Sumando en salud en beneficio del paciente en el 1er congreso SEMERGEN-SEFAC

Asistimos en España a un progresivo envejecimiento demográfico, que en las próximas décadas se agravará de manera más palpable. Este irreversible cambio en la pirámide de población es ya una realidad de pronóstico inquietante: en el año 2060, las personas de más de 65 años representarán más de un tercio –concretamente, un 35,6%– del total de la población española. Organismos como el Observatorio Europeo de Sistemas de Políticas de salud alertan de que los agentes de salud aún no han encontrado fórmulas para adecuar los procesos de prevención y manejo de enfermedades a la nueva realidad sociosanitaria. Sobra voluntad, pero faltan mecanismos.Asistimos en España a un progresivo envejecimiento demográfico, que en las próximas décadas se agravará de manera más palpable. Este irreversible cambio en la pirámide de población es ya una realidad de pronóstico inquietante: en el año 2060, las personas de más de 65 años representarán más de un tercio –concretamente, un 35,6%– del total de la población española. Organismos como el Observatorio Europeo de Sistemas de Políticas de salud alertan de que los agentes de salud aún no han encontrado fórmulas para adecuar los procesos de prevención y manejo de enfermedades a la nueva realidad sociosanitaria. Sobra voluntad, pero faltan mecanismos

Impacto de la presencia de enfermedad cardiovascular en el control de presión arterial y lípidos en la población hipertensa asistida en atención primaria

ObjetivosDeterminar el impacto de la enfermedad cardiovascular (ECV) (insuficiencia cardíaca, cardiopatía isquémica, enfermedad cerebrovascular, insuficiencia renal y arteriopatía periférica) en el control de la presión arterial (PA) y del colesterol de las lipoproteínas de baja densidad (cLDL) en una población de pacientes hipertensos.DiseñoSe analizó al subgrupo de pacientes incluidos en el estudio PRESCOT (estudio transversal de sujetos hipertensos asistidos en atención primaria).EmplazamientoEn el estudio participaron 2.000 médicos de atención primaria, en España.ParticipantesSe analizó a 12.954 pacientes (el 50,1%, varones; media de edad, 62,1±10,7 años). Se consideró buen control de PA cifras < 140/90mmHg (< 130/80mmHg en diabéticos), y de cLDL, los establecidos por ATP III para cada grupo de riesgo.ResultadosDel total de pacientes incluidos, 3.294 (25,43%) tenían ECV establecida (media de edad, 66,0±10,2 años; el 56,3%, varones). El 82,2% de los pacientes con ECV eran dislipémicos, y el 45,6%, diabéticos (frente al 72,3 y el 23,9%, respectivamente, del grupo de pacientes sin ECV; p<0,0001). Los pacientes con ECV tomaban más antihipertensivos (el 55,7 frente al 30,4% tomaban 2 o más fármacos; p<0,001) y más hipolipemiantes (el 67,6 frente al 55,4%; p<0,001) que los pacientes sin ECV. La PA se controló en el 25,3% de los pacientes con ECV frente al 26,7% (p=0,095), y el cLDL en el 13,3 frente al 40,2% (p<0,001). El 7% de los pacientes con ECV tenían bien controlados ambos parámetros frente al 18,7% (p<0,001).Los principales factores relacionados con el mal control de PA fueron la diabetes (odds ratio [OR] = 1,20; intervalo de confianza [IC] del 95%, 1,10-1,30), el sedentarismo (OR=1,19; IC del 95%, 1,11-1,29) y el sexo femenino (OR=1,12; IC del 95%, 1,02-1,23), entre otros, mientras que para el control del cLDL, los antecedentes familiares de ECV (OR=1,34; IC del 95%, 1,24-1,46), el sedentarismo (OR=1,28; IC del 95%, 1,18-1,39) y la diabetes (OR=1,15; IC del 95%, 1,06-1,26), entre otros.ConclusionesEl control de la PA y del cLDL es muy pobre en la población hipertensa con ECV. Únicamente el 7% tienen ambos parámetros bien controlados.ObjectivesTo determine the impact of cardiovascular disease (CVD) (heart failure, ischaemic heart disease, stroke, renal insufficiency, and peripheral arterial disease) on blood pressure (BP) and LDL-cholesterol (LDL-C) control in hypertense patients.DesignWe analysed the subset of patients with CVD from those included in the PRESCOT study (a cross-sectional study of hypertense patients attended in primary care).SettingA total of 2000 primary care physicians participated in the study.ParticipantsIn an analysis of 12 954 patients (50.1% males; aged 62.1 [10.7]), good BP control was defined as <140/90mm Hg (<130/80mm Hg for diabetics) and good LDL-C control, according to the ATP-III stipulations for every risk group.ResultsOverall, 3294 (25.43%) patients had established CVD (mean age, 66.0 [10.2] years; 56.3% males). Of these, 82.2% had dyslipidaemia and 45.6% were diabetics (vs 72.3% and 23.9%, respectively, in non-CVD group; P<.0001). Patients with CVD were treated with more anti-hypertensives (55.7% vs 30.4% were on ≥2 drugs; P<.001) and more lipid-lowering drugs (67.6% vs 55.4%, P<.001) than patients without CVD. BP was controlled in 25.3% of patients with CVD versus 26.7% (P=.095); and LDL-C in 13.3% versus 40.2% (P<.001). Only 7.0% of patients with CVD were well controlled for both parameters versus 18.7% of those without CVD (P<.001). The main predictive factors of poor BP control were Diabetes (OR, 1.20; 95% CI, 1.10-1.30), sedentary lifestyle (OR, 1.19; 95% CI, 1.11-1.29) and female gender (OR, 1.12; 95% CI, 1.02-1.23), among others; whilst the main factors for poor LDL-C control were a family history of CVD (OR, 1.34; 95% CI, 1.24-1.46), sedentary lifestyle (OR, 1.28; 95% CI, 1.18-1.39), and diabetes (OR, 1.15; 95% CI, 1.06-1.26).ConclusionsBP and LDL-C control in the hypertense population with CVD is very poor. In fact, only 7% of these patients have both parameters well controlled

