Use of portable single-lead electrocardiogram device as an alternative for QTc monitoring in critically ill patients.

PURPOSE: Acquired QT prolongation is frequent and leads to a higher mortality rate in critically ill patients. KardiaMobile 1L® (KM1L) is a portable, user-friendly single lead, mobile alternative to conventional 12-lead electrocardiogram (12-L ECG) that could be more readily available, potentially facilitating more frequent QTc assessments in intensive care units (ICU); however, there is currently no evidence to validate this potential use. METHODS: We conducted a prospective diagnostic test study comparing QT interval measurement using KM1L with conventional 12-L ECG ordered for any reason in patients admitted to an ICU. We compared the mean difference using a paired t-test, agreement using Bland-Altman analysis, and Lin's concordance coefficient, numerical precision (proportion of QT measurements with <10 ms difference between KM1L and conventional 12-L ECG), and clinical precision (concordance for adequate discrimination of prolonged QTc). RESULTS: We included 114 patients (61.4% men, 60% cardiovascular etiology of hospitalization) with 131 12-L ECG traces. We found no statistical difference between corrected QT measurements (427 ms vs. 428 ms, p = .308). Lin's concordance coefficient was 0.848 (95% CI 0.801-0.894, p = .001). Clinical precision was excellent in males and substantial in females (Kappa 0.837 and 0.781, respectively). Numerical precision was lower in patients with vasoactive drugs (-13.99 ms), QT-prolonging drugs (13.84 ms), antiarrhythmic drugs (-12.87 ms), and a heart rate (HR) difference of ≥5 beats per minute (bpm) between devices (-11.26 ms). CONCLUSION: Our study validates the clinical viability of KM1L, a single-lead mobile ECG device, for identifying prolonged QT intervals in ICU patients. Caution is warranted in patients with certain medical conditions that may affect numerical precision.

Adherence to Treatment Guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA).

INTRODUCTION: Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aimed to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS: Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart failure (HF) medication prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS: Out of 2,528 patients in the registry, 1,384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION: Prescription rates and target dose achievement are suboptimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.

Sex Differences in Cardiovascular Disease Risk Factor Prevalence, Morbidity, and Mortality in Colombia: Findings from the Prospective Urban Rural Epidemiology (PURE) Study.

Background: Controversies exist on whether the presence of cardiovascular risk factors and their association with major cardiovascular events (MACE) is different between men and women. Most of the evidence comes from high-income countries, hindering extrapolation of sociocultural and demographic factors of other regions. Objective: To evaluate sex differences in the prevalence of cardiovascular risk factors and the incidence of MACE and diabetes in Colombian adults. Methods: We performed a survival analysis from women and men aged 35-70 belonging to the Prospective Urban Rural Epidemiology-Colombia prospective study. Incidence rates for MACE composite (myocardial infarction, stroke, heart failure, death) and each outcome and diabetes were calculated. Kaplan-Meier curves and log-rank tests were performed. The association between demographic, behavioral, and metabolic variables with MACE and diabetes were evaluated with Cox proportional hazards models. Results: 7,552 participants (50±9.7 years) were included; 64% were women. Women had higher hypertension prevalence, body mass index, levels of total cholesterol, LDL-c, and HDL-c but lower triglycerides levels. Women were more sedentary but fewer smokers or active alcohol consumers and had higher educational levels. After 12-year mean follow-up (SD 2.3), the incidence rate of MACE composite was higher in men [4.2 (3.6-4.9) vs. 3.2 (2.8-3.7) cases per 1000 person-years]. Diabetes had the greatest association with MACE (HR = 2.63 95%CI:1.85;3.76), followed by hypertension (HR = 1.75 95%CI:1.30;2.35), low relative grip strength (HR = 1.53 95%CI:1.15;2.02), smoking (HR = 1.47 95%CI: 1.11;1.93), low physical activity (HR = 1.42 95%CI: 1.03;1.96). When evaluating risk factors by sex, only an increased waist-to-hip ratio was more strongly associated with MACE in men (p-interaction <0.05). Conclusions: The composite MACE outcome was higher in men despite having a lower overall burden of risk factors. The risk factors contribution was similar, leading us to reconsider the need to carrying out differentiated cardiovascular risk prevention and management campaigns, at least in our region.

Análisis del programa de apoyo al paciente de evolocumab (Repatha®) para pacientes con enfermedades cardiovasculares en Colombia / Analysis of the evolocumab (Repatha®) patient support program for patients with cardiovascular disease in Colombia

