Current heart failure disease management and treatment in accredited units from Cardiology and Internal Medicine in Spain

BACKGROUND AND OBJECTIVES

Heart failure (HF) is a complex disease with high prevalence, incidence and mortality rates leading to high healthcare burden. In Spain, there are multidisciplinary HF units coordinated by Cardiology and Internal Medicine. Our objective is to describe its current organizational model and their adherence to the latest scientific recommendations.

MATERIALS AND METHODS

In late 2021, a scientific committee (with cardiology and internal medicine specialists) developed a questionnaire that was sent as an online survey to 110 H F units. 73 from cardiology (accredited by SEC-Excelente) and 37 from internal medicine, (integrated in UMIPIC program).

RESULTS

83 answers were received (75.5% total: 49 from cardiology and 34 from internal medicine). HF units are mostly integrated by specialists from cardiology, internal medicine and specialized nurse practitioners (34.9%). Patient characteristics from HF units are widely different when comparing those in cardiology to UMIPIC, being the latter older, more frequently with preserved ejection fraction and higher comorbidity burden. Most HF units (73.5%) currently use a hybrid face-to-face/virtual model to perform patient follow-up. Natriuretic peptides are the biomarkers most commonly used (90%). All four disease-modifying drug classes are mainly implemented at the same time (85%). Only 24% of HF units hold fluent communication with primary care.

CONCLUSIONS

Both models from Cardiology and Internal Medicine HF units are complementary, they include specialized nursing, they use hybrid approach for patient follow-up and they display a high adherence to the latest guideline recommendations. Coordination with primary care remains as the major improvement area.

[Diabetes mellitus in hypertensive population attended in Primary Care in Spain. Blood pressure and lipid control rates]

OBJECTIVES AND METHODS

The aim of this study was to determine the blood pressure and LDL-cholesterol (LDL-c) control rates of hypertensive patients with diabetes mellitus attended in primary care setting in Spain, and to compare the data with those of the hypertensive population without diabetes. For this purpose, we analyzed the subset of diabetic patients of those included in the PRESCOT study (a cross-sectional survey of hypertensive subjects > 18 years attended in primary care). 12,954 patients (49.9% females; 62.1 +/- 10.7 years) were included in the PRESCOT study. Good controls were considered blood pressure < 130/80 mmHg (according to European Society of Hypertension-European Society of Cardiology [ESH-ESC] guidelines) and LDL-c < 100 mg/dl (National Cholesterol Education Program-Adult Treatment Panel III [NCEP-ATP III]).

RESULTS

Overall, 3868 (29.9%) of PRESCOT patients were diabetics (mean age 64.2 +/- 9.8 years; 47.5% males). Almost all the diabetic patients (98.5%) were taking some drug besides the antidiabetic treatment and 84.9% were taking at least 2 drugs. Although diabetic patients were treated with more antihypertensive medication than those without diabetes (48.75% vs 40.85% were on > 2 drugs, p < 0.001), blood pressure control was much lower in diabetics (6.3% vs 32.7%, p < 0.0001). In the same way, LDL-c control was also lower in these patients (12.0% vs 31.9%, p < 0.0001). Only 1.0% of diabetic hypertensives were well controlled for both risk factors (vs 11.9% of non-diabetics, p < 0.0001). Predictors of bad blood pressure control were sedentarism and presence of associated clinical conditions, and for lipid control the younger age, female gender, overweight, alcoholism and non-use of lipid-lowering agents.

CONCLUSIONS

The presence of diabetes in hypertensive population attended in Spanish primary health care is frequent. One out of every three hypertensives who attend the outpatient clinic daily is diabetic. Even though more drugs are prescribed in these patients, blood pressure and LDL-c control rates are significantly lower than in patients without diabetes. In the daily practice of primary care setting, almost no diabetic hypertensive subject is well controlled for blood pressure and LDL-c.

[Blood pressure and lipid control and coronary risk in the hypertensive population attended in Primary Care setting in Spain. The PRESCOT study]

OBJECTIVES AND METHODS

The aim of this cross-sectional and multicenter study was to determine the coronary risk of hypertensive patients attended in Spanish Primary Care and to evaluate whether blood pressure and LDL-cholesterol (LDL-c) control rates could change according to the ATP-III risk groups. Good blood pressure control was considered <140/90 mmHg (<130/80 mmHg for diabetics) and LDL-c according to the established by ATP-III for every risk group.

RESULTS

A total of 12,954 patients were included in the study (49.9 % women, mean age 62.1+/-10.7 years). Of these, 12.6% belonged to the group of low risk, 45% to the medium risk group and 42.4% to the high risk group. The control rates were different according to the risk group (p <0.0001). Blood pressure control: 37.5 % in low risk, 30.2 % in medium and 15.4 % in high risk group. LDL-c control: 65.6 % in low risk group, 28 % in medium risk group and 12.3 % in high risk group. Only 25.8 % of the patients of low risk were controlled for both blood pressure and LDL-c, 9.6 % of medium risk group and 2.7 % of high risk group.

CONCLUSIONS

The majority of hypertensive patients daily attended in Primary Care setting in Spain belongs to the medium or high coronary risk groups. Blood pressure and LDL-c controls rates in hypertensive population are low, and very few patients have both risk factors controlled. The control rates decline when the risk increases. In fact, less than 3% of high-risk patients have both parameters well controlled, what may result in significant clinical implications.