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[Abstract] Introduction and objectives. Atrial fibrillation is associated with substantial morbidity and mortality and both its incidence and prevalence are high. Nevertheless, comprehensive data on this condition in Spain are lacking. The aim of this study was to estimate the prevalence of atrial fibrillation in Spain. Methods. A cross-sectional study was conducted in the general Spanish population older than 40 years. Two-stage random sampling was used, in which first-stage units were primary care physicians randomly selected in every Spanish province and second-stage units were 20 randomly selected persons drawn from each participating physician's assigned population. The reported prevalence was standardized for the age and sex distribution of the Spanish population. The electrocardiogram recordings were read centrally. Results. Overall, 8343 individuals were evaluated. The mean age was 59.2 years (95% confidence interval, 58.6-59.8 years), and 52.4% of the participants were female. The overall age-adjusted prevalence of atrial fibrillation was 4.4% (95% confidence interval, 3.8-5.1). Prevalence was similar in both sexes, men 4.4% (3.6-5.2) and women 4.5% (3.6-5.3), rising with increasing age older than 60 years. In patients older than 80 years, the prevalence was 17.7% (14.1-21.3). In 10% of patients an unknown atrial fibrillation was diagnosed. Conclusions. The prevalence of atrial fibrillation in the general Spanish population older than 40 years is high, at 4.4%. The prevalence is similar in both sexes and rises steeply above 60 years of age. It is estimated that there are over 1 million patients with atrial fibrillation in the Spanish population, of whom over 90 000 are undiagnosed. [Resumen] Introducción y objetivos. La fibrilación auricular se asocia con elevadas morbilidad y mortalidad, y tanto su incidencia como su prevalencia son altas. No obstante, hay escasos datos poblacionales sobre su epidemiología en España. El objetivo de este estudio es estimar la prevalencia de fibrilación auricular en España. Métodos. Estudio transversal en población española de 40 o más años. Se realizó un muestreo en dos etapas, una primera selección aleatoria de médicos de atención primaria de cada provincia española y, en segundo lugar, se seleccionó aleatoriamente a 20 individuos de la población asignada a cada médico participante. La prevalencia se ponderó por edad, sexo y área geográfica. Se realizó una lectura centralizada de los registros electrocardiográficos. Resultados. Se evaluó a 8.343 personas (media de edad, 59,2 [intervalo de confianza del 95%, 58,6-59,8] años; el 52,4% mujeres). La prevalencia total de fibrilación auricular fue del 4,4% (intervalo de confianza del 95%, 3,8-5,1). La prevalencia fue similar en varones (4,4% [3,6-5,2]) y mujeres (4,5% [3,6-5,3]) y se incrementa progresivamente a partir de los 60 años de edad. En los mayores de 80 años, la prevalencia fue del 17,7% (14,1-21,3). En un 10% de pacientes se diagnosticó una fibrilación auricular no conocida. Conclusiones. La prevalencia de fibrilación auricular en la población general española mayor de 40 años es elevada, del 4,4%. La prevalencia es similar en varones y mujeres y se incrementa escalonadamente a partir de los 60 años. Se estima en más de 1 millón de pacientes con fibrilación auricular en la población española, de los que más de 90.000 están sin diagnosticar.

Background: The successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs. Methods. A cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire. Results: More than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations. Conclusions: Most PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools. © 2013 Brotons et al.; licensee BioMed Central Ltd.

In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems.Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems.Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles.Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management.

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 BP140/90 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.