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Carmen Suárez

Publications and source records attributed to Carmen Suárez.

14 recordsLinked to original sources
PubMed2006

Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

BACKGROUND: Left ventricular hypertrophy is an important predictor of cardiovascular risk and its detection contributes to risk stratification. However, echocardiography is not a routine procedure and electrocardiography (ECG) underestimates its prevalence. OBJECTIVE: To evaluate the prevalence of echocardiographic left ventricular hypertrophy in low and medium risk non-treated hypertensive subjects, in order to find out the percentage of them who would be reclassified as high risk patients. METHODS: Cross-sectional, multicenter study was performed in hospital located hypertension units. An echocardiogram was performed in 197 previously untreated hypertensive patients, > 18 years, classified as having low (61%) or medium (39%) risk, according to the OMS/ISH classification. The presence of left ventricular hypertrophy was considered if left ventricular mass index was > or = 134 or 110 g/m(2) in men and women, respectively (Devereux criteria). A logistic regression analysis was performed to identify factors associated to left ventricular hypertrophy. RESULTS: The prevalence of left ventricular hypertrophy was 23.9% (95% CI:17.9-29.9), 25.6% in men and 22.6% in women. In the low risk group its prevalence was 20.7% and in medium risk group 29.5%. Factors associated to left ventricular hypertrophy were: years since the diagnosis of hypertension, OR:1.1 (95% CI:1.003-1.227); systolic blood pressure, OR:1.08 (95% CI:1.029-1.138); diastolic blood pressure, OR:0.9 (95% CI:0.882-0.991); and family history of cardiovascular disease, OR:4.3 (95% CI:1.52-12.18). CONCLUSIONS: These findings underline the importance of performing an echocardiogram in low and high risk untreated hypertensive patients in which treatment would otherwise be delayed for even one year.

Adult↗
PubMed2006

Association of clinic and ambulatory blood pressure with vascular damage in the elderly: the EPICARDIAN study.

OBJECTIVES: In middle-aged adults, vascular damage correlates better with ambulatory than with clinic blood pressure. This study aimed to determine whether vascular damage evaluated by carotid ultrasonography in the elderly is also more closely related to ambulatory than to clinic blood pressure, and which blood pressure variables are better associated with vascular damage. METHODS: Cross-sectional study of 292 randomly selected >65 years old participants who underwent 24-h noninvasive ambulatory blood pressure monitoring. Blood pressure variables analyzed were (a) clinic blood pressure: systolic and diastolic blood pressure, pulse pressure; (b) ambulatory blood pressure monitoring: mean values of systolic and diastolic blood pressure, systolic and diastolic blood pressure load, pulse pressure, as well as variability, evaluated within 24 h, diurnal and nocturnal periods; and day-night blood pressure difference. A clinical history, physical examination, carotid ultrasonography and laboratory tests were performed. To estimate the relationship between blood pressure and vascular damage, univariate and multivariate analyses were performed. RESULTS: Mean age: 73+/-6 years, 45% men, 76.7% hypertensive patients. In the simple regression analysis, the best significant correlations (P<0.05) were common carotid intima-media thickness with 24-h and nocturnal pulse pressure (r=0.32), and common carotid diameter with 24-h systolic blood pressure load (r=0.47). In the multivariate analysis, the significant associations (P<0.05) were (a) linear regression: nocturnal pulse pressure with common carotid intima-media thickness, and diurnal pulse pressure as well as 24-h systolic blood pressure load with common carotid diameter; (b) logistic regression, adjusted odds ratio: nocturnal pulse pressure and nocturnal diastolic blood pressure load with the presence of carotid atherosclerotic plaques 1.03 and 0.98, respectively. CONCLUSIONS: In the elderly, ambulatory blood pressure monitoring is better associated with carotid damage than clinic blood pressure. Systolic blood pressure variables are the best associated, blood pressure load and pulse pressure being better associated with carotid damage than the mean levels of ambulatory blood pressure.

Aged↗
PubMed2006

Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE).

BACKGROUND AND OBJECTIVES: Elderly patients with venous thromboembolism (VTE) have an increased rate of bleeding complications on therapeutic doses of anticoagulant therapy. DESIGN AND METHODS: Using data in RIETE, an international registry of consecutive patients with objectively confirmed, symptomatic acute VTE, we analyzed the clinical characteristics and outcome within 90 days of therapy of all enrolled patients aged > or = 80 years old. RESULTS: Of the 13,011 patients with VTE enrolled in RIETE up tp September 2005, 2890 (22%) were aged > or = 80 years old. During the study period 99 patients (3.4%) aged > or = 80 years, and 212 aged < 80 years (2.1%) had major bleeding events (odds ratio: 1.7; 95% CI: 1.3-2.1). Fatal bleeding occurred in 0.8% and 0.4%, respectively (odds ratio: 2.0; 95% CI: 1.2-3.4). The incidence of recurrent VTE was 2.1% and 2.8%. However, 3.7% of patients > or = 80 years and 1.1% < 80 years died of pulmonary embolism (PE) (odds ratio: 3.6; 95% CI: 2.7-4.7). On multivariate analysis, patients > or = 80 years with symptomatic PE, heart failure, long-term therapy with low-molecular-weight heparin (LMWH) or a vena cava filter had an increased risk of recurrent VTE. Those with recent bleeding, abnormal renal function, use of corticosteroids or long-term therapy with LMWH had an increased risk of major bleeding. INTERPRETATION AND CONCLUSIONS: In patients aged > or = 80 years old the 3.4% incidence of major bleeding exceeded the 2.1% incidence of VTE recurrences. However, the 3.7% incidence of fatal PE outweighed the 0.8% of fatal bleeding. Thus, there seems to be more reason to be concerned about fatal PE than about bleeding in elderly patients with VTE.

Aged, 80 and over↗
PubMed2005

[PREVENCAT study: control of cardiovascular risk in primary care].

BACKGROUND AND OBJECTIVE: Most studies of cardiovascular risk factors (CVRF) conducted in our environment concentrate in a single CVRF. The PREVENCAT study was designed to estimate the control of CVRF in the population attended in primary care presenting arterial hypertension (HT), type 2 diabetes mellitus (DM2) and/or hypercholesterolemia (HC) as well as to assess the prevalence of Metabolic Syndrome in these patients. PATIENTS AND METHOD: Multicenter, cross-sectional study, in patients with HT, DM2 and/or HC, consecutively recruited by primary care physicians in Spain. The blood pressure, cholesterol, basal glycaemia, obesity, smoking and physical activity were assessed. The degree of control of these CVRF and the prevalence of MS were estimated. RESULTS: 2,649 patients were recruited, aged 64 (11.3) years, with a 51.6% of women. The most frequent diagnosis was HT (78.9%), followed by HC (58.4%) and DM2 (37.4%). In the whole sample, the percentages of patients who had a control or had initially normal values of blood pressure, cholesterol and basal glycemia were 40.0% (confidence interval [CI], 95% 38.2-41.9), 42.6% (95% CI, 40.5-44.7) and 62.7% (95% CI, 60.8-64.5), respectively. 15.6% of cases (95% CI, 14.3-17.0) had body mass index < or = 25 kg/m2; 87.5% were non-current smokers (95% CI, 86.2-88.8); and 46.2% practiced regular physical activity (95% CI, 44.3-48.1). 40% of patients had < or = 2 CVRF in good control. The prevalence of metabolic syndrome was 50.6% (95% CI, 48.7-52.5). CONCLUSIONS: The control of the CVRF considered in primary care attended population is insufficient. Hardly one of each 2 patients with HT, DM2 and HC is under control. The overweight and sedentarism control is still poorer.

Adult↗
PubMed2004

[Venous thromboembolism in patients with neurosurgical process or stroke. A prospective analysis from the RIETE registry].

