Estudis epidemiològics a la Comunitat Valenciana: el projecte ESCARVAL (2008-2019)

En aquest article es justifica l’Estudi Cardiometabòlic Valencià (ESCARVAL) a partir del fet que les malalties cardiovasculars són la primera causa de malaltia i mort en la població valenciana i espanyola, de l’alta prevalença de factors de risc cardiovascular al nostre país, de la falta d’escales de risc amb dades pròpies per a identificar la població que més es pot beneficiar dels tractaments i de la importància que ha tingut a la Comunitat Valenciana la implementació de la història clínica electrònica, tant per a la investigació com per a la millora de la pràctica clínica. S’enuncia tant la hipòtesi com l’objectiu d’investigació del projecte ESCARVAL i es realitza un resum de la situació de l’estudi en el moment actual. Aquest projecte inclou millores en formació continuada d’aspectes cardiovasculars per als equips d’atenció primària, millores de pràctica clínica en el seguiment de la història clínica electrònica cardiovascular i investigació transversal i longitudinal no sols per a conèixer els indicadors epidemiològics, sinó també per a generar escales amb dades pròpies.En este artículo se justifica el Estudio Cardiometabólico Valenciano (ESCARVAL) partiendo de las siguientes premisas: que las enfermedades cardiovasculares son la primera causa de enfermedad y muerte en la población valenciana y española, la alta prevalencia de factores de riesgo cardiovascular en nuestro país, la falta de escalas de riesgo con datos propios para identificar a la población que más se puede beneficiar de los tratamientos y de la importancia que ha tenido en la Comunidad Valenciana la implementación de la historia clínica electrónica, tanto por la investigación como por la mejora de la práctica clínica. Se enuncian la hipótesis y el objetivo de investigación del proyecto ESCARVAL y se realiza un resumen de la situación actual del estudio. Este proyecto incluye mejoras en la formación continua de aspectos cardiovasculares para los equipos de atención primaria, mejoras de práctica clínica en el seguimiento de la historia clínica electrónica cardiovascular y la investigación transversal y longitudinal; no solo para conocer los indicadores epidemiológicos, sino también para generar escalas con datos propios.Cet article justifie l’Estudi Cardiometabòlic Valencià (ESCARVAL : Étude Cardiométabolique Valencien) à partir du fait que les maladies cardiovasculaires sont la première cause de maladie et de mort chez la population valencienne et espagnole, ainsi que de la grande prévalence des facteurs de risque cardiovasculaire en Espagne, du manque d’échelles de risque de données propres pour identifier la population pouvant bénéficier le plus des traitements et de l’importance que l’implémentation de l’histoire clinique électronique a eu à la Communauté Valencienne, soit pour la recherche, soit pour l’amélioration de la pratique clinique. L’hypothèse et le but de la recherche du projet ESCARVALsont annoncés ici, ainsi qu’un résumé de sa situation au moment actuel. Ce projet comprend des améliorations en formation continue sur des aspects cardiovasculaires pour les équipes de soin primaire, des améliorations de pratique cliniques pour le suivi de l’histoire clinique électronique cardiovasculaire ainsi que des progrès pour la recherche transversale et longitudinale en vue de connaître des indicateurs épidémiologiques et générer des échelles de données propres.This article describes the motivation for the Valencian Cardiometabolic Study (ESCARVALRISK), based on the following premises: the fact that cardiovascular diseases are the main cause of illness and death in Spain and in the Valencian Community, the high prevalence of cardiovascular risk factors in Spain, the absence of data-based risk assessment scales to identify the population that could most benefit from treatment, and the importance that the implementation of electronic medical records has had for the population of the Valencian Community, both for research and for the improvement of clinical practice. Furthermore, the hypothesis and the objective of the ESCARVAL-RISK study are formulated and a summary of the current state of the project is presented. The project includes improvements to lifelong training for primary-care teams dealing with cardiovascular problems, improvements to clinical practice regarding the monitoring of cardiovascular medical records, as well as cross-sectional and long-term research, not only to identify clinical indicators, but also to create scales based on the project’s own data