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 ageof ≥ 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 significant in the univariate analysis, to establish the variables that were associated with the presence of arrhythmia.CONCLUSION: In patients with hypertension over 65 years of age, there are relevant gender differences in the factors associated with AF

OPENCRONIC Study. Knowledge and experiences of Spanish patients and carers about chronic disease

Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.Boehringer Ingelheim España, S.

Consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem that, in its different stages, may affect up to 10% of the Spanish population and results in high morbidity and mortality, as well as high consumption of National Health System resources. Ten scientific societies involved in the management of kidney patients agreed to update the 2007 CKD consensus document. The current version is an abridged edition of the detailed general document, which can be consulted on the webpages of each signatory society. It includes the following aspects: CKD definition, epidemiology and risk factors and criteria on diagnosis, assessment and staging of CKD, albuminuria and glomerular filtration estimation. Progression factors and concept. Criteria for referral to Nephrology. Patient follow-up, attitudes and objectives by specialty. Prevention of nephrotoxicity. Detection of cardiovascular damage. Attitudes, lifestyle and treatment: management of high blood pressure, dyslipidaemia, hyperglycaemia, smoking, obesity, hyperuricaemia, anaemia and mineral and bone metabolism disorders. Coordinated follow-up by Primary Care - other specialties - Nephrology. Management of renal replacement therapy, haemodialysis, peritoneal dialysis and renal transplantation patients. Palliative treatment of terminal uraemia. We hope that this document will be very useful in the multidisciplinary management of CKD patients, in view of the updated recommendations

Análisis de Agencias de Innovación. Estudio de caso: Centro para el Desarrollo Tecnologico Industrial (CDTI)

Se estudia el papel de CDTI (Centro para el Desarrollo Tecnologico Industrial) como Agencia de Innovación, en perspectica comparada. EL informe resume la situación hasta 2017Banco Interamericano de Desarrollo (BID) / Interamerican Development Bank (IDB)Peer reviewe

COVID-19 and cardiovascular and kidney disease: Where are we? Where are we going?

La pandemia SARS-CoV-2 es una emergencia sanitaria global y necesitamos conocer más sobre ella. Los pacientes con riesgo cardiovascular y renal previo se han identificado como especialmente vulnerables para una mayor morbimortalidad cuando sufren la COVID-19, y una proporción considerable de pacientes pueden desarrollar una lesión vascular en el contexto de la enfermedad que conlleva una mayor letalidad. Las complicaciones cardiovasculares y renales representan un problema, y es probable que en un futuro próximo puedan suponer una amenaza para los pacientes que han sobrevivido a la COVID-19. Como médicos no podemos olvidar que durante una epidemia como esta otras enfermedades ----crónicas---- siguen presentes, y los pacientes continúan precisando atención. Estamos obligados a vigilar de una forma incluso más intensa sus tratamientos y el grado de control. Además, no debemos olvidar que las situaciones urgentes siguen presentándose en esta situación de pandemia y precisan atención rápida; en esta situación actual es muy probable que muchos pacientes, por miedo, no hayan buscado atención médica. La situación durante la epidemia y la incertidumbre de la época post COVID-19 exige la intensificación en el control y seguimiento de la enfermedad cardiovascular y renal de nuestros pacientes. La atención primaria constituye un nivel asistencial clave para el cuidado de la población con enfermedad cardiovascular. Del mismo modo, y ante este nuevo escenario sanitario, necesitamos impulsar las medidas de prevención y control que emanen de los estudios actualmente en desarrollo. Ahora más que nunca necesitamos la investigación, crucial para mejorar el pronóstico cardiovascular y renal de nuestros pacientes.The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of cardiovascular and kidney disease in our patients. Primary care constitutes a key level of care for the care of the population with cardiovascular disease. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients