Publications by authors named "Carlos Escobar"

243 Publications

Effectiveness and Safety of Dabigatran Compared to Vitamin K Antagonists in Non-Asian Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Clin Drug Investig 2021 Oct 13. Epub 2021 Oct 13.

Grup de Recerca d'Epidemiologia Clínica i Serveis Sanitaris, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.

Background And Objective: Real-life data about the use of dabigatran in patients with non-valvular atrial fibrillation are warranted. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of dabigatran, globally and stratified by dose (110/150 mg twice daily), vs vitamin K antagonists in non-Asian patients with non-valvular atrial fibrillation from "real-world" studies.

Methods: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement) statement. The ROBINS-I tool was used to assess bias risk. MEDLINE and EMBASE, from inception up to May 2021, using appropriate controlled vocabulary and free search terms, were searched.  RESULTS: A total of 34 studies, corresponding to 37 articles involving 1,600,722 participants (1,154,283 exposed to vitamin K antagonists and 446,439 to dabigatran) were eligible for this review. Dabigatran 150 mg reduced the risk of ischemic stroke compared with vitamin K antagonists, with a 14% risk reduction (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.74-0.98). Globally, dabigatran reduced the risk of all-cause mortality compared with vitamin K antagonists (HR 0.76, 95% CI 0.69-0.84), with a greater effect observed with dabigatran 150 mg (HR 0.65, 95% CI 0.58-0.73). There was a trend towards a lower risk of myocardial infarction with dabigatran 150 mg (HR 0.86, 95% CI 0.71-1.04). Regarding the primary safety outcomes, dabigatran (either at a dose of 150 mg or 110 mg) reduced the risk of major bleeding compared with vitamin K antagonists (HR 0.77, 95% CI 0.70-0.83), as well as the risk of intracranial bleeding (HR 0.44, 95% CI 0.39-0.50) and fatal bleeding (HR 0.76, 95% CI 0.60-0.95), but with a slight increase in gastrointestinal bleeding risk (HR 1.16, 95% CI 1.08-1.26).

Conclusions: Dabigatran has a favorable impact on effectiveness and safety outcomes compared with vitamin K antagonists in real-world populations.
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http://dx.doi.org/10.1007/s40261-021-01091-wDOI Listing
October 2021

Analysis of the prescription process of PCSK9 inhibitors in the cardiology departments of Spanish hospitals and optimization proposal. The IKIGAI study.

Clin Investig Arterioscler 2021 Jul 25. Epub 2021 Jul 25.

Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, España.

Aims: To ascertain the formalities and procedures required for the prescription of PCSK9 inhibitors in the cardiology departments of Spanish hospitals, making proposals for improvement to optimize the prescription process.

Methods: A first phase of collecting information about the variables and administrative procedures required for the prescription of PCK9 inhibitors and the elaboration of a specific questionnaire and a second phase of collecting data with an online self-administered questionnaire.

Results: A total of 88 hospitals participated in the study (mean number of beds 625; mean number of cardiologists 18 ± 10; 78% university hospitals). There was underuse of PCSK9 inhibitors (real prescription of 30 treatments/year; potential prescription of 80), mainly because of not fulfilling the therapeutic positioning report (52%) and application refusal (31%). Beyond the requirements of the therapeutic positioning report, 1.2 ± 0.4 applications are required with 8.5 ± 4.2 variables. Only 21% of hospitals did not require a previous authorization process and in the remaining hospitals, approval from a committee was necessary. The accumulated time of the prescription process was 6 weeks. Discontinuation rates during follow-up were 9% ± 12%.

Conclusions: Treatment with PCSK9 inhibitors is clearly underused in Spain. This is mainly due to both inappropriate identification of patients, and complex administrative procedures that could inhibit/discourage prescription by cardiologists and consequently, limit their use. In addition, there is a substantial delay from drug approval tadministration.
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http://dx.doi.org/10.1016/j.arteri.2021.05.003DOI Listing
July 2021

Synthesis, characterisation, crystal structure and antimicrobial evaluation of novel 6-alkoxyergosta-4,6,8(14),22-tetraen-3-one derived from natural ergosta-5,7,22-trien-3β-ol.

Nat Prod Res 2021 Jun 30:1-8. Epub 2021 Jun 30.

Facultad de Ciencias, Departamento de Ciencias y Recursos Naturales, Universidad de Magallanes, Punta Arenas, Chile.

In this study, we report a facile transformation starting from 5α-hydroxyergosta-7,22-dien-3,6-dione to afford two novel compounds: 6-methoxyergosta-4,6,8(14),22-tetraen-3-one and 6-ethoxyergosta-4,6,8(14),22-tetraen-3-one ( using alcoholic acid catalysis. Their structures were elucidated using NMR experiments, FT-IR, MS and X-ray analysis. These compounds were evaluated for antibacterial activity using the disk and broth diffusion test. In those tests, compound was found to be the most significant antibacterial agent. In general, compounds showed inhibition zone in the range of 7.00-12.3 mm for and , meanwhile for Gram-negative bacteria and was found to be in the range of 7.00-8.00 mm. For the most active, compound , MIC was significantly lower than that reported for ergosterol, in a value of 160 µg/mL. Overall, these compounds were more active than their natural precursor.
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http://dx.doi.org/10.1080/14786419.2021.1946534DOI Listing
June 2021

Epidemiology, clinical profile, management, and two-year risk complications among patients with chronic kidney disease in Spain.

Nefrologia (Engl Ed) 2021 Jun 18. Epub 2021 Jun 18.

Endocrine department, University Hospital Lucus Augusti, Lugo, Spain.

Objectives: To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial).

Methods: Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m (CKD-EPI), or albuminuria >30mg/g.

Results: We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8mg/g, eGFR 49.7mL/min/1.73m). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population.

Conclusions: In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit.
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http://dx.doi.org/10.1016/j.nefro.2021.03.006DOI Listing
June 2021

Primary prevention. The cornerstone to reduce the burden of cardiovascular disease.

Rev Esp Cardiol (Engl Ed) 2021 Oct 1;74(10):827-828. Epub 2021 Jun 1.

Department of Hypertension, Medical University of Lodz (MUL), Lodz, Poland; Department of Medicine, University of Zielona Góra, Zielona Góra, Poland.

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http://dx.doi.org/10.1016/j.rec.2021.04.013DOI Listing
October 2021

Costs and healthcare utilisation of patients with chronic kidney disease in Spain.

BMC Health Serv Res 2021 Jun 1;21(1):536. Epub 2021 Jun 1.

Hospital Universitario Lucus Augusti, Lugo, Spain.

Background: Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain.

Methods: Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.

Results: We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m). During the 2015-2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time.

Conclusions: Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.
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http://dx.doi.org/10.1186/s12913-021-06566-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167969PMC
June 2021

Revisiting Hypertension in Rural Areas: A New Approach Is Required.

Am J Hypertens 2021 09;34(9):910-911

Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.

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http://dx.doi.org/10.1093/ajh/hpab078DOI Listing
September 2021

Fixed-dose combination of rosuvastatin and ezetimibe: treating hypercholesteremia according to cardiovascular risk.

Expert Rev Clin Pharmacol 2021 Jul 24;14(7):793-806. Epub 2021 May 24.

Cardiology Department, University Hospital La Paz, Madrid, Spain.

: Reducing low-density lipoprotein cholesterol (LDL-C) with lipid-lowering therapies has been associated with a decrease in the frequency of cardiovascular events.: A systematic search was conducted on PubMed (MEDLINE), using the MeSH terms [Rosuvastatin] + [Ezetimibe] + [Dyslipidemia] + [treatment]. Original data from clinical trials, prospective and retrospective studies and more useful reviews were selected.: While statins continue to be the cornerstone of dyslipidemia management, many patients do not attain LDL-C targets with high-intensity statins alone. Rosuvastatin is a high-intensity statin with a low risk of adverse effects and drug-drug interactions and proven benefits in the prevention of cardiovascular disease. Rosuvastatin and ezetimibe have complementary mechanisms of action that enhance their ability to reduce LDL-C levels. Various studies have shown that the combination of rosuvastatin 10-40 mg and ezetimibe 10 mg enables considerable reductions in LDL-C (up to 60-75%) with a good safety profile in a broad spectrum of patients with hypercholesterolemia, including those at high risk and those with atherosclerotic cardiovascular disease. In addition, a fixed-dose combination of rosuvastatin and ezetimibe may improve adherence to medication. In this review, the available evidence on the combination of rosuvastatin and ezetimibe is updated.
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http://dx.doi.org/10.1080/17512433.2021.1925539DOI Listing
July 2021

Soft skills in cardiology telemedicine consultations. Response.

Rev Esp Cardiol (Engl Ed) 2021 06 15;74(6):563-564. Epub 2021 Apr 15.

Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Islas Baleares, Spain.

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http://dx.doi.org/10.1016/j.rec.2021.03.007DOI Listing
June 2021

Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning.

Undersea Hyperb Med 2021 First Quarter;48(1):53-56

Pediatric Intensive Care Unit, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal.

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.
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March 2021

Canagliflozin: metabolic, cardiovascular and renal protection.

Future Cardiol 2021 05 4;17(3):443-458. Epub 2021 Feb 4.

Cardiology Department, University Hospital La Paz, Madrid, Spain.

Patients with Type 2 Diabetes (T2D) are at risk of developing macrovascular (cardiac, cerebrovascular, peripheral arterial disease) and microvascular (nephropathy, neuropathy, retinopathy) complications. Glycemic control improves only microvascular outcomes. However, some SGLT-2 inhibitors and GLP1-R agonists have proven beneficial in macrovascular conditions. Canagliflozin is an SGLT2 inhibitor that provides sustained reductions in HbA1c, blood pressure and weight. Remarkably, as CANVAS program and CREDENCE trial demonstrated, canagliflozin promotes significant reductions in the frequency of atherosclerotic cardiovascular events, hospitalizations for heart failure and renal outcomes. In addition, real-world studies have confirmed the results of clinical trials in clinical practice. Therefore, canagliflozin should be considered a first-line therapy in the management of T2D patients in order to reduce both micro- and macrovascular complications.
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http://dx.doi.org/10.2217/fca-2020-0192DOI Listing
May 2021

Should we make the risk stratification process more complex in patients with atrial fibrillation? Authors' reply.

Europace 2021 06;23(6):978-979

Professor Clinical Cardiology (Emeritus), St. George's University of London, London, UK.

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http://dx.doi.org/10.1093/europace/euab020DOI Listing
June 2021

Telemedicine for patients with valvular heart disease or aortic disease in the era of COVID-19. Response.

Rev Esp Cardiol (Engl Ed) 2021 04 13;74(4):362-363. Epub 2021 Jan 13.

Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Balearic Islands, Spain.

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http://dx.doi.org/10.1016/j.rec.2020.11.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832051PMC
April 2021

SGLT2 inhibitors and GLP1 agonists administered without metformin compared to other glucose-lowering drugs in patients with type 2 diabetes mellitus to prevent cardiovascular events: A systematic review.

Diabet Med 2021 03 4;38(3):e14502. Epub 2021 Jan 4.

Centro Cochrane Iberoamericano, Institut d'Investigació Biomèdica Sant Pau, CIBERESP, Barcelona, Spain.

Objectives: To assess the efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, administered without metformin on cardiovascular outcomes in type 2 diabetes patients.

Methods: A systematic review was performed according to Cochrane's methodological standards. We included randomized clinical trials (RCTs) on adult type 2 diabetes patients, assessing the efficacy of SGLT2 inhibitors and GLP1-RAs compared to other glucose-lowering drugs and/or RCTs that presented data of a subgroup of type 2 diabetes patients without metformin use at baseline. The main outcome was the reduction of the risk of any major adverse cardiovascular events (MACE) reported individually or as a composite outcome.

Results: Five RCTs including 50,725 type 2 diabetes patients, of whom 10,013 had not received metformin, were included in this meta-analysis. Three of these studies assessed the efficacy of GLP1-RAs and two of SGLT2 inhibitors. In patients without metformin at baseline, GLP1-RAs in comparison with placebo reduced the risk of MACE significantly by 20% (HR: 0.80; 95% CI: 0.71-0.89). SGLT2 inhibitors also significantly reduced the risk of MACE by 32% (HR: 0.68; 95% CI: 0.57-0.81).

Conclusions: SGLT2 inhibitors and GLP1-RAs provided without metformin at baseline may reduce the risk of MACE in comparison with placebo in type 2 diabetes patients at increased risk of cardiovascular events.
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http://dx.doi.org/10.1111/dme.14502DOI Listing
March 2021

A new index to predict quality of anticoagulation control in patients on vitamin K antagonists: the DAFNE score.

Future Cardiol 2021 07 17;17(4):685-692. Epub 2020 Dec 17.

Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart & Chest Hospital, Liverpool, United Kingdom & Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

To derive a new clinical score to improve the prediction of those at risk of poor International Normalized Ratio control among patients with atrial fibrillation taking vitamin K antagonists. The score was calculated using PAULA database and validated in the FANTASIIA population. The DAFNE score (cardiovascular isease, concomitant treatment with miodarone, ood/dietary transgression and taking ≥7 pills daily, female sex) score was related to a higher probability of poor International Normalized Ratio control. C-indexes were 0.611 and 0.576 (De Long test, p = 0.007) for the DAFNE and SAMe-TTR scores, respectively. The DAFNE score is a new clinical score which may potentially help determine those patients with atrial fibrillation who are at high risk of poor anticoagulation control with vitamin K antagonists.
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http://dx.doi.org/10.2217/fca-2020-0122DOI Listing
July 2021

[Telemedicine for patients with valvular heart disease or aortic disease in the era of COVID-19. Response].

Rev Esp Cardiol 2021 Apr 2;74(4):362-363. Epub 2020 Dec 2.

Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Illes Balears, España.

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http://dx.doi.org/10.1016/j.recesp.2020.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709606PMC
April 2021

[Management of patients with dyslipidaemia in Spain. The Cardio Right Care Control of cardiovascular risk project].

Semergen 2021 Jan-Feb;47(1):28-37. Epub 2020 Oct 23.

Unión de Mutuas, Valencia, España.

Objective: To ascertain the opinion of physicians about diagnostic criteria, control targets, control rates, and therapeutic approach of patients with dyslipidaemia in Spain.

Methods: A specific questionnaire was created about diagnostic criteria, control targets, control rates, lipid lowering therapies, and therapeutic inertia in patients with dyslipidaemia. Physicians completed the questionnaire online during a 4-month period.

Results: A total of 959 questionnaires were collected from all over Spain. The most frequent scale to stratify cardiovascular risk is SCORE (54.9%), and guidelines from the European Society of Cardiology are the most common guidelines used (50.5%). The majority of patients are on primary prevention (57.7%), and 31.4% have a high-very high cardiovascular risk. More than 70% of investigators considered that the target among patients at very high risk and those in secondary prevention is an LDL cholesterol < 70 mg/dL. It is considered by 60.0% and 66.4% of investigators that their patients on primary and secondary prevention, respectively, achieve control targets. Statins are the most common lipid lowering drugs used, followed by ezetimibe. In the majority of cases, when a patient is not adequately controlled with statins, there is an increase in the dose or a change to another statin. Poor adherence to treatment and therapeutic inertia are the main reasons for poor LDL cholesterol control.

Conclusions: The Cardio Right Care CVR Control project allows those aspects to be identified, as well as areas of improvement in patients with dyslipidaemia in Spain.
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http://dx.doi.org/10.1016/j.semerg.2020.08.007DOI Listing
August 2021

Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation.

Europace 2021 06;23(6):837-843

Cardiovascular Clinical Academic Group, St. George's University of London, London, UK.

Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.
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http://dx.doi.org/10.1093/europace/euaa324DOI Listing
June 2021

Atrial fibrillation, an equivalent of cardiovascular disease risk.

Eur Heart J 2020 12;41(48):4599

Cardiology Department, University Hospital La Paz, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain.

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http://dx.doi.org/10.1093/eurheartj/ehaa771DOI Listing
December 2020

May we apply results data from classical hypertension clinical trials to all beta-blockers?

J Hypertens 2020 12;38(12):2544

Cardiology Department, University Hospital La Paz, Madrid, Spain.

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http://dx.doi.org/10.1097/HJH.0000000000002673DOI Listing
December 2020

Telematic cardiology consultation in the elderly. The 5M framework can help. Response.

Rev Esp Cardiol (Engl Ed) 2021 01 25;74(1):118. Epub 2020 Oct 25.

Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2020.09.022DOI Listing
January 2021

Costs and healthcare utilisation of patients with heart failure in Spain.

BMC Health Serv Res 2020 Oct 20;20(1):964. Epub 2020 Oct 20.

Hospital Universitario Lucus Augusti, Lugo, Spain.

Background: Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain.

Methods: Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.

Results: We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs.

Conclusions: During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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http://dx.doi.org/10.1186/s12913-020-05828-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576860PMC
October 2020

[Telematic cardiology consultation in the elderly. The 5 M framework can help. Response].

Rev Esp Cardiol 2021 Jan 6;74(1):118. Epub 2020 Oct 6.

Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.

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http://dx.doi.org/10.1016/j.recesp.2020.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537665PMC
January 2021

Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology.

Rev Esp Cardiol (Engl Ed) 2020 Aug 29. Epub 2020 Aug 29.

Servicio de Cardiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care.
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http://dx.doi.org/10.1016/j.rec.2020.06.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456304PMC
August 2020

[Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology].

Rev Esp Cardiol 2020 Nov 8;73(11):910-918. Epub 2020 Jul 8.

Servicio de Cardiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.

The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care.
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http://dx.doi.org/10.1016/j.recesp.2020.06.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345370PMC
November 2020

First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study.

Clin Investig Arterioscler 2020 Nov - Dec;32(6):231-241. Epub 2020 Jun 27.

Departamento Médico, Amgen España, Barcelona, España.

Objective: To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world» setting.

Methods: Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units.

Results: A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14).

Conclusions: In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials.
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http://dx.doi.org/10.1016/j.arteri.2020.05.002DOI Listing
September 2021

A Delphi consensus on the management of oral anticoagulation in patients with non-valvular atrial fibrillation in Spain: ACOPREFERENCE study.

PLoS One 2020 1;15(6):e0231565. Epub 2020 Jun 1.

Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain.

Objective: To evaluate the level of agreement between cardiologists regarding the management of oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) in Spain.

Materials And Methods: A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with the questionnaire items on a 9-point Likert scale. Item selection was based on acceptance by ≥66.6% of panellists and the agreement of the scientific committee. In round 2, the same panellists evaluated those items that did not meet consensus in round 1.

Results: A total of 238 experts participated in round 1; of these, 217 completed the round 2 survey. In round 1, 111 items from 4 dimensions (Thromboembolic and bleeding risk evaluation for treatment decision-making: 18 items; Choice of OAC: 39 items; OAC in specific cardiology situations: 12 items; Patient participation and education: 42 items) were evaluated. Consensus was reached for 92 items (83%). Over 80% of the experts agreed with the use of DOACs as the initial anticoagulant treatment when OAC is indicated. Panellists recommended the use of DOACs in patients at high risk of thromboembolic complications (CHA2DS2-VASc ≥3) (83%), haemorrhages (HAS-BLED ≥3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on VKA treatment (93%), and those who are to undergo cardioversion (80%). Panellists agreed that the efficacy and safety profile of each DOAC (98%), the availability of a specific reversal agent (72%) and patient's preference (85%) should be considered when prescribing a DOAC. A total of 97 items were ultimately accepted after round 2.

Conclusions: This Delphi panel study provides expert-based recommendations that may offer guidance on clinical decision-making for the management of OAC in NVAF. The importance of patient education and involvement has been highlighted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231565PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263623PMC
August 2020

Patients' perceptions with dabigatran in patients with atrial fibrillation previously treated with vitamin K antagonists.

J Comp Eff Res 2020 06 29;9(9):615-625. Epub 2020 May 29.

Medical Affairs Department, Boehringer-Ingelheim, Sant Cugat del Vallès, Barcelona, Spain.

To analyze the perception of anticoagulation with dabigatran in patients with nonvalvular atrial fibrillation previously treated with vitamin K antagonists over a 6-month period.  This is a prospective, noninterventional, noncontrolled, multicenter study. To assess patients' perceptions, PACT-Q2 questionnaire was completed.  Six hundred and fifty nine patients (73.1 ± 9.4 years, CHADS-VASc 3.6 ± 1.6) were included. At baseline, the convenience and satisfaction scores were 60.9 ± 24.9 and 49.9 ± 17.7, respectively. The scores significantly increased along the study. Convenience score was higher in males and in patients with low-moderate thromboembolic risk. Satisfaction score was higher in females. Only 8.0% of patients discontinued dabigatran (3.7% due to side effects). Convenience and satisfaction scores for nonvalvular atrial fibrillation patients treated with dabigatran at 6 months were significantly better than with previous vitamin K antagonists.
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http://dx.doi.org/10.2217/cer-2020-0001DOI Listing
June 2020

COVID-19 and QT interval prolongation: more than just drug toxicity?

Europace 2020 10;22(10):1479

CARD-COVID Investigators, Arrhythmia and Robotic Electrophysiology Unit, La Paz University Hospital, IdiPaz, UAM, P. Castellana, 261, 28046 Madrid, Spain.

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http://dx.doi.org/10.1093/europace/euaa145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314041PMC
October 2020
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