Papers by Francesc Formiga
Revista Clínica Española, 2010
Revista Española de Salud Pública, 2007
En respuesta a la carta «Desacuerdos diagnósticos entre médicos generales y psiquiatras» de Arago... more En respuesta a la carta «Desacuerdos diagnósticos entre médicos generales y psiquiatras» de Aragonès sobre nuestro artículo «Concordancia en el diagnóstico entre atención primaria y salud mental» 1 , querríamos realizar algunas consideraciones. En su carta, Aragonès cuestiona el hecho de diferenciar como trastornos independientes cuadros que en el pasado se situaban en un área común (las neurosis); sin embargo, debemos considerar que fue precisamente la inespecificidad y la imprecisión de dicho término lo que llevó a su abandono y a sustituirlo por nuevas categorías diagnósticas que, aunque presentan importantes limitaciones, suponen una ventaja, ya que aportan criterios diagnósticos sistematizados. No obstante, admitimos, y así constaba en la «Discusión» como una de las limitaciones de la investigación, que tanto las imperfecciones del sistema de clasificación como la diferente perspectiva adoptada por el especialista o por el profesional de atención primaria (AP) explican, en parte, la falta de concordancia. Así, se mencionaba: «por otro lado, contribuyen factores inherentes al sistema de clasificación como la escasa clarificación de los criterios diagnósticos, de tal forma que el diagnóstico diferencial puede basarse en una cuestión de grado o de número de síntomas. En este sentido, hay
The Journal of Nutrition Health and Aging, 2008
Delirium, a mental disorder that becomes established over a few hours or days, is characterised b... more Delirium, a mental disorder that becomes established over a few hours or days, is characterised by fluctuating attention and cognitive states. This article reviews the disorder, which has all the features of an important geriatric syndrome: it appears mainly in persons older than 65 years of age, is closely linked with very prevalent diseases and complications arising in the elderly, and is the mode of presentation of many other diseases in this age group. We discuss diagnostic, clinical preventive and therapeutic aspects and analyse the most common risk and precipitating factors in our hospitalised patients from the viewpoint of clinical practice. Finally, we propose a scheme for the prevention and treatment of delirium.
Quality of Life Research, 2015
The proportion of very old people is rising, and so, describing their health-related quality of l... more The proportion of very old people is rising, and so, describing their health-related quality of life (HRQoL) is an important point of interest. The aim of this study was to analyse the predictive factors on HRQoL throughout a 3-year follow-up period, in a community-based cohort of octogenarian people. From 290 subjects aged 85 and over, sociodemographic and geriatric data, including levels of frailty phenotype assessment, and HRQoL using the EuroQol 5D3L (EQ-5D) instrument were collected. A longitudinal analysis was performed by generalized estimating equations (jointly testing the bivariate effect of variables and its time dependence) and regression mixed models to evaluate the adjusted effect of variables on HRQoL after a 3-year follow-up. In the EQ-5D baseline assessment, the average visual analogue self-rating scale value was 63.82 (SD ± 19.45), the EQ-5D index was 0.67 (0.34) and the most significant issues were pain/discomfort (61.2 %), depression (45.3 %) and mobility (44.6 %). The third year index was 0.55 (0.38). Independent predictive factors of a lower HRQoL identified by the regression mixed models were female gender (marginal effect ME = -0.101; p = 0.003), being pre-frail (ME = -0.142; p = 0.011) or frail (ME = -0.071; p = 0.030), having heart failure (ME = -0.081; p = 0.037) and having a high social risk score (ME = -0.020; p = 0.015). In contrast, higher functional status (ME = 0.050; p < 0.001) and nutritional score (ME = 0.013; p = 0.011) appeared to be predictive factors of an enhanced HRQoL. The adjusted effect of "time of follow-up" had no statistical significance. Frail individuals at baseline have a significant lower HRQoL, whereas a higher functional status and nutritional status are independent predicting factors of an enhanced HRQoL after 3 years of follow-up. These findings may encourage clinicians in order to asses HRQoL.
People aged 85 years old and older constitute a growing population group. Falls and malnutrition ... more People aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly. To determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old. The OCTABAIX study is a randomized controlled clinical trial lasting 3 years in primary care in Costa de Ponent (seven primary care teams). Community-dwelling elders born in 1924 who agreed to participate in the study have been included. Three in-home visits will be made annually by a trained nurse or physician and will be complemented by two biannual analytical studies. Participants will be followed-up for hospitalizations, falls and weight using a monthly calendar. The specifically-designed algorithm to detect risk factors for falls and malnutrition will be used to provide recommendations and specific, standardized interventions for risk reduction in a randomly selected intervention group. Two face-to-face interventions will be carried out and telephone calls will be made to reinforce adherence. The control group will follow routine primary care recommendations. The primary outcome is a decline in the rate of falls and malnutrition. The OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included. The OCTABAIX study will help to determine the characteristics of persons aged 85 years old as well as the rate of falls and nutritional risk. The effectiveness of the measures adopted to reduce these geriatric syndromes will also be assessed.
Medicina clínica, Jan 21, 2014
Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic dis... more Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.
