Mortality and Cardiovascular Complications in Older Complex Chronic Patients with Type 2 Diabetes

Mortality; Cardiovascular diseases;Type 2 DiabetesMortalitat; Malalties cardiovasculars; Diabetis tipus 2Mortalidad; Enfermedades cardiovasculares; Diabetes tipo 2AIMS/INTRODUCTION: Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. MATERIALS AND METHODS: We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. RESULTS: The prevalence of diabetes was 53% and average age 81.16 ± 8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02-2.13, p  0.038], presence of heart failure [HR 1.73, 95% CI 1.25-2.38, p  0.001], Charlson score [HR 1.20, 95% CI 1.06-1.36, p  0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24-2.40, p  0.001], and no treatment with statins [HR 1.49, 95% CI 1.08-2.04, p  0.038]. CONCLUSIONS: We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies

Analysis of gender perspective in the Directive Plans of Health Department of Generalitat de Catalunya

La perspectiva de género entra a formar parte de las políticas públicas para paliar las desigualdades entre hombres y mujeres. Los elementos que consideramos que tendrían que estar presentes en las políticas públicas con perspectiva de género son: la visibilidad de las mujeres, la participación paritaria en los organismos determinados, el lenguaje que no sea androcéntrico ni sexista, la transversalidad y los determinantes de género como construcción social. El objetivo de nuestro trabajo es analizar si la perspectiva de género está presente en los Planes Directores del Departamento de Salud de la Generalitat de Catalunya.Gender perspective becomes part of public policies to avoid inequalities between men and women. The elements that we believe would have to be present in public policies with gender perspective are: the visibility of women, equal participation, not andocentric or sexist language, transverse and gender determinants as social construction. The aim of our study is to analyze whether the gender perspective is present in the Master Plan of the Department of Health of the Generalitat de Catalunya

The costs associated with stroke care continuum: a systematic review

Abstract Stroke, a leading cause of death and long-term disability, has a considerable social and economic impact. It is imperative to investigate stroke-related costs. The main goal was to conduct a systematic literature review on the described costs associated with stroke care continuum to better understand the evolution of the economic burden and logistic challenges. This research used a systematic review method. We performed a search in PubMed/MEDLINE, ClinicalTrial.gov, Cochrane Reviews, and Google Scholar confined to publications from January 2012 to December 2021. Prices were adjusted using consumer price indices of the countries in the studies in the years the costs were incurred to 2021 Euros using the World Bank and purchasing power parity exchange rate in 2020 from the Organization for Economic Co-operation and Development with the XE Currency Data API. The inclusion criteria were all types of publications, including prospective cost studies, retrospective cost studies, database analyses, mathematical models, surveys, and cost-of-illness (COI) studies. Were excluded studies that (a) were not about stroke, (b) were editorials and commentaries, (c) were irrelevant after screening the title and abstract,(d) grey literature and non-academic studies, (e) reported cost indicators outside the scope of the review, (f) economic evaluations (i.e., cost-effectiveness or cost–benefit analyses); and (g) studies not meeting the population inclusion criteria. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 724 potential abstracts were identified of which 25 articles were pulled for further investigation. The articles were classified into the following categories: 1)stroke primary prevention, 2) expenditures related to acute stroke care, 3) expenditures for post-acute strokes, and 4) global average stroke cost. The measured expenditures varied considerably among these studies with a global average cost from €610-€220,822.45. Given the great variability in the costs in different studies, we can conclude that we need to define a common system for assessing the costs of strokes. Possible limitations are related to clinical choices exposed to decision rules that trigger decisions alerts within stroke events in a clinical setting. This flowchart is based on the guidelines for acute ischemic stroke treatment but may not be applicable to all institutions

Mortality and Cardiovascular Complications in Older Complex Chronic Patients with Type 2 Diabetes

Mortality; Cardiovascular diseases;Type 2 DiabetesMortalitat; Malalties cardiovasculars; Diabetis tipus 2Mortalidad; Enfermedades cardiovasculares; Diabetes tipo 2AIMS/INTRODUCTION: Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. MATERIALS AND METHODS: We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. RESULTS: The prevalence of diabetes was 53% and average age 81.16 ± 8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02-2.13, p  0.038], presence of heart failure [HR 1.73, 95% CI 1.25-2.38, p  0.001], Charlson score [HR 1.20, 95% CI 1.06-1.36, p  0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24-2.40, p  0.001], and no treatment with statins [HR 1.49, 95% CI 1.08-2.04, p  0.038]. CONCLUSIONS: We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies

Diferencias en la supervivencia después de un episodio de ictus tratado con fibrinólisis. Estudio Ebrictus

Objetivo: Investigar la relación entre género y supervivencia después de un episodio de ictus tratado con fibrinólisis. Diseño: Estudio de cohortes. Emplazamiento: Atención primaria. Participantes: Los casos tratados con fibrinólisis por un ictus agudo desde el 1 de abril de 2006 al 13 de septiembre de 2013. Intervenciones: Seguimiento del estado vital. Mediciones principales: Riesgos vasculares: escala Framingham, REGICOR, CHA2DS2-VASc, Essen, NIHSS, índice Barthel; densidad de incidencia; análisis de supervivencia por Kaplan-Meier; bivariado entre supervivientes y fallecidos; y multivariante de Cox. Resultados: Noventa y un pacientes con edad media 68,02 ± 11,9 años. Los hombres tienen mayor riesgo cardiovascular basal. El tiempo medio de seguimiento fue de 2,95 ± 2,33 años. La razón de tasa de incidencias mostró un mayor riesgo en los hombres respecto a las mujeres IR = 3,2 (IC 95%: 1,2-8,0). Los fallecidos en relación con los supervivientes son mayores (p = 0,032); mayor riesgo cardiovascular basal (p = 0,040) y de recidiva de ictus (p < 0,001); mayor severidad del episodio (p = 0,002); y una mayor caída en la puntuación Barthel un año después del ictus (p = 0,016). El porcentaje de muertes es significativamente más alto cuando el paciente es derivado a centros de agudos o de larga estancia (p = 0,006) que cuando se deriva al domicilio, pero solo el género (HR: 1,12; IC 95%: 1,05-1,20) y la prevención cardiovascular secundaria (HR: 0,13; IC 95%: 0,06-0,28) se asociaron con la mortalidad de los pacientes. Conclusiones: Después de un episodio de ictus tratado con fibrinólisis los hombres tienen un 12% más de riesgo de morir que las mujeres, y la ausencia de prevención cardiovascular secundaria aumenta 7,7 veces el riesgo de mortalidad

El circuito asistencial de la fibrilación auricular en pacientes ambulatorios: estudio observacional Audit fibrilación auricular en el Baix Ebre

Objetivo: Conocer el circuito asistencial de la fibrilación auricular (FA): diagnóstico, tratamiento y seguimiento en el contexto asistencial del sistema sanitario público. Diseño: AFABE es un estudio observacional, multicéntrico y descriptivo, con datos retrospectivos relacionados con el diagnóstico, tratamiento y seguimiento de una cohorte de pacientes ambulatorios con FA en el contexto de la atención primaria, servicios de urgencias y cardiología referentes. Emplazamiento: Atención primaria y especializada. Comarca del Baix Ebre. Tarragona. España. Participantes: Muestra representativa de pacientes con FA > 60 años, seleccionados aleatoriamente entre los pacientes registrados en los 22 centros de atención primaria existentes en el territorio del estudio. Mediciones principales: Datos demográficos, comorbilidades, valor CHA2DS2-VASc y HAS_BLED, y patrones asistenciales resultantes entre la atención primaria y servicios referentes. Resultados: Se incluyeron 182 pacientes, de 78,5; DE:7,3 años, y el 50% mujeres. En atención primaria (AP) se realizó el primer contacto en el 68,3% (IC 95% 60,3-76,3) de los casos de FA, de los que un 56,3% (IC 95% 45,2-66,0) fueron enviados al servicio de urgencias del hospital referente. El 72,7% (IC 95% 63,5-79,0) de los tratamientos anticoagulantes orales y el 58,44% (IC 95% 49,4-66,9) de los tratamientos antiarrítmicos se iniciaron en el servicio de urgencias referente. Un 55,9% (IC 95% 47,2-64,7) de los pacientes son seguidos por el servicio de cardiología referente. Conclusiones: El médico de AP realiza el primer contacto de la mayoría de FA y deriva el 55% de los casos al servicio de urgencias hospitalario donde se inician la mayoría de tratamientos específicos de la FA

Early Diagnosis of Atrial Fibrillation and Stroke Incidence in Primary Care: Translating Measurements into Actions—A Retrospective Cohort Study

(1) Background: AF-related strokes will triple by 2060, are associated with an increased risk of cognitive decline, and alone or in combination, will be one of the main health and economic burdens on the European population. The main goal of this paper is to describe the incidence of new AF associated with stroke, cognitive decline and mortality among people at high risk for AF. (2) Methods: Multicenter, observational, retrospective, community-based studies were conducted from 1 January 2015 to 31 December 2021. The setting was primary care centers. A total of 40,297 people aged ≥65 years without previous AF or stroke were stratified by AFrisk at 5 years. The main measurements were the overall incidence density/1000 person-years (CI95%) of AF and stroke, prevalence of cognitive decline, and Kaplan–Meier curve. (3) Results: In total, 46.4% women, 77.65 ± 8.46 years old on average showed anAF incidence of 9.9/103/year (CI95% 9.5–10.3), associated with a four-fold higher risk of stroke (CI95% 3.4–4.7), cognitive impairment(OR 1.34 (CI95% 1.1–1.5)), and all-cause mortality (OR 1.14 (CI95% 1.0–1.2)), but there was no significant difference in ischemic heart disease, chronic kidney disease, or peripheral arteriopathy. Unknown AF was diagnosed in 9.4% and of these patients, 21.1% were diagnosed with new stroke. (4) Conclusions: The patients at high AF risk (Q4th) already had an increased cardiovascular risk before they were diagnosed with AF

Sex Differences in Long-Term Survival after a First Stroke with Intravenous Thrombolysis: Ebrictus Study

Background: A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences. We sought to examine the relationship between sex and outcome after thrombolysis. Methods: This was a prospective cohort study including 1,272 incident ischemic strokes (597 in women) from April 1, 2006 to December 31, 2014. Statistical approaches were used for analyzing survival outcomes and their relationship with thrombolysis therapy. Results: The death rates were lower (p = 0.003) in the thrombolysis therapy group with an incidence ratio of 0.57 (95% CI 0.39-0.83). 113 (8.8%) patients (53 women) received thrombolysis. They were significantly younger (69.2 ± 12.7 vs. 73.9 ± 12.5 years; p Conclusions: The stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting. The overall benefit on survival of the patients treated with thrombolysis might be explained by the beneficial effect of the thrombolysis on the women

Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults—Ineffectiveness of Oral Anticoagulation Treatment with VKA

Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC≥2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC<2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7–36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%