Search PubMed⌕ Search

Biomedical subjects

C Brotons Cuixart

Publications and source records attributed to C Brotons Cuixart.

At least 19 recordsLinked to original sources
PubMed2002

[Medical care of patients with heart failure: clinical characteristics, determinants of prognosis and follow-up in primary care].

OBJECTIVE: To assess the process of care and prognosis of patients with heart failure (HF) attended in a tertiary hospital and follow up at the primary care level. DESIGN: Prospective study of 18 months of follow up.Setting. Tertiary hospital and primary care centers of the reference area. Participants. Patients admitted to a tertiary hospital from the first of july until de 31 of december of 1998. OUTCOME MEASUREMENTS: Pharmacological data and morbimortality at discharge and at the end of the follow-up, functional capacity of survivors. RESULTS: 265 patients were included, with a mean age of 75 years, 57% were females, 73.8% had HF as first diagnosis, 6.1% had MI, and 20% were attended for other medical reasons. The most frequent cause of HF was HTA. Drugs more prescribed at the discharge and follow up were diuretics and ACE inhibitors. Hospital mortality was 6.4% and mortality at the end of the follow-up was 46% (in 77% of those for cardiac reasons). After being discharged 38.5% of the patients were readmitted to the hospital with the diagnosis of HF, 72% were visited by the family physician, 43% at the outpatient clinic and 33% by the cardiologist; 60% of the patients who survived were in I-II NYHA functional class, 76% walked regularly, and 25% did recreational activities and physical exercise. CONCLUSIONS: Patients attended at the hospital with HF are an old population, have frequently associated other chronic diseases, and have a very bad prognosis. These patients spend an important amount of health resources. Drug prescription at the follow up is suboptimum. Patients who survived have an acceptable functional capacity.

Adult↗
PubMed2001

[Therapeutic control and quality of life in coronary artery bypass surgery patients].

BACKGROUND: Description of measures of secondary prevention and of health related quality of life one year after the intervention in patients undergoing coronary artery bypass surgery. PATIENTS AND METHOD: One year follow up prospective study in patients undergoing first coronary bypass surgery without associated procedures and aged less than 80 in public and private hospitals in Cataluña, Spain. RESULTS: 710 patients were included, 85.4% were men, and mean age was of 63 years. When compared women and men, 74.8 vs 48.7% patients were diagnosed of hypertension, 70.2 vs 55% of hypercholesterolemia, and 42.3 vs 28.7% of diabetes (p < 0.01); on the other hand, 31.2% of men and 2.9% of women were active smokers (p < 0.01). After a year of follow-up, 7% of the total population remained smokers; a significant reduction of anti-anginal treatments and a significant improvement in health related quality of life were observed. Cholesterol lowering treatment in patients previously diagnosed of hypercholesterolemia increased significantly between hospital admission and one year after hospital discharged (from 44% at the beginning to a 58% at the year of follow up; p < 0.01). CONCLUSIONS: Patients undergoing coronary artery bypass surgery clinically improved one year after the intervention, improving also their health related quality of life. However, the percentage of smokers and the level of antihypertensive and lowering cholesterol treatment at the end of follow up suggest a suboptimal control of risk factor

Aged↗
PubMed2001

[Clinical outcome and health related quality of life in patients undergoing coronary angioplasty with balloon or stent. A prospective multicenter study].

INTRODUCTION AND OBJECTIVES: Clinical outcome and health related quality of life after coronary angioplasty with stent or balloon are insufficiently studied in routine practice. The aim of the present study was to assess the impact of angioplasty on the clinical results and quality of life in real clinical practice. PATIENTS AND METHODS: All the consecutive patients undergoing angioplasty with stent or balloon attending two Spanish tertiary hospitals from October, 1997 to July, 1998 were evaluated at baseline and one year after discharge from hospital with a structured clinical questionnaire and the generic SF-36 quality of life questionnaire. RESULTS: Three hundred ninety-seven patients with a mean age of 63 years were included in the study. A stent (or stent plus balloon) was implanted in 342 patients and angioplasty with a single balloon was performed in 55 patients. More advanced coronary disease and suboptimal lesions for treatment were found in patients treated with only balloon. At one year of follow up the total mortality was 6% and 54% of the patients were free of angina. Mean baseline scores of the SF-36 questionnaire were remarkably low (35 for physical health and 45 for mental health). At one year the scores achieved levels similar to those of the general Spanish population matched for age and sex (45 for physical health and 52 for mental health). Independent predictors of quality of life at one year were the following: baseline quality of life, age, sex, comorbidity, previous hospitalizations, hospital where the patient was attended, symptoms at admission and late angina. CONCLUSIONS: a) After percutaneous myocardial revascularization the mean quality of life achieved was similar to that of the general population; b) different clinical subgroups did not achieve these levels, although improvement was similar to that of the remaining subgroups

Adult↗
PubMed2001

[Outcomes of coronary artery surgery: determinants of quality of life related to postoperative health].

BACKGROUND AND OBJECTIVES: Little is known of the clinical and nonclinical determinants of health related quality of life after coronary artery bypass graft in routine clinical practice. The aim of this study was to assess the quality of life and its determinants after a first coronary bypass in a representative population of Catalonia, Spain. PATIENTS AND METHOD: Clinical and quality of life questionnaires were given to all the patients (n = 710) undergoing a first coronary bypass in private and public Catalan hospitals, prior to surgery and at six months and one year of follow-up. Quality of life was assessed with the DASI and the SF-36. RESULTS: The rate of clinical events at one year was 23%. The mean quality of life improved to levels slightly below those in general population; with greater changes reported in physical than in mental condition although the latter was less impaired. In 24%, the quality of life scores at one year were below 1.5 standard deviations of those in the general population. Females, patients with comorbidity and those with public health care insurance showed lower quality of life scores. Independent predictors of one-year quality of life included initial quality of life scores, public insurance, comorbidity, gender, age and chronic disease. Postoperative angina and dyspnoea were also associated with quality of life. CONCLUSION: The mean quality of life improves after coronary bypass, although up to one fourth of the patients may have unsatisfactory one-year clinical or quality of life outcome. Female patients, public insurance and comorbidity predict a worse quality of life.

Adult↗
PubMed2000

[Adaptation of the MacNew QLMI quality of life questionnaire after myocardial infarction to be used in the Spanish population].

BACKGROUND: The advantage of specific quality of life instruments is its ability to evaluate specific issues related to the illness of interest. The aim of the present study is to develope a Spanish version of the self-administered questionnaire MacNew QLMI, specific for patients after myocardial infarction (MI). MATERIAL AND METHOD: Forward and back-translation method by bilinguals was performed; once the test for feasibility and comprehension was carried out. 143 patients with a first MI completed the Spanish version of the MacNew QLMI and principal components factor analysis was performed. Reliability was assessed in 50 patients with stable MI that completed twice the questionnaire (with an interval of two weeks), measuring reproducibility and internal consistency with Student t test, intraclass correlation and Cronbach's alpha. RESULTS: Factor analysis showed a similar three dimensional structure as the original version. Intraclass correlation coeficient were 0.83, 0.87 and 0.83, and Cronbach's alpha coeficients were 0.85, 0.88 and 0.83 for the emotional, physical and social dimensions respectively. CONCLUSIONS: The Spanish version of the MacNew QLMI questionnaire has a good equivalence with the original version, a good internal consistency and a good reproducibility; it can be used in the Spanish population to study its validity.

Adult↗
PubMed2000

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study].

BACKGROUND: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed. SUBJECTS AND METHODS: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron). RESULTS: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59). CONCLUSIONS: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

Adolescent↗
PubMed1999

[Meta-analysis, megatrials, and clinical practice in cardiology].

One of the factors that raises more scepticism and concern in physicians is the combination of data from different clinical trials. In order to combine the results of different trials three requisites must be followed through: similar treatment, the patients have the same disease, and the main outcome variables must be the same. Publication bias is one important limitation of meta-analysis, and it occurs when studies with negative results are not published, which causes the effect of the treatment to be overestimated. It might seem reasonable that the demonstrated effect in the entire study population with a large sample size could be easily analyzed in different subgroups of patients, getting closer to the prediction of effect in the individual patient. This apparently obvious observation is a fallacy and subgroup analysis is often problematic. Possibly the most important condition in the analysis of subgroups is the definition of the subgroups in the design stage of the study, which can permit an adequate presight of the necessary requisites for the validity of the study. The problem of generalization of the results has been traditionally related with of extrapolation of the results to certain groups of patients not included in the clinical trial. In these cases it is important to consider other nonexperimental epidemiological studies, its internal validity and the consistency of their results. The most important characteristics that differentiate conventional clinical trials from megatrials are the following: megatrials recruit a very large and heterogenous population, with few inclusion and exclusion criteria; the only outcome variable that can be better assessed in these heterogenous conditions is eventually mortality; due to their very large sample size, results are obtained with a high level of precision (very narrow confidence intervals).

Clinical Trials as Topic↗
PubMed1998

[The unequal clinical profile, quality of life and hospital mortality in patients undergoing aortocoronary bypass in the public and private centers of Catalonia. The CIRCORCA Study].

INTRODUCTION AND AIMS: The influence of the type of health care funding and management of hospital centres on hospital mortality in coronary artery bypass surgery (CABG) has not been analyzed in detail. We therefore assessed clinical and quality of life preoperative profiles and in-hospital mortality in public and private patients undergoing coronary bypass surgery in Catalonia. METHODS: Clinical questionnaires, Duke Activity Status Index (DASI) and SF-36 were preoperatively administered to all patients undergoing first coronary bypass surgery without associated procedures in Catalonia between November 1996-June 1997. In-hospital morbidity and mortality were recorded. RESULTS: Predictors of in-hospital death, including DASI, SF-36 and comorbidity scores, were significantly worse in public than in private patients. In-hospital mortality rate was more than ten times greater in public than in private patients (8.2% vs 0.7%; p < 0.001). Multivariate analysis identified private funding of health care, among others, as an independent predictor of in-hospital survival. Non evidence-based indications for surgery were significantly more common in private than in public patients (6% vs 0.7%, p < 0.001). CONCLUSIONS: a) In catalonia, the risk profile of public patients undergoing coronary bypass surgery was significantly higher than that of private patients, accounting, at least in part, for a remarkable mortality difference; b) non evidence-based indications for surgery were more common in private than in public patients; c) these unequal patterns raise questions about the adequacy of care and referral patterns in both private and public sectors.