Antecedentes: Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial. El objetivo es describir las características demográficas, los patrones de tratamiento, cumplimiento terapéutico y continuidad del tratamiento y explorar las variables relacionadas con la falta de adherencia de los pacientes inscritos en un programa de apoyo al paciente (PSP, por sus siglas en inglés) cardiovascular para al tratamiento con evolocumab en Colombia. Métodos: Estudio observacional-retrospectivo del registro de datos de los pacientes que ingresaron al programa PSP de evolocumab. Resultados: El análisis incluyó a 930 pacientes inscritos en el PSP (2017-2021). La edad media fue de 65,1 años (DE±1,1) y el 49,1% eran mujeres. La tasa media de cumplimiento del tratamiento con evolocumab fue del 70,5% (DE±21,8). Un total de 367 pacientes (40,5%) reportaron una tasa de cumplimiento superior al 80%. El análisis de continuidad incluyó a 739 pacientes (81,5%); el 87,8% de estos pacientes fueron considerados persistentes en el tratamiento. Un total de 871 pacientes (93,7%) reportaron al menos un evento adverso durante el período de seguimiento (en su mayoría no graves). Conclusión: Este es el primer estudio de la vida real sobre el tratamiento para la dislipidemia en un programa de apoyo a pacientes en Colombia. La adherencia encontrada fue superior al 70%, cifra similar a los hallazgos de otros estudios de vida real. Entre las causas del bajo cumplimiento se destacan las barreras administrativas y médicas para la suspensión o abandono del tratamiento con evolocumab. (AU)

Background: Cardiovascular diseases are considered the leading cause of death globally. This study describes the demographic characteristics, treatment patterns, self-reported compliance and persistence, and to explore variables related to non-adherence of patients enrolled in the cardiovascular patient support program (PSP) for evolocumab treatment in Colombia. Methods: This retrospective observational of the data registry of patients who entered the evolocumab PSP program. Results: The analysis included 930 patients enrolled in the PSP (2017-2021). Mean age was 65.1 (SD±13.1) and49.1% patients were female. The mean compliance rate to evolocumab treatment was 70.5% (SD±21.8). A total of 367 patients (40.5%) reported compliance higher than 80%. Persistence analysis included 739 patients (81.5%) where 87.8% of these patients were considered persistent to treatment. A total of 871 patients (93.7%) reported the occurrence of at least one adverse event during the follow-up period (mostly non-serious). Conclusion: This is the first real-life study describing patient characteristics, compliance and continuity of treatment for dyslipidemia in a patient support program in Colombia. The overall adherence found was higher than 70%; similar to findings reported in other real-life studies with iPCSK9. However, the reasons for low compliance were different, highlighting the high number of administrative and medical reasons for suspension or abandonment of treatment with evolocumab. (AU)

Waist circumference cut-off points to identify major cardiovascular events and incident diabetes in Latin America: findings from the prospective Urban rural epidemiology study Colombia.

Background: Abdominal obesity (AO) indirectly represents visceral adiposity and can be assessed by waist circumference (WC) measurement. In Latin America, cut-off points for the diagnosis of AO are based on Asian population data. We aim to establish the WC cut-off points to predict major cardiovascular events (MACE) and incident diabetes. Methods: We analyzed data from the cohort PURE study in Colombia. WC cut-off points were defined according to the maximum Youden index. Multivariate logistic regression was used to obtain associations between WC and MACE, diabetes, and cumulative incidence of outcomes visualized using Kaplan-Meier curves. Results: After a mean follow-up of 12 years, 6,580 individuals with a mean age of 50.7 ± 9.7 years were included; 64.2% were women, and 53.5% were from rural areas. The mean WC was 85.2 ± 11.6 cm and 88.3 ± 11.1 cm in women and men, respectively. There were 635 cases of the MACE composite plus incident diabetes (5.25 events per 1,000 person-years). Using a cut-off value of 88.85 cm in men (sensitivity = 0.565) and 85.65 cm in women (sensitivity = 0.558) resulted in the highest value for the prediction of the main outcome. These values were associated with a 1.76 and 1.41-fold increased risk of presenting the composite outcome in men and women, respectively. Conclusions: We defined WC cut-off points of 89 cm in men and 86 cm in women to identify the elevated risk of MACE and incident diabetes. Therefore, we suggest using these values in cardiovascular risk assessment in Latin America.

Analysis of the evolocumab (Repatha®) patient support program for patients with cardiovascular disease in Colombia. / Análisis del programa de apoyo al paciente de evolocumab (Repatha®) para pacientes con enfermedades cardiovasculares en Colombia.

BACKGROUND: Cardiovascular diseases are considered the leading cause of death globally. This study describes the demographic characteristics, treatment patterns, self-reported compliance and persistence, and to explore variables related to non-adherence of patients enrolled in the cardiovascular patient support program (PSP) for evolocumab treatment in Colombia. METHODS: This retrospective observational of the data registry of patients who entered the evolocumab PSP program. RESULTS: The analysis included 930 patients enrolled in the PSP (2017-2021). Mean age was 65.1 (SD±13.1) and49.1% patients were female. The mean compliance rate to evolocumab treatment was 70.5% (SD±21.8). A total of 367 patients (40.5%) reported compliance higher than 80%. Persistence analysis included 739 patients (81.5%) where 87.8% of these patients were considered persistent to treatment. A total of 871 patients (93.7%) reported the occurrence of at least one adverse event during the follow-up period (mostly non-serious). CONCLUSION: This is the first real-life study describing patient characteristics, compliance and continuity of treatment for dyslipidemia in a patient support program in Colombia. The overall adherence found was higher than 70%; similar to findings reported in other real-life studies with iPCSK9. However, the reasons for low compliance were different, highlighting the high number of administrative and medical reasons for suspension or abandonment of treatment with evolocumab.

Prevalence of cardiovascular risk factors in a historical cohort of people living with human immunodeficiency virus during a 10-year period.

Objective: Data on the frequency of cardiovascular disease in people living with human immunodeficiency virus from low- and middle-income countries is scarce. Methods: We performed an observational study based on data from a historical cohort of people living with human immunodeficiency virus in Colombia during a 10-year follow-up to describe the prevalence of cardiovascular risk factors and their behavior according to CD4 count. Results: One thousand patients were initially included, out of which 390 had a 10-year follow-up. The mean age was 34 (standard deviation 10) years, and 90% were male. We observed an increase in the prevalence of dyslipidemia (29%-52%, p < 0.001) and obesity (1.1%-3.5%, p < 0.001). Major cardiovascular events occurred in less than 1% of patients. Patients with a CD4 count <200 cells/mm3 had a higher frequency of acute myocardial infarction and obesity. Conclusion: Over time, people living with human immunodeficiency virus present with an increasing prevalence of cardiovascular risk factors, particularly those with a lower CD4 count.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Experimentos de elección discreta. Diseño, análisis e implementación en salud / Discrete choice experiments. Design, analysis and implementation in health

Resumen: Los experimentos de elección discreta (DCE, su sigla en inglés), son una metodología usada para evaluar preferencias de desenlaces o intervenciones relacionadas con salud. A diferencia de otras técnicas de medición que utilizan métodos simples de elección o herramientas estadísticas básicas que fallan al evaluar los beneficios específicos de una intervención, proceso de entrega, beneficio, satisfacción y preferencia de los usuarios en términos de tiempo, calidad o atributo específico, los DCE combinan, en la generación de atributos y modelamiento matemático, complejas tareas de diseño y ejecución, que mejoran la calidad y optimizan la cantidad necesaria de información mediante el uso eficiente de recursos y resultados de excelente calidad. Este documento presenta la historia, el desarrollo y la fundamentación teórica de los DCE y muestra las críticas, las potenciales limitaciones y las precauciones.

Abstract: Discrete choice experiments (DCE) are a methodology for evaluate patient preferences for health-related outcomes or interventions. Other preference measurement techniques that use simple methods of choice or basic statistical tools that fail to evaluate the specific benefits of an intervention, delivery process, benefit, satisfaction and patients' preferences in terms of time, quality or specific attribute. The DCE combine in the generation of attributes and mathematical modeling, complex task of designing and execution, to improve the quality and optimize the necessary amount of information, achieving an efficient use of resources with excellent quality results. This document presents globally a brief of the history, development and theoretical foundation of the DCE and then presents in a critical way the potential limitations, precautions in their use and implementation that allow to establish the possible scenarios of use and development.

Modelo de aceptación tecnológica de la aplicación móvil de seguimiento ControlVit® en pacientes con falla cardiaca / Technological acceptance model of the ControlVit® mobile monitoring application in patients with heart failure

Resumen Introducción: Los sistemas de monitoreo remoto basados en teléfonos inteligentes para pacientes con falla cardiaca podrían ser herramientas sencillas y económicas para mejorar el seguimiento ambulatorio. Objetivo: Identificar la utilidad y aceptación de la aplicación ControlVit® en pacientes con falla cardiaca. Método: Estudio piloto observacional descriptivo, en 20 pacientes ambulatorios con fracción de eyección reducida, que asisten a un programa de falla cardiaca. Durante seis meses, los pacientes utilizaron la aplicación ControlVit®, que suministra al paciente información para mejorar su autocuidado y permite el registro diario de variables médicas relevantes. Los datos se consignaron en la bitácora del sistema para verificar la frecuencia y el envío de datos. Se aplicó un cuestionario de aceptación tecnológica (TAM) a todos los pacientes y profesionales. Resultados: 100% de los pacientes reconoció la utilidad de la aplicación frente a su autocuidado, 90% niegan ansiedad tecnológica o temor para emplearla por la facilidad de uso. En general, se detectaron 164 alertas en tiempo real ―el aumento de peso fue la más frecuente (49%)―, y en 91% de los pacientes no se registraron reingresos hospitalarios. Conclusión: la aplicación ControlVit® es útil para la detección temprana de síntomas que permiten identificar, de forma precoz, complicaciones y modificar su tratamiento. La excelente aceptación de la aplicación por parte de los pacientes y su facilidad de uso plantean la posibilidad de implementarla como una estrategia complementaria de seguimiento en pacientes con falla cardiaca.

Abstract Introduction: Mobile phone based remote monitoring systems for heart failure patients could become simple and affordable tools to improve home management. Objective: to identify utility and acceptance of ControlVit® in heart failure patients. Method: descriptive observational pilot study in 20 outpatients with reduced ejection fraction, attending at hospital heart failure program. For six months, patients use the ControlVit® application, which supplies patient information to improve self-care and allows daily recording of specific medical variables. The data was recorded in the system log to verify frequency and data transmission. A technological acceptance questionnaire (TAM) was applied to all patients and professionals. A descriptive analysis with absolute and relative frequency distribution was also performed. Results: 100% of patients recognized the usefulness of the application compared to self-care, 90 % deny technological anxiety or fear of using it due to the ease of use. Overall, 164 real-time alerts were detected, weight gain was the most frequent (49 %) and 91 % of patients had no hospital readmissions. Conclusion: The ControlVit® application is useful for the early detection of symptoms that allow timely detection of complications and early modification of treatment. The excellent acceptance of the application by patients and its ease of use, raise the possibility of implementing it as a complementary monitoring strategy in patients with heart failure.

