Objetivo: detectar personas en riesgo alto o muy alto de padecer diabetes mellitus tipo 2 (DM2) o alteraciones del metabolismo de los hidratos de carbono, derivación para posible diagnóstico al ...médico y realizar una intervención educativa. Métodos: estudio observacional transversal y longitudinal prospectivo con intervención educativa en farmacias comunitarias situadas en la provincia de Valencia entre junio y noviembre de 2018. Se incluyeron usuarios de las farmacias comunitarias, mayores de 18 años, no diagnosticados de DM2 que aceptaron realizar la encuesta. Muestreo no probabilístico. Variable principal: puntuación en el test Findrisc, determinación capilar (si F≥15), intervención y número de diagnósticos de DM2 y preDM2. Las diferencias entre grupos se calcularon con el test de chi-cuadrado, t de Student o de Wilcoxon. Resultados: el estudio se realizó en 25 farmacias. La muestra incluyó a 752 usuarios. De ellos, 148 (19,7 %) tenían alto o muy alto riesgo de DM2 (F≥15). Se realizaron 118 determinaciones capilares válidas (22 no aceptaron y 8 no la repitieron), 78 (10,4 %) tuvieron resultados superiores a los normales y a 48 (6,4 %) se les derivó al médico. 32 de estos no fueron al médico o no informaron al farmacéutico del resultado. De los 16 que conocemos el resultado, 12 (1,6 %) fueron diagnosticados de diabetes o prediabetes. Conclusiones: los resultados de este estudio piloto dejan entrever la utilidad de la farmacia comunitaria como agente con un papel importante en el cribado de DM2 al detectar el presente trabajo casi un 20 % de usuarios con un riesgo elevado de padecer la enfermedad.
Background:
The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure.
Methods:
Patients with acute heart failure from 41 ...Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor.
Results:
Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02–3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56–0.94) and hypertension (OR 0.34; 95% CI 0.21–0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors.
Conclusions:
Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient’s gender and age. They can be managed with specific treatments and can sometimes be prevented.
Background
Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High‐sensitive troponin T (hs‐TnT) has been used as a tool to stratify prognosis in many scales but ...always as a qualitative and not as a quantitative variable.
Objectives
The main objective of this study was to determine the best hs‐TnT cut‐off for prediction of 30‐day all‐cause mortality.
Methods
The EAHFE registry, a prospective follow‐up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs‐TnT cut‐off point previously determined by receiver operating characteristic (ROC) curve analysis.
Results
Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs‐TnT determination was available. The area under the ROC curve for 30‐day all‐cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut‐off of hs‐TnT of 35 ng/L. The sensitivity and specificity of this cut‐off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut‐off of 35 ng/L for hs‐TnT. In the analysis of the population obtained with the propensity score, patients with hs‐TnT > 35 ng/L showed a greater 30‐day all‐cause mortality, with a HR of 2.95 (CI95% 1.83‐4.75; P < .001). External validation reported similar results.
Conclusions
An hs‐TnT value of 35 ng/L is an adequate cut‐off to evaluate the prediction of 30‐day all‐cause mortality with a NPV of 95.3%.
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