Valoración del tratamiento anticoagulante en pacientes diagnosticados de fibrilación auricular no valvular en una zona básica de salud / Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area

Introducción: La fibrilación auricular (FA) es la arritmia cardiaca más frecuente. En su manejo, es clave valorar la necesidad de anticoagulación. Nuestro objetivo fue valorar en pacientes diagnosticados de FA no valvular si la indicación de anticoagulación es adecuada en función de la escala CHA2DS2-VASc y la adecuación del rango del International Normalizad Ratio (INR) en los pacientes en tratamiento con antivitamina K. Métodos: Estudio observacional, analítico transversal. Se seleccionaron 232 pacientes con diagnóstico de FA no valvular. Se han analizado variables demográficas, variables de la escala CHA2DS2-VASc, tratamiento prescrito y valores de INR durante 6 meses consecutivos. La comparación de variables se realizó con ji cuadrado y la tendencia lineal entre grupos por Mantel Haenzel, siendo calculadas las odds ratios. Resultados: La prevalencia total de FA no valvular en el área fue 1,05%. El 88,4% presentó un CHA2DS2-VASc ≥ 2. Un 71,1% de pacientes con fibrilación auricular estaban anticoagulados, de los que el 58,2% tomaban fármacos antivitamina K. El 46,7% de los pacientes en tratamiento con acenocumarol presentó un INR con un tiempo en rango terapéutico directo insuficiente. La prescripción de antivitamina K en los pacientes con FA permanente fue superior que en pacientes con FA paroxística (62,8 vs. 37,2%, p<0,001). El consumo de fármacos que aumentan el sangrado se asoció a un peor control de INR (tras ajuste por las principales variables de relevancia clínica (odds ratio 2,17 [1,02-4,59], p=0,043). Conclusiones: El control de la anticoagulación oral con antivitamina K fue subóptimo pese a la adecuada adherencia de los pacientes. Los pacientes con FA paroxística recibieron menos antivitamina-K que los de FA persistente/permanente (AU)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs. Methods: This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test. Results: The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043). Conclusions: The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF (AU)

Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area. / Valoración del tratamiento anticoagulante en pacientes diagnosticados de fibrilación auricular no valvular en una zona básica de salud.

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs. METHODS: This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test. RESULTS: The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043). CONCLUSIONS: The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF.

Análisis de la calidad de vida y su relacióncon el riesgo cardiovascular en una poblaciónmediterránea con bajo riesgo / Quality of life and its relationship with cardiovascular risk in a Mediterranean population of low risk

Introducción. Analizar si hay relación entre la calidad de vida y el riesgo cardiovascular (RCV). Material y métodos. Estudio observacional, descriptivo y transversal de prevalencia. Se incluyó a 336 individuos de 40 a 65 años. Se aplicó el test SF-36 para medir la calidad de vida. El RCV se calculó mediante las tablas SCORE y de la European Society of Hypertension (ESH). Resultados. Según las tablas ESH, al analizar cada subescala del SF36, solamente se evidencia relación estadística en la subescala SF1 (función física), con una puntuación media de 71,97 ± 28,20 en los sujetos con riesgo elevado, inferior que la puntuación obtenida por el grupo de bajo riesgo (80,55 ± 23,70; p = 0,020). Según las tablas SCORE, en la subescala SF1, presentan unos valores mayores los sujetos con riesgo bajo (79,22 ± 24,18 puntos), frente a los del grupo con riesgo alto (67,97 ± 28,12; p = 0,009). La subescala SF9, “evolución de la salud”, muestra unos valores menores en los sujetos con riesgo bajo (3,18 ± 0,72 frente a 3,43 ± 0,64 puntos) que en los del grupo con riesgo alto (p = 0,032). Discusión. Hay evidencias a favor del deterioro de la calidad de vida que supone tener un mayor riesgo cardiovascular (AU)

Introduction. To analyse the relationship between the quality of life and cardiovascular risk (CVR). Material and methods. An observational, descriptive and cross-sectional prevalence study. A total of 336 subjects from 40 to 65 years were include. The SF-36 questionnaire was used to measure the quality of life. The CVR was calculated using SCORE and of European Society of Hypertension (ESH) tables. Results. Using the ESH tables to analyze each SF36 subscale, there was only evidence of a statistical association in the SF1 subscale (physical function), with an average score of 71.97 ± 28.20 in subjects with high risk, which was lower than the score for the low risk group, 80.55 ± 23.70 (p = 0.020). According tables SCORE in the subscale SF1, show values greater subjects with low risk (79.22 ± 24.18 points), compared with 67.97 ± 28.12 with high risk group (p = 0.009). The SF9 subscale, “evolution of health” shows lower values in subjects with low risk 3.18 ± 0.72 points, compared with 3.43 ± 0.64 points in the high risk group (p = 0.032). Discussion. There is evidence that a deteriorating quality of life leads to having a greater cardiovascular risk (AU)

[Level of knowledge and action on lipaemia among Spanish primary and specialist care doctors. Press cholesterol study]. / Nivel de conocimiento y actuación sobre dislipidemias de los médicos de atención primaria y especializada españoles. Estudio Colesterol Press.

OBJECTIVES: To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. DESIGN AND INTERVENTION: A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. SETTING AND PARTICIPANTS: A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. RESULTS: A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. CONCLUSIONS: The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors.

Nivel de conocimiento y actuación sobre dislipidemias de los médicos de atención primaria y especializada españoles. Estudio Colesterol Press / Level of knowledge and action on lipaemia among spanish primary and specialist care doctors. Press Cholesterol Study

Objetivos. Determinar el nivel de conocimiento, las pautas de actuación y el control sobre las dislipidemias de los médicos de atención primaria y especializada españoles. Diseño e intervención. Se ha diseñado un cuestionario autodefinido formado por 12 ítems donde se completan datos acerca de la población tratada y la valoración subjetiva sobre los objetivos, el tratamiento y el control de los parámetros lipídicos. Emplazamiento y participantes. Ha participado un total de 1.998 médicos de todo el territorio nacional. El 68,8% de los médicos entrevistados trabaja en atención primaria de salud y el 30,2%, en centros de especialidades o en hospitales. Resultados. Globalmente, el 91% de los médicos declara seguir los consensos internacionales sobre el control de las dislipidemias. El parámetro objetivo terapéutico para tratar las dislipidemias más utilizado es el colesterol unido a lipoproteínas de baja densidad (cLDL) (83%), seguido del colesterol total (62%), el colesterol unido a lipoproteínas de alta densidad (cHDL) (56%) y los triglicéridos (51%). Ante un paciente bien controlado, el 21,8% de los facultativos reduce la dosis del hipolipidemiante. En líneas generales, no se aprecian grandes diferencias entre los criterios que siguen los médicos de atención primaria y los de atención especializada. Conclusiones. Los criterios de actuación ante las dislipidemias son mejorables. No hay diferencias importantes en las opiniones y actuación entre médicos de atención primaria y especialistas en los criterios clínicos y terapéuticos ante las dislipidemias

Objectives. To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. Design and intervention. A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. Setting and participants. A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. Results. A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. Conclusions. The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors

Efficacy of moxonidine in the treatment of hypertension in obese, noncontrolled hypertensive patients.

BACKGROUND: Obesity has become an epidemic problem, contributing to metabolic syndrome, type 2 diabetes, hypertension, and cardiovascular disease. An adequate blood pressure control in this population of obese individuals is extremely difficult to achieve, and in most cases, therapeutic combinations are required. Pharmacologic treatment with moxonidine, a central I(1) imidazole receptor agonist, is a very interesting option because it acts upon the mechanisms implicated in the development of arterial hypertension in these patients. In addition, the drug improves the peripheral insulin resistance often found in obese patents, which contributes to maintain high blood pressure. METHODS: An interventional study has been designed, adding moxonidine to noncontrolled hypertensive, obese subjects in whom a hypocaloric diet was previously recommended. A total of 25 primary care centers participated in the study, with a total of 135 patients recruited. RESULTS: One hundred twelve patients were included in the study; 25 of them had type 2 diabetes. The mean reduction in systolic and diastolic blood pressure after 6 months treatment with moxonidine was 23.0 and 12.9 mm Hg, respectively. The mean systolic and diastolic pressures were 158.5 +/- 10.6 and 95.1 +/- 9 mm Hg, respectively, at baseline, versus 135.5 +/- 11.6 and 82.2 +/- 5.8 mm Hg at the end of the study. Creatinine clearance was significantly decreased in hyperfiltrating obese patients (143.6 +/- 31 vs. 128.2 +/- 27.9, P < 0.0001), without any significant change in patients with normal or slightly decreased renal function (81.9 +/- 18.9 vs. 80.9 +/- 17.5). Only 8 mild adverse reactions in 7 patients were recorded during the study. CONCLUSION: Moxonidine is useful and safe for controlling arterial hypertension in obese patients.