0000000000010951
AUTHOR
Vicente Francisco Gil-guillén
Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment
Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians.The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it.An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia.Clinical inertia was defined when physicians did n…
Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study
Background: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization.Methods: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008–2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care.Results: A total of 11,003 (57%) patients had uncontrolle…
Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care
Aims: To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. Methods: Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c >= 6.5%) between patients exposed and not exposed to DIABSCORE >= 100, and to fasting blood glucose >= 126 mg/dL were calculated. The opinions of both the professionals and the patients concernin…
In the Identification of Cardiovascular Risk With the SCORE Model, Could We Recommend Its Calculation Interchangeably With Total Cholesterol or Atherogenic Index? Concordance Between Total Cholesterol and Atherogenic Index in the SCORE Table
The SCORE table indiscriminately recommends the use of total cholesterol (SCORE-TC) or atherogenic index (SCORE-AI) for calculating cardiovascular (CV) risk. We evaluated reliability and agreement between both methods and the clinical implications for the identification of high CV risk. Observational study (n = 8942) in a 40- to 65-year-old population. Spearman’s Rho correlation was 0.987 (P < .001), the agreement intraclass correlation coefficient was 0.671 (IC 95% 0.413–0.796; with Bland–Altman’s method, the average of the differences between models was 0.74. Kappa index was poor, 0.297 (P < .001) and positive specific agreement was 0.31. Discrepancies fitted individuals with high CV risk…
Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study
Introduction The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with allcause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to corona…
Is the Physician’s Behavior in Dyslipidemia Diagnosis in Accordance with Guidelines? Cross-Sectional Escarval Study
Background: Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires $ 2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC). Objectives: To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors. Design: Cross-sectional. Setting: All health center visits in the second half of 2010 in the Valencian Community (Spain). Patient…
Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study
Background and aim Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics. Methods Cross-sectional study in occupational risks prevention centre in Castellon (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analyse…
En la identificación del riesgo cardiovascular con el modelo SCORE, ¿se puede recomendar su cálculo indistintamente con colesterol total o índice aterogénico? Concordancia entre el colesterol total y el índice aterogénico en la tabla SCORE
Resumen La escala SCORE recomienda indistintamente dos metodos para el calculo del riesgo cardiovascular: uso de colesterol total (CT) o del indice aterogenico (IA). Se evalua la correlacion entre ambos y la concordancia en la identificacion del riesgo cardiovascular elevado. Estudio observacional en poblacion de 40-65 anos. Se calcula el coeficiente de correlacion intraclase (CCI) de acuerdo, el metodo de Bland-Almand (MBA) y el indice Kappa (IK). El CCI intraclase fue de 0,671 (intervalo del confianza [IC] del 95%, 0,413-0,796; p
Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors
The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to ide…
Hospital admissions trends for severe hypoglycemia in diabetes patients in Spain, 2005 to 2015.
Abstract Aims To analyze hospital admissions trends, inpatient mortality, and mean length of hospital stay due to hypoglycemia in patients with diabetes in Spain from 2005 to 2015. Methods National Institute of Statistics provided information on hospital discharge and mortality. Hospital admissions due to severe hypoglycemia were identified using ICD-9 codes. Age-adjusted admission and mortality rates were stratified by sex and year. Joinpoint regression models were used to estimate trends. Results Admissions rates per 100,000 population were higher for men than women in 2005 (30.2, 95%CI:29.3, 31.0 versus 21.5, 95%CI:20.9, 22.1) and 2015 (23.7, 95%CI:23.0, 24.4 versus 13.2, 95%CI:12.7, 13.…
Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria()
ResumenObjetivosDescribir la producción científica internacional en el ámbito de la atención primaria en el período 1985-2004.DiseñoAnálisis bibliométrico.EmplazamientoBase de datos Medline. Acceso mediante WebSPIRS versión 4,3. Se analizan 2 períodos: 2000-2004 (transversal) y 1985-2004 (evolutivo). Búsqueda basada en MesH Major con los descriptores: Primary Care o Primary Health Care, Family Practice, Physicians Family, Nurse Practitioners y los Entry Terms relacionados con ellos.Mediciones principalesSe analizaron los indicadores bibliométricos de producción, circulación, dispersión y visibilidad. Criterios de inclusión: se consideró aquel registro (documento citable) indexado en Medline…
Effectiveness of the 2010–2011 seasonal influenza vaccine in preventing confirmed influenza hospitalizations in adults: A case–case comparison, case-control study
Highlights ► We perform a case–case comparison as an improvement of the test-negative design. ► We report IVE estimates with a low probability of bias. ► Influenza vaccination halved the risk of confirmed influenza hospitalization. ► This effect was consistent regardless of age over 60. ► The measured effect was specific for confirmed influenza hospitalizations.
El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial
ResumenObjetivoComparando los resultados obtenidos en los estudios EUROASPIRE I y EUROASPIRE III en pacientes con cardiopatía isquémica se muestra que el grado de control de los factores de riesgo mayores es mejorable. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial orientada a la mejora del grado de control en estos pacientes en el ámbito de la atención primaria.MétodosEn este estudio de intervención aleatorizado, con 1 año de seguimiento, se reclutó a pacientes con diagnóstico de cardiopatía isquémica (145 en el grupo de intervención y 1.461 en el grupo control). Se aplicó una intervención organizativa mixta basada en la mejora de la relación profesio…
Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia
Abstract Background The Escarval-Risk study aims to validate cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia living in the Valencia Community, a European Mediterranean region, based on data from an electronic health recording system comparing predicted events with observed during 5 years follow-up study. Methods/Design A cohort prospective 5 years follow-up study has been designed including 25000 patients with hypertension, diabetes and/or dyslipidemia attended in usual clinical practice. All information is registered in a unique electronic health recording system (ABUCASIS) that is the usual way to register clinical practice in the Valencian Health System…
Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort
Abstract Aims To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. Methods A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. Results Mean follow-up was 3.2…
Gender Inequalities in Diagnostic Inertia around the Three Most Prevalent Cardiovascular Risk Studies: Protocol for a Population-Based Cohort Study
Evidence shows that objectives for detecting and controlling cardiovascular risk factors are not being effectively met, and moreover, outcomes differ between men and women. This study will assess the gender-related differences in diagnostic inertia around the three most prevalent cardiovascular risk factors: dyslipidemia, arterial hypertension, and diabetes mellitus, and to evaluate the consequences on cardiovascular disease incidence. This is an epidemiological and cohort study. Eligible patients will be adults who presented to public primary health care centers in a Spanish region from 2008 to 2011, with hypertension, dyslipidemia, or/and diabetes and without cardiovascular disease. Parti…
Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados. Estudio PREV-ICTUS
Fundamento y objetivo: Los datos sobre prevalencia de obesidad en poblacion de edad avanzada en Espana son escasos. El objetivo de este trabajo ha sido describir la prevalencia de obesidad y los factores relacionados en una muestra aleatoria de la poblacion espanola de 60 anos o mas, estratificada por comunidades autonomas (CC.AA.). Sujetos y metodo: Se analizo el estudio PREV-ICTUS, realizado en una muestra seleccionada aleatoriamente entre septiembre y diciembre de 2005, estratificada por CC.AA. segun el censo y el habitat de atencion. Se clasifico a los sujetos segun su indice de masa corporal (IMC) en aquellos con peso normal (IMC < 25), sobrepeso (IMC de 25-29,9) y obesos (IMC $ 30). R…
A cardiovascular educational intervention for primary care professionals in Spain: positive impact in a quasi-experimental study
Background Routine general practice data collection can help identify patients at risk of cardiovascular disease. Aim To determine whether a training programme for primary care professionals improves the recording of cardiovascular disease risk factors in electronic health records. Design and setting A quasi-experimental study without random assignment of professionals. This was an educational intervention study, consisting of an online-classroom 1-year training programme, and carried out in the Valencian community in Spain. Method The prevalence rates of recording of cardiovascular factors (recorded every 6 months over a 4-year period) were compared between intervention and control group. …
A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project.
AbstractThis study aimed to assess atrial fibrillation (AF) incidence and predictive factors in hypertensive patients and to formulate an AF risk assessment score that can be used to identify the patients most likely to develop AF. This was a cohort study of patients recruited in primary healthcare centers. Patients aged 40 years or older with hypertension, free of AF and with no previous cardiovascular events were included. Patients attended annual visits according to clinical practice until the end of study or onset of AF. The association between AF incidence and explanatory variables (age, sex, body mass index, medical history and other) was analyzed. Finally, 12,206 patients were includ…
The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study
Abstract Aim Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. Methods Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008–2012. We included men and women aged ≥ 70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-…
Concordancia de las escalas REGICOR y SCORE para la identificación del riesgo cardiovascular alto en la población española
Introduction. The aims of this study were to evaluate the consistency between the SCORE (Systematic Coronary Risk Evaluation) and REGICOR (Registre Gironi del Cor) scales in identifying high cardiovascular risk and to describe the characteristics of those individuals for whom scale results were discrepant. Methods. This cross-sectional study involved 8942 subjects aged 40-65 years who had an indication for a complete lipid profile. The agreement between SCORE (for low-risk countries) and Framingham-REGICOR (with a high risk threshold of 10%) scales in classifying patients as high risk was evaluated using the kappa statistic. Subjects for whom there was a discrepancy between classifications …