Estimación del impacto económico y sanitario de las complicaciones de la diabetes mellitus tipo 2 en la Comunidad de Madrid / Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the autonomous community of Madrid (Spain)

OBJETIVO: Estimar el impacto económico y sanitario de las complicaciones crónicas macro y microvasculares de la diabetes mellitus tipo 2 (DM2) en la Comunidad de Madrid (CM). MÉTODOS: El número de complicaciones esperadas se obtuvo de un estudio descriptivo transversal que incluyó una cohorte de 3.268 pacientes con DM2 de la CM. El coste de las complicaciones (Euros de 2012) se valoró tanto a nivel hospitalario como en la atención primaria. El número de consultas médicas en atención primaria y el tratamiento farmacológico de las complicaciones se obtuvo mediante un panel de 21 médicos con experiencia en el tratamiento de la DM2. Los datos poblacionales, epidemiológicos y los costes sanitarios se consiguieron de fuentes españolas. Se hicieron análisis de sensibilidad univariantes. RESULTADOS: Se estima que la población con DM2 en la CM asciende a 390.944 pacientes y que estos sufren a lo largo de su vida 172.406 y 212.283 complicaciones macro y microvasculares, respectivamente. El coste promedio de las complicaciones de la DM2 por paciente se calcula en 4.121,54 € (el 66% debido a las complicaciones macrovasculares). El impacto económico de las complicaciones de la DM2 en la CM sería de 1.611 millones de euros (1.065 en las complicaciones crónicas de tipo macrovascular y 545 en las complicaciones de tipo microvascular). El impacto económico oscilaría entre los 1.249 y los 2.509 millones de euros, según la prevalencia de DM2. CONCLUSIONES: Las complicaciones de la DM2 tienen un gran impacto, tanto sanitario como económico en la CM

OBJECTIVE: To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS: The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (Euros, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS: It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at Euros 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from Euros 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS: Complications of T2DM have a great health and economic impact in ACM

Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the autonomous community of Madrid (Spain).

OBJECTIVE: To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS: The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS: It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS: Complications of T2DM have a great health and economic impact in ACM.

Efficacy of a strategy for implementing a guideline for the control of cardiovascular risk in a primary healthcare setting: the SIRVA2 study a controlled, blinded community intervention trial randomised by clusters.

UNLABELLED: This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid. BACKGROUND: The results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CPG is known to influence its final use. Strategies based on the involvement of opinion leaders and that are easily executed appear to be among the most successful. AIM: The main aim of the present work was to compare the effectiveness of two strategies for implementing a CPG designed to reduce cardiovascular risk in the primary healthcare setting, measured in terms of improvements in the recording of calculated cardiovascular risk or specific risk factors in patients' medical records, the control of cardiovascular risk factors, and the incidence of cardiovascular events. METHODS: This study involved a controlled, blinded community intervention in which the 21 health centres of the Number 2 Health Area of Madrid were randomly assigned by clusters to be involved in either a proposed CPG implementation strategy to reduce cardiovascular risk, or the normal dissemination strategy. The study subjects were patients ≥ 45 years of age whose health cards showed them to belong to the studied health area. The main variable examined was the proportion of patients whose medical histories included the calculation of their cardiovascular risk or that explicitly mentioned the presence of variables necessary for its calculation. The sample size was calculated for a comparison of proportions with alpha = 0.05 and beta = 0.20, and assuming that the intervention would lead to a 15% increase in the measured variables. Corrections were made for the design effect, assigning a sample size to each cluster proportional to the size of the population served by the corresponding health centre, and assuming losses of 20%. This demanded a final sample size of 620 patients. Data were analysed using summary measures for each cluster, both in making estimates and for hypothesis testing. Analysis of the variables was made on an intention-to-treat basis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01270022.

Ten-year fatal and non-fatal myocardial infarction incidence in elderly populations in Spain: the EPICARDIAN cohort study.

BACKGROUND: In Spain, more than 85% of coronary heart disease deaths occur in adults older than 65 years. However, coronary heart disease incidence and mortality in the Spanish elderly have been poorly described. The aim of this study is to estimate the ten-year incidence and mortality rates of myocardial infarction in a population-based large cohort of Spanish elders. METHODS: A population-based cohort of 3729 people older than 64 years old, free of previous myocardial infarction, was established in 1995 in three geographical areas of Spain. Any case of fatal and non-fatal myocardial infarction was investigated until December 2004 using the "cold pursuit method", previously used and validated by the the WHO-MONICA project. RESULTS: Men showed a significantly (p < 0.001) higher cumulative incidence of myocardial infarction (7.2%; 95%CI: 5.94-8.54) than women (3.8%; 95%CI: 3.06-4.74). Although cumulative incidence increased with age (p < 0.05), gender-differences tended to narrow. Adjusted incidence rates were higher in men (957 per 100 000 person-years) than in women (546 per 100 000 person-years) (p < 0.001) and increased with age (p < 0.001). The increase was progressive in women but not in men. Adjusted mortality rates were also higher in men than in women (p < 0.001), being three times higher in the age group of > or = 85 years old than in the age group of 65-74 years old (p < 0.001). CONCLUSION: Incidence of fatal and non-fatal myocardial infarction is high in the Spanish elderly population. Men show higher rates than women, but gender differences diminish with age.

