Pacientes con el diagnóstico de insuficiencia cardiaca en Atención Primaria: envejecimiento, comorbilidad y polifarmacia / Heart failure patients in Primary Care: aging, comorbidities and polypharmacy

ObjetivoDescribir el perfil clínico y de consumo farmacológico de los pacientes con registro diagnóstico de insuficiencia cardiaca (IC) en una región sanitaria, a partir de los registros informáticos. Ver si existen diferencias por sexos.DiseñoEstudio descriptivo transversal multicéntrico.EmplazamientoRegión Sanitaria de Lleida.ParticipantesToda la población adscrita a 21 centros de salud, diagnosticada de IC (3.017 de 306.229).Mediciones principalesDatos demográficos, comorbilidades y subgrupos terapéuticos en pacientes con el diagnóstico de IC en la historia clínica.ResultadosRegistro de IC 0,99%, 59% mujeres, media de edad 80 años. Antecedentes: hipertensión 67%, fibrilación auricular (FA) 31%, diabetes (DM2) 30%, obesidad 27%, dislipemia 26,5%, asma/EPOC 26%, cardiopatía isquémica (CI) 19%, accidente vascular cerebral (AVC) 11%, e insuficiencia renal (IR) 12%. Hipertensión, dislipemia y obesidad son más frecuentes en mujeres y EPOC, CI e IR en hombres. No hay diferencias en DM2, AVC ni FA. Mediana de consumo de subgrupos terapéuticos por paciente durante el 2007 de 8 (P25=6 y P75=11). Las mujeres tienen mayor prescripción de diuréticos (76% vs 71%), glucósidos cardíacos (22% vs 19.3%) e IECA/ARAII (68% vs 64%) y los hombres de tratamiento combinado IECA/ARAII+beta bloqueantes (26,9% vs 23,5%). Hay una tendencia a mayor prescripción de estos últimos en hombres sin ser significativa.ConclusionesLos pacientes diagnosticados de IC en Atención Primaria son de edad muy avanzada, presentan pluripatología asociada y consumen muchos fármacos. Existen diferencias por sexos tanto en factores de riesgo cardiovascular y enfermedades asociadas como en el perfil de consumo farmacológico(AU)

ObjectiveTo assess heart failure prevalence, epidemiology, co-morbidities and polypharmacy in our region from electronic patient records. To evaluate gender differences in heart failure patients.DesignDescriptive, cross-sectional study.SettingPrimary care Lleida (Spain).ParticipantsAll patients from 21 primary care centers with the diagnosis of heart failure in medical records were included.Main outcome measurementsDemografic data, comorbidities and therapeutical subgroups in patients with a diagnosis of heart failure in their clinical record.ResultsHeart failure was found in 0.99% (3017 from 306229 patients), of whom 59% were women, and a mean age of 80 years. Comorbidities: hypertension 67%, diabetes 30%, hyperlipidemia 26.5%, obesity 27%, ischemic heart disease 19%, stroke 11%, atrial fibrillation 31%, COPD 26%, renal failure 12%. Hypertension, hyperlipidemia and obesity were more frequent in women, COPD, ischemic heart disease and renal failure in men. There were no differences in diabetes, stroke and atrial fibrillation. Patients were prescribed a median of 8 different therapeutic subgroups (P25=6 and P75=11). Women were more frequently prescribed diuretics (76%), cardiac glycosides (22%) and ACE inhibitors/angiotensin II receptor antagonists, and men ACE inhibitors/angiotensin II receptor antagonists in combination with beta-blockers.ConclusionsHeart failure patients in primary care are elderly, with significant co-morbidities and treated with a high number of drugs. Gender differences exist in cardiovascular risk factors, co-morbidities, and also in therapy(AU)

[Evolution in consumption of anti-depressants during the years 2002 to 2004]. / Evolución en el consumo de antidepresivos durante los años 2002 a 2004.

OBJECTIVE: To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. DESIGN: Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. SETTING: Lleida Health Region, Spain. PARTICIPANTS: A total of 54,890 patients received an antidepressant drug between 2002 and 2004. MEASUREMENTS: Age, sex, medicine, prescription period, centre. RESULTS: The prevalence of antidepressant treatment was: 8.4% in 2002 (368,976 inhabitants); 8.6% in 2003 (376,638 inhabitants); and 8.7% in 2004 (388,148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). CONCLUSIONS: A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system.

Evolución en el consumo de antidepresivos durante los años 2002 a 2004 / Evolution in consumption of anti-depressants during the years 2002 to 2004

Objetivo. Analizar el consumo de fármacos antidepresivos y la duración del tratamiento antidepresivo durante los años 2002 a 2004. Diseño. Estudio descriptivo, transversal, de las dispensaciones de medicamentos antidepresivos realizadas mediante receta del Sistema Nacional de Salud. Emplazamiento. Región Sanitaria de Lleida. Participantes. Han participado 54.890 individuos que han recibido algún fármaco antidepresivo durante los años 2002 a 2004. Mediciones principales. Edad, sexo, medicamento, período de dispensación, centro. Resultados. La prevalencia anual de tratamiento antidepresivo ha sido del 8,4% en 2002 (368.976 habitantes), del 8,6% en 2003 (376.638 habitantes) y del 8,7% en 2004 (388.148 habitantes). El incremento en el porcentaje de pacientes en tratamiento en 2004 respecto al 2002 es de un 9,4%. La prevalencia en los varones es del 5,4% y en las mujeres del 12,7%. La distribución por grupos de fármacos antidepresivos es la siguiente: inhibidores selectivos de la recaptación de serotonina un 73,7%, antidepresivos tricíclicos un 26,2%, heterocíclicos un 10% e inhibidores de la monoaminooxidasa un 0,1%. La duración del tratamiento ha sido de 1-3 meses en el 43%, 4-12 meses en el 22,7%, 13-24 meses en el 14,4% y > 24 meses en el 19,9%. Conclusiones. Hay un incremento progresivo en las prescripciones de antidepresivos, con predominio de nuevas moléculas. Respecto a la duración del tratamiento, un porcentaje elevado de individuos realiza tratamientos < 4 meses, hecho contradictorio con las recomendaciones de la literatura científica para el tratamiento de la depresión. Este hecho conlleva una importante ineficiencia del sistema sanitario

Objective. To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. Design. Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. Setting. Lleida Health Region, Spain. Participants. A total of 54 890 patients received an antidepressant drug between 2002 and 2004. Measurements. Age, sex, medicine, prescription period, centre. Results. The prevalence of antidepressant treatment was: 8.4% in 2002 (368 976 inhabitants); 8.6% in 2003 (376 638 inhabitants); and 8.7% in 2004 (388 148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). Conclusions. A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system