Factores relacionados con la aparición de fibrilación auricular, insuficiencia cardíaca, y su pronóstico en Cataluña.

Abstract

This thesis describes: _x000D_ 1. Incidence and mortality in patients with heart failure, as well as the use of resources in primary care after diagnosis. Period between 2010 and 2014. It was a retrospective observational cohort study. The registered patients were those who had a new diagnosis of heart failure in the study period. The information was obtained from the electronic medical records of people >=18 years of age treated at any of the 279 ICS centers (5,165,778 individuals). A total of 64,441 patients with a new diagnosis of heart failure were registered. Mortality occurred in 16,305 (25.3%) patients. It was observed that the incidence of heart failure increased with age, was higher in men and remained stable over time. Mortality remains high in newly diagnosed patients despite current improvements in treatment; and, home visits represent the highest cost for the management of this disease in the primary care setting._x000D_ _x000D_ 2. The development of a scale in diabetic hypertensive patients to determine the group with the maximum risk of suffering from Atrial Fibrillation to classify them and facilitate predicting its appearance. Two cohorts were analyzed, in the period 2013 to 2017. One for derivation with patients over 50 years of age suffering from hypertension and diabetes in 52 primary care centers in Barcelona and another cohort with the same characteristics to carry out the validation, which was obtained from 11 centers of primary care in Tierras del Ebro. Risk factors that were associated with this arrhythmia were identified using a multivariable Cox model. The predictive model described factors related to atrial fibrillation as age, overweight, number of antihypertensive medications, valvular disease, heart failure, male gender, stroke, thromboembolism, peripheral vascular disease, and to myocardial infarction. The predictive model carried out allows hypertensive diabetic patients to be classified into risk categories for suffering from atrial fibrillation._x000D_ _x000D_ 3. Mortality in patients suffering from atrial fibrillation and heart failure, together with their prognosis in relation to digoxin and diuretics. A retrospective cohort of patients with heart failure diagnosed between January 2010 and December 2014 from the 279 primary care centers of the Catalan Institute of Health was analyzed. The effect of clinical and demographic characteristics on survival was assessed using a Cox proportional hazards model. 13,334 patients with heart failure were included, and 36.8% had atrial fibrillation. At the end of the study, 25.8% of patients died, and mortality was higher when arrhythmia was present (28.8% vs 24.1%, respectively). Therefore, excess mortality was found in patients with heart failure and atrial fibrillation in a large community cohort, greater than when patients suffered from heart failure alone. Digoxin and diuretics did not affect the prognosis of patients with these two concomitant conditions.

Date of Award	21 May 2024
Original language	Spanish
Supervisor	Miguel Angel Muñoz Perez (Director), Josep Lluís Clua Espuny (Director) & Alejandro Bustamante Rangel (Director)