[Medical care of patients with heart failure: clinical characteristics, determinants of prognosis and follow-up in primary care]. / La atención médica de los pacientes con insuficiencia cardíaca: características clínicas, determinantes del pronóstico y seguimiento en la atención primaria.

OBJECTIVE: To assess the process of care and prognosis of patients with heart failure (HF) attended in a tertiary hospital and follow up at the primary care level. DESIGN: Prospective study of 18 months of follow up.Setting. Tertiary hospital and primary care centers of the reference area. Participants. Patients admitted to a tertiary hospital from the first of july until de 31 of december of 1998. OUTCOME MEASUREMENTS: Pharmacological data and morbimortality at discharge and at the end of the follow-up, functional capacity of survivors. RESULTS: 265 patients were included, with a mean age of 75 years, 57% were females, 73.8% had HF as first diagnosis, 6.1% had MI, and 20% were attended for other medical reasons. The most frequent cause of HF was HTA. Drugs more prescribed at the discharge and follow up were diuretics and ACE inhibitors. Hospital mortality was 6.4% and mortality at the end of the follow-up was 46% (in 77% of those for cardiac reasons). After being discharged 38.5% of the patients were readmitted to the hospital with the diagnosis of HF, 72% were visited by the family physician, 43% at the outpatient clinic and 33% by the cardiologist; 60% of the patients who survived were in I-II NYHA functional class, 76% walked regularly, and 25% did recreational activities and physical exercise. CONCLUSIONS: Patients attended at the hospital with HF are an old population, have frequently associated other chronic diseases, and have a very bad prognosis. These patients spend an important amount of health resources. Drug prescription at the follow up is suboptimum. Patients who survived have an acceptable functional capacity.

La atención médica de los pacientes con insuficiencia cardíaca: características clínicas, determinantes del pronóstico y seguimiento en la atención primaria / Medical care in patients with heart failure: clinical characteristics, determinants of prognosis and follow-up in primary care

Objetivo. Analizar el proceso asistencial de los pacientes ingresados con el diagnóstico de insuficiencia cardíaca (IC) y posteriormente durante el seguimiento en la atención primaria. Diseño. Estudio prospectivo de un año y medio de seguimiento. Emplazamiento. Hospital terciario y centros de atención primaria del área de referencia. Participantes. Pacientes diagnosticados de IC al alta hospitalaria desde el 1 de julio hasta el 31 de diciembre de 1998.Mediciones principales. Datos farmacológicos al alta y al final del seguimiento, morbimortalidad al final del seguimiento, capacidad funcional de los supervivientes. Resultados. Se incluyó a 265 pacientes. La edad media de los mismos era de 75 años, el 57 por ciento eran mujeres, el 73,9 por ciento ingresó por IC, el 6,1 por ciento por infarto agudo de miocardio (IAM) y el 20 por ciento por otros motivos. El factor causal más frecuente fue la hipertensión arterial. Los fármacos más utilizados tanto al alta hospitalaria como en el seguimiento fueron los diuréticos, seguidos de los inhibidores de la enzima conversiva de la angiotensina (IECA). La mortalidad hospitalaria fue del 6,4 por ciento, y a los 18 meses de seguimiento, de un 46 por ciento (en un 77 por ciento de éstos de causa cardíaca). Tras el alta hospitalaria el 38,5 por ciento de los pacientes reingresó por IC, el 72 por ciento se visitaba por el médico de familia, el 43 por ciento en consultas externas del hospital y el 33 por ciento por el cardiólogo; un 76 por ciento caminaba regularmente y el 25 por ciento hacía actividades recreacionales y ejercicio físico. Conclusiones. La población atendida por IC es una población envejecida, con alta comorbilidad y un mal pronóstico, que precisa una cantidad destacable de recursos sanitarios. La prescripción farmacológica en el seguimiento es subóptima. La población superviviente disfruta de una aceptable capacidad funcional. (AU)

[Impact of biomedical publications on the incorporation of new therapeutic attitudes in cardiovascular pathology]. / Impacto de las publicaciones biomédicas en la incorporación de nuevas actitudes terapéuticas en patología cardiovascular.

OBJECTIVE: To evaluate the application degree of results from three clinical trials on cardiovascular pathology in clinical practice: SOLVD trial (in patients with congestive heart failure), SAVE trial (in patients with acute myocardial infarction) and SPINAF trial (in patients with chronic atrial fibrillation). DESIGN: Retrospective cross-sectional study performed in the first six months in 1990 and 1992 (SOLVD trial) and in the first six months in 1991 and 1993 (SAVE trial) admitted to the Consorci Hospitalari del Parc Taulí, and a cross-sectional study in a single randomized sample of all patients with the discharge diagnosis of atrial fibrillation at Hospital Vall d'Hebron during 1994. An absolute increase of 23% and 19% in the prescription of ACEI agents was observed for patients with heart failure and myocardial infarction, respectively. Forty-eight percent of patients with atrial fibrillation received antithrombotic therapy, which included aspirin and acenocoumarine for 51% and 49% of cases, respectively.