papers

Influence of morbidity, metabolic control, and use of resources in subjects with cardiovascular risk in the primary care setting

Aten Primaria 40:447-454. Published in Spanish.

Dirección de Planificación y Desarrollo Organizativo. Badalona Serveis Assistencials S.A. Badalona. Barcelona. España

OBJECTIVE: To determine the comorbidity, the therapeutic objectives, and economic impact in subjects with cardiovascular risk in primary care (PC).

DESIGN: Multicentre, cross-sectional study.

SETTING: Five urban PC centres, Spain.

PARTICIPANTS: Patients over 55 years seen during the year 2006. Compared according to the presence/absence of a cardiovascular event (CVE).

MEASUREMENTS: Demographics, cardiovascular/general comorbidity (adjusted clinical groups), Charlson index, clinical parameters, multiple drugs and semi-fixed direct costs (operational) and variables (tests, referrals, drugs). A logistical regression and ANCOVA analysis was performed to correct the models. SPSSWIN Program (P< .05).

RESULTS: Of 24 410 patients, 15.4% (CI, 14.9-15.9) had a CVE. The subjects with a CVE showed a higher mortality (4.0% vs 1.8%) and general morbidity (8.1 vs 6.4 episodes) (P .001). The CVE had an independent association in males (OR=2.7), Charlson index (OR=2.1), dyslipaemia (OR=1.5), depression (OR=1.4), age (OR=1.3), arterial hypertension (O=1.2) and diabetes (OR=1.1) (P .005). In primary prevention worse average cholesterols were obtained (211.6 vs 192.4 mg/dL), while in secondary prevention blood glucose was worse (111.3 vs 104.2 mg/dL; P< .001). The average correctd direct costs were euro1543.55 versus euro1027.65, respectively (P .001). These differences were maintained in all the cost components.

CONCLUSIONS: The presence of a CVE is associated with higher comorbidity, causing an increase in costs. The achievement of therapeutic control objectives could be improved, in primary prevention as well as in secondary. Intervention strategies should be increased to modify life styles in these patients.

PMID: 19054440