ABSTRACT
Fundamento y objetivo: Evaluar el grado general de consecución de objetivos de control de los factores de riesgo en prevención secundaria de los pacientes que han tenido un episodio coronario y son seguidos en atención primaria. Pacientes y método: Estudio descriptivo, transversal y multicéntrico con inclusión mediante muestreo consecutivo de los primeros 5 pacientes que acudieron a consulta y habían tenido un episodio coronario en un período previo de 6 meses a 10 años. Los objetivos de control fueron: presión arterial < 140/90 mmHg en población general y < 130/85 mmHg en diabéticos, colesterol de las lipoproteínas de baja densidad (cLDL) < 100 mg/dl y no ser fumador. Resultados: Se incluyó a 8.817 pacientes (varones el 73,7%) con una media (desviación estándar) de edad de 65,4 (10,3) años. El 76,6% eran hipertensos; el 73,4%, dislipémicos, y el 32,7%, diabéticos. El 60,2% alcanzó el objetivo de presión arterial, el 26,3% alcanzó el objetivo de cLDL < 100 mg/dl y el 11,4% siguió fumando. Cumplió la totalidad de las recomendaciones el 16,4%. Los factores relacionados de forma independiente con un buen control fueron la menor edad, el sexo masculino, el ingreso por síndrome coronario agudo sin elevación del ST (odds ratio [OR] = 1,39; intervalo de confianza [IC] del 95%, 1,01-1,93; p = 0,04) o para revascularización (OR = 1,37; IC del 95%, 1,12-1,67; p = 0,002), tener enfermedad arterial periférica (OR = 1,43; IC del 95%, 1,11-1,84; p = 0,005) y que los objetivos planteados por los médicos fueran adecuados (OR = 1,90; IC del 95%, 1,48-2,44; p < 0,0001). El control fue peor en los pacientes hipertensos o dislipémicos. Conclusiones: El control general de los factores de riesgo en prevención secundaria de la enfermedad coronaria se consigue en 1 de cada 6 pacientes atendidos en atención primaria
Background and objective: Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. Patients and method: Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. Results: 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. Conclusions: Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care
Subject(s)
Male , Female , Middle Aged , Aged , Humans , Risk Adjustment/methods , Coronary Disease/prevention & control , Risk Factors , Primary Health Care/methods , Epidemiology, Descriptive , Comorbidity , Hypertension/epidemiology , Hyperlipidemias/epidemiologyABSTRACT
BACKGROUND AND OBJECTIVE: Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. PATIENTS AND METHOD: Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. RESULTS: 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. CONCLUSIONS: Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care.
