Caracterización de la pandemia de gripe A H1N1 2009 en Navarra

Fundamento. Describir la actividad gripal durante la pandemia de 2009-2010 en Navarra y compararla con la de temporadas anteriores. Métodos. Se han analizado los casos de gripe notificados en atención primaria y todas las confirmaciones virológicas realizadas en pacientes de atención primaria y en hospitales de Navarra entre las semanas 21 de 2009 y 20 de 2010. Resultados. El virus de la gripe A (H1N1) 2009 se detectó en Navarra entre las semana 23 de 2009 a la 2 de 2010, periodo en el que se registraron 39 casos con diagnóstico médico de síndrome gripal por 1.000 habitantes. El umbral epidémico se superó en dos periodos, con un pico en julio y otro mayor en noviembre. La mayor incidencia se alcanzó en niños de 5 a 14 años (121 por mil), seguidos por el grupo de menores de 5 años. Se produjeron 224 hospitalizaciones (36 por 100.000 habitantes) con confirmación de gripe A H1N1 2009, 8% de ellos requirieron ingreso en unidades de cuidados intensivos y hubo cuatro defunciones (0,6 por 100.000 habitantes). La tasa de hospitalizaciones fue mayor en niños menores de 5 años (163 por 100.000 habitantes), mientras que la probabilidad de derivación a cuidados intensivos aumentó con la edad. Conclusión. A pesar de no haber dispuesto de una vacuna específica hasta que la temporada estaba muy avanzada, el virus de gripe A (H1N1) 2009 produjo una onda gripal en rangos similares a los de otras temporadas y su repercusión en hospitalizaciones y casos graves fue moderada.Background. To describe influenza activity during the 2009-2010 pandemic in Navarre and compare it to previous seasons. Methods. An analysis was made of all influenza-like illness cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. Results. Influenza 2009 H1N1 virus was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of influenza-like illness per 1,000 inhabitants were registered. The epidemic threshold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives. There were 224 hospitalisations (36 per 100,000 inhabitants) with confirmation of influenza 2009 H1N1 virus, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. Conclusion. In spite of not having a specific vaccine available until the season was very well advanced, influenza 2009 H1N1 virus produced a wave of cases with similar incidence to those of other seasons and its repercussion in hospitalisations and serious cases was moderate

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

Importance: Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes. Objective: To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]). Design, Setting, and Participants: The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52014 patients with AF were enrolled between March 2010 and August 2016. A total of 11738 patients 18 years and older with newly diagnosed AF (</=6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018. Exposures: One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed. Main Outcomes and Measures: Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals. Results: The median age of the population was 71.0 years, 22987 of 52013 were women (44.2%) and 31958 of 52014 were white (61.4%). Of 11738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of beta blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9). Conclusions and Relevance: Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM. Trial Registration: ClinicalTrials.gov Identifier: NCT01090362

Caracterización de la pandemia de gripe A H1N1 2009 en Navarra

Fundamento. Describir la actividad gripal durante la pandemia de 2009-2010 en Navarra y compararla con la de temporadas anteriores. Métodos. Se han analizado los casos de gripe notificados en atención primaria y todas las confirmaciones virológicas realizadas en pacientes de atención primaria y en hospitales de Navarra entre las semanas 21 de 2009 y 20 de 2010. Resultados. El virus de la gripe A (H1N1) 2009 se detectó en Navarra entre las semana 23 de 2009 a la 2 de 2010, periodo en el que se registraron 39 casos con diagnóstico médico de síndrome gripal por 1.000 habitantes. El umbral epidémico se superó en dos periodos, con un pico en julio y otro mayor en noviembre. La mayor incidencia se alcanzó en niños de 5 a 14 años (121 por mil), seguidos por el grupo de menores de 5 años. Se produjeron 224 hospitalizaciones (36 por 100.000 habitantes) con confirmación de gripe A H1N1 2009, 8% de ellos requirieron ingreso en unidades de cuidados intensivos y hubo cuatro defunciones (0,6 por 100.000 habitantes). La tasa de hospitalizaciones fue mayor en niños menores de 5 años (163 por 100.000 habitantes), mientras que la probabilidad de derivación a cuidados intensivos aumentó con la edad. Conclusión. A pesar de no haber dispuesto de una vacuna específica hasta que la temporada estaba muy avanzada, el virus de gripe A (H1N1) 2009 produjo una onda gripal en rangos similares a los de otras temporadas y su repercusión en hospitalizaciones y casos graves fue moderada.Background. To describe influenza activity during the 2009-2010 pandemic in Navarre and compare it to previous seasons. Methods. An analysis was made of all influenza-like illness cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. Results. Influenza 2009 H1N1 virus was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of influenza-like illness per 1,000 inhabitants were registered. The epidemic threshold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives. There were 224 hospitalisations (36 per 100,000 inhabitants) with confirmation of influenza 2009 H1N1 virus, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. Conclusion. In spite of not having a specific vaccine available until the season was very well advanced, influenza 2009 H1N1 virus produced a wave of cases with similar incidence to those of other seasons and its repercussion in hospitalisations and serious cases was moderate