0000000000010956
AUTHOR
Vicente Pallarés
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…
Prevalencia de fibrilación auricular y uso de fármacos antitrombóticos en el paciente hipertenso ≥ 65 años. El registro FAPRES.
Introduccion y objetivos Entre los principales factores asociados a la presencia de fibrilacion auricular y mayor riesgo embolico estan la edad y la hipertension arterial. Nuestro objetivo es conocer la prevalencia de fibrilacion auricular en el paciente hipertenso de 65 o mas anos de edad en la Comunidad Valenciana y el empleo de farmacos antitromboticos. Metodos Cada investigador incluyo a los primeros 3 pacientes hipertensos de edad ≥ 65 anos que acudian a la consulta el primer dia de la semana durante 5 semanas. Se recogieron los factores de riesgo, la historia cardiovascular, la puntuacion CHADS2 y el tratamiento farmacologico y se realizo un electrocardiograma para su analisis central…
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…
Twenty-four-hour ambulatory heart rate and organ damage in primary hypertension.
The relationship between basal heart rate (HR) and the occurrence of myocardial ischemia, sudden death, cardiovascular mortality have been described. Therefore, further studies are warranted to evaluate the behaviour of heart rate in different scenarios. We sought to determine whether ambulatory heart rate is associated with the presence of target organ damage (TOD) in hypertensive patients.Crossectional study of essential hypertensive patients in whom a twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed. The relationship between TOD and 24 hour ambulatory heart rate (HR) was analyzed.Five hundred and sixty-six patients with arterial hypertension were included (55.8%…
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…
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
Gender differences related to the presence of atrial fibrillation in older hypertensive patients
AIM: To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF. METHODS: Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individuals with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were signific…
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…
Los desafíos del profesorado clínico en la educación médica
Resumen: Antecedentes: La enseñanza clínica en la educación médica tiene una particularidad única: el contexto clínico. Este estudio tiene como objetivo analizar las principales barreras de la enseñanza clínica en una facultad joven de Medicina de España. Métodos: Se trata de un estudio transversal descriptivo en el que se solicitó a todos los profesores clínicos (todos ellos profesores asociados) de una facultad joven de Medicina que respondieran a un cuestionario en línea, anónimo y voluntario sobre aspectos de carga asistencial, promoción de la investigación clínica y reconocimiento de sus carreras profesionales. Resultados: Sesenta y un profesores (42%) respondieron al cuestionario. Los…
26th Annual Computational Neuroscience Meeting (CNS*2017): Part 2
International audience; No abstract available