Cardiovascular risk tables: opinion and degree of use of primary care doctors from Madrid, Spain.

AIMS AND OBJECTIVES: To determine the opinion of primary care doctors regarding the cardiovascular risk tables, their degree of use in clinical practice and the specific difficulties encountered when using them. METHOD: Transversal descriptive study. LOCATION: Primary Care, Madrid, Spain. PARTICIPANTS: Primary care doctors from four of Madrid's sanitary areas. PRINCIPAL MEASUREMENTS: Anonymous self-administered questionnaire that studies age, gender, professional data, variables related with the opinion on cardiovascular risk tables, with their application in daily clinical practice, and main barriers for their use. A total of 34 closed questions and one open question were performed. RESULTS: Four hundred and sixty-two questionnaires were received (46% replied). Ninety-three per cent agrees that prevention based on a global evaluation of cardiovascular risk is more convenient than the one based on an independent assessment of each factor. When a new diagnosis of hypertension or elevated cholesterol is performed, 45 and 52% respectively estimate the cardiovascular risk systematically. Twenty per cent uses this information to start a treatment for hypertension and 32% for raised cholesterol. Seventy-three per cent is aware of the tool available in the computer program to estimate the cardiovascular risk and 35% uses it. Eighty-seven per cent gives their patients information about cardiovascular risk. Main identified barriers: lack of time, lack of consensus and absence of computer support. CONCLUSIONS: Primary care doctors are aware of the need to estimate a global cardiovascular risk, recognize the usefulness of the tables but find problems in their practical application. In order to make their application feasible, tables should be simplified and unified, and their format should be improved.

Palliative performance status, heart rate and respiratory rate as predictive factors of survival time in terminally ill cancer patients.

To determine which symptoms, signs, and characteristics that define the patient's functional status predict the survival time in terminally ill cancer patients, a prospective longitudinal study was conducted with terminally ill cancer patients followed by a Home Care Support Team. Patients were followed up with at least weekly visits until death, collecting variables at each visit. A Cox multivariate regression analysis took into account all the follow-ups in the same patient. Ninety-eight patients were studied, and 250 evaluations were done. The mean age was 72 years. The median survival was 32 days. In the multivariate analysis, three independent variables were identified: Palliative Performance Score of 50 or under, heart rate of 100/minute or more, and respiratory rate of 24/minute or more. The variables that were found to be prognostic in our study are objective, easy, and quick to measure, and do not require that the professional have special training or experience. The prediction of survival time may be improved by considering these variables.