Dislipidemia y riesgo vascular. Una revisión basada en nuevas evidencias

La dislipidemia es uno de los principales factores de riesgo de cardiopatía isquémica, primera causa de mortalidad en el mundo. Realizar una detección temprana y una intervención terapéutica precoz son elementos clave a la hora de establecer una adecuada prevención de una enfermedad cardiovascular. Debemos conocer el arsenal terapéutico de que disponemos para su adecuada utilización en cada una de las situaciones clínicas que puedan presentar nuestros pacientes. En los últimos 3 años, la proliferación de múltiples guías para el manejo clínico del paciente dislipidémico con aparentes mensajes contradictorios en relación con la consecución de los objetivos de control llegan a confundir a los médicos. En esta revisión se pretende ofrecer una visión actualizada de la situación de la dislipidemia, partiendo del posicionamiento de las guías tanto europeas como americanas, pasando por diferentes situaciones de riesgo y finalizando con el concepto de dislipidemia aterogénica, reconocido factor de riesgo cardiovascular.Dyslipidaemia is one of the major risk factors for ischaemic heart disease, the leading cause of death worldwide. Early detection and therapeutic intervention are key elements in the adequate prevention of cardiovascular disease. It is essential to have knowledge of the therapeutic arsenal available for their appropriate use in each of the clinical situations that might be presented in our patients. In the past 3 years, there has been a proliferation of multiple guidelines for the clinical management of patients with dyslipidaemia, with apparent contradictory messages regarding the achievement of the control objectives, which are confusing clinicians. This review aims to provide an updated overview of the situation as regards dyslipidaemia, based on the positioning of both European and American guidelines, through different risk situations and ending with the concept of atherogenic dyslipidaemia as a recognized cardiovascular risk factor

Uso de la escala CHADS2 como predictor de riesgo de mortalidad en pacientes hipertensos. El estudio FAPRES

Fundamentos y objetivo El objetivo del estudio es analizar la escala CHADS2 como marcador de riesgo de mortalidad en pacientes hipertensos, independientemente de la presencia o no de fibrilación auricular. Métodos Se incluyó a 1.003 pacientes hipertensos ≥ 65 años, recogiendo factores de riesgo y puntuación CHADS2. Se realizó un seguimiento clínico de la mortalidad. Resultados La media de edad de la población fue 72,8 ± 5,8 años; el 47,5% eran varones. Durante el seguimiento hubo 41 muertes, 20 de origen cardiovascular. Los pacientes con mayor CHADS2 tuvieron una mayor mortalidad: 1,5% en CHADS2 = 1; 4,7% en CHADS2 = 2; 9,1% en CHADS2 = 3, y 7,8% en CHADS2 ≥ 4. Conclusiones La puntuación CHADS2 puede ser un instrumento clínico de sencilla aplicación para identificar pacientes hipertensos con alto riesgo de mortalidad.Foundations and aim The aim of this study is to analyze the CHADS2 score as a marker of the risk of mortality in hypertensive patients, with and without the presence of atrial fibrillation. Methods We included 1,003 hypertensive patients ≥ 65 years. Risk factors, and CHADS2 score were recorded among other factors, as well as clinical follow-up of number and type of deaths. Results Mean age was 72.8 ± 5.8 years, and 47.5% were men. During follow-up there were 41 deaths, 20 were of cardiovascular origin. Patients with higher CHADS2 had a higher mortality: 1.5% CHADS2 = 1; 4.7% in CHADS2 = 2; 9.1% in CHADS2 = 3, and 7.8% in CHADS2 ≥ 4. Conclusions The CHADS2 score can be a clinical instrument of easy application to identify hypertensive patients with a high risk of mortality

Cardiovascular Risk in Patients with Dyslipidemia and Their Degree of Control as Perceived by Primary Care Physicians in a Survey—TERESA-Opinion Study

Objective: The aim of this study was to evaluate, through a survey, the opinion of primary care (PC) physicians on the magnitude of dyslipidemia and its degree of control in their clinical practice. Materials and methods: An ecological study was carried out, in which the physicians were invited to participate by means of an online letter. Data were collected at a single timepoint and were based only on the experience, knowledge, and routine clinical practice of the participating physician. Results: A total of 300 physicians answered the questionnaire and estimated the prevalence of dyslipidemia between 2% and 80%. They estimated that 23.5% of their patients were high-risk, 18.2% were very high-risk, and 14.4% had recurrent events in the last 2 years. The PC physicians considered that 61.5% of their patients achieved the targets set. The participants fixed the presence of side-effects to statins at 14%. The statin that was considered safest with regard to side-effects was rosuvastatin (69%). Conclusions: PC physicians in Spain perceive that the CVR of their patients is high. This, together with the overestimation of the degree of control of LDL-C, could justify the inertia in the treatment of lipids. Moreover, they perceive that one-sixth of the patients treated with statins have side-effects

