[Risk factor prevalence and drug treatment in coronary patients at hospital discharge. Results of a national multicenter registry (3C Program)]. / Prevalencia de los factores de riesgo y tratamiento farmacológico al alta hospitalaria en el paciente coronario. Resultados de un registro multicéntrico nacional (Programa 3C).

INTRODUCTION AND OBJECTIVES: Based on the results of clinical trials the guidelines of international societies recommend secondary prevention in patients. Several surveys have shown that the application of these guidelines in clinical practice is not adequate. The aim of this study was to determine the practical application of the recommendations of these guidelines and drug prescription in patients with coronary heart disease on hospital discharge. METHODS: We included 3,215 coronary patients (myocardial infarction, angina and post-revascularization) discharged from 25 Spanish hospitals. We studied the prevalence of risk factors and the medical treatment on discharge in relation to gender, age, and clinical diagnosis. RESULTS: We found a significantly higher prevalence of risk factors, except for smoking, in women. With regards to age and diagnosis neither was, the prevalence uniform, with an increase in hypertension and diabetes being predominantly seen in the elderly as well as angina patients. Fifty-six point three percent of the patients showed a total cholesterol greater than 200 mg/dl and 88% demonstrated a LDL-cholesterol greater than 100 mg/dl. The prevalence of hypercholesterolemia and low HDL was higher among women. The prescription of betablockers and lipid-lowering drugs is low, especially in women and in patients over the age of 64 years. CONCLUSIONS: The registry of data concerning some risk factors in patient clinical files is poor. The prevalence of risk factors is higher in women. The prescription of betablockers and lipid-lowering drugs was lower than recommended, mainly among women and patients older than 64 years. There is a need for improvement in secondary prevention in coronary patients on hospital discharge.

Risk stratification in heart failure using artificial neural networks.

Accurate risk stratification of heart failure patients is critical to improve management and outcomes. Heart failure is a complex multisystem disease in which several predictors are categorical. Neural network models have successfully been applied to several medical classification problems. Using a simple neural network, we assessed one-year prognosis in 132 patients, consecutively admitted with heart failure, by classifying them in 3 groups: death, readmission and one-year event-free survival. Given the small number of cases, the neural network model was trained using a resampling method. We identified relevant predictors using the Automatic Relevance Determination (ARD) method, and estimated their mean effect on the 3 different outcomes. Only 9 individuals were misclassified. Neural networks have the potential to be a useful tool for making prognosis in the domain of heart failure.

[Secondary prevention of myocardial infarction in Spain. The PREVERSE study]. / La prevención secundaria del infarto de miocardio en España. Estudio PREVESE.

INTRODUCTION AND OBJECTIVES: We present the results from the PREVESE Study, conducted in two phases: the first to identify the secondary prevention measurements recommended in Spain in patients who were discharged after a myocardial infarction; the second, 6 months later, to determine their evolution. METHODS: Data was collected from 1,242 patients in 39 hospitals. An analysis was made of the patients background, risk factors, working status, diagnostic procedures used during hospitalization, laboratory findings and drug therapy prescribed at discharge. At the second control, the risk factors status, diagnostic or assessment tests performed during the 6-month period, working status, mortality and cardiac events were revised. RESULTS: The previous history and risk factors studied showed a high risk profile among patients after myocardial infarction. Among the drug therapies prescribed at discharge the small percentage (6.7%) of lipid lowering prescriptions should be highlighted. An improvement in the risk factor profile was found at the six month checkup with a substantial reduction in the number of smokers, a very low number of hypertensives and an improvement in physical activity. There was no improvement in total-cholesterol levels. CONCLUSIONS: The implementation of preventive measures is not similar in all risk factors. An improvement is reached in prevention of smoking habit and hypertension, but not in the treatment of abnormal levels of hyperlipidemia.