Atención Primaria, 2011
Anciano de 80 o más años; Anciano frágil; Personas con discapacidad; Cognición; Comorbilidad Resu... more Anciano de 80 o más años; Anciano frágil; Personas con discapacidad; Cognición; Comorbilidad Resumen Objetivo: Evaluar diferencias del estado de salud según género de personas de 85 años en la comunidad. Diseño: Estudio descriptivo transversal multicéntrico, en el marco de ensayo clínico aleatorio de caídas y malnutrición. Emplazamiento: Siete centros de Atención Primaria. Participantes: personas de 85 años no institucionalizadas. Metodología: Se recogieron datos sociodemográficos, factores de riesgo cardiovascular, índice Barthel (IB), miniexamen cognitivo Lobo (MEC); caídas, estado nutricional con Mini-Nutritional Assessment (MNA), comorbilidad según índice Charlson, riesgo social según Escala Gijón, calidad de vida mediante Escala Visual Analógica (EQ-EVA) de salud percibida y fármacos. Resultados: De 328 habitantes, 61,6% eran mujeres, 53% viudos y un tercio vivían solos. Se recogieron antecedentes de hipertensión arterial 76%, dislipemia 51,2% y diabetes mellitus 17,4%. La mediana IB fue 95 (rango: 0-100), del MEC 28 (0-35), índice Charlson 1 (0-7), MNA 25 (10-30), Escala de Gijón 10 (5-21), y del EQ-EVA 60 (0-100); la media fármacos 6,1 ± 3,3. Las mujeres vivían solas más frecuentemente (p < 0,001), presentaron más caídas (p < 0,006), mayor riesgo nutricional (p < 0,016) y riesgo social (p < 0,001); existían más hombres casados (p < 0,001), con mejor cognición (p < 0,003) y funcionalidad (p < 0,018), y mayor comorbilidad (p < 0,001).
The journal of nutrition, health & aging, 2010
Prospective cohort study. Setting: A community-based study. Participants: Nonagenarians enrolled ... more Prospective cohort study. Setting: A community-based study. Participants: Nonagenarians enrolled in the NonaSantfeliu study. Measurements: Functional status was determined by the Lawton-Brody and Barthel indexes (BI), while cognition was assessed using the Spanish version of the Mini-Mental State Examination (MEC). Nonagenarians scoring up to 59 points on the BI were defined as individuals with significant functional impairment. Nonagenarians with cognitive decline were defined as those individuals with a score of 23 or less on the MEC. Subjects scoring <60 on the BI and <24 on the MEC were considered to show combined impairment (both functional and cognitive). Results: Sixty-three of 71 (88.8%) subjects with a BI <60 and 73 of 84 (86.9%) with a MEC score <24 had died after five years. Forty-eight of 53 nonagenarians (90%) with combined impairment died during the same follow-up period. A prior diagnosis of heart failure was the only variable associated with higher mortality in the three groups of subjects. Conclusion: Most of the nonagenarian subjects with functional and/or cognitive impairment at baseline had died at five-year follow-up
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2019
OBJECTIVES Information on criteria for admitting elderly patients with acute coronary syndrome (A... more OBJECTIVES Information on criteria for admitting elderly patients with acute coronary syndrome (ACS) to intensive care units (ICUs) is scarce. We aimed to describe factors associated with ICU admission in unselected older patients with ACS in Spain. MATERIAL AND METHODS The prospective LONGEVO-SCA registry (Impact of Frailty and Other Geriatric Syndromes on the Management of and Mortality in Elderly Patients With Non-ST-segment Elevation Acute Coronary Syndrome) included unselected patients over the age of 80 years with non-ST-segment elevation SCA. A geriatric assessment of each patient was done in the hospital. Clinical outcomes at 6 months were analyzed. Bivariate logistic regression analysis was applied to identify ICU admission criteria. RESULTS Of 508 patients with a mean age of 84.3 years, 150 (29.5%) were admitted to the ICU. The admitted patients were younger and more often had acute heart failure, elevated troponin levels, and poor left ventricular function. They also scor...
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2011
ObjectivesTo analyse the prescription according to the STOPP (Screening Tool of Older Person'... more ObjectivesTo analyse the prescription according to the STOPP (Screening Tool of Older Person's Prescriptions) and Beer's suitability criteria, and associated factors in patients over 85 years-old.
Journal of Nutrition Health & Aging, 2011
Objectives To calculate the prevalence of hypovitaminosis D in subjects aged 85 years old and to... more Objectives To calculate the prevalence of hypovitaminosis D in subjects aged 85 years old and to study the relationship between some common geriatric evaluation scales and vitamin D status. Design Prospective cohort study. Setting A community-based study. Participants 312 subjects aged 85 years old. Measurements Geriatric assessment was based on comorbidity, functional status according to the Barthel Index (BI) and Lawton Index (LI), cognitive status
Revista espanola de cardiologia (English ed.), Jan 27, 2018
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reser... more Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frail...
Revista espanola de geriatria y gerontologia
In the current context of increased life expectancy and progressive aging of the population a ver... more In the current context of increased life expectancy and progressive aging of the population a very significant increase in the number of people with cognitive impairment and dementia is expected. Consequently, Spain will face an enormous social and health problem in the next decades. The Mapa de la enfermedad de Alzheimer y otras demencias en España project aims to analyse plans, prevention and early diagnosis activities, process of care and resources available across the 17 Spanish regions for the management of cognitive impairment and dementia in order to identify improvement areas, as well as to provide a list of recommendations. The working group consisted of an Advisory Committee of 5 national experts and a Committee of Experts from each region made up of professionals in the field of Neurology, Geriatrics, Psychiatry, and Primary Care, as well as representatives of Family Associations of People with Alzheimer's and other dementias. The Expert Committee of each region held ...
Aging clinical and experimental research, Jan 17, 2018
Renal insufficiency is associated with medical complications in patients with non-valvular atrial... more Renal insufficiency