Características del tratamiento anticoagulante oral en la fibrilación auricular crónica de alto riesgo

ObjetivoEstimar la prevalencia de la fibrilación auricular crónica (FAC), qué porcentaje se considera de alto riesgo (FACar) y el grado de cobertura con tratamiento anticoagulante oral (TAO).DiseñoEstudio descriptivo y multicéntrico.EmplazamientoNueve áreas básicas de salud. Servei d’Atenció Primària Terres de l’Ebre.ParticipantesMuestra aleatoria de 375 pacientes con FAC, de los que 150 reunían los criterios de FACar, durante el año 2002.Mediciones principalesPerfil de pacientes con FACar, cobertura con TAO, lugar de seguimiento, presencia de complicaciones vasculares y relación temporal entre el diagnóstico de la FAC, las complicaciones vasculares y el inicio del TAO. Se utilizaron todas las determinaciones de la razón normalizada internacional practicadas a los pacientes incluidos en el período de estudio.ResultadosLa prevalencia de FAC es del 2,2% (intervalo de confianza del 95%, 1,4- 3,3). El 40% de las FAC tienen criterios de FACar. Un 74,2% están tratadas con TAO. En un 41,7% el diagnóstico de la FAC coincide con la incidencia de una complicación vascular. No hay diferencias en los resultados globales de las razones normalizadas internacionales obtenidas en el hospital y en atención primaria. La efectividad esperada del TAO en la prevención tromboembólica en nuestra población de alto riesgo es del 61,12%.ConclusionesEl 40% de las FAC son de alto riesgo. En más de un tercio de los pacientes el TAO se indicó después de una complicación vascular asociada a una FAC desconocida. La proporción de una razón normalizada internacional entre 2 y 3 obtenida en los centros de atención primaria es similar a la del servicio de hematología de referencia.ObjectiveTo calculate the prevalence of chronic auricular fibrillation (CAF), how much of it is considered high-risk (CAFhr) and the degree of coverage with oral anticoagulation treatment (OAT).DesignMulti-centre descriptive study.Setting9 health districts. The “Terres de l’Ebre” Primary Care Service.ParticipantsRandomised sample of 375 patients with CAF, of whom 150 met the criteria of CAFh-r during 2002.Main measurementsProfile of patients with CAFh-r; coverage with OAT; place of follow-up; presence of vascular complications, and the time relationships between the diagnosis of CAF, vascular complications and the start of OAT. All the INR determinations taken from the patients included in the study were used.ResultsThere was 2.2% prevalence of CAF (95% CI, 1.4-3.3). 40% of CAF had criteria of CAFh-r. 74.2% were treated with OAT. In 41.7% the diagnosis of CAF coincided with the incidence of some vascular complication. There were no differences between the overall results of the INR obtained in hospital and in PC. The expected efficacy of OAT for thromboembolism prevention in our highrisk sample was 61.12%.Conclusions40% of the CAF are high-risk. In over a third of patients OAT was indicated after a vascular complication linked to an unknown CAF. The INR between 2-3 is similar in PC centres and the corresponding haematology service

Análisis coste-efectividad de la automonitorización de la glucosa sanguínea en diabéticos tipo 2

AbstractObjectiveCompare the cost-efectiveness of self-monitoring of blood glucose (MBG) with your non-use.DesignDescriptive and retrospective study covering the period 1995-97 in the 597 type-2 diabetes patients: 286 practicing MBG on a stable basis and 311 not doing so. All are registered in seven health districts in the territorial ambit of Tortosa Primary Care. Werw quantified the direct costs in relation to comsumption of reagent strips for the practice of MBG, outpatients visits in your primary care center, derivations to specialist of reference and complementary test according to recomendations of the European NIDDM Policy Group in the population user of MBG and no-user; the annual cost increment, the average annual cost and the total annual cost in the population user of MBG and in the application of a ideal model of quantitative and qualitative cover according to clinical recommendations of the Gedaps; and the cost-effectiveness.ResultsWhile the 78% of the total diabetic population satisfy some clinical indication for prescribing MBG, only the 42,5% practice the MBG. The comsumption of reagent strips rising of 8% to 15% of the global cost of the diabetic population. In the aplication of the ideal model of cover, this cost increase up the 30% of global cost. The effectiveness obtained, an 27%, not are significatively different in the population user of MBG and no user. The cost-effectiveness in the user of MBG increased of 210.789 ptes/year to 213.148 ptes/year; and nouser of 162.019 ptes/year to 162.051 ptes/year. The application of ideal model of cover and the gain of an effectiveness near to possible level of efficiencie imply an descent average of cost-effectiveness of approximately 60%: 78.904 ptes/year in user MBG and 54.682 ptes/year in no-user.Conclusions1. We choose in the presents conditions the option of no-user MBG. 2. The average cost-effectiveness per diabetic patient will increase by the needs of accomodate the therapy to new standards of metabolic control. 3. Are clear oportunity for the improve the management and to motivate an efficient use of tecnology associate to defects of public sanitary market. 4. The model of ideal cover associated to greater effectiveness are necessary for to unify the economic and clinic efficiency

Relationship between AF-risk, ischemic stroke AF related, and cognitive dysfunction in population older than 65 years-old. MIND-COR study

Abstract Background The number of individuals with atrial fibrillation (AF) and cognitive impairment (CI) will increase 150% by 2050. Purpose The main objective of this study is to elucidate the relationship between AF-risk, the ischemic stroke, and the cognitive dysfunction. Methods Multicenter, longitudinal and retrospective community-based study of cohort ≥65 year-old without AF between 1/1/2013–31/12/2017 conducted by 11 Primary Care teams. Variables: sociodemographic; Charlson, CHA2DS2VASc score, Pfeiffer and NIHSS scores from records database (primary care, specialty clinics and hospitalizations). Kaplan-Meier to evaluate mortality. Descriptive analysis Cox regression to create an AF risk score was developed: Q1 (lowest AF-risk)-Q4 (highest AF-risk). Incidence density (ID) rate per 1000/people/years of AF and stroke; and CI prevalence were calculated by risk stratum. Approved by Ethics Committee of IDIAP Jordi Gol PP15/047. Results 46706 (women 49%) cases, aged 78.01±11.9 and average follow-up time 4.9±0.7 years. Q4 risk group (Q4) was characterized by women's (85.2%), highest age, AF, stroke, CI and mortality. 1244 AF were diagnosed (ID 10.5/1000/year's IC95% 9.9–11.2). Q3–4 levels included 53.8% of AF in men vs 84.2% in women. 214 strokes were diagnosed and 78.5% happened in Q3–4, especially among women (88.1%). The stroke and AF were diagnosed simultaneously in 9.8% (ID 5.8/1000/year CI95% 3.4–8.1) and showed higher severity (NIHSS 7.25±8.62 vs 4.55±5.74, p=0.002). The cognitive impairment increased from 2.6% (Q1) up to 16.4% (Q4) significantly higher in women (17.6% vs 12.1%) Conclusions Differences were found according to gender and risk groups. The risk-based screening could improve the effectiveness of AF screening in primary care. Funding Acknowledgement Type of funding source: None </jats:sec