Pub Date : 2024-11-20DOI: 10.1016/j.rceng.2024.11.003
M Rubio-Rivas, J M Mora-Luján, A M Sáez, M D Martín-Escalante, V G Galvañ, G M de la Calle, M L Taboada Martínez, A M Míguez, C Lumbreras-Bermejo, J-M Antón-Santos
Background: The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.
Methods: Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st,2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5,314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.
Results: Higher in-hospital mortality was found in the groups with PAFI < 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, p < 0.001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI > 300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05-1.06)], moderate [OR = 1.87 (1.49-2.33)] and severe [OR = 2.64 (1.96-3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03-1.39)], higher Charlson index [OR = 1.19 (1.14-1.24)], tachypnea on admission [2.23 (1.91-2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65-0.90)] and the use of RDSV [OR = 0.72(0.56-0.93)] were found to be protective factors.
Conclusions: The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.
{"title":"Which one is a better predictor of prognosis in COVID-19: analytical biomarkers or PaO2/FiO2?","authors":"M Rubio-Rivas, J M Mora-Luján, A M Sáez, M D Martín-Escalante, V G Galvañ, G M de la Calle, M L Taboada Martínez, A M Míguez, C Lumbreras-Bermejo, J-M Antón-Santos","doi":"10.1016/j.rceng.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.rceng.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.</p><p><strong>Methods: </strong>Retrospective cohort study with data on patients collected from March 1<sup>st</sup>, 2020 to March 1<sup>st</sup>,2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5,314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.</p><p><strong>Results: </strong>Higher in-hospital mortality was found in the groups with PAFI < 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, p < 0.001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI > 300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05-1.06)], moderate [OR = 1.87 (1.49-2.33)] and severe [OR = 2.64 (1.96-3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03-1.39)], higher Charlson index [OR = 1.19 (1.14-1.24)], tachypnea on admission [2.23 (1.91-2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65-0.90)] and the use of RDSV [OR = 0.72(0.56-0.93)] were found to be protective factors.</p><p><strong>Conclusions: </strong>The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.rceng.2024.11.002
R Dal-Ré
Point-8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point-8 be modified in the opposite direction, i.e., that it be acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change and uses as an example what happened with the experimental SARS-CoV-2 vaccines versus placebo masked trials. When the high efficacy of the vaccines became evident, the question arose as to what should be done, whether to keep the trials masked until long-term efficacy, immunogenicity and safety data were obtained, or to break the masking and offer participants who received placebo the vaccine that had been shown to be efficacious. The latter was the correct attitude that translated point-8 into practice.
{"title":"The rights and interests of participants as limits to clinical trials.","authors":"R Dal-Ré","doi":"10.1016/j.rceng.2024.11.002","DOIUrl":"10.1016/j.rceng.2024.11.002","url":null,"abstract":"<p><p>Point-8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point-8 be modified in the opposite direction, i.e., that it be acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change and uses as an example what happened with the experimental SARS-CoV-2 vaccines versus placebo masked trials. When the high efficacy of the vaccines became evident, the question arose as to what should be done, whether to keep the trials masked until long-term efficacy, immunogenicity and safety data were obtained, or to break the masking and offer participants who received placebo the vaccine that had been shown to be efficacious. The latter was the correct attitude that translated point-8 into practice.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1016/j.rceng.2024.11.001
R Puchades, L Ramos-Ruperto
A revolution is taking place within the field of artificial intelligence (AI) with the emergence of generative AI. Although we are in an early phase at the clinical level, there is an exponential increase in the number of scientific articles that use AI (discriminative and generative) in their methodology. According to the current situation, we may be in an "AI bubble" stage; requiring filters and tools to evaluate its application, based on the quality and evidence provided. In this sense, initiatives have been developed to determine standards and guidelines for the use of discriminative AI (CONSORT AI, STARD AI and others), and more recently for generative AI (the CHART collaborative). As a new technology, AI requires scientific regulation to guarantee the efficacy and safety of its applications, while maintaining the quality of care; an evidence-based AI (IABE).
{"title":"Artificial intelligence in clinical practice: Quality and evidence.","authors":"R Puchades, L Ramos-Ruperto","doi":"10.1016/j.rceng.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.rceng.2024.11.001","url":null,"abstract":"<p><p>A revolution is taking place within the field of artificial intelligence (AI) with the emergence of generative AI. Although we are in an early phase at the clinical level, there is an exponential increase in the number of scientific articles that use AI (discriminative and generative) in their methodology. According to the current situation, we may be in an \"AI bubble\" stage; requiring filters and tools to evaluate its application, based on the quality and evidence provided. In this sense, initiatives have been developed to determine standards and guidelines for the use of discriminative AI (CONSORT AI, STARD AI and others), and more recently for generative AI (the CHART collaborative). As a new technology, AI requires scientific regulation to guarantee the efficacy and safety of its applications, while maintaining the quality of care; an evidence-based AI (IABE).</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.09.002
S. Conde Díez , R. de las Cuevas Allende , E. Conde García
Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient’s quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.
