ABSTRACT
No disponible
Subject(s)
Humans , Family Practice/legislation & jurisprudence , Family Practice/trends , Public Health Administration/trends , Spain , 51725 , Primary Health Care/legislation & jurisprudence , Primary Health Care/trendsABSTRACT
El objetivo del protocolo es conocer qué estudios deben solicitarse ante una anemia en un paciente con enfermedad renal crónica, el diagnóstico diferencial de la anemia renal, conocer y corregir otras anemias carenciales y los criterios de remisión del paciente anémico con enfermedad renal crónica a Nefrología u otras especialidades (AU)
The objective of this protocol is to know which test are needed to study an anaemia in a patient with chronic kidney disease, the differential diagnosis of renal anaemia, to know and correct other deficiency anaemias, and the criteria for referral to Nephrology or other specialties of the anaemic patient with chronic kidney disease (AU)
Subject(s)
Humans , Anemia/epidemiology , Renal Insufficiency, Chronic/complications , Glycated Hemoglobin/analysis , Practice Patterns, Physicians' , Renal Insufficiency, Chronic/physiopathology , Anemia/classification , Diagnosis, Differential , 16595/drug therapy , Iron Compounds/therapeutic useABSTRACT
The objective of this protocol is to know which test are needed to study an anaemia in a patient with chronic kidney disease, the differential diagnosis of renal anaemia, to know and correct other deficiency anaemias, and the criteria for referral to Nephrology or other specialties of the anaemic patient with chronic kidney disease.
Subject(s)
Anemia/etiology , Referral and Consultation , Renal Insufficiency, Chronic/complications , Anemia/diagnosis , Anemia/therapy , Diagnosis, Differential , HumansSubject(s)
Attitude to Health , Health Promotion , Self Care , Community Medicine , Family Practice , Humans , Societies, Medical , SpainABSTRACT
No disponible
Subject(s)
Humans , Self-Care Units/organization & administration , Disease Prevention , Healthy People Programs/organization & administration , Primary Health Care/methods , Health Promotion/organization & administrationABSTRACT
BACKGROUND AND AIMS: Patients with stable coronary heart disease (CHD) and atherogenic dyslipidemia (AD) have a high-risk of recurrence and are those who derive most benefit from treatment with lipid-lowering agents. The aim of this study was to examine the prevalence of AD in patients with stable coronary heart disease and to investigate associated factors. METHODS: Cross-sectional study involving 7823 subjects admitted for a coronary event between 6 months and 10 years previously. AD was considered to be the concurrent presence of low HDL-cholesterol (<1.03 mmol/L [40 mg/dL] in males, <1.29 mmol/L [50 mg/dL] in females) and elevated triglycerides (≥1.7 mmol/L [150 mg/dL]). RESULTS: Mean age was 65.3 (10.1) years, 73.6% were males and 80.3% were receiving treatment with statins. Low HDL-cholesterol was observed in 26.3% of the participants, 39.7% had elevated triglyceride concentration and 13.0% had AD. The percentage of AD in patients with criteria for metabolic syndrome was 30.9%. Factors associated directly and independently with the presence of AD in the multivariate analysis were female sex, history of coronary syndrome without ST elevation or coronary revascularization, presence of atrial fibrillation, body mass index, LDL-cholesterol, systolic blood pressure and blood glucose levels, while age and glomerular filtration rate were significantly and inversely associated with AD. CONCLUSION: A significant proportion of patients with coronary disease could benefit from interventions aimed at increasing HDL-cholesterol and reducing triglycerides.
Subject(s)
Atherosclerosis/blood , Atherosclerosis/epidemiology , Coronary Artery Disease/blood , Coronary Artery Disease/epidemiology , Dyslipidemias/blood , Dyslipidemias/epidemiology , Aged , Atherosclerosis/complications , Body Mass Index , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Artery Disease/complications , Cross-Sectional Studies , Dyslipidemias/complications , Female , Humans , Hypolipidemic Agents/pharmacology , Male , Middle Aged , Prevalence , Triglycerides/bloodABSTRACT
OBJECTIVE: The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). METHODS: A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. RESULTS: Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). CONCLUSION: Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs.
Subject(s)
Cardiovascular Agents/therapeutic use , Coronary Disease/complications , Coronary Disease/drug therapy , Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Aged , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Female , Humans , Male , Prevalence , Risk FactorsABSTRACT
Objetivo. La consecución de objetivos terapéuticos en pacientes con cardiopatía isquémica crónica y síndrome metabólico (SM) es desconocida. El objetivo del estudio fue analizar en pacientes con enfermedad coronaria estable si la prevalencia de los factores de riesgo, la utilización de fármacos cardiovasculares y la consecución de objetivos terapéuticos eran diferentes en función de la presencia o no del SM. Métodos. Estudio transversal multicéntrico en el que participaron 7.600 sujetos con enfermedad coronaria estable atendidos en Atención Primaria. Para el diagnóstico del SM se utilizaron los criterios del National Colesterol Educational Programm Adult Treatment Programm III (NCEP-ATP III). Resultados. La edad media fue 65,3 años (hombres, 82%). El 37,7% cumplía criterios de SM. Los pacientes con SM tenían una significativa mayor prevalencia e intensidad de los factores de riesgo, así como una mayor comorbilidad cardiovascular. Además, utilizaban con mayor frecuencia antihipertensivos, hipolipemiantes e hipoglucemiantes, no existiendo diferencias en antitrombóticos y betabloqueantes. Tras ajustar por los factores de riesgo y la comorbilidad solo los fibratos y los antagonistas del receptor de la angiotensina II eran utilizados más frecuentemente por los pacientes con SM. Los objetivos terapéuticos de colesterol-LDL (23,4% versus 27,7%, p<0,001), de presión arterial (29,1% versus 52,2%, p<0,001) y de hemoglobina glucada en diabéticos (54,7% versus 75,9%, p<0,001), se alcanzaron menos frecuentemente en los pacientes con SM. Conclusión. Los pacientes con enfermedad coronaria estable y SM alcanzan unos objetivos terapéuticos con menor frecuencia que los enfermos sin SM, a pesar de recibir una mayor cantidad de fármacos(AU)
Objective. The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). Methods. A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. Results. Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). Conclusion. Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Metabolic Syndrome/epidemiology , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Myocardial Ischemia/complications , Myocardial Ischemia/diagnosis , Risk Factors , Coronary Vessels/pathology , Myocardial Ischemia/epidemiology , Cross-Sectional Studies , Primary Health Care , Comorbidity , Secondary Prevention , 28599 , Logistic Models , Confidence IntervalsABSTRACT
UNLABELLED: Patients with type 2 diabetes use to be managed in their primary care settings during the early stages of the disease. The main objective of the study was to determine renal impairment prevalence, and to assess its significance, within type 2 diabetics controlled by their family physicians. PATIENTS AND METHOD: Transverse observation of patients with type 2 diabetes who were the first 20 unselected cases seen by 183 family physicians from 16 of the 17 Autonomic Communities of our country. The following variables were determined: serum creatinine, glucose, and HbA1c concentrations, proteinuria (dipstick test in a first-voided morning urine sample), blood pressure levels, and associated cardiovascular disease. RESULTS: Data from 3,583 type 2 diabetic subjects were evaluated. Mean age was 64 +/- 10 years and 45% were male. A serum creatinine > or = 1.2 mg/dl was observed in 523 (15.5%) patients. Proteinuria was present in 794 (23.5%) cases, being > or = 2 + in 215 (6.5%) subjects. Patients with a serum creatinine > or = 1.2 mg/dl were older, shower higher blood pressure levels, and suffered from more cardiovascular disease (32.0 vs 19.5%) than those with a serum creatinine < 1.2 mg/dl. In a multivariate analysis, this difference continued to be significant (OR 1.47; 95% CI 1.14 to 1.90; p = 0.002. Patients with proteinuria showed a higher prevalence of cardiovascular disease (OR 1.83; 95% CI 1.47 to 2.27; p < 0.0001) than those without proteinuria. This association was continuous through no proteinuria to the > or = 2 + proteinuria (p < 0.001). Blood pressure level was > or = 140/90 mmHg in 69% of the cases, being < 130/85 mmHg in only 8% of the subjects. CONCLUSIONS: There is a high prevalence of renal impairment, approximately of 25% within type 2 diabetic patients seen at the primary care level. Optimal blood pressure level seems to be extremely infrequent bearing in mind the diagnosis of diabetes and the associated cardiovascular disease.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/epidemiology , Aged , Comorbidity , Cross-Sectional Studies , Female , Follow-Up Studies , Glycated Hemoglobin/analysis , Heart Diseases/epidemiology , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Kidney Function Tests , Male , Middle Aged , Obesity/epidemiology , Prevalence , Primary Health Care/statistics & numerical data , Proteinuria/diagnosis , Proteinuria/epidemiology , Reagent Strips , Risk Factors , Smoking/epidemiology , Spain/epidemiologyABSTRACT
En sus fases iniciales el seguimiento clínico de la mayoría de los pacientes con diabetes tipo 2 se realiza en Atención Primaria. El objetivo principal del trabajo es conocer, en este nivel asistencial, la prevalencia y significado de la presencia de nefropatía. Pacientes y métodos: Estudio descriptivo y transversal realizado en el ámbito de la Atención Primaria. Durante tres meses consecutivos 183 médicos de 16 Comunidades Autónomas de nuestro país incluyeron los primeros 20 enfermos con diabetes tipo 2, que de un modo consecutivo acudieron a la consulta. En cada paciente se midió la presión arterial y se determinó la concentración en sangre de creatinina, glucosa y HbA1c. La proteinuria se midió en la primera orina de la mañana mediante una tira reactiva. Además, se verificó la presencia de patología cardiovascular asociada. Resultados: El total de la muestra fue de 3.583 diabéticos, con edad media de 64 ñ 10 años (varones 45 por ciento). En 523 (15,5 por ciento) pacientes se observó una creatinina 1,2 mg/dl y en 794 (23,5 por ciento) la proteinuria fue positiva, siendo 2 + en 215 (6,5 por ciento). Los pacientes con creatinina 1,2 mg/dl presentaron mayor edad, niveles más altos de presión arterial y mayor prevalencia de patología cardiovascular asociada (32 por ciento vs 19,5 por ciento), respecto a los enfermos con creatinina inferior. Esta diferencia se mantuvo tras el análisis de regresión logística múltiple (OR 1,47 I de C 1,14-1,90; p = 0,002). Los pacientes con proteinuria mostraron una mayor prevalencia de patología cardiovascular concomitante (OR1,83; I de C 1,47-2,27; p < 0,0001) que los pacientes con proteinuria negativa. Dicha asociación fue continua y creciente desde el grado de proteinuria negativa al de proteinuria 2 + (p < 0,001 para la tendencia). El 69 por ciento de los diabéticos tenía un PA 140/90 mmHg y únicamente el 8 por ciento de ellos tenía una PA estrictamente controlada con cifras inferiores a 130/85 mmHg. Conclusiones: La cuarta parte de los diabéticos tipo 2 seguidos en Atención Primaria tienen afectación renal. El control estricto de presión arterial es muy deficitario a pesar de la mayor prevalencia de patología cardiovascular asociada en estos pacientes de alto riesgo. (AU)
