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Biomedical subjects

A Agustí

Publications and source records attributed to A Agustí.

At least 37 records · Page 2Linked to original sources
PubMed1998

Trends of prescribing patterns for the secondary prevention of myocardial infarction over a 13-year period.

OBJECTIVE: The efficacy of beta-adrenergic blocking agents and acetylsalicylic acid in the secondary prevention of myocardial infarction has been well recognized since the beginning of the 1980s. In a previous paper, however, we reported a lower than expected use of these drugs during the period 1982 1988. In 1989 the results of this survey were presented and discussed with the prescribing physicians. In the present paper we describe the prescription patterns for the same indication and in the same centre over the following 6 years (1989-1994). We also describe the use of angiotensin-converting enzyme (ACE) inhibitors, for which efficacy in certain subgroups has been recently shown. METHODS: Random samples of patients discharged from our hospital between 1989 and 1994 with a diagnosis of acute myocardial infarction with Q-wave were studied. Information about diagnoses, other clinical variables and treatments prescribed at discharge was obtained from the hospital discharge forms. The results were compared with those obtained in the previous study. RESULTS: We studied 514 patients (80% men) with a median age of 59 years (range 31-89). The proportions of patients prescribed beta-adrenergic blocking agents and acetylsalicylic acid increased from 34% and 28%, respectively, in 1986-1988, to 62% and 75% in 1989 1991. In 1994 they had reached a steady state (63% and 71%). In addition, a continued decrease in the use of calcium channel blockers was noted, from 36% in 1986-1988 to 17% in 1994. The increase in the prescription of beta-adrenergic blocking agents was especially remarkable in the subgroups for which a larger underuse was recorded in the previous study, such as the elderly. The proportion of patients prescribed an ACE inhibitor increased from 14% in 1989-1991 to 23% in 1994. In a multivariate analysis the prescription of ACE inhibitors was associated with female gender, hypertension during admission, heart failure during admission, and previous myocardial infarction. A substantial increase in the prescription of beta-adrenergic blocking agents and acetylsalicylic acid and a decrease in the prescription of calcium channel blockers was recorded between 1982 and 1994. The prescription rate of beta-adrenergic blocking agents has increased substantially in certain subgroups where underuse had been previously recorded. Most of the changes occurred in 1989-1991, and reached a steady state in 1994. In 1994 an increase in the prescription of ACE inhibitors was also recorded.

Adrenergic beta-Antagonists↗
PubMed1997

[Utilization of thrombolytic drugs in Barcelona. Study Group on Secondary Prevention of Myocardial Infarction].

BACKGROUND: A number of clinical trials including more than 50,000 patients have shown the efficacy of thrombolytic therapy in reducing mortality associated with acute myocardial infarction (AMI). However, the results of some recently published drug utilization studies have shown that only one third of admitted patients with a diagnosis of AMI receive thrombolytic treatment. The aim of the present study was to quantify and characterize the use of thrombolytic drugs in three hospitals in Barcelona, Spain. PATIENTS AND METHODS: We collected retrospective information about some clinical variables and drug prescription of patients discharged with a diagnosis of AMI from three hospitals in Barcelona between January and June 1994. RESULTS: Three hundred and sixty-four patients (247 men, 68%) with a mean age of 68 years (SD 13) were included in the study. The median time from the beginning of clinical symptoms to hospital admission was 3 h (range 1 to 96). One hundred and two patients (28%) were prescribed thrombolytic drugs, and of these, 62%, received streptokinase. No one patient received any thrombolytic treatment before hospital admission. In a multivariate analysis the following variables were negatively associated with thrombolytic use: age over 75 years, more than three hours from the beginning of symptoms to hospital admission and an EKG with bundle-branch block, ST depression or normal. After excluding patients with limitations to thrombolytic use, 18% of all patients could be identified who did not receive any thrombolytic treatment they could have benefited from. CONCLUSIONS: Only one third of admitted patients with a diagnosis of AMI in the three study hospitals receive thrombolytic treatment. One fifth of the study population with AMI does not receive any thrombolytic therapy but could have benefited from it.

Age Factors↗
PubMed1997

From clinical trials to clinical practice: oral anticoagulation among patients with non-rheumatic, atrial fibrillation.