BACKGROUND AND OBJECTIVE: We studied the characteristics of thromboembolic disease in patients who have suffered a deep venous thrombosis or a pulmonary thromboembolism with the occurrence, two months before, of a neurosurgical process or a stroke. PATIENTS AND METHOD: We analyzed the variables of 57 patients who underwent a neurosurgical operation and those of 86 patients who suffered a stroke. These variables were included in the Computerised Records of Thromboembolic Disease. RESULTS: The average age was of 62.3 (1.9) for neurosurgical and 71.7 (1.5) for stroke patients (p < 0.001). Prophylaxis was previously applied to 31.6% of neurosurgical patients and to 37.2% of patients in the stroke group. Most patients were treated with low molecular weight heparin during the acute phase of the illness. In both groups, 50% of deaths was associated with thromboembolic disease. The proportion of deceases was related to the associated disease and it was significantly higher in the stroke group (18% versus 4.2% in the neurosurgical group, p = 0.028). CONCLUSIONS: In our study, thromboembolic disease was responsible of 50% of deaths. Stroke patients make up a group with a bad prognosis due to their older age and higher frequency of associated pathology; they have a higher risk of death.

Aged↗
PubMed2004

Rapid D-dimer test combined a clinical model for deep vein thrombosis. Validation with ultrasonography and clinical follow-up in 383 patients.

An optimal approach to the diagnosis of deep vein thrombosis (DVT) in lower limbs in the emergency department is still unknown. In this prospective cohort study, we aimed to evaluate the accuracy of the widely available plasma D-dimer test (VIDAS) and establish the usefulness of combining D-dimer testing with a clinical model to reduce the need for serial ultra-sonographies and improve the diagnostic strategy of DVT. We performed a cohort study in 383 consecutive outpatients referred to the emergency department of Hospital La Princesa, with clinical suspicion of DVT. The patients were stratified into three pre-test probability categories using an explicit clinical model (Wells score), and underwent a quantitative automated ELISA D-dimer assay (VIDAS D-Dimer bioMérieux). Patients were managed according to the diagnostic strategy based on clinical probability and compression ultrasonography (CU). Patients for whom DVT was considered a high pre-test probability with negative ultrasonographic findings in the initial CU, returned the following week for repeat ultrasonography. All patients with DVT excluded did not receive anticoagulant therapy, and were followed up for three months to monitor the development of venous thromboembolic complications. DVT was confirmed in 102 patients (26.6%): 95 in the initial test, four in the second test, and three who developed venous thromboembolic complications in the three-month follow-up period. The calculated D-dimer cut-off level was 1 micro g/ml. One hundred patients (98%) with DVT had positive D-dimer. D-dimer had a sensitivity of 98% and a negative predictive value of 98.6%. Among the high-probability patients with positive D-dimer tests and initial negative CU, 9.75% had DVT on repeat CU at one week. The study results suggest that the addition of VIDAS D-dimer to this diagnostic algorithm could improve the management of patients with suspected DVT in daily practice. A diagnostic approach of DVT based on D-dimer (cut-off > or =1 microg/ml) as the first diagnostic tool for the exclusion of DVT, and the clinical probability model as the tool that identifies those patients requiring a second ultrasonography is useful and suitable for daily medical practice.

Aged↗
PubMed2003

The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients.

