13 research outputs found
Elaboración de un instrumento estandarizado para detectar la necesidad de atención socio sanitaria después de un ictus. Propuestas en atención primaria para el ictus
No full textDespués de un accidente cerebrovascular, las familias requieren la asistencia
coordinada de los servicios de salud y sociales. Actualmente existe una carencia de evaluación integral y de herramientas apropiadas para identificar necesidades al alta hospitalaria, hay una gestión separada de los recursos de salud y sociales, y el acceso a estos servicios es variable entre las regiones. El objetivo principal fue investigar sobre los factores asociados al riesgo de la dependencia después de sufrir un ictus y proponer un instrumento para identificar aquellos pacientes con mayor riesgo.
MÉTODOS: Estudio prospectivo y comunitario de una cohorte de pacientes que sufrieron un ictus durante 2 años. La variable principal fue la situación de dependencia reconocida. Los predictores potenciales fueron identificados mediante una regresión multivariante y mediante la curva ROC para definir su capacidad discriminativa.
RESULTADOS: Se incluyeron 233 casos supervivientes tras un episodio de enfermedad cerebrovascular; el 49,8% eran mujeres y la edad media 78,1±11,6 años. La densidad de incidencia de dependencia fue de 31.5 (IC95% 26,1-37,7) personas-año. Los factores independientes asociados al pronóstico de dependencia fueron: edad>80 años (RR 2,03 IC95% 1,32-3,12, p=0,001), Pfeiffer¿4 (RR 1,82 IC95% 1,25-2,66, p=0,002), Barthel<60 (RR 1,79 IC95% 1,21-2,66 p=0,003), y Charlson ¿3 (RR 1,49IC95% 1,02-2,16 p=0,039). El AUC fue
0,84 (IC95% 0,79-0,89; p <0,001).
CONCLUSIONES: El accidente cerebrovascular tiene importantes consecuencias como resultado de dependencia. La edad, el deterioro cognitivo y/o físico, y las comorbilidades medidas el test de Pfeiffer, la escala de Barthel, y el índice de Charlson identificaron a las personas de alto riesgo de dependencia y pueden facilitar el papel coordinado de los servicios médicos sociales
The Incidence of Intracerebral Haemorrhage in Complex Chronic Patients
No full textBackground: Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).
Methods: This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex.
Results: 161 (4.4%) participants suffered an ICH episode. Mean age 87±9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127-174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p=0.02), hypercholesterolemia (55.3% vs. 47.4%, p=0.05), cardiovascular disease (36.6% vs. 28.9%; p=0.03), and use of antiaggregants drugs (64.0% vs. 52.9%; p=0.006). 93.2% had a HAS-BLED score ≥3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88-6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11-2.35], and cardiovascular disease [OR 1.48 IC95% 1.05-2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.97-0.89] and negative predictive value [0.98 (CI95% 0.83-1.12)].
Conclusions: In the CCP subgroup the incidence density of ICH was 5-60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH.The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The Department of Information and New Technologies carried out an automated extraction of the CMBD of hospital discharges and SIRE. All the data were included in an ad hoc repository, which was delivered to the main researcher in a completely anonymous format, supervised and assessed according to the General Data Protection Regulation of Spain/Europe of 1st February 2017. The Catalan Health Plan extensively implemented a case finding system classifying high risk chronic patients into two different categories based on defined criteria and primary care physician judgment: i) Complex chronic patients (CCP, approximately 5% of the population); and, ii) Patients with less than 12 months expected life survival (ACD, approximately 1% of the population). The medical records including the CCP condition were incorporated into the computerised medical record of the Catalan Health Institute in January 2013. This database is managed by primary care professionals, who administer and update it in a specific format called "Shared individual intervention plan" (PIIC, Catalan acronym for Pla d'Intervenció Individualitzat Compartit). Currently, 82% of individuals registered as CCPs have an updated report
MVP Risk score y nuevo diagnóstico de fibrilación auricular: estudio de cohorte prospectivo PREFATE
No full textFibrilación auricular; MVP risk score; Bloqueo interauricular avanzadoAtrial fibrillation; MVP risk score; Advanced interatrial blockFibril·lació auricular; MVP risk score; Bloqueig interauricular avançatObjetivo: Describir la asociación entre patrones de electrocardiograma (ECG) según MVP risk score (Morphology-Voltage-P-wave duration) y un diagnóstico de fibrilación auricular (FA).