Prevalencia de fibrilación auricular en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of atrial fibrillation in Colombia according to information from the Comprehensive Information System of the Social Protection (SISPRO)

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca más frecuente, es una de las causas más importantes de eventos cerebrovasculares de origen embólico y se asocia con el desarrollo de insuficiencia cardíaca y muerte súbita. En Colombia, constituye una enfermedad con altos costos para el sistema de salud; sin embargo, su prevalencia es desconocida. Objetivo: Describir la prevalencia de fibrilación auricular reportada a los sistemas oficiales de información en Colombia. Método: Mediante la extracción, el tabulado y el análisis de datos de la herramienta SISPRO, del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de fibrilación auricular estandarizada por edad, global y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Se identificaron 143,656 casos reportados con el código I48X, que corresponde a fibrilación auricular en la CIE-10. La prevalencia de fibrilación auricular se incrementó desde 41 hasta 87 por cada 100,000 habitantes entre 2013 y 2017 (p < 0.001). En Colombia, la fibrilación auricular es más frecuente en las mujeres, con mayor prevalencia en mayores de 60 años (606/100,000 en 2017); hay zonas con prevalencia superior a 150/100,000 en los departamentos de Antioquia, Caldas, Santander y Bogotá D.C. Conclusiones: Este estudio sugiere que la fibrilación auricular tiene una tendencia ascendente en Colombia, es más frecuente en las mujeres y más prevalente en los centros urbanos, posiblemente debido a una mayor proporción de pacientes mayores y al mejor acceso a los sistemas de salud.

Abstract Introduction: Atrial fibrillation is the most frequent cardiac arrhythmia. It is responsible for an important proportion of embolic strokes and is associated with the development of congestive heart failure and sudden cardiac death. In Colombia, atrial fibrillation is highly costly for the healthcare system; however, its true prevalence is unknown. Objective: To describe the prevalence of atrial fibrillation reported to the official information systems in Colombia. Method: We calculated the prevalence of atrial fibrillation through the extraction, tabulation and analysis of data contained in the Integral Information System for Social Protection tool, which was created by the Ministry of Health and Social Protection in Colombia. Global and age-standardized prevalence rates were obtained for the period between years 2013 and 2017. Results: A total of 143,656 cases were identified. These were reported through the ICD-10 code I48X, corresponding to atrial fibrillation. The prevalence of atrial fibrillation increased from 41 to 87 cases per 100,000 inhabitants between years 2013 and 2017 (p < 0.001). In Colombia, atrial fibrillation is more frequent among women, and individuals over the age of 60 (606/100,000 in 2017). The departments of Antioquia, Caldas, Santander and Bogotá D.C had zones with prevalence greater than 150/100,000. Conclusions: This study suggests that atrial fibrillation displays an upward trend in Colombia. Its prevalence is higher in women and urban centers. The latter may be due to the higher proportion of older patients and better access to healthcare in these subgroups.

Evaluation of Long-Term Kidney Function Following Orthotopic Heart Transplantation.

INTRODUCTION: Acute impairment of kidney function in patients with heart failure and heart transplantation is a frequent condition. However, the impact of the transplant on long-term kidney function remains controversial. METHODS: This study describes a cohort of patients who received a heart transplant in a reference hospital between 2005 and 2019. Glomerular filtration rate during follow-up was calculated at 0, 6,12, 24, and 60 months using the Cockcroft-Gault and MDRD (modification of diet in renal disease study) equations. To identify changes we compared glomerular filtration rate (GFR) at baseline with measurements over time after heart transplantation, using a paired t test and a longitudinal model of Generalized Estimating Equations (GEE). RESULTS: Forty-four patients were included. The mean of baseline GFR was 67.9 ± 1.3 mL/min. A triple immunosuppressive therapy scheme was used with cyclosporine/tacrolimus, mycophenolate mofetil, and steroid, with progressive dose reduction. After adjusting for multiple variables, we found no reduction of GFR over time with the GEE model. There was no significant difference in GFR using Cockcroft-Gault equation at 6 (mean difference [MD] 4.46; confidence interval [CI] -2.1 to 11.09; P = 0.18), 12 (MD 1.65, CI -4.5 to 7.82; P = 0.59), 36 (MD 0.69; CI -6.04 to 7.43; P = 0.83), and 60 months (MD 0.62; CI -5.5 to 6.79; P = 0.83). Similar findings were found using MDRD equation. CONCLUSIONS: There is no significant GFR decline between the time of heart transplantation and a follow-up at 60 months. New studies are needed to evaluate changes in renal function beyond this timeframe.

Prevalencia de hipertensión arterial en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of arterial hypertension in Colombia according to data from the Comprehensive Social Protection Information System (SISPRO)

Resumen Introducción: La hipertensión arterial es el principal factor de riesgo cardiovascular modificable y aumenta la probabilidad de mortalidad de causa cardiovascular. Las mediciones de prevalencia en Colombia han incluido ciudades principales y pequeñas regiones, pero no se dispone de información en el país. Objetivo: Describir la prevalencia de hipertensión arterial a partir de los reportes a los sistemas oficiales de información en Colombia. Método: Mediante la extracción y el análisis de datos de la herramienta SISPRO del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de hipertensión arterial, estandarizada por edad y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Durante los 5 años evaluados hubo 12,386,343 registros con diagnóstico principal de hipertensión arterial; en 2013 se observó la menor prevalencia (4.65%) y en 2017 la mayor (5.83%). El promedio de prevalencia nacional en los mayores de 60 años durante los 5 años fue del 28.14%. La prevalencia es mayor en las mujeres, con una relación mujer: hombre de 1.78:1. El grupo de mayor prevalencia durante el estudio fueron las mujeres mayores de 80 años en 2017, con una prevalencia ajustada del 54.4%. Las regiones con prevalencia mayor al 10% fueron Risaralda, Caldas, Boyacá, Antioquia y Sucre. Conclusiones: La prevalencia nacional de los registros de consultas por hipertensión arterial a las fuentes oficiales de información es menor que la reportada en estudios realizados en poblaciones similares y sugiere que existe un subregistro del reporte a dichas fuentes de información.

Abstract Introduction: Systemic hypertension is the main modifiable cardiovascular risk factor, leading to increased probability of mortality due to cardiovascular causes. Studies assessing the prevalence of systemic hypertension in Colombia have included main cities and small regions. However, there is no available data regarding the country as a whole. Objective: To describe the prevalence of systemic hypertension according to reports made to the official information systems in Colombia. Method: The prevalence of systemic hypertension was calculated through the extraction and analysis of data contained within the SISPRO tool, the official information system for the Colombian Ministry of Health and Social Protection. The prevalence was then standardized by age, and for the different geographical regions of the country in the period comprised between years 2013 and 2017. Results: During the five years of follow-up, we located 12,386,343 registries reporting systemic hypertension as a main diagnosis. The lowest prevalence (4.65%) was found in year 2013, and the highest prevalence (5.83%) was found in 2017. The mean national prevalence for patients above the age of 60, during the aforementioned 5-year period, was 28.14%. The prevalence was higher in women, with a women-to-men ratio of 1.78:1. The group with the higher adjusted prevalence during the study period was composed of women above the age of 80 in year 2017, with an adjusted prevalence of 54.4%. The regions with a prevalence over 10% were Risaralda, Caldas, Boyacá. Antioquia and Sucre. Conclusions: The national prevalence of registered consultations due to systemic hypertension to the official information sources is lower than that reported in previous studies conducted on similar populations, suggesting the existence of underreport to said information sources.

Cardiovascular Risk Prediction Models in People Living with HIV in Colombia.

BACKGROUND: People living with HIV are at increased risk of cardiovascular disease. Cardiovascular risk (CVR) prediction scores are powerful tools for individualized assessment that inform decision-making about follow-up frequency, hypolipemiant treatment intensification, and choice antiretroviral therapy. OBJECTIVES: The objectives of the study were to evaluate the performance of multiple cardiovascular assessment scores in predicting major adverse cardiovascular events (MACE) at 5 and 10 years. Framingham (2004, 2008, and Colombia-adjusted), SCORE, PROCAM, ASCVD, and D:A:D scores were included in the analysis. METHODS: Data were obtained from a medical registry of adults living with HIV attended by a teaching hospital in Colombia. All patients with complete information necessary for risk score calculations and determination of MACE at 5 and 10 years were included in the study. Receiver operating characteristic curves (ROC) were generated using calculations with all the aforementioned models for every individual. Differences between curves were compared with De- Long's test. RESULTS: A total of 808 patients were included in the analysis. Mean age was 35 years, and 12% were female. The majority of subjects had low and very low CVR. Eight MACE occurred during follow-up. Area under ROC curves were: Framingham (0.90), Framingham ATP3 (0.92), Framingham calibrated for Colombia (0.90), SCORE (0.92), PROCAM (0.92), ASCVD (0.89), and D:A:D (0.92), with no statistically significant differences. CONCLUSIONS: The evaluated scores had an acceptable performance for HIV-infected patients in the studied cohort, especially for those in low and very low risk categories.

Uso e impacto en las redes sociales por parte de las revistas de reumatología / Use and impact of social networks by rheumatology journals

RESUMEN Introducción: Las redes sociales como Twitter®, Facebook® y YouTube® se han convertido en medios de interacción y visualización de información científica. Han surgido medidas alternativas (almetrics) que evalúan la diseminación y el impacto de las revistas científicas en las redes sociales; sin embargo, se desconoce si existe correlación entre la actividad de las revistas de reumatología en redes sociales y las métricas tradicionales de impacto basadas en número de citaciones. Métodos: Se identificaron las revistas de reumatología a partir de la base de datos de SCImago de Scopus® y se extrajo la información de las métricas tradicionales basadas en el número de citaciones. Se determinaron métricas alternativas de actividad de las revistas en Facebook®, Twitter®, YouTube® e Instagram®. Se evaluó la correlación entre ellas usando el coeficiente de correlación de Spearman, ajustado por el tiempo transcurrido desde la creación de la cuenta. Resultados: De un total de 60 revistas de reumatología, 14 contaban con la presencia en las redes sociales evaluadas. El SCImago Journal Rank (SJR) fue más alto en revistas con red social (90,5 vs. 21; p < 0,05). La correlación entre el SJR y las métricas de actividad del Twitter® fue excelente: con el número de seguidores (r = 0,85), seguidores/ano (r = 0,83) y número de tweets (r = 0,82). Conclusión: Nuestro estudio sugiere que las métricas tradicionales de impacto basadas en el número de citaciones, se correlacionan muy bien con las métricas de presencia en redes sociales de las revistas de reumatología, en especial en Twitter®.

ABSTRACT Introduction: The social networks like Twitter®, Facebook® and YouTube® have become interaction media with visualisation scientific information. Alternative metrics (altmetrics) have emerged that assess the dissemination and the impact of the scientific journals in the social networks. However, it is unknown if there is a correlation between the journal and the traditional measurements of impact based on the number of citations for the journal of rheumatology. Methods: The journals of rheumatology included in Scimago Country and Journal Ranking were identified, and the results of their metrics were collected based on the number of cita tions. The presence in social networks was determined using metrics, such as the number of followers and tweets. The correlation between them was evaluated using the Spearman correlation coefficient, adjusted for the time elapsed since the account was created. Results: Out of a total of 60 rheumatology journals, 14 had a presence in social networks. The Scimago journal ranking indicator (SJR) was higher in journals with a social network (90.5 vs. 21; p< .05). The correlation between the SJR and Twitter® activity metrics was excellent: with the number of followers (r = 0.85), followers/year (r=0.83), and number of tweets (r = 0.82). Conclusion: This study suggests that traditional impact metrics based on the number of cita tions correlate very well with the social network presence metrics of rheumatology journals, especially on Twitter®.

Evaluación y comparación del desempeño de cinco modelos de predicción de mortalidad intrahospitalaria en pacientes con falla cardiaca aguda / Evaluation and comparison of the performance of five prediction models of in-hospital mortality in patients with acute heart failure

Resumen Objetivo: Los modelos de predicción de mortalidad intrahospitalaria en pacientes con falla cardiaca aguda pueden ser útiles para la toma de decisiones, situación que hace necesario evaluar la capacidad predictiva y de discriminación en la población colombiana. Método: Estudio de cohorte retrospectiva de pacientes con falla cardiaca aguda. Se evaluó el desempeño de los modelos de predicción de mortalidad intrahospitalaria ADHERE, OPTIMIZE-HF, GWTG-HF y PROTECT, durante los años 2013 a 2015. Se realizó el cálculo de la puntuación para cada uno de los modelos y se determinó la capacidad de predicción y discriminación. Resultados: Se incluyeron 776 pacientes con una edad promedio de 71.5 años (desviación estándar: 14.3), el 56% hombres, con fracción de eyección del ventrículo izquierdo del 39%. La mortalidad global fue del 6.1%. El área bajo la curva para ADHERE fue de 0.56 (intervalo de confianza del 95% [IC95%]: 0.49-0.64), para EHMRG de 0.63 (IC95%: 0.55-0.71], para GWTG-HF de 0.63 (IC95%: 0.55-0.70), para OPTIMIZE de 0.65 (IC95%: 0.56-0.74) y para PROTECT de 0.69 (IC95%: 0.60-0.77). Conclusiones: Los modelos de predicción de muerte intrahospitalaria en pacientes con falla cardiaca aguda muestran pobre desempeño y baja capacidad de predicción y discriminación en población colombiana, lo cual sugiere el desarrollo de escalas de predicción de mortalidad en pacientes con falla cardiaca aguda específicas para dicha población.

Abstract Objective: In-hospital mortality prediction models on acute heart failure can be beneficial for decision-making, a situation necessary to evaluate, our goal was to compare predictive and discriminatory capacity of Colombian population. Method: A retrospective cohort study in patients with acute heart failure was conducted. The following performance evaluation of in-hospital mortality prediction models were conducted from 2013 to 2015: ADHERE, EHMRG, OPTIMIZE-HF, GWTG-HF and PROTECT. Data was calculated for each model, prediction and discriminatory capacity was evaluated. Results: A sample of 776 patients, 56% male, with an average age of 71.5 (standard deviation: 14.3) and with left ventricle ejection fraction rate of 39% was studied. Global mortality was of 6.1%. The area under curve for ADHERE was of 0.56 (95% confidence interval [95% CI]: 0.49-0.64), for EHMRG 0.63 (95% CI: 0.55-0.71), for GWTG-HF 0.63 (95% CI: 0.55-0.70), for OPTIMIZE 0.65 (95% CI: 0.56-0.74) and for PROTECT 0.69 (95% CI: 0.60-0.77). Conclusions: The models for predicting in-hospital death in patients with acute heart failure show poor performance, predictability and discrimination in the Colombian population, suggesting the development of mortality prediction scales in patients with acute heart failure specific to our population.

Factores de riesgo asociados a estancia hospitalaria prolongada en pacientes con falla cardiaca aguda / Risk factors associated with prolonged hospital stay in patients with acute heart failure

Resumen Introducción:: La falla cardiaca aguda es un motivo frecuente de consulta a urgencias, genera estancias hospitalarias prolongadas y altos costos para el sistema de salud. Objetivo: Determinar los factores asociados a estancia hospitalaria prolongada en pacientes hospitalizados por falla cardiaca aguda en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, se incluyeron pacientes adultos con falla cardiaca aguda. Se obtuvieron variables demográficas, comorbilidades y resultados de laboratorios de rutina. Se definió hospitalización prolongada, como una estancia mayor a 5 y 10 días respectivamente. Resultados: Un total de 776 pacientes fueron incluidos en el análisis, 56% eran hombres, el promedio de edad fue de 71.5 años, fracción de eyección de 39.8%. Los factores asociados con estancia hospitalaria prolongada fueron: edad, elevación de troponina, hiperglucemia y albúmina < 3 g/dl. Para el corte de 10 días adicionalmente se identificaron: presión arterial sistólica, frecuencia cardiaca y elevación de péptidos natriuréticos. Conclusiones: La evaluación integral de variables clínicas y resultados de laboratorio es útil para identificar pacientes con mayor riesgo de estancias hospitalarias prolongadas.

Abstract Introduction: Acute heart failure is a frequent reason for consulting to emergency department, it generates long hospital stays and high costs for the health system. Objective: To determine the associated factors with prolonged hospital stay in patients hospitalized for acute heart failure in a teaching hospital. Methods: Retrospective cohort study, adult patients with acute heart failure were included. Demographic variables, comorbidities, and routine laboratory results were obtained. Prolonged hospitalization was defined as a stay greater than 5 and 10 days, respectively. Results: A total of 776 patients were included in the analysis, 56% were men, the mean age was 71.5 years, and ejection fraction was 39.8%. Factors associated with prolonged hospital stay were: age, elevated troponin, hyperglycemia, and albumin < 3 g/dl. For the 10-day cut-off, additionally, systolic blood pressure, heart rate and elevation of natriuretic peptides were identified. Conclusions: Comprehensive evaluation of clinical variables and laboratory results is useful to identify patients at increased risk for prolonged hospital stays.

Uso de modelos de predicción de eventos cardiovasculares para pronóstico de lesión vascular coronaria significativa / Use of cardiovascular events prediction models for the prognosis of a severe coronary artery lesion

Resumen Objetivos: Determinar el mejor punto de corte y el grado de conformidad de las escalas de riesgo, Framingham, PROCAM y Reynolds, para el diagnóstico de lesión vascular coronaria arterioesclerótica severa a través de la comparación de las áreas bajo la curva de acuerdo con las curvas operativas del receptor (COR). Métodos: Estudio de corte transversal en adultos que fueron sometidos a arteriografía coronaria. Se aplicaron las escalas Framingham, PROCAM y Reynolds, las dos primeras ajustadas según estudio de calibración colombiano. Luego se realizó la recolección de los datos de manera concurrente en instituciones de referencia en cardiología y hemodinámica en Bogotá. Resultados: De 200 pacientes estudiados, 66% eran mujeres, 37,5% mayores de 70 años, 53,2% con hipertensión, 52,7% en sobrepeso u obesidad, 61,5% presentaron valores altos de Proteína C Reactiva ultrasensible (PCRus) y 50% tenían al menos una lesión coronaria mayor de 70%. Se encontraron los mejores puntos de corte, de acuerdo con cada curva de características operativas del receptor (COR): Framingham ajustado 5,8% (sensibilidad 80%, especificidad 41%). PROCAM ajustado 1,7% (sensibilidad 78%, especificidad 45%) y Reynolds 3,8% (sensibilidad 68%, especificidad 45%). Adicionalmente, se encontró que las tres escalas presentaron áreas bajo la curva (ABC) de 0,59, 0,59 y 0,57, respectivamente.

Abstract Objectives: To determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. Methods: A cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjusted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. Results: Of the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.

Glomerular diseases related to HIV in Colombian population: Better outcomes with highly active antiretroviral therapy?

INTRODUCTION: End-stage renal disease (ESRD) related to HIV is becoming a leading cause of renal replacement therapy requirement is some areas of the world. Our study aims to describe the incidence and renal outcomes of HIV-associated nephropathy (HIVAN), and immune-mediated kidney disease related to HIV (HIVICK) in Colombia. METHODOLOGY: A retrospective cohort study was performed, including all HIVAN or HIVICK incident cases assessed by the infectious diseases division in a high complexity institution in Colombia, between 2004 and 2018. A longitudinal data model under the Generalized Estimating Equations (GEE) method was used to determine changes on the glomerular filtration rate (GFR) over time. RESULTS: Within a cohort composed by 1509 HIV-infected patients, we identified 22 with HIV-associated glomerular disease. Cumulative incidence was 1.45%. At diagnosis, GFR was above 30 mL/min in 90.8% of patients, and 77.2% displayed sub-nephrotic proteinuria. Factors associated with GFR at diagnosis were: level of CD4 (Coefficient 0.113, CI 95 %: 0.046, 0.179, p < 0.01), and the inverse of the CD4/CD8 ratio. The GEE model did not demonstrate significant changes in the GFR over a 3-year period. Findings were similar when comparing GFR at diagnosis with GFR at 12 (-3.9 mL/min/1.73m2, CI 95% -7.3, 0.4, p = 0.98), 24 (-2.47 mL/min/1.73m2, CI 95% -7.0, 2.1, p=0.85), and 36 months (0.39 mL/min/1.73m2, CI 95% -4.4, 5.2, p = 0.43) of follow-up. CONCLUSIONS: Patients with glomerular disease associated with HIV have stable GFR over a 3-year period, and low rates of progression towards dialysis requirement. Differences with previous reports could be related with early diagnosis and treatment with highly active antiretroviral therapy.

Total cholesterol in dyslipidemias. Is it a useful measure? / Colesterol total en dislipidemias. ¿Útil medirlo?

Abstract Introduction: the relationship between lipid fractions and cardiovascular risk is clear. However, the operational characteristics of total cholesterol (TC) for the diagnosis of dyslipidemias due to elevated LDL cholesterol (LDLC), hypertriglyceridemia and low HDL cholesterol (HDLC) are not clear. Objective: to establish the sensitivity (Sen) specificity (Spe) and predictive values (PPV and NPV) of TC (>200 mg/dL) for diagnosing various types of dyslipidemias. Materials and methods: a study of diagnostic tests using all the lipid profiles processed at the Hospital Universitario San Ignacio in Bogotá (Colombia) from January 2006 to January 2017. Sensitivity, Spe, PPV and NPV were calculated for each dyslipidemia and for each LDLC goal. Results: in 25,754 profiles, the average age was 53.6±18 years. The prevalence of elevated LDLC (based on the goals of 160, 130, 100, 70 or 55 mg/dL) was: 19.9%, 44.5%, 72.7%, 92.1% and 96.8%, respectively; for hypertriglyceridemia (>150 mg/dL) it was 44.7%, and for low HDLC (< 40 mg/dL) it was 33.9%. The sensitivity of TC (>200 mg/dL) for elevated LDLC according to the same goals was: 100%, 95%, 70%, 56% and 53%, with a specificity of: 59%, 81%, 94%, 95% and 92%; PPV=37%, 80%, 97%, 99% and 99%; and NPV=100%, 95%, 54%, 15% and 5.8%. For hypertrygliceridemia: Sen=61%, Spe=61%, PPV=55% and NPV=66%. For low HDLC: Sen=36%, Spe=42%, PPV=26% and NPV=54%. Conclusions: given the operational characteristics of TC>200 mg/dL, it should not be used as an isolated tool for diagnosing dyslipidemia due to LDLC, HDLC or hypertriglyceridemia. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1320).

Resumen Introducción: es clara la relation entre las fracciones lipídicas y riesgo cardiovascular, sin embargo, no son claras las características operativas del colesterol total (CT) para el diagnóstico de dislipidemias por colesterol LDL (C-LDL) elevado, hipertrigliceridemia y colesterol HDL (C-HDL) bajo. Objetivo: establecer sensibilidad (S), especificidad (E), y valores predictivos (VPP y VPN) del CT (>200 mg/dL) para diagnóstico de diferentes tipos de dislipidemias. Material y métodos: estudio de pruebas diagnosticas a partir de la totalidad de perfiles lipídicos procesados en el Hospital Universitario San Ignacio de Bogotá (Colombia), desde enero de 2006 hasta enero de 2017. Se calcularon S, E, VPP y VPN para cada dislipidemia y para cada meta de C-LDL. Resultados: en 25 754 perfiles, la edad promedio fue 53.6±18 años. Las prevalencias de C-LDL elevado (según metas de 160, 130, 100, 70 o 55 mg/dL) fueron: 19.9%, 44.5%, 72.7%, 92.1% y 96.8% respectivamente; hipertrigliceridemia (>150 mg/dL) 44.7% y C-HDL bajo (< 40 mg/dL) 33.9%. Las sensibilidades del CT (>200 mg/dL) para C-LDL elevado según las mismas metas fueron: 100%, 95%, 70%, 56% y 53% y especificidades: 59%, 81%, 94%, 95% y 92%. VPP=37%, 80%, 97%, 99% y 99%, y VPN=100%, 95%, 54%, 15% y 5.8%. Para hipertrigliceridemia: S=61%, E=61%, VPP=55% y VPN=66%. Para C-HDL bajo: S=36%, E=42%, VPP=26% y VPN=54%. Conclusiones: dadas las características operativas del CT>200 mg/dL, éste no debe ser utilizado como herramienta aislada para el diagnóstico de dislipidemia por C-LDL, por C-HDL, ni para hipertrigliceridemia. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1320).