Revista clinica espanola最新文献

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Resultados de la implementación del proyecto DP-TRANSFERS en Cataluña: un método traslacional para mejorar el cribado y la prevención de la diabetes en atención primaria 在加泰罗尼亚实施 DP-TRANSFERS 项目的结果：在初级保健中改进糖尿病筛查和预防的转化方法。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.017

J.J. Cabré , F. Barrio , J. Vizcaíno , A. Martínez , T. Mur , R. Sagarra , S. Dalmau

Introduction

DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.

Objective

Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.

Methodology

Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC >11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.

Results

The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2,381 subjects screened, 1,713 participated in the basic module, with 1,186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second.

The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference.

Conclusions

The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.

简介：DP-TRANSFERS 是一项生活方式干预转化项目，遵循 DE-PLAN-CAT 研究中描述的先前方案。筛查后，干预包括基本模块和持续模块。按照群组（医疗中心）进行分层，从2016年至2020年对代表性样本（中心、专业人员和参与者）进行评估（FINDRISC>11和/或糖尿病前期）。结果123个中心中有95个可行，647名专业人员中有343名参与了干预。在筛选出的 2381 名受试者中，1713 人参加了基础模块，其中 1186 人完成了第一年的学习，776 人完成了第二年的学习。双变量分析表明，受糖尿病影响的受试者在以下方面存在差异：之前的血糖状况、A1c、高密度脂蛋白胆固醇、FINDRISC 评分和对地中海饮食的坚持程度，以及在研究开始和结束时体重、体重指数和腹围的差异。结论与之前估计的标准化干预相比，强化干预大大降低了糖尿病的发病率（23.6%）。以下因素起到了保护作用：较好的血糖状况、较低的基线风险、较高的高密度脂蛋白胆固醇，或在研究期间实现了体重或腹围的减少。

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引用次数: 0

La amiloidosis cardiaca empeora el pronóstico en los pacientes con insuficiencia cardiaca: hallazgos del estudio PREVAMIC 心脏淀粉样变性会加重心力衰竭患者的预后：PREVAMIC 研究的发现

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.06.006

R. Ruiz Hueso , P. Salamanca Bautista , M.A. Quesada Simón , S. Yun , A. Conde Martel , J.L. Morales Rull , I. Fiteni Mera , D. Abad Pérez , I. Páez Rubio , Ó. Aramburu Bodas , en representación del grupo de trabajo PREVAMIC

Background and objectives

Cardiac amyloidosis (CA) is a common pathology in elderly patients that usually presents as heart failure (HF). However, it is not clear whether CA associated with HF has a worse prognosis compared with HF due to other etiologies.

Material and methods

Prospective, observational cohort study that recruited patients ≥65 years of age with HF in 30 Spanish centers. The cohort was divided according to whether the patients had AC or not. Patients were followed for 1 year.

Results

A total of 484 patients were included in the analysis. The population was elderly (median 86 years) and 49% were women CA was present in 23.8% of the included patients. In the CA group, there was a lower prevalence of diabetes mellitus and valvular disease. At one year of follow-up, mortality was significantly more frequent in patients with CA compared to those without (33.0 vs.14.9%, p < 0.001). However, there were no differences between both groups in visits to the emergency room or readmissions. In the multivariate analysis, the variables that were shown to predict all-cause mortality at one year of follow-up were chronic kidney disease (HR 1.75 (1.01-3.05) p = 0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) p < 0.001), confusion (HR 2.05 (1.01-4.17), p = 0.048), and the presence of CA (HR 1.77 (1.11-2.84), p = 0.017).

Conclusion

The presence of CA in elderly patients with HF is related to a worse prognosis at one year of follow-up. Early diagnosis of the pathology and multidisciplinary management can help improve patient outcomes.

背景和目的心脏淀粉样变性（CA）是老年患者的一种常见病症，通常表现为心力衰竭（HF）。然而，与其他病因引起的心力衰竭相比，与心力衰竭相关的心脏淀粉样变性是否预后更差，目前尚不清楚。根据患者是否患有交流性心脏病对队列进行了划分。结果共有 484 名患者纳入分析。研究对象为老年人（中位数为 86 岁），49% 为女性，23.8% 的患者患有冠心病。在CA组中，糖尿病和瓣膜病的发病率较低。随访一年后，CA患者的死亡率明显高于非CA患者（33.0% vs.14.9%, p <0.001）。不过，两组患者在急诊就诊和再入院方面没有差异。在多变量分析中，可预测随访一年后全因死亡率的变量是慢性肾病（HR 1.75 (1.01-3.05) p = 0.045）、NT-proBNP 水平（HR 2.51 (1.46-4.30) p < 0.001）、精神错乱（HR 2.05 (1.01-4.17)，p = 0.048）和CA的存在（HR 1.77 (1.11-2.84)，p = 0.017）。早期病理诊断和多学科治疗有助于改善患者的预后。

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