[Ten-year incidence of fatal and non-fatal myocardial infarction in the elderly population of Madrid]. / Incidencia a diez años de infarto de miocardio fatal y no fatal en la población anciana de Madrid.

INTRODUCTION AND OBJECTIVES: To determine the incidence of and mortality due to myocardial infarction and coronary heart disease in the elderly population of Madrid, Spain. METHODS: The study involved a population-based cohort of 1297 individuals aged over 64 years without cardiovascular disease who were recruited in 1995. All cases of fatal and non-fatal myocardial infarction recorded up until December 2004 were investigated and classified using WHO-MONICA (World Health Organization-Multinational MONItoring of trends and determinants in CArdiovascular disease) criteria. RESULTS: Men had a significantly higher cumulative incidence of ischemic events (P< .001) and sudden death (P< .001), and a non-significantly higher risk of myocardial infarction (6.30%; 95% confidence interval [CI], 4.33%-8.76%) than women (4.90%; 95% CI, 3.54%-6.70%; P=.181). While the risk of myocardial infarction increased with age (P< .05), gender differences tended to narrow. The incidence was higher in men (889/100 000 person-years) than women (610/100,000 person-years; P< .001) and increased with age (P< .01). This increase was progressive in women but not in men. The mortality rate was also higher in men (472/100,000 person-years; 95% CI, 248-697) than women (328/100,000 person-years; 95% CI, 188-469; P< .001), and was six times higher in the 385-year-old age group than in those aged 65-74 years (P< .001). CONCLUSIONS: The incidence of fatal and non-fatal myocardial infarction was very high in the elderly population of Madrid. Both incidence and mortality rates increased dramatically with age after 64 years. Rates were higher in men than women at all ages, though gender differences decreased with age.

Incidencia a diez años de infarto de miocardio fatal y no fatal en la población anciana de Madrid / Ten-year incidence of fatal and non-fatal myocardial infarction in the elderly population of Madrid

Introducción y objetivos. Estimar las tasas de incidencia y mortalidad por infarto de miocardio (IM) y enfermedad coronaria (EC) en la población anciana de Madrid. Métodos. En 1995 se estableció una cohorte de base poblacional formada por 1.297 individuos de edad superior a 64 años y sin enfermedades cardiovasculares. Se investigaron todos los casos de infarto de miocardio mortales y no mortales hasta diciembre de 2004 y se clasificaron según los criterios OMS-MONICA. Resultados. Los varones presentaron incidencias acumulativas significativamente superiores de episodios isquémicos (p < 0,001) y de muerte súbita (p < 0,001), así como un riesgo de infarto de miocardio superior, aunque no significativamente (6,3%; intervalo de confianza [IC] del 95%, 4,33%-8,76%), a los de las mujeres (4,9%; IC del 95%, 3,54%-6,7%) (p = 0,181). Aunque el riesgo de infarto de miocardio aumentaba con la edad (p < 0,05), las diferencias entre los dos sexos tendían a reducirse. Las tasas de incidencia fueron mayores en los varones (889/100.000 personas-años) que en las mujeres (610/100.000 personas-años) (p < 0,001) y con la edad más avanzada (p < 0,01). Este aumento era progresivo en las mujeres, pero no en los varones. Las tasas de mortalidad fueron también más altas entre los varones (472; IC del 95%, 248-697) que entre las mujeres (328; IC del 95%, 188-469) (p < 0,001), con unos valores en el grupo de edad 3 85 años 6 veces superiores a los del grupo de edad de 65-74 años (p < 0,001). Conclusiones. La incidencia de infarto de miocardio mortal y no mortal es muy alta en la población anciana de Madrid. Las tasas de incidencia y de mortalidad aumentan de manera muy notable con la edad a partir de los 64 años. Los varones presentan unas tasas más altas que las mujeres de cualquier edad, pero las diferencias entre los sexos disminuyen con la edad (AU)

Introduction and objectives. To determine the incidence of and mortality due to myocardial infarction and coronary heart disease in the elderly population of Madrid, Spain. Methods. The study involved a population-based cohort of 1297 individuals aged over 64 years without cardiovascular disease who were recruited in 1995. All cases of fatal and non-fatal myocardial infarction recorded up until December 2004 were investigated and classified using WHO-MONICA (World Health Organization-Multinational MONItoring of trends and determinants in CArdiovascular disease) criteria. Results. Men had a significantly higher cumulative incidence of ischemic events (P<.001) and sudden death (P<.001), and a non-significantly higher risk of myocardial infarction (6.30%; 95% confidence interval [CI], 4.33-8.76) than women (4.90%; 95% CI, 3.54-6.70; P=.181). While the risk of myocardial infarction increased with age (P<.05), gender differences tended to narrow. The incidence was higher in men (889/100 000 person-years) than women (610/100 000 person-years; P<.001) and increased with age (P<.01). This increase was progressive in women but not in men. The mortality rate was also higher in men (472/100 000 person-years; 95% CI, 248-697) than women (328/100 000 person-years; 95% CI, 188-469; P<.001), and was 6 times higher in the ≥85-year-old age group than in those aged 65-74 years (P<.001). Conclusions. The incidence of fatal and non-fatal myocardial infarction was very high in the elderly population of Madrid. Both incidence and mortality rates increased dramatically with age after 64 years. Rates were higher in men than women at all ages, though gender differences decreased with age (AU)