scholarly journals Comorbidities of Primary Care patients with COVID-19 during the first wave of the SARS-CoV-2 pandemic in the Community of Madrid

2021 ◽  
Author(s):  
José-Luis Puerta ◽  
Macarena Torrego-Ellacuría ◽  
Ángel Del Rey-Mejías ◽  
César Biénzobas López
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
High Blood Pressure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Group 2 ◽  
Group 1

Objectives. Recent publications on inpatients with COVID-19 describing their comorbidities and demographic profile exists, but data from large populations requiring only primary care (PC) are scarce. This paper aims to fill this gap and report the prevalence of eight comorbidities (high blood pressure, diabetes mellitus, cancer, cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and chronic heart failure) among patients attending PC during the onset of the SARS-CoV-2 pandemic in the Community of Madrid (CoM), Spain. Patients and methods. This is an observational retrospective study that collects data registered in the CoM between February 25th and May 31st, 2020. Data are divided in two groups: Group-1 (N=339,890) consist of all patients with suspected or proven SARS-CoV-2 infection; and Group-2 is the subgroup (N=48,556, 14.3% of Group-1) of individuals with COVID-19 confirmed by positive RT-PCR test. Results. Comparing Group-1 with Group-2, 339,890/48,556 patients, respectively, the main results were as follows: average age (60.9/69.9 years), presence of at least one comorbidity (33.51%/47.69%), high blood pressure (19.74%/32.74%), diabetes mellitus (7.13%/13.75%), cancer (6.56%/10.6%), cardiovascular disease (4.52%/9.26%), asthma (7.98%/6.56%), chronic kidney disease (1.84%/4.41%), chronic obstructive pulmonary disease (2%/4.03%), and chronic heart failure (1.14%/2.77%). High blood pressure and diabetes mellitus were seen to be the most frequent (6.56%/8.38%) association. Conclusions. Patients requiring PC attention during the first wave of the COVID-19 pandemic in the CoM presented with a very high rate of comorbidities, with marked differences among those with or without a confirmed SARS-CoV-2 infection.

scholarly journals Increased adherence to the treatment of comorbid patients with arterial hypertension and chronic obstructive pulmonary disease on the background of complex therapy

2021 ◽  
pp. 18-25
Author(s):  
I. G. Menshikova ◽  
E. V. Magalyas ◽  
I. V. Sklyar ◽  
N. V. Loskutova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Antihypertensive Drugs ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Complex Therapy ◽  
Group 2 ◽  
Group 1

Aim. To determine the adherence to treatment of patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) against the background of complex therapy.Materials and methods. We examined 56 patients with stage II hypertension in combination with COPD. Men accounted for 70%, women – 30%. The average age of patients is 52.9±0.46 years. The patients were prescribed a fixed combination of antihypertensive drugs – telmisartan 40 mg with amlodipine 5 mg and COPD therapy according to GOLD. Patients of group 1 (n=30) studied at a health school against the background of drug treatment, patients in group 2 (n=26) did not attend a health school.Results. After 6 months of treatment, the number of patients in group 1 increased (p=0.001) regularly taking antihypertensive drugs, 96.7% of patients began to independently control blood pressure and keep a diary of a patient with hypertension. Patients of group 2 showed a statistically significant increase in the level of awareness of the presence of the disease and the awareness of patients about the risk factors for the development of the disease (p=0.01), although the number of patients controlling blood pressure remained low (p=0.1). In group 1, there was a positive trend in terms of the main risk factors, in group 2 the frequency of the prevalence of risk factors practically did not change. By the 6th month of therapy, all patients in group 1 achieved the target blood pressure, in group 2 – in 73.1% of patients. By the end of the observation, in patients of group 1, against the background of the chosen treatment tactics, there was a significantly more significant decrease in left ventricular mass index (LVMI) with its normalization in 33.3% of patients, indicating regression of LV hypertrophy (p=0.01), as well as a significant increase in the ratio of peak velocities on the mitral valve (E/A), (p=0.01), indicating an improvement in LV diastolic function. In group 2, antihypertensive therapy showed a moderate decrease in LVMI (p=0.1) with normalization of this indicator in only 2 (7.7%) of patients. By the 6th month of treatment, an improvement in the parameters of bronchial patency was revealed, however, in the 2nd group of patients, the changes in these parameters were statistically insignificant.Conclusion. The effectiveness of the treatment of hypertension and COPD depends not only on the choice of the optimal treatment tactics, but also on the patient's compliance with the prescribed therapy regimen. The results obtained indicate a positive effect of the chosen complex treatment regimen on the functional parameters of the left ventricle and bronchial patency. 

scholarly journals Diagnosis of chronic heart failure in patients with chronic obstructive pulmonary disease

2019 ◽  
Vol 100 (3) ◽  
pp. 530-536
Author(s):  
V I Koliev ◽  
I E Sarapulova ◽  
L V Ryabova
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Linear Dimensions ◽  
The Right ◽  
Group 1

Aim. To identify methods for diagnosing early signs of heart failure in patients with chronic obstructive pulmonary disease. Methods. We examined 54 patients with chronic obstructive pulmonary disease without exacerbation. Patients were divided into two groups: group 1 - 26 patients with chronic obstructive pulmonary disease in combination with chronic heart failure; group 2 - 28 patients with chronic obstructive pulmonary disease without chronic heart failure. The groups were comparable by age and severity of chronic obstructive pulmonary disease. Electrocardiography, echocardiography were performed with additional determination of the right heart chamber parameters, spirometry, X-ray, pulse oximetry. The level of highly sensitive C-reactive protein, blood acid-base composition and brain natriuretic peptide was evaluated. Results. Patients with comorbidity have decreased exercise tolerance according to the 6-minute walk test and mMRS scale, higher body mass index and dyspnea intensity, larger linear dimensions of the heart chambers and their volume parameters. Heart failure with preserved ejection fraction was observed in 21 (80%) of patients in group 1, therefore, the signs of heart failure can be explained by diastolic dysfunction of the right and left ventricles. Among patients with chronic obstructive pulmonary disease and chronic heart failure in our study, extended linear dimensions and structural changes in the ventricles, indicating pre- and postcapillary hypertension, were significantly more common. Conclusion. The use of tissue Doppler study allows more accurately determining the diastolic function of the right and left ventricles; the brain natriuretic peptide study is a sensitive marker of early forms of diastolic chronic heart failure.

scholarly journals Chronic obstructive pulmonary disease as a risk factor in primary care: a Canadian retrospective cohort study

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Andrew Cave ◽  
Anh Pham ◽  
Cliff Lindeman ◽  
Boglarka Soos ◽  
Tyler Williamson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Risk Factor ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Chronic Conditions ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

AbstractChronic obstructive pulmonary disease (COPD) is a complex disease that is predicted to be the third most common cause of death by 2030. In Canada, the care and management of chronic conditions is largely provided by primary care providers. Although there is emerging research and initiatives that describe the prevalence of COPD in Canadian primary care settings, to our knowledge, there have been no efforts to use a large pan-Canadian database to analyze COPD as a risk factor for other common chronic conditions managed in primary care. We report the risk of developing comorbidities after the onset of COPD, that is, the extent to which COPD is a risk factor for developing common chronic conditions (heart failure, depression, anxiety, coronary artery disease, diabetes, anemia, hypertension, ischemic heart disease, underweight, and osteoporosis). After adjusting for age, sex, urban vs rural residence, and smoking status, the relative risks for patients with COPD at baseline were significantly higher for subsequent incidence of anemia, anxiety, diabetes, depression, heart failure, ischemic heart disease, lung cancer, osteoporosis, sleep apnea, underweight, and hypertension than patients without COPD. Using a cut-point of a 200% increase in relative risk as indicative of particular clinical relevance, COPD has a statistically and clinically significant association with developing lung cancer, becoming underweight, and developing heart failure.

scholarly journals Features of the Functional Status and Cytokine Profile of Patients with Chronic Heart Failure in Combination with Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 11 (1) ◽  
pp. 9-13
Author(s):  
Roman Tokmachev ◽  
Andrey Kravchenko ◽  
Andrey Budnevsky ◽  
Evgeniy Ovsyannikov ◽  
Evgeniy Tokmachev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Functional Status ◽  
Serum Levels ◽  
Cytokine Profile ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Group 2 ◽  
Hs Crp ◽  
Group 1

The purpose of this research was to study the effect of COPD on the functional status and cytokine profile of patients with chronic heart failure (CHF) with different ejection fraction (EF). Methods and Results: The study involved 240 patients diagnosed with CHF (mean age of 72.4±8.7 years). Among them, 80 patients were diagnosed with CHF and COPD. Depending on the presence of COPD, the patients were divided into two groups: Group 1 included 160 patients with CHF without COPD; Group 2 included CHF 80 patients with COPD. According to the value of LVEF, each of the two groups was divided into two more subgroups: In Group 1, CHFpEF (EF≥50%) was recorded in 69 patients (Subgroup 1) and CHFrFV (EF<50%) in 91 patients (Subgroup 2). In Group 2, CHFpEF was observed in 36 patients (Subgroup 3) and CHFrEF in 44 patients (Subgroup 4). The 6-minute walk distance (6MWD) was measured in meters and compared with the proper 6MWD(i). All patients included in the study underwent the Borg test to assess dyspnea after 6MWT. The serum levels of NT-proBNP, hs-CRP, IL-1β, IL-6, and TNF-α were determined using an automatic analyzer IMMULITE 2000 (Siemens Diagnostics, USA) and quantitative ELISA kits. The patients with CHFpEF had higher levels of hs-CRP, pro-inflammatory cytokines than patients with CHFrEF. The combination of COPD and CHF amplifies systemic inflammation (hs-CRP, proinflammatory cytokines) and myocardial remodeling processes (NT-proBNP) in comparison with the isolated course of CHF. COPD negatively affects the functional status of patients with CHF with different EF by lower values of 6MWD, 6MWD/6MWD(i) ratio, and higher results on the Borg dyspnea test.

scholarly journals How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease?

2020 ◽  
Vol 4 (7) ◽  
pp. 418-424
Author(s):  
N.Yu. Grigorieva ◽  
◽  
M.O. Samolyuk ◽  
T.V. Sheshina ◽  
N.B. Koroleva ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lipid Peroxidation ◽  
Arterial Hypertension ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Group 2 ◽  
Azilsartan Medoxomil ◽  
Group 1

Aim: to conduct a comparative assessment of the hypotensive effect, as well as the effect on endothelial function, oxidative stress, and pulmonary artery pressure of chlorthalidone and hydrochlorothiazide as part of combined antihypertensive therapy in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).Patients and Methods: the prospective study included 66 patients divided into two groups. As the main antihypertensive therapy, group 1 was prescribed with a combination of azilsartan medoxomil 40 mg and chlortalidone 12.5 mg as a fixed combination of Edarbi® CLO. Group 2 received a free combination of azilsartan medoxomil 40 mg (Edarbi®) and hydrochlorothiazide 12.5 mg. All patients underwent 24-hour blood pressure monitoring: (ABPM), echodopplercardiography, endothelium-dependent vasodilation, lipid peroxidation (LPO), nitric oxide metabolites, and endothelin-1 levels at baseline and after 6 months of treatment. Results: target blood pressure values (<130/80 mm Hg) were achieved in 91% of patients in group 1, and 51.5% in group 2 after 1 month of the study. After 6 months of treatment, all patients in both groups reached the target BP values, but in group 2, the dose of hydrochlorothiazide had to be increased to 25 mg. According to the ABPM data, after 6 months of treatment, group 1 showed a decrease in the morning surge in SBP by 7.0±2.1% and DBP by 10±7.3%. There was also an increase in the number of patients with the daily profile of «dipper» type to 78.8%. In group 2, there was a decrease in the morning surge in SBP by 6.3±5.9% and DBP by 4.8±4.6% after 6 months of treatment. There was an increase in the number of patients with the daily profile of «dipper» type to 36.4%. After 6 months of treatment, there was more pronounced improvement in laboratory parameters of group 1 characterizing endothelial dysfunction and oxidative stress. Statistically significant results were obtained for conjugated trienes, NO2, S, Imax, and endothelin-1 when comparing groups 1 and 2.Conclusion: treatment of AH in patients with concomitant COPD in the form of a fixed combination of azilsartan medoxomil and chlorthalidone versus free combination of azilsartan medoxomil with hydrochlorothiazide has a more pronounced antihypertensive effect, positively affecting the daily BP profile, pulmonary artery pressure, endothelial function and lipid peroxidation processes after 6 months of treatment.KEYWORDS: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, lipid peroxidation, azilsartan medoxomil, chlorthalidone.FOR CITATION: Grigorieva N.Yu., Samolyuk M.O., Sheshina T.V. et al. How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease? Russian Medical Inquiry. 2020;4(7):418–424. DOI: 10.32364/2587-6821-2020-4-7-418-424.

scholarly journals “She knows me best”: a qualitative study of patient and caregiver views on the role of the primary care physician follow-up post-hospital discharge in individuals admitted with chronic obstructive pulmonary disease or congestive heart failure

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarah Griffiths ◽  
Gaibrie Stephen ◽  
Tara Kiran ◽  
Karen Okrainec
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Hospital Discharge ◽  
Care Provider ◽  
Primary Care Provider ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge. Methods A qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes. Results Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care. Conclusions Patients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.

Changes in blood pressure among patients in the Ontario Telehomecare programme: An observational longitudinal cohort study

2017 ◽  
Vol 24 (6) ◽  
pp. 420-427 ◽  
Author(s):  
Yeva Sahakyan ◽  
Lusine Abrahamyan ◽  
Nida Shahid ◽  
Alexandra Stanimirovic ◽  
Petros Pechlivanoglou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Confidence Interval ◽  
Diastolic Blood Pressure ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Uncontrolled Blood Pressure ◽  
Longitudinal Cohort

Background The objective of this study was to investigate the changes in blood pressure among patients enrolled in the Telehomecare programme in Ontario, Canada. Methods This observational study utilised a prospective longitudinal cohort design, including patients with heart failure and chronic obstructive pulmonary disease enrolled in the Ontario Telehomecare programme from July 2012 to July 2015. The outcome of interest was change in mean (biweekly) systolic and diastolic blood pressure levels over a six-month period. Patient data were extracted from the Ontario Telemedicine Network database, and analysed using generalised linear mixed model procedures. Results Overall, we analysed data for 3513 patients. Patients were on average 74.1 ± 11.4 years of age; almost half were men, 62% had heart failure, 55% chronic obstructive pulmonary disease and 29% diabetes. At baseline, the mean systolic and diastolic blood pressure levels were 130.4 ± 19.1 mmHg and 72.2 ± 12.5 mmHg for the total sample. At six months, the adjusted reduction in systolic and diastolic blood pressure values were 4.0 mmHg (95% confidence interval: −4.5 to −3.5) and 2.7 mmHg (95% confidence interval: −3.1 to −2.4), respectively. In a subgroup of 1220 patients with uncontrolled blood pressure at baseline (systolic/diastolic blood pressure of 150.7 ± 10.2 mmHg/80.2 ± 13.5 mmHg) the adjusted reduction in systolic blood pressure was 12.5 mmHg (95% confidence interval: −13.4 to −11.6) and in diastolic blood pressure was 7.1 mmHg (95% confidence interval: −7.8 to −6.5) over the six-month period. Conclusions Blood pressure levels were significantly reduced in patients enrolled in the Telehomecare programme, with changes being more pronounced in patients with uncontrolled blood pressure. The sustainability of decreased blood pressure on other clinical outcomes needs further evaluation.

scholarly journals Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland

2009 ◽  
Vol 12 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Nathaniel M. Hawkins ◽  
Pardeep S. Jhund ◽  
Colin R. Simpson ◽  
Mark C. Petrie ◽  
Michael R. MacDonald ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Care Burden ◽  
Patients With Heart Failure
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