Grado de adecuación del tratamiento farmacológico en pacientes con insuficiencia cardíaca crónica. Visión desde atención primaria
| Autor: | D. Diez-Juárez, C. Alberte Pérez, V. Arias Cobos, J.C. Naveiro-Rilo, M.L. Flores-Zurutuza, R. Molina Mazo |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Gynecology
medicine.medical_specialty education.field_of_study business.industry Population Public Health Environmental and Occupational Health Primary care Atencion primaria Appropriate use New york heart association Pharmacological treatment medicine Ischaemic heart disease In patient Family Practice business education |
| Zdroj: | SEMERGEN - Medicina de Familia. 39:183-190 |
| ISSN: | 1138-3593 |
| DOI: | 10.1016/j.semerg.2012.08.006 |
| Popis: | espanolIntroduccion y objetivo. La adecuacion del tratamiento farmacologico a las indicaciones de las guias clinicas reduce la morbimortalidad en enfermos con insuficiencia cardiaca cronica (ICC). Numerosos estudios informan sobre esta adecuacion en el ambito hospitalario, mientras que en atencion primaria son escasos. El objetivo es evaluar el grado de adecuacion a la guia clinica de la Sociedad Europea de Cardiologia en la ICC en los pacientes de medicos de atencion primaria. Metodos. Diseno observacional descriptivo, de utilizacion de medicamentos, tipo indicacion-prescripcion. Poblacion y muestra: equipos de atencion primaria del Area Sanitaria de Leon (9 urbanos y 19 rurales). La poblacion de estudio esta formada por los pacientes con un diagnostico de insuficiencia cardiaca cronica en grado II-IV de la New York Heart Association (NYHA), de un registro de 2.047 con insuficiencia cardiaca cronica, pertenecientes a 97 medicos de atencion primaria. Mediante un muestreo aleatorio se seleccionaron 474 enfermos con afijacion proporcional a los estratos rural y urbano. Mediciones principales: se evalua la adherencia a los farmacos recomendados en la guia clinica mediante 2 indicadores, uno global y otro para farmacos con mayor grado de evidencia (A1: inhibidores de la enzima conversora de angiotensina/antagonistas de los receptores de angiotensina II [IECA/ARA-II], ?-bloqueantes [BB] y espironolactona). Resultados. Se estudian 456 enfermos, con una edad promedio de 78,4 anos, de los cuales son mujeres el 53,1%. La hipertension arterial (HTA) y la isquemia cardiaca causan el 64,7%. La comorbilidad promedio, excluyendo la ICC, fue de 2,9. El 40,4% estan en grado III-IV de la NYHA. El Indice de Adherencia Global (diureticos, IECA/ARA-II, ?-bloqueantes, espironolactona, digoxina y anticoagulantes orales) y el de Adherencia a la Evidencia A1 (IECA/ARA-II, BB y espironolactona) fueron del 55,2 y del 44,6%, respectivamente. El 39,5% tiene una baja adherencia, solo el 12,9% de los pacientes exhiben una perfecta adherencia a los medicamentos con el mejor grado de evidencia, mientras que tener menos de 70 anos, los antecedentes de isquemia, HTA e ingreso hospitalario son variables asociadas a mejor adherencia. Conclusion. Existe una infrautilizacion de medicamentos recomendados por la guia clinica para la insuficiencia cardiaca, sobre todo de aquellos con mejores evidencias para reducir la morbimortalidad. EnglishIntroduction and objective. The appropriate use of pharmacological treatment according to the indications in Clinical Guidelines reduces morbidity and mortality in patients with chronic heart failure (CHF). There are numerous studies regarding this in the hospital environment, but there are few studies done in Primary Care. The objective of this study is to evaluate the degree of compliance by Primary Care doctors to the Clinical Guidelines of the European Society of Cardiology in patients with CHF. Methods. A descriptive, observational study on the use of indication-prescription drugs was conducted. Population and sample: Primary Care teams of the Leon Health Area (9 urban and 19 rural). The study population included patients with a diagnosis of New York Heart Association (NYHA) Grade II-IV chronic heart failure, from a register of 2047 with chronic heart failure patients treated by 97 Primary Care doctors. A proportional representative random sample of 474 patients from the urban and rural areas was studied. Main measurements: Adherence to the drugs recommended in the Clinical Guidelines was evaluated using two indicators; one overall, and another for drugs with a higher level of evidence (A1: angiotensin converting enzyme inhibitors-angiotensin II receptor antagonists [ACE-I/ARA-II], ?-blockers [BB] and spironolactone). Results. A total of 456 patients were studied, with a mean age of 78.4 years, and 53.1% females. Arterial hypertension (AHT) and ischaemic heart disease were present in 64.7% of patients. The mean comorbidity rate, excluding CHF, was 2.9. Around 40% were diagnosed a NYHA Grade 11-1 V. The overall compliance rate (diuretics, ACE-I/ARA-II, ?-blockers, spironolactone, digoxin, and oral anticoagulants) and rate of adherence to evidence-based ones was 55.2% and 44.6%, respectively. There was low compliance by 39.5%, and only 12.9% of patients showed perfect compliance with the drugs with a higher level of evidence, while to be less than 70 years-old, a history of ischaemia, AHT, and a hospital admission, were variables associated with better adherence to treatment. Conclusion. There is a low use of the drugs recommended by the Clinical Guidelines for heart failure, particularly of those with better evidence for reducing morbidity and mortality. |
| Databáze: | OpenAIRE |
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