{"title":"Anemia of inflammation and iron metabolism in chronic diseases","authors":"S. Conde Díez , R. de las Cuevas Allende , E. Conde García","doi":"10.1016/j.rceng.2024.09.002","DOIUrl":"10.1016/j.rceng.2024.09.002","url":null,"abstract":"<div><div>Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient’s quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 598-608"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.10.010
C-P Fu, P-K Fu, M-C Lu, Y-Y Liao, J-S Wang
Backgroud and objectives: As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.
Materials and methods: Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.
Result: A total of 1954 patients joined the smoking cessation program, and 1381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.
Conclusion: Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.
{"title":"Impact of smoking cessation on metabolic parameters and renal function in patients with and without diabetes mellitus.","authors":"C-P Fu, P-K Fu, M-C Lu, Y-Y Liao, J-S Wang","doi":"10.1016/j.rceng.2024.10.010","DOIUrl":"10.1016/j.rceng.2024.10.010","url":null,"abstract":"<p><strong>Backgroud and objectives: </strong>As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.</p><p><strong>Materials and methods: </strong>Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.</p><p><strong>Result: </strong>A total of 1954 patients joined the smoking cessation program, and 1381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.</p><p><strong>Conclusion: </strong>Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.08.001
Lu Chen , Xiang-Jun Zeng , Xin-Ying Guo , Jian Liu , Feng-He Du , Cai-Xia Guo
Aims
Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.
Materials and methods
In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.
Results
There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR < 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) μg/L, P < 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (r = 0.196, P < 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12–6.15), P < 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543–0.778), P < 0.01)].
Conclusions
Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.
{"title":"Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease","authors":"Lu Chen , Xiang-Jun Zeng , Xin-Ying Guo , Jian Liu , Feng-He Du , Cai-Xia Guo","doi":"10.1016/j.rceng.2024.08.001","DOIUrl":"10.1016/j.rceng.2024.08.001","url":null,"abstract":"<div><h3>Aims</h3><div>Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.</div></div><div><h3>Materials and methods</h3><div>In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.</div></div><div><h3>Results</h3><div>There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR < 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) μg/L, <em>P</em> < 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (<em>r</em> = 0.196, <em>P</em> < 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12–6.15), <em>P</em> < 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543–0.778), <em>P</em> < 0.01)].</div></div><div><h3>Conclusions</h3><div>Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 580-587"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.09.005
J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de laSEMI
Aims
To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).
Methods
Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.
Results
The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.
Conclusions
SEMI seeks to be a key player in the transformation of the Spanish healthcare system.
{"title":"Strategic framework for the Spanish Society of Internal Medicine. 2025-2029. Executive summary on guaranteeing person-centered care in a high value National Health System","authors":"J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de laSEMI","doi":"10.1016/j.rceng.2024.09.005","DOIUrl":"10.1016/j.rceng.2024.09.005","url":null,"abstract":"<div><h3>Aims</h3><div>To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Methods</h3><div>Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.</div></div><div><h3>Results</h3><div>The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.</div></div><div><h3>Conclusions</h3><div>SEMI seeks to be a key player in the transformation of the Spanish healthcare system.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 609-622"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.08.002
F. Richard Espiga , M. Almendro Delia , F. Caballero Martínez , D. Monge Martín , F. Neria Serrano , R. Quirós López
Introduction
We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.
Methods
This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.
Results
A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.
Conclusions
In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.
{"title":"Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study","authors":"F. Richard Espiga , M. Almendro Delia , F. Caballero Martínez , D. Monge Martín , F. Neria Serrano , R. Quirós López","doi":"10.1016/j.rceng.2024.08.002","DOIUrl":"10.1016/j.rceng.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.</div></div><div><h3>Methods</h3><div>This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.</div></div><div><h3>Results</h3><div>A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.</div></div><div><h3>Conclusions</h3><div>In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 560-568"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.rceng.2024.08.003
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 2381 subjects screened, 1713 participated in the basic module, with 1186 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.
{"title":"Results of the implementation of the DP-TRANSFERS project in Catalonia: a translational method to improve diabetes screening and prevention in primary care","authors":"J.J. Cabré , F. Barrio , J. Vizcaíno , A. Martínez , T. Mur , R. Sagarra , S. Dalmau","doi":"10.1016/j.rceng.2024.08.003","DOIUrl":"10.1016/j.rceng.2024.08.003","url":null,"abstract":"<div><h3>Introduction</h3><div>DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.</div></div><div><h3>Objective</h3><div>Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.</div></div><div><h3>Methodology</h3><div>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.</div></div><div><h3>Results</h3><div>The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 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.</div><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 569-579"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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