Diseno: Estudio de cohorte prospectivo (1/01/2023-31/12/2024).
Emplazamiento: Centros de atención primaria.
Participantes: Muestra aleatorizada de 150 pacientes entre 65 y 85 anos; ˜ sin diagnóstico previo de FA, ni ictus, ni tratamiento anticoagulante actual; alto riesgo de una futura FA; CHA2DS2-VASc ≥ 2; y capacidad para utilizar la aplicación (App) FibricheckR.
Mediciones: A la inclusión, se realizó un ECG basal estándar, puntuación en MVP risk score y monitorización del ritmo cardíaco basal durante 15 días utilizando la App FibricheckR. Las variables dependientes fueron la presencia de patrones de la onda P en el ECG según MVP risk score y un nuevo diagnóstico de FA.
Resultados: El diagnóstico de FA fue confirmado en 14 casos (9,3%, IC95% 5,6-15,1), 3 hombres y 11 mujeres. En 3 casos, la arritmia fue diagnosticada en el ECG basal, y en 11 por Holter después de ser informadas como posible FA por FibricheckR App. Se detectó una prevalencia superior de bloqueo interauricular avanzado (BIA-A) atípico (p = 0,007) entre los participantes con FA, así como la prevalencia de onda P < 0,1 mV (p = 0,006). Todos los nuevos diagnósticos de FA se realizaron en puntuaciones ≥4 en el MVP risk score.El presente trabajo ha sido financiado por la beca PERIS 2022 4R22/031 (SLT021/21/000027)
Evidence Gaps and Lessons in the Early Detection of Atrial Fibrillation: A Prospective Study in a Primary Care Setting (PREFATE Study)
No full textArrhythmias; Atrial fibrillation; Cardiac/diagnosis; Heart rate determination;
Echocardiography/Statistics and numerical data; Electrocardiography; ambulatory/standards;
Diagnostic techniques and procedures; Clinical risk scores; Device detected atrial fibrillation;
Ischemic strokeArritmias; Fibrilación auricular; Cardíaco/diagnóstico; Determinación de la frecuencia cardíaca; Ecocardiografía/Estadísticas y datos numéricos; Electrocardiografía; ambulatoria/estándares; Técnicas y procedimientos diagnósticos; Puntuaciones de riesgo clínico; Fibrilación auricular detectada por dispositivo; Ictus isquémicoArrítmies; Fibril·lació auricular; Determinació de la freqüència cardíacaBackground/Objectives: In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3-5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care. This study aims to estimate the prevalence of device-detected atrial fibrillation (DDAF) and assess the feasibility and impact of systematic screening in routine primary care. Methods: The prospective cohort study (NCT05772806) included 149 patients aged 65-85 years, identified as high-risk for AF. Participants underwent 14 days of cardiac rhythm monitoring using the Fibricheck® app (CE certificate number BE16/819942412), alongside evaluations with standard ECG and transthoracic echocardiography. The primary endpoint was a new AF diagnosis confirmed by ECG or Holter monitoring. Statistical analyses examined relationships between AF and clinical, echocardiographic, and biomarker variables. Results: A total of 18 cases (12.08%) were identified as positive for possible DDAF using FibriCheck® and 13 new cases of AF were diagnosed during follow-up, with a 71.4-fold higher probability of confirming AF in FibriCheck®-positive individuals than in FibriCheck®-negative individuals, resulting in a post-test odds of 87.7%. Significant echocardiographic markers of AF included reduced left atrial strain (<26%) and left atrial ejection fraction (<50%). MVP ECG risk scores ≥ 4 strongly predicted new AF diagnoses. However, inconsistencies in monitoring outcomes and limitations in current guidelines, particularly regarding AF burden, were observed. Conclusions: The study underscores the feasibility and utility of AF screening in primary care but identifies critical gaps in diagnostic criteria, anticoagulation thresholds, and guideline recommendations.This research was funded by the Department of Health of the Generalitat of Catalonia in its Strategic Plan in Research and Innovation in Health (PERIS), on the 2021 call (expedient file SLT/21/000027)
N-Terminal Pro B-Type Natriuretic Peptide's Usefulness for Paroxysmal Atrial Fibrillation Detection Among Populations Carrying Cardiovascular Risk Factors