OBJECTIVE: To obtain a realistic overview of management and clinical outcomes of patients with venous thromboembolism (VTE) in Spain on the basis of data from a national multicenter registry. METHODS: A prospective registry was initiated in Spain in March 2001. Data were collected from patients with objectively confirmed deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and entered into the online registry by physicians who were responsible for the management of these patients. RESULTS: As of August 2002, 4011 patients with confirmed VTE were included in the registry: 60% with DVT, 23% with PE, and 17% with both DVT and PE. Diagnostic methods for VTE included compression ultrasonography (86%), venography (10%), V/Q lung scans (42%), computed tomography scan (28%), and pulmonary angiography (0.9%). D-dimer testing was performed in 61% of cases and was positive in 92% of patients with confirmed VTE. The majority of DVT (95%) were located in the lower extremities (82% proximal and 4% bilateral), while 4.8% were located in the upper extremities or neck veins. Most patients (90.5%) were admitted to hospital. In the acute phase, treatment consisted of low molecular weight heparin (LMWH) in 88%, unfractionated heparin (UFH) in 11%, and fibrinolysis in 0.8%. Cava filters were inserted in 2% of patients, mainly because of active bleeding (13%), increased hemorrhagic risk (38%), or recurrent VTE (29%). Absolute bed rest was recommended to 63% of patients. Secondary prevention of VTE included oral anticoagulants (75%) and LMWH (24.5%). Therapeutic compression stockings were prescribed to 53% of patients at the time of hospital discharge. Regarding the main clinical outcomes during an average (+/-SD) follow-up period of 156 +/- 95 days, 19% had adverse events: 12.5% of patients died, 5.5% had clinically confirmed VTE recurrence, and 9.8% suffered bleeding complications (44% with major bleeding). CONCLUSIONS: This prospective observational multicenter registry provides a large database reflecting the actual day-to-day clinical practice regarding VTE management in a European country. The most important findings were the increasing use of spiral computed tomography for PE diagnosis, the unexpectedly high proportion of patients admitted to hospital despite the use of LMWH in almost 90% of cases in the acute phase, and the utilization of LMWH for secondary prevention in almost 25% of cases. On the other hand, this large-scale prospective registry permits on-line consultation of high-risk situations to assess how difficult cases were treated and what their outcomes were. This will provide a most useful tool for the practicing physician responsible for the management of VTE patients.

Acute Disease↗
PubMed2003

Ambulatory blood pressure monitoring: is the daytime period enough for making clinical decisions?

AIM: To assess the agreement between the clinical information provided by the ambulatory daytime average and 24 h average blood pressure value for diagnosing hypertension and assessing the effects of antihypertensive treatment. METHODS: We analysed 261 24 h ambulatory monitoring records (SpaceLabs 90207, SpaceLabs, Redmond, Washington, USA) obtained from hypertensives over 18 years of age (mean age 55.8 years) in order to make a diagnosis of hypertension or assess its control in response to treatment. Recording was programmed to occur every 20 min during waking periods and every 30 min during sleep, daily activity also being registered. The criteria compared in the diagnosis of hypertension were: (1) the evaluation criterion: an average blood pressure for the activity period of less than 135/85 mmHg (Joint National Committee VI); (2) the gold standard: an average blood pressure over 24 h of less than 125/80 mmHg (World Health Organization-International Society of Hypertension, 1999). RESULTS: In 90% of the records, there was agreement between both criteria. In 7.2%, the awake blood pressure average was normal and the 24 h average high. Values obtained were: sensitivity, 89% (95% confidence interval 84-89%); specificity, 92% (95% CI 88-95%); positive predictive value, 95.6% (95% CI 93-98%); negative predictive value, 81% (95% CI 75-85%); pretest probability, 66% (95% CI 60-72%); positive likelihood ratio, 11; and negative likelihood ratio, 0.3. There were no significant differences in age, gender or percentage of treated subjects between the groups with and without agreement. CONCLUSIONS: Daytime and 24 h average blood pressure may indeed carry similar information for diagnosing hypertension and assessing the effects of antihypertensive treatment in clinical practice. Ambulatory blood pressure monitoring used only during the daytime period could be better tolerated and agreed to by patients than 24 h monitoring.

Adult↗
PubMed2002

[Deep venous thrombosis of lower extremities in an Emergency Department. Utility of a clinical diagnosis model].

BACKGROUND: Deep vein thrombosis (DVT) is a difficult to diagnostic disease. The aim of this study was to determine the utility and accuracy of a risk stratification questionnaire and a diagnostic strategy, which were applied to patients with suspected DVT on lower extremities in an emergency department. PATIENTS AND METHOD: A prospective cohort study was performed in 569 outpatients with clinical suspected DVT during 14 months. The applied questionnaire stratified patients into three pre-test probability categories. Items included signs, symptoms, risk factors and potential alternative diagnosis, which were based on a modified Wells clinical model. DVT was diagnosed by the combined use of clinical model, compression ultrasonography (CUS) and follow-up CUS one week later in those moderate-high risk patients with an initial normal test. These patients were followed over three months for the development of venous thromboembolic complications. RESULTS: Two hundred three (35.7%) patients were classified as having a low, 186 (32.7%) moderate and 180 (31.6%) high clinical probability. Overall, DVT was diagnosed in 153 patients (26%; CI95%, 23.2-30.7%): 144 (96%) at the initial CUS, 6 (3.5%) at the second testing and 3 over the 3-month follow-up period. 22 patients had a low pretest probability (11%; CI95%, 7-16%), 43 (23%; CI95%, 17-30%) moderate, and 88 (49%; CI95%, 41-56%) high pretest probability. The difference in the prevalence of DVP among risk categories was significant (p < 0.00001). When the high and moderate groups were joined, the model had a 86% sensitivity, a 90% negative predictive value and a 43% specificity for diagnosis of DVT. CONCLUSIONS: The clinical model used in this study is accurate and feasible, though it is not enough to take clinical decisions. The diagnostic strategic used is effective but not efficient.

Adolescent↗
PubMed2002

Deep vein thrombosis: can a second sonographic examination be avoided?

OBJECTIVE: Our objective was to determine the prevalence of deep vein thrombosis in symptomatic patients and its distribution based on the assessment of prior clinical probability. We evaluated whether repeated sonography is necessary in patients with either intermediate or high clinical probability for deep vein thrombosis after an initial examination with negative findings. SUBJECTS AND METHODS: We prospectively evaluated 438 consecutive patients with clinical suggestion of deep vein thrombosis of the lower limbs, classified according to the prior clinical probability (high, intermediate, low). Sonography with positive findings was diagnostic for deep vein thrombosis. Negative findings in low-risk patients excluded thrombosis. Patients with intermediate or high clinical risk whose initial sonographic examination showed negative findings underwent a second examination after 1 week. RESULTS: Of the 438 patients with clinical symptoms, 112 patients (26%) had positive findings on sonography, and 326 (74%) had negative findings. Of the 202 intermediate- and high-risk patients with negative initial sonography, 140 patients underwent a single follow-up sonographic examination 1 week later. In three cases, findings were positive for deep vein thrombosis. Two other patients developed pulmonary embolism. Sonographic follow-up increased the detection of deep vein thrombosis in the patients with intermediate or high probability from 32.5% to 33.5%; the prevalence of thromboembolic disease in this group was 34%. CONCLUSION: The prevalence of deep vein thrombosis studied by sonography in the patients with intermediate or high clinical risk was 33.5%. Initial sonography revealed a 32.5% prevalence, and a second examination 1 week later detected an additional 1%. Sonography did not reveal 0.5% of thromboembolic events. Our results do not justify a routine second scanning at 1 week.

Adolescent↗
PubMedDate not supplied

Clinical validity of negative helical computed tomography for clinical suspicion of pulmonary embolism.

BACKGROUND: Helical computed tomography has been introduced for the diagnosis of pulmonary embolism. OBJECTIVE: To determine the clinical safety of withholding anticoagulant treatment in patients with suspicion of pulmonary embolism and negative helical computed tomography study. METHODS: During a 9-month period, we performed a prospective study including 209 consecutive patients who underwent helical computed tomography for clinical suspicion of pulmonary embolism. In 53 patients (25.5%), helical computed tomography was diagnostic for pulmonary embolism, and in 24 patients (11.5%) it was indeterminate. In 132 patients (63%), the examination was negative for pulmonary embolism and no anticoagulation treatment was given. A clinical 3-month follow-up was carried out. During this period, 29 patients (22%) were excluded because anticoagulation therapy was initiated for other reasons, or because other diagnostic techniques were performed for pulmonary embolism. Four patients were lost in the 3-month period. In the end, 99 patients (75%) were included in the clinical follow-up. RESULTS: Out of the 99 patients, 9 (9%) died during the 9-month follow-up, the cause of death in each case was not due to thromboembolic venous disease. No venous thromboembolic events were detected in the other 90 patients. Negative predictive value of helical computed tomography for pulmonary embolism was 99.09% (95% CI, 95.03-99.97%). CONCLUSIONS: In patients with clinical suspicion of pulmonary embolism and initial negative helical computed tomography from whom anticoagulants are withheld, no thromboembolic disease was detected in a 3-month follow-up. We consider helical computed tomography an effective method for ruling out pulmonary embolism as well as a front-line tool for diagnosis.

Age Distribution↗
PubMedDate not supplied

Management of patients with acute venous thromboembolism: findings from the RIETE registry.

Guidelines for the treatment of venous thromboembolism (VTE) are mainly based on randomized controlled trials, but a number of patients with VTE are excluded from trials due to co-morbidities (i.e., recent bleeding, renal insufficiency, thrombocytopenia, abnormal prothrombin time or pregnancy). Thus, treatment regimens derived from clinical studies may not be suitable for all patient groups. RIETE (Registro Informatizado de la EnfermedadTromboEmbólica) is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute VTE. We compared the clinical outcome during the first 3 months of therapy of VTE patients with at least one of the mentioned co-morbidities with that in patients without them. Of 6855 patients enrolled up to February 2004, 1635 (24%) had at least one reason to be excluded from clinical trials: recent bleeding (2.6%); renal insufficiency (13.6%); thrombocytopenia (2.5%); abnormal prothrombin time (9.1%) and pregnancy (0.7%). During the 3-month follow-up period the rates of fatal pulmonary embolism (odds ratio: 3.3; 95% CI: 2.5-5.2); minor bleeding (odds ratio: 1.8; 95% CI: 1.3-2.2); major bleeding (odds ratio: 3.1; 95% CI: 2.3-4.1) and fatal bleeding (odds ratio: 4.1; 95% CI: 2.1-8.0) were significantly higher in patients with at least one of these co-morbidities than in the remaining 5220 patients. The clinical outcome was significantly worse inpatients with either recent bleeding, renal insufficiency, thrombocytopenia, abnormal prothrombin time, or pregnancy. The expanding RIETE database of "real-world"outcomes may lead to improved treatment of VTE, especially for those patients not usually included in randomized clinical trials.

Acute Disease↗
PubMedDate not supplied

[Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention].

We are pleased to present the European Guidelines on Cardiovascular Disease Prevention, translated and adapted by the Interdisciplinary Spanish Committee for Cardiovascular Disease Prevention. This guide is focused on the prevention of cardiovascular disease as a whole, recommending the SCORE model for risk assessment and placing priority on the care of patients and high-risk individuals. The objective is to prevent premature death due to CVD by means of dealing with its related risk factors in clinical practice. Hence, a maintained professional intervention is required in order to obtain an increase of physical activity and of healthy diets in patients high-risk individuals, and smoking cessation in smokers. The decision to start blood pressure treatment will depend upon the BP values, cardiovascular risk and possible damage to target organs. The treatment goal is to achieve BP < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, a past history of ictus, coronary heart disease or heart failure, lower levels must be pursued. Serum cholesterol must be below 200 mg/dl and LDL cholesterol below 130 mg/dl, although among patients with CVD or diabetes, levels respectively below 175 mg/dl and 100 mg/dl must be pursued. Advice of a professional dietitian is always required in order to keep blood sugar levels controlled. Proper insulin therapy is required in Type I diabetes. Patients with Type II diabetes and those with metabolic syndrome must lose weight and increase their physical activity.,dngus beiln aiministered wherever applicable. Lastly, an appendix is included providing diet recommendations adapted to our environment and criteria related to referral or seeing a specialist for hypertensive or dyslipemic patients.

Cardiovascular Diseases↗