Atencion Primaria最新文献

Objective

To assess the association between electrocardiogram (ECG) patterns according to the MVP ECG risk score (morphology-voltage-P-wave duration) and a diagnosis of Atrial Fibrillation (AF).

Design

Prospective observational cohort study (1/01/2023-31/12/2024).

Site

Primary care.

Participants

Randomized sample of 150 patients aged 65-85 years without prior diagnosis of AF, stroke, or current anticoagulant treatment; high risk of future AF; CHA2DS2-VASc ≥ 2; and ability to use the FibricheckR application (App).

Measurements

At baseline, a standard ECG, MVP risk score assessment, and cardiac rhythm monitoring for 15 days using the Fibricheck^R App were performed. The dependent variables were the presence of P-wave patterns on the electrocardiogram according to MVP risk score and a new diagnosis of AF.

Results

The diagnosis of AF was confirmed in 14 cases (9.3%, 95% CI 5.6-15.1), 3 men and 11 women. In 3 cases, the arrhythmia was diagnosed on the baseline ECG, and in 11 cases by Holter after being reported as possible AF by the Fibricheck^R App. A higher prevalence of atypical advanced interatrial block (A-AIB) (p 0.007) was detected among participants with AF, as well as the prevalence of P-wave < 0.1 mV. (p = 0.006). All new diagnoses of AF were made at scores ≥ 4 in the MVP risk score.

Conclusions

Using scales for identifying ECG patterns in high-risk subjects in primary care can facilitate the diagnosis of unknown AF.

The high incidence of obesity in our environment, the progressive and recurrent nature of this disease makes it necessary to know and use all the possibilities of prevention and treatment.

When a person suffers from obesity we must offer a treatment plan with specific objectives that will include healthy eating, physical activity and, if necessary, treatment with medication or even surgery.

At present in Spain, there are 3 medications available:

• •

  Orlistat, with low efficacy and little use.

• •

  Liraglutide and semaglutide, both based on incretins and capable of improving obesity, diabetes and other obesity-related conditions. The high potency and safety of these drugs has revolutionized the pharmacological treatment of obesity.

New molecules will soon be marketed that will expand the treatment possibilities, which will also be reviewed in this article.

Objective

To analyze the prescription of drugs to aid smoking cessation and to detect whether there are differences by age or sex.

Design

Retrospective cohort study.

Site

Zamora Health Area.

Participants

Persons with smoking cessation attempts employing drugs funded in the period from 2020 to 2023.

Interventions

Request of pharmaceutical consumption of varenicline, bupropion and cytisine to the Pharmacy Information System of the Regional Health Management of Castilla y León.

Main measurements

Number of quit attempts per person, treatment drug, number of medication containers per attempt, year, age and sex. Descriptive and statistical analysis using SPSS© v. 20.

Results

2581 people tried to quit smoking with drugs, 2206 made one attempt and 375 made several attempts. Mean age was 50.7 years (95% CI: 50.2-51.1). No significant differences were found for age (P=.71) or sex (P=.74). There was a preference for prescribing varenicline over bupropion and low drug compliance, with only one container of medication being collected in about 50% of cases. A total of 1680 attempts were made to quit using cytisine in 2023, equivalent to 55.4% of the total number of treatment drugs used in the four years. The estimated cumulative incidence rate of drug withdrawal attempts in smokers between 18 and 65 years of age was 11.9%.

Conclusions

The drug intervention had a low reach and poor compliance with the recommended treatment. It is essential to emphasize patient follow-up and drug adherence.