No full textCopyright © 2019 Palà, Bustamante, Clúa-Espuny, Acosta, Gonzalez-Loyola, Ballesta-Ors, Gill, Caballero, Pagola, Pedrote, Muñoz and Montaner[Background]: Atrial fibrillation (AF) systematic screening studies have not shown a clear usefulness in stroke prevention, as AF might present as paroxysmal and asymptomatic. This study aims to determine the usefulness of some blood-biomarkers to identify paroxysmal atrial fibrillation in the context of a screening programme.[Methods]: A total of 100 subjects aged 65–75 years with hypertension and diabetes were randomly selected. AF was assessed by conventional electrocardiogram (ECG) and 4 weeks monitoring with a wearable Holter device (Nuubo™). N-terminal pro B-type natriuretic peptide (NT-proBNP), apolipoprotein CIII (ApoC-III), von Willebrand factor (vWF), ADAMTS13, urokinase plasminogen activator surface receptor (uPAR), and urokinase plasminogen activator (uPA) were determined in serum/plasma samples and the levels were compared depending on AF presence and mode of detection.[Results]: The AF prevalence in the studied population was found to be 20%. In seven subjects, AF was only detected after 1 month of Holter monitoring (hAF group). NT-proBNP levels were higher in subjects with AF compared with subjects with no AF (p 95 pg/ml cut-off showed high sensitivity and specificity to detect AF (95%, 66.2%) or hAF (85.72%, 66.2%) and was found to be an independent predictor of AF and hAF in a logistic regression analysis. NT-proBNP correlated with AF burden (r = 0.597, p = 0.024).[Conclusion]: NT-proBNP was elevated in AF cases not identified by ECG; thus, it may be used as a screening biomarker in asymptomatic high-risk populations, with a promising cut-off point of 95 pg/ml that requires further validation.The study received a research grant by Fundació Marató de TV3 in the research call La Marató 2014: malalties del cor. Grant number: 201528-30-31-3. AB was supported by a Juan Rodés research contract (JR16/00008) from Instituto de Salud Carlos III. EP has received a predoctoral grant from Vall D’Hebron Institute of Research
Risk of Long-Term Mortality for Complex Chronic People with Intracerebral Hemorrhage: A Population Based e-Cohort Observational Study
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Blood-biomarkers and devices for atrial fibrillation screening: Lessons learned from the AFRICAT (Atrial Fibrillation Research In CATalonia) study
No full textBACKGROUND AND OBJECTIVE: AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring. METHODS: 359 subjects aged 65–75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (Nuubo(TM)), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck. RESULTS: AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780–1]), while MyDiagnostick showed the highest specificity (97.10%). CONCLUSION: The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible
Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment : Study of a Population Cohort ≥65 Years of Age
No full textTo evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive statu
Diferencias en la supervivencia después de un episodio de ictus tratado con fibrinólisis. Estudio Ebrictus
No full textObjetivo: 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
Predictive model for atrial fibrillation in hypertensive diabetic patients
No full textBackground: Several scores to identify patients at high risk of suffering atrial fibrillation have been developed. Their applicability in hypertensive diabetic patients, however, remains uncertain. Our aim is to develop and validate a diagnostic predictive model to calculate the risk of developing atrial fibrillation at five years in a hypertensive diabetic population. Methods: The derivation cohort consisted of patients with both hypertension and diabetes attended in any of the 52 primary healthcare centres of Barcelona; the validation cohort came from the 11 primary healthcare centres of Terres de l'Ebre (Catalonia South) from January 2013 to December 2017. Multivariable Cox regression identified clinical risk factors associated with the development of atrial fibrillation. The overall performance, discrimination and calibration of the model were carried out. Results: The derivation data set comprised 54 575 patients. The atrial fibrillation rate incidence was 15.3 per 1000 person/year. A 5-year predictive model included age, male gender, overweight, heart failure, valvular heart disease, peripheral vascular disease, chronic kidney disease, number of antihypertensive drugs, systolic and diastolic blood pressure, heart rate, thromboembolism, stroke and previous history of myocardial infarction. The discrimination of the model was good (c-index = 0.692; 95% confidence interval, 0.684-0.700), and calibration was adequate. In the validation cohort, the discrimination was lower (c-index = 0.670). Conclusions: The model accurately predicts future atrial fibrillation in a population with both diabetes and hypertension. Early detection allows the prevention of possible complications arising from this disease
