Abstract
Objetivo
Analizar el proceso asistencial de los pacientes ingresados con el diagnóstico de insuficiencia cardíaca (IC) y posteriormente durante el seguimiento en la atención primaria.
Diseño
Estudio prospectivo de un año y medio de seguimiento.
Emplazamiento
Hospital terciario y centros de atención primaria del área de referencia.
Participantes
Pacientes diagnosticados de IC al alta hospitalaria desde el 1 de julio hasta el 31 de diciembre de 1998.
Mediciones principales
Datos farmacológicos al alta y al final del seguimiento, morbimortalidad al final del seguimiento, capacidad funcional de los supervivientes. Resultados. Se incluyó a 265 pacientes. La edad media de los mismos era de 75 años, el 57% eran mujeres, el 73,9% ingresó por IC, el 6,1% por infarto agudo de miocardio (IAM) y el 20% por otros motivos. El factor causal más frecuente fue la hipertensión arterial. Los fármacos más utilizados tanto al alta hospitalaria como en el seguimiento fueron los diuréticos, seguidos de los inhibidores de la enzima conversiva de la angiotensina (IECA). La mortalidad hospitalaria fue del 6,4%, y a los 18 meses de seguimiento, de un 46% (en un 77% de éstos de causa cardíaca). Tras el alta hospitalaria el 38,5% de los pacientes reingresó por IC, el 72% se visitaba por el médico de familia, el 43% en consultas externas del hospital y el 33% por el cardiólogo; un 76% caminaba regularmente y el 25% hacía actividades recreacionales y ejercicio físico.
Conclusiones
La población atendida por IC es una población envejecida, con alta comorbilidad y un mal pronóstico, que precisa una cantidad destacable de recursos sanitarios. La prescripción farmacológica en el seguimiento es subóptima. La población superviviente disfruta de una aceptable capacidad funcional.
Palabras clave: Insuficiencia cardíaca, Pronóstico, Atención sanitaria, Atención primaria
Abstract
Objective
To assess the process of care and prognosis of patients with heart failure (HF) attended in a tertiary hospital and follow up at the primary care level.
Design
Prospective study of 18 months of follow up.
Setting
Tertiary hospital and primary care centers of the reference area.
Participants
Patients admitted to a tertiary hospital from the first of july until de 31 of december of 1998.
Outcome measurements
Pharmacological data and morbimortality at discharge and at the end of the follow-up, functional capacity of survivors.
Results
265 patients were included, with a mean age of 75 years, 57% were females, 73.8% had HF as first diagnosis, 6.1% had MI, and 20% were attended for other medical reasons. The most frequent cause of HF was HTA. Drugs more prescribed at the discharge and follow up were diuretics and ACE inhibitors. Hospital mortality was 6.4% and mortality at the end of the follow-up was 46% (in 77% of those for cardiac reasons). After being discharged 38.5% of the patients were readmitted to the hospital with the diagnosis of HF, 72% were visited by the family physician, 43% at the outpatient clinic and 33% by the cardiologist; 60% of the patients who survived were in I-II NYHA functional class, 76% walked regularly, and 25% did recreational activities and physical exercise.
Conclusions
Patients attended at the hospital with HF are an old population, have frequently associated other chronic diseases, and have a very bad prognosis. These patients spend an important amount of health resources. Drug prescription at the follow up is suboptimum. Patients who survived have an acceptable functional capacity.
Key words: Heart failure, Prognosis, Process of care, Primary care
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