OBJECTIVES: The aim of the present study was to evaluate the impact of the results of clinical trials on the prophylactic treatment of non-rheumatic atrial fibrillation with oral anticoagulants. METHODS: Retrospectively, we studied a random sample of 375 patients discharged from our hospital with a diagnosis of non-rheumatic atrial fibrillation between 1991 and 1993. Information about diagnoses, other clinical variables and treatments prescribed at discharge was obtained from the hospital medical records. RESULTS: During the whole study period, 14% of patients were prescribed an oral anticoagulant agent and 17% were prescribed acetylsalicylic acid. A non-significant increase in the proportion of patients prescribed oral anticoagulant drugs, from 9% to 17%, was observed. Multivariate analysis showed that a history of stroke (OR = 5.96) and younger age were significantly associated with the prescription of oral anticoagulants. ASA prescription was strongly associated with a history of concomitant vascular disease (OR = 5.8), but not with other risk factors for stroke. Sixty-five percent of patients had one or more risk factors for stroke, did not present any contraindications to anticoagulant agents, but nevertheless were not prescribed one of these drugs. CONCLUSIONS: Anticoagulant agents and acetylsalicylic acid were largely underprescribed to patients with non-rheumatic atrial fibrillation, and oral anticoagulants were not prescribed according to the individual patients' risk of stroke.

Acenocoumarol↗
PubMed1997

Is aspirin underused in myocardial infarction?

This article reviews the relevant published literature in order to assess whether aspirin (acetylsalicylic acid; ASA) is underused in myocardial infarction (MI), taking into account: (i) the evidence of efficacy and safety from clinical trials; (ii) authoritative recommendations about its use; and (iii) published drug-utilisation studies. The use of low-dosage aspirin in the acute phase of MI, and as secondary prevention, should be recommended to all patients who do not have contraindications to the drug. This is a solid evidence-based recommendation with potential benefits that are, at least, similar to those obtained with other standard treatments. As this treatment is well tolerated and inexpensive, it is also assumed that net savings can be achieved. No conventionally used prophylactic aspirin regimen seems to be free from the risk of serious gastrointestinal toxicity. This is especially important in primary prevention, in which the benefits are small; there is, as yet, no clear evidence that aspirin is indicated for routine use in patients at low risk of occlusive vascular events. We have identified 21 published drug-utilisation studies, and the potential underuse of aspirin in MI was not properly assessed in most of them. In these studies, fairly high aspirin prescription rates were usually documented. However, it seems clear that there is room for improvement, and that a significant proportion of patients who could have benefited from aspirin did not receive it or received less well-studied and more costly drugs. The prescription rates for other drugs with proven efficacy have been lower, and the potential underuse greater, than those documented for aspirin.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Clinical trials versus clinical practice in the secondary prevention of myocardial infarction.

To examine whether the results of trials on the secondary prevention of myocardial infarction have led to a change of prescription practice, the discharge forms of a random sample of 737 patients admitted to a university hospital with a diagnosis of acute myocardial infarction (MI) with Q wave from 1982 to 1988 were examined. Information about cardiovascular and other risk factors, contraindications, and prescription of beta-adrenoceptor antagonists (beta AA), acetylsalicylic acid (ASA) and calcium channel blockers (CCB) was collected. The prescription of these drugs was analysed in relation to clinical variables and the date of patients' discharge from hospital. During the 7 years of follow-up, the prescription of beta AA increased gradually from 20% to 30-35%; the prescription of CCB was above 30% during the same period and did not change significantly with time. The prescription of ASA increased from 0% to 30-35% in the last 3 years of follow-up. Contraindications to beta AA were present in 23.2% of cases and contraindications to ASA in 14.4%. In a multivariate analysis, hypertension (odds ratio 2.29, 95% confidence interval 1.55-3.38) and the period 1986-1988 (OR 2.27, 95% CI 1.57-3.30) were associated with the prescription of beta AA, although the prescription of beta AA decreased significantly with advancing age. Other variables inversely associated with the prescription of beta AA were contraindications (OR 0.41, 95% CI 0.24-0.66) and the presence of heart failure during admission (OR 0.08, 95% CI 0.03-0.20).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1991

[A multicenter study of the breaking of the smoking habit with nicotine chewing gum in health personnel].