Aged↗
PubMed1998

[Impact of biomedical publications on the incorporation of new therapeutic attitudes in cardiovascular pathology].

OBJECTIVE: To evaluate the application degree of results from three clinical trials on cardiovascular pathology in clinical practice: SOLVD trial (in patients with congestive heart failure), SAVE trial (in patients with acute myocardial infarction) and SPINAF trial (in patients with chronic atrial fibrillation). DESIGN: Retrospective cross-sectional study performed in the first six months in 1990 and 1992 (SOLVD trial) and in the first six months in 1991 and 1993 (SAVE trial) admitted to the Consorci Hospitalari del Parc Taulí, and a cross-sectional study in a single randomized sample of all patients with the discharge diagnosis of atrial fibrillation at Hospital Vall d'Hebron during 1994. An absolute increase of 23% and 19% in the prescription of ACEI agents was observed for patients with heart failure and myocardial infarction, respectively. Forty-eight percent of patients with atrial fibrillation received antithrombotic therapy, which included aspirin and acenocoumarine for 51% and 49% of cases, respectively.

Aged↗
PubMed1997

[Investigation methods in clinical cardiology. VI. Evaluation of results (outcomes) and its clinical relevance in cardiology: with a special reference to the quality of life].

Over the last decade, changes in health care delivery and concern with costs and with dramatic variations in practice between regions, institutions and even physicians at the same institution have led the administrators and health politicians to focus on the outcomes of medical care. The Agency for Health Care Policy and Research was established with the objective of fostering research on the outcomes of medical interventions and on the development of guidelines. The Agency supports studies based not only on standard outcomes such as mortality and morbidity, but also on quality of life and patient satisfaction. The Patient Outcome Research Teams (PORTs) projects are the showcase displays of the Agency, and their goals are to identify and analyze the outcomes and costs of alternative interventions for a given clinical condition, in order to determine the most effective and cost-effective means to prevent, diagnose, treat, or manage it and develop and test methods for reducing inappropriate or unnecessary variations. Three PORTs are focused on the following cardiovascular conditions: acute myocardial infarction, chronic ischemic heart disease and stroke. There are many situations in which randomized clinical trials are not feasible and large-scale observational studies are necessary to generate information about what happens in the real practice. This information deepens the understanding of practical effectiveness as opposed to theoretical efficacy since trials do not always measure all the outcomes of interest to patients and physicians. One way to solve the problem of inaccurate data of observational studies is by establishing a specific registry to measure in an efficient way key patient characteristics, process of care elements and relevant outcomes. The Cardiac Surgery Reporting System is a registry that collects clinical data on all patients undergoing cardiac surgery in New York State. This registry has produced reliable and valid measures of quality and hospitals and cardiac surgery programs throughout New York use this information to improve outcomes for their patients. Health related quality of life can be a useful outcome measure in the assessment of clinical effectiveness. However, there are still many methodological questions regarding the validity and sensitivity of quality of life measurement an optimal study design calls for caution in the interpretation of current results and makes refinement of methodological issues a desirable goal. Nevertheless, apparently valid studies of cardiovascular diseases and interventions using health related quality of life as an outcome measures have been reported where such measures have provided information about undesirable side effects of medications and the impact of the intervention on the health related quality of life. Moreover, some of these studies have identified different patterns of health care as leading to different quality of life outcomes. Thus, quality of life measurement appears as a technology which holds promise for the future assessment of clinical effectiveness.

Cardiology↗
PubMed1997

[Practical clinical implications of megastudies for primary prevention].

The results of different meta-analyses conducted in primary prevention have shown an insignificant difference in total mortality or coronary heart disease (CHD) mortality; and only two studies have shown differences in the incidence of CHD. The WOS study, the first study in primary prevention done with statines, observed a 20% reduction in the total cholesterol, a relative risk reduction of 31%, an absolute risk reduction of 2.4% and the number of patients who needed to be treated, to prevent coronary disease during a five year period, was 42. Subgroup analyses showed a greater benefit for high risk patients: smokers and those with peripheral vascular disease. This is why the utilization of a cardiovascular risk estimation, instead of isolated cholesterol levels or other risk factors, is currently recommended. However, it is important to bear in mind that the results of the WOS study cannot be easily extrapolated to Spain because the rates of CHD are much lower here than the ones observed in Scotland. Promotion of treatment of high risk patients with statines must be accompained by a promotion of a healthy lifestyle at both the individual and the community level.

Coronary Disease↗