Abstract
Objetivo
Conocer cuántos diabéticos deberían recibir tratamiento antiagregante según las recomendaciones que desde 2001 hace la American Diabetes Association (ADA), cuántos episodios cardiovasculares podrían evitarse con 100 mg diarios de ácido acetilsalicílico (AAS) y cuál sería el coste por episodio evitado con esta medida.
Diseño
Estudio multicéntrico descriptivo transversal.
Emplazamiento
Atención primaria: 8 consultas de 5 zonas básicas de salud (3 rurales, una semiurbana, 4 urbanas) del área de León.
Participantes
Pacientes diabéticos de 14 o más años diagnosticados con los criterios de la ADA de 1997.
Mediciones principales
Auditoría de historias clínicas en la que se recogieron los siguientes datos: edad y sexo, presencia de aquellos criterios a los que hace referencia la ADA para antiagregación, existencia de enfermedad cardiovascular (ECV) establecida y tratamiento antiagregante que reciben los pacientes.
Resultados
Un total de 544 pacientes diabéticos (97,2%; IC del 95%, 95,8-98,6) cumplen criterios de antiagregación.
Un total de 101 pacientes tienen una ECV establecida (18,6%; IC del 95%, 15,3-21,9); reciben antiagregantes el 77,2% (IC del 95%, 73,7-80,7).
Un total de 428 pacientes no presentan ECV y sí criterios de antiagregación (78,7%; IC del 95%, 75,3-82,1); el 9,3% (IC del 95%, 6,9-11,7) recibe tratamiento.
Conclusiones
Escaso seguimiento de las recomendaciones de antiagregación de la ADA, fundamentalmente en prevención primaria.
Tratando a nuestros diabéticos con 100 mg/día de AAS se evitarían 7,64 episodios cardiovasculares en 5 años (IC del 95%, 5,56-9,72).
El coste por episodio cardiovascular evitado es de 6.625,37 € (IC del 95%, 4.821,60-8.429,14 €).
Palabras clave: Diabetes, Antiagregantes, Eficiencia, Atención primaria
Abstract
Objectives
To find how many diabetics should receive anti-aggregant treatment according to the recommendations made since 2001 by the American Diabetes Association (ADA), how many cardiovascular events could be avoided by 100 mg daily of acetylsalicylic acid (ASA), and the cost per event avoided by this measure.
Design
Transversal, descriptive, multi-centre study.
Setting
Primary care. 8 clinics in 5 health districts (3 rural, 1 semi-urban, 4 urban) in the León area.
Participants
Diabetics aged 14 or over diagnosed through the ADA criteria since 1997.
Main measurements
Audit of clinical records, collecting age and sex, the presence of the criteria of the ADA for anti-aggregation, the existence of established cardiovascular disease (CVD) and the anti-aggregant treatment patients receive.
Results
544 diabetics. 97.2% (95% CI, 95.8%-98.6%) comply with anti-aggregation criteria. 101 had established CVD (18.6%; CI, 15.3%-21.9%); 77.2% received antiaggregants (CI, 73.7%-80.7%). 428 had no CVD and did have antiaggregation criteria (78.7%; CI, 75.3%- 82.1%); 9.3% (CI, 6.9%-11.7%) received treatment.
Conclusions
There was basically little followup of the ADA anti-aggregation recommendations in primary prevention.
Treatment of our diabetics with 100 mg/day of ASA would avoid 7.64 cardiovascular events in five years (CI, 5.56-9.72). The cost per cardiovascular event avoided was 6,625.37 euros (CI, 4821.60-8429.14 euros).
Key words: Diabetes, Anti-aggregants, Efficiency, Primary care
Footnotes
Premio Mejor Comunicación PAPPS-SCLMFyC. II Congreso de Atención Primaria de Castilla y León (Segovia, abril de 2002).
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