BACKGROUND: The health professionals have a leading role in the reduction of the smoking prevalence. Spain has one of the big rate of "per capita" tobacco consumption in the world, and the Spanish doctors have the biggest prevalence of smokers among their colleagues from the EEC countries. METHODS: The effectiveness of a stop smoking programme in health care professionals was evaluated. This programme combined group therapy, nicotine chewing gum and behavioural assistance through the evaluation of CO contained in expired breath; and it is being applied with good results between the smokers of general population in Spain. A total of 211 voluntary smokers working in Spanish six general hospitals were treated, from those 149 (71%) were physicians and nurses (PS) and 62 (29%) others professionals without sanitary responsibilities (PNA). RESULTS: At one year follow-up, 64 (30%) were not smoking, and the P.S. had a higher rate of give up than the PNA (p less than 0.05). Specifically the women of P.S. obtained a greater issue than the women of PNA (p less than 0.05). Both, nicotine chewing gum and behavioural assistance were as effective as usual in smoking cessation programme like this, in our country. CONCLUSIONS: Although the outcome is lower than the obtained with the same approaches in smokers from general population, the better results of the PS than the PNA imply a good change of attitude of them. Specially the women PS obtained a big success, and this is outstanding in this group with a great prevalence of smokers, increasing in the recent years. The subjects who give up smoking increased their corporal weight less than the observed in smokers of the general population, who also give up with this treatment.

Adult↗
PubMed1991

[Research on drug utilization in primary health care in national journals].

In order to discover the present state of research into the use of medication (UM) in primary care, articles published in the "Original Articles" sections of Medicina Clínica (MC) (Clinical Medicine) and Atención Primaria (AP) (Primary Care) between 1983 and 1990, were studied. A total of 130 articles that meet the definition of the WHO for studies into the use of Medications (SUM) were identified. The instigator and organiser of the research, the drugs included, the kind of study, the source of the data, the main variables used and the qualitative analysis made, were all studied. In conclusion we were able to point out that the characteristics of UM were met in the majority of the studies; although they are the main objective of the study in only a minority of cases. The people who undertook most of the research were those who themselves prescribed the drugs or dealt with very common pathologies. In general, the studies are only descriptive and have a poor level of assessment of the results.

Drug Utilization↗
PubMed1989

[Antibody-coated bacteria in the sputum from patients with pneumococcal pneumonia].

In the present study an immunofluorescence technique detecting antibody-coated bacteria was evaluated. It was applied to the sputum of seven patients with bacteremic pneumococcal pneumonia to assess its diagnostic usefulness. We conclude that it is a valid, quick and easy technique which permits to differentiate between bacteria contaminating the sputum from those involved in the infection. This gives, therefore, a new value to the study of sputum. In our series the duration of the disease had no influence on the results, and the three antigammaglobulins used (anti-IgG, anti-IgA and anti-IgM) yielded the same results in each sample. Thus, we feel that the local pulmonary immune response was secondary in type.

Adult↗
PubMed1986

[Determination of the distribution of ventilation-perfusion ratios: technic of elimination of multiple inert gases].

The multiple inert gas elimination technique (MIGT) facilitates the estimation of the distributions of ventilation-perfusion (VA/Q) ratios in the experimental and clinical setting. The most relevant technical aspects and equipment and operational requirements needed to measure a mixture of inert gases in both the gas phase and the blood phase using gas chromatography are overviewed with detail. Results obtained in 3 dogs and 4 syringe-homogeneous lung models were entirely consistent with data formerly reported in the literature. Particular attention is paid to the linearity of the gas chromatograph detectors, reproducibility of inert gases sampling, and analysis of brands of heparin to detect acetone content. The errors of measurement (coefficients of variation) in blood were: 1.4 for sulfur hexafluoride; 1.8% for ethane; 2% for cyclopropane and halothane, each; 2.4% for diethyl ether; and, 3.6% for acetone. Important practical points are also emphasized in order to draw attention to potential problems and issues that should be concentrated upon to minimize the error in the measurements. It is concluded that the setting up of the MIGT is well established and validated.

Animals↗