Los desafíos del profesorado clínico en la educación médica

Background: There is a unique particularity of clinical teaching in medical education that isbeyond knowledge, skills or teaching methods of each clinician: this is clinical teaching context.This study aimed to analyze the main barriers in clinical teaching in a single medical school in Spain. Methods: This was a descriptive study in which all the clinical teachers (all of them associateprofessors) of a single and novel faculty of medicine were asked to answer an online, anonymousand voluntary questionnaire about aspects of support to clinical work, promotion of clinicalresearch and recognition of their professional careers. The questionnaires were organized andanalyzed into these three main issues.Results: 61 clinical teachers (42%) answered the questionnaire. The main findings that emergedwere: (i) lack of protected time for practical teaching at hospital; (ii) lack of support for clinicalresearch from hospital or faculty; and (iii) lack of recognition of their professional careers.Conclusions: The clinical teaching in medical education is a continuing challenge for busyclinicians. Further studies on this topic are needed.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 laense˜nanza clínica en una facultad joven de Medicina de Espa˜na.Métodos: Se trata de un estudio transversal descriptivo en el que se solicitó a todos losprofesores clínicos (todos ellos profesores asociados) de una facultad joven de Medicina que res-pondieran 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 principales hallaz-gos que se obtuvieron fueron: 1) la falta de tiempo protegido para la ense˜nanza práctica en lainstitución sanitaria; 2) el escaso apoyo para la investigación clínica por parte de la instituciónsanitaria o de la facultad; y 3) el escaso de reconocimiento de la carrera profesional.Conclusiones: La ense˜nanza clínica en la educación médica es un desafío continuo para elclínico. Son necesarios futuros estudios que analicen estos aspectos de forma más exhaustiva

Documento de consenso SEA/SEMERGEN 2019. Recomendaciones dietéticas en la prevención cardiovascular

El actual paradigma en las ciencias de la nutrición establece que la unidad nutricional básica no son los nutrientes, sino los alimentos que los contienen (aceites, frutos secos, productos lácteos, huevos, carnes rojas o procesadas, etc.), que actúan como matriz alimentaria en la que los diferentes nutrientes modulan sinérgica o antagónicamente sus efectos sobre diversas vías metabólicas determinantes para la salud y la enfermedad. La alimentación no se basa en nutrientes ni en alimentos aislados sino en complejas mezclas de unos y otros que forman parte de un patrón alimentario concreto, concepto que se ha señalado como el más pertinente para evaluar las asociaciones entre nutrición y salud o enfermedad. Este documento resume las evidencias disponibles sobre la relación existente entre los diferentes alimentos y la salud cardiovascular, y ofrece recomendaciones sencillas para ser implementadas en el consejo dietético que se ofrezca por parte del profesional sanitario

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. Clinical relevance was calculated by absolute risk reduction (ARR), relative risk reduction (RRR), and number of patients needed-to-attend (NNA), to avoid under-recording, with their 95% confidence intervals (CIs). Linear regression models were used for each of the variables. Results Of the 941 professionals initially registered, 78.1% completed the programme. The ARR ranged from 1.87% (95% CI = 1.79 to 1.94) in the diagnosis of diabetes to 15.27% (95% CI = 15.14 to 15.40) in the recording of basal blood glucose. The NNA ranged from 7 in blood pressure, cholesterol, and blood glucose recording to 54 in the diagnosis of diabetes. The RRR ranged from 26.7% in the diagnosis of diabetes to 177.1% in the recording of the Systematic Coronary Risk Evaluation (SCORE). The rates of change were greater in the intervention group and the differences were significant for recording of cholesterol (P<0.001), basal blood glucose (P<0.001), smoking (P<0.001), alcohol (P<0.001), microalbuminuria (P = 0.001), abdominal circumference (P<0.001), and SCORE (P<0.001). Conclusion The education programme had a beneficial effect at the end of the follow-up that was significant and clinically relevant.We are grateful to Conselleria de Sanidad for allowing access to the ABUCASIS system and Antonio Fernandez who provided technical support during the study period

Multidisciplinary management of cardiovascular disease in women: Delphi consensus

BackgroundCurrent clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women.MethodsThrough a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up.ResultsAfter two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men.ConclusionsThe high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic