica clínica.

The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six months after discharge following an episode of acute coronary syndrome, (CAM-2 Project): a randomized controlled trial.

OBJECTIVES: We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached, improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome. BACKGROUND: There is room to improve mid-term adherence to clinical guidelines' recommendations in coronary heart disease secondary prevention, specially non-pharmacological ones, often neglected. METHODS: In CAM-2, patients discharged after an acute coronary syndrome were randomly assigned to the intervention or the usual care group. The primary outcome was reaching therapeutic objectives in various secondary prevention variables: smoking, obesity, blood lipids, blood pressure control, exercise and taking of medication. RESULTS: 1757 patients were recruited in 64 hospitals and 1510 (762 in the intervention and 748 in the control group) attended the six-months follow-up visit. After adjustment for potentially important variables, there were, between the intervention and control group, differences in the mean reduction of body mass index (0.5 vs. 0.2; p < 0.001) and waist circumference (1.6 cm vs. 0.6 cm; p = 0.05), proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl (64.7% vs. 56.5%; p = 0.001). The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins (98.1% vs. 95.9%; p = 0.029). CONCLUSIONS: At least in the short term, lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention.