Jose Luis Clua Espuny - Academia.edu (original) (raw)

Papers by Jose Luis Clua Espuny

Biomedicines

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with an in... more Background: Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with an increased risk of major adverse cardiovascular events (MACE). The main goal was to analyze the links and associations between AF and MACE. Methods: A multicenter, observational, retrospective, community-based study of a cohort (n = 40,297) of the general population aged 65–95 years between 1 January 2015 and 31 December 2021 without a previous diagnosis of AF or MACE in the Primary Care setting. Results: 2574 people (6.39%) developed a first AF event, resulting in an overall incidence of 8.9/1000 people-years [CI95% 8.6–9.2]. The incidence of MACE among those with AF was 75.1/1000 people-years [CI95% 70.8–79.5], whereas among those without AF, it was 20.6/1000 people-years [CI 95% 20.2–21.1], resulting in a rate ratio of 3.65 [CI 95% 3.43–3.88, p < 0.001]. Besides, the incidence of HF with AF was 40.1 people-years [CI 95% 37.1–43.2], while in the group without AF, it was 8.3 people-year...

Biomedicines

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Background: Demographic aging is a generalised event and the proportion of older adults is increa... more Background: Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods: This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with s...

European Journal of Clinical Investigation, 2018

Background: The impact of atrial fibrillation (AF) on mortality of patients with heart failure (H... more Background: The impact of atrial fibrillation (AF) on mortality of patients with heart failure (HF) has been established. Nevertheless, the effect of some factors in mortality, such as digoxin or diuretic use, remains controversial. This study aims at assessing mortality in community-dwelling patients with stable HF related to AF and determine the relation of these drugs with prognosis. Materials and methods: Community-based cohort study of HF patients diagnosed between January 2010 and December 2014, attended at any one of the 279 primary healthcare centers of the Catalan Institute of Health (Spain). Follow up ended at 31st December 2015 and the main outcome was mortality for all causes. The effect of clinical and demographic characteristics on survival was assessed by Cox proportional hazards model. Results: 13,334 HF patients were included. Mean age was 78.7 years (SD 10.1) and 36.8% had AF. Mean follow up was 26.9 months (SD 14.0). At the end of the study 25.8% patients had died, and mortality was higher when AF was present (28.8% versus 24.1%, p<0.001, respectively). Multivariate model confirmed the higher risk of death for AF patients (HR 1.10 95%, CI 1.02 to 1.19). Digoxin and diuretics were not associated with higher mortality in AF patients (HR 1.04 95% CI 0.92 to 1.18 and HR 1.04 95% CI 0.85 to 1.26, respectively).

Vaccines

In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organiza... more In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organization (WHO) declared the Global Strategy Goal for 2030, advocating for reaching a vaccination coverage rate of >90% against human papillomavirus for girls by the age of 15 years. The main objectives of this study were (1) to determine the papillomavirus vaccination coverage among women 15–40 years old and (2) to identify the at-risk subgroups and possible barriers to achieving WHO’s 2030 goal. Multicentre, observational, retrospective, and community-based cohort studies were conducted on women from a rural area in southern Catalonia until 31 December 2021. A total of 23,136 women were included, with a mean age of 26.6 (SD = 5.6) years. The average dose number was 1.7 (SD = 0.7). The results showed overall vaccination coverage of 17.4% among the target women. This coverage was unequal across regions (16.6–24.5%, p < 0.001), primary healthcare teams (15.5–24.3%, p < 0.001), and age...

International Journal of Environmental Research and Public Health, 2021

Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients... more Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients. The main objective of this study was to identify modifiable risk factors of intracerebral haemorrhage. Methods: Multicentre, retrospective, community-based cohort study was conducted, including patients in the Adjusted Morbidity Group 4 with no history of intracerebral haemorrhage. Cases were obtained from electronic clinical records of the Catalan Institute of Health and were followed up for five years. The primary outcome was the occurrence of intracerebral haemorrhage during the study period. Demographic, clinical and pharmacological variables were included. Logistic regression analyses were carried out to detect prognostic variables for intracerebral haemorrhage. Results: 4686 subjects were included; 170 (3.6%) suffered an intracerebral haemorrhage (85.8/10,000 person–year [95% CI 85.4 to 86.2]). The HAS-BLED score for intracerebral haemorrhage risk detection obtained the best AUC ...

Revista Española de Cardiología (English Edition), 2013

Introduction and objectives: Atrial fibrillation constitutes a serious public health problem beca... more Introduction and objectives: Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. Methods: A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA 2 DS 2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. Results: The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA 2 DS 2-VASc!2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score!3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA 2 DS 2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. Conclusions: The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants.

Revista Española de Cardiología, 2013

Introduccio´n y objetivos: La fibrilació n auricular significa un grave problema de salud pú blic... more Introduccio´n y objetivos: La fibrilació n auricular significa un grave problema de salud pú blica por sus complicaciones, por lo que su manejo debería incluir no só lo su tratamiento, sino tambié n la prevenció n de las complicaciones tromboembó licas. El objetivo principal es conocer las proporciones de la fibrilació n auricular desconocida y la no tratada con anticoagulantes. Me´todos: Estudio observacional, transversal, retrospectivo, de base poblacional y multicé ntrico. Se seleccionó aleatoriamente a 1.043 sujetos mayores de 60 añ os para realizarles un electrocardiograma en visita concertada. Se registraron variables sociodemográ ficas, valores en las escalas CHA 2 DS 2-VASc y HAS-BLED, razó n internacional normalizada y motivos de no recibir tratamiento anticoagulante oral. Resultados: La prevalencia total de fibrilació n auricular fue del 10,9% (intervalo de confianza del 95%, 9,1-12,8%), de la que el 20,1% era desconocida. De la fibrilació n auricular conocida, el 23,5% con un valor de CHA 2 DS 2-VASc ! 2 no recibía tratamiento anticoagulante y el 47,9% tenía un valor HAS-BLED ! 3. La odds ratio de no recibir tratamiento anticoagulante fue 2,04 (intervalo de confianza del 95%, 1,11-3,77) para las mujeres, 1,10 (intervalo de confianza del 95%, 1,05-1,15) para la mayor edad de diagnó stico y 8,61 (intervalo de confianza del 95%, 2,38-31,0) si el valor de CHA 2 DS 2-VASc es < 2. El deterioro cognitivo (15,2%) fue el motivo principal de no recibir tratamiento anticoagulante. Conclusiones: El 20,1% de las fibrilaciones auriculares de pacientes mayores de 60 añ os son desconocidas previamente y no se trata con anticoagulantes al 23,5% del total.

International Journal of Pharmaceutical Sciences and Developmental Research, 2018

Compare long-term survival by sex after reperfusion therapies with simultaneous medical therapy o... more Compare long-term survival by sex after reperfusion therapies with simultaneous medical therapy of cardiovascular conditions. Methods: AIS patients identifi ed from the population-based register between 01Jan2011 and 31Dec2012 and classifi ed into: 1) AIS + intravenous thrombolysis [group I], 2) AIS + mechanical thrombectomy with or without intravenous thrombolysis [group II], and 3) AIS + medical therapy alone (no reperfusion therapies) [group III]. Follow-up went through up until December 2016. Statistical approaches were employed for analyzing survival outcomes and their relationship with reperfusion therapy. Results: 14,368 AIS patients (men 50.1%), 77.1±11.0 years-old. There was higher survival among those treated with intravenous thrombolysis (p <0.001); women treated with thrombectomy (p <0.001); and women <80 year-old without reperfusion therapy. The most common medications were antiplatelets (52.8%), associated with lower survival (p<0.001); and statins (46.5%), associated with higher survival. The regression model produced the following independent outcome variables associated to mortality: anticoagulant HR 1.53 (CI95% 1.44-1.63, p<0.001), diuretics HR 1.71 (CI95% 1.63-1.79, p<0.001), antiplatelet HR 1.49 (CI95% 1.42-1.56, p<0.001), statins HR 0.73 (CI95% 0.70-0.77, p<0.001), A-IIRA HR 0.93 (CI95% 0.89-0.98, p=0.008) and reperfusion therapy HR 0.88 (CI95% 0.81-0.97, p=0.009). Conclusions: Under 80 year-old the women had a better outcome than men when treated with thrombolysis therapy and/or catheter-based thrombectomy and with medical therapy alone. The men had a better outcome when received intravenous thrombolysis. The chronic cardiovascular pharmacotherapy must be evaluated to determine their effects on the reperfusion therapy outcome and whether they should be included as factors in the decision to reperfusion. Long-term survival after Acute Ischemic Stroke by types of reperfusion therapy, sex and chronic treatments of cardiovascular conditions. Long-term Survival differences after reperfusion therapy.

PLOS ONE

Background and objective AFRICAT is a prospective cohort study intending to develop an atrial fib... more Background and objective AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring. Methods 359 subjects aged 65–75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (NuuboTM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagno...

Circulation, 2022

Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive... more Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atheroscler...

Article full text The article associated with this page h... more Article full text The article associated with this page has been accepted for online publication and is in the final stages of production. The link to the full text will be made available on this page in the next few days. The article associated with this page has been accepted for online publication and is in the final stages of production. The link to the full text will be made available on this page in the next few days. In the meantime, a pre-typeset version of the article is attached. This is not the final publication and may be subject to some minor changes. Provide enhanced digital features for this article If you are an author of this publication and would like to provide additional enhanced digital features for your article then please contact adisrapidplus@springer.com. The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as 'peer reviewed' to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content. Other enhanced features include, but are not limited to: • Slide decks • Videos and animations • Audio abstracts • Audio slides

Journal of Clinical and Experimental Research in Cardiology, 2017

Background: In developed countries, around 3-5% of the people could be identified as chronic comp... more Background: In developed countries, around 3-5% of the people could be identified as chronic complex patients, and they are increasingly at risk of atrial fibrillation (AF) and cognitive impairment. The main objective of this study was to present the current findings on the association between AF and cognitive impairment and mortality risk among chronic complex outpatients (CCP). Methods: A multicenter and prospective cohort study of mortality incidence was carried out from 1 January 2013 to 30 September 2016 in a sample of 932 adult patients registered as CCP. To predict hazard ratios, mean survival time, and survival probabilities, a multivariate Cox regression was used. Results: The overall mortality among the CCP with AF was 40.9% (CI95% 35.4-46.4) and 56.9% if associated with cognitive impairment (p 0.001). The long-term survival was not different between the groups of CCP with AF and without AF (p 0.463). In the survival analyses, the outcome-independent factors were Pfeiffer score (HR 1.07 CI95% 1.005-1.146, p 0.036), Barthel score (HR 0.99 CI95% 0.98-0.99, p 0.019), Charlson index (HR 1.17 CI95% 1.03-1.33, p 0.015), and heart failure (HR 1.91 CI95% 1.33-2.74, p <0.001). Cognitive impairment was found to increase the mortality by twofold (relative risk: 1.69; CI95%: 1.31-2.17). The results showed higher stroke incidence but fewer and poor quality (c-TTR <60%) treatment with oral anticoagulants among those with cognitive impairment and a Barthel score <60 (p < 0.001). Conclusion: Persons with AF should be investigated for the presence of cognitive impairment and heart failure. A nurse-led, multidisciplinary home-based intervention-using an AF algorithm-should be able to demonstrate favourable effects in patients with AF by the use of an integrated approach specifically directed to AF.

Vascular Health and Risk Management, 2020

Purpose To evaluate a model for calculating the risk of AF and its relationship with the incidenc... more Purpose To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. Materials and Methods It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. Results The prognostic index was o...

BMC Geriatrics, 2021

Background Demographic aging is a generalised event and the proportion of older adults is increas... more Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suf...

European Heart Journal, 2020

Background The number of individuals with atrial fibrillation (AF) and cognitive impairment (CI) ... more Background The number of individuals with atrial fibrillation (AF) and cognitive impairment (CI) will increase 150% by 2050. Purpose The main objective of this study is to elucidate the relationship between AF-risk, the ischemic stroke, and the cognitive dysfunction. Methods Multicenter, longitudinal and retrospective community-based study of cohort ≥65 year-old without AF between 1/1/2013–31/12/2017 conducted by 11 Primary Care teams. Variables: sociodemographic; Charlson, CHA2DS2VASc score, Pfeiffer and NIHSS scores from records database (primary care, specialty clinics and hospitalizations). Kaplan-Meier to evaluate mortality. Descriptive analysis Cox regression to create an AF risk score was developed: Q1 (lowest AF-risk)-Q4 (highest AF-risk). Incidence density (ID) rate per 1000/people/years of AF and stroke; and CI prevalence were calculated by risk stratum. Approved by Ethics Committee of IDIAP Jordi Gol PP15/047. Results 46706 (women 49%) cases, aged 78.01±11.9 and average f...

CJC Open, 2020

Background: First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus... more Background: First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Data on the extent of CVD risk-factor management in FN peoples with T2DM in Canada are scarce. Methods: A T2DM registry with data from 7 FN communities in Canada was utilized to identify individuals eligible for primary and secondary CVD prevention. Proportions of individuals meeting clinical practice guidelineespecified targets (hemoglobin A1c 7.0%; blood pressure 130/80 mm Hg; low-density lipoprotein 2 mmol/L) were CJC Open 2 (2020) 547e554

International Journal of Environmental Research and Public Health, 2020

(1) Background: The link between diabetes and hypertension is mutual and reciprocal, increasing t... more (1) Background: The link between diabetes and hypertension is mutual and reciprocal, increasing the risks for the development of atrial fibrillation (AF). The main objective was to develop a prediction model for AF in a population with both diabetes and hypertension at five years of follow-up. (2) Methods: A multicenter and community-based cohort study was undertaken of 8237 hypertensive diabetic patients without AF between 1 January 2103 and 31 December 2017. Multivariate Cox proportional-hazards regression models were used to identify predictors AF and to stratify risk scores by quartiles. (3) Results: AF incidence was 10.5/1000 people/years (95% confidence interval (CI) 9.5-11.5), higher in men. The independent prognostic factors identified: age (hazard ratio (HR) 1.07 95% CI 1.05-1.09, p < 0.001), weight (HR 1.03 95% CI 1.02-1.04, p < 0.001), CHA 2 DS 2 VASc score (HR 1.57 95% CI 1.16-2.13, p = 0.003) and female gender (HR 0.55 95% CI 0.37-0.82, p = 0.004). Q4 (highest-risk group for AF) had the highest AF incidence, stroke and mortality, and the smallest number needed to screen to detect one case of AF. (4) Conclusions: Risk-based screening for AF should be used in high cardiovascular risk patients as the hypertensive diabetics, for treatment of modifiable cardiovascular risk, and monitoring AF detection.

Biomedicines

European Journal of Clinical Investigation, 2018

Vaccines

International Journal of Environmental Research and Public Health, 2021

Revista Española de Cardiología (English Edition), 2013

Revista Española de Cardiología, 2013

International Journal of Pharmaceutical Sciences and Developmental Research, 2018

PLOS ONE

Circulation, 2022

Journal of Clinical and Experimental Research in Cardiology, 2017

Vascular Health and Risk Management, 2020

BMC Geriatrics, 2021

European Heart Journal, 2020

CJC Open, 2020

International Journal of Environmental Research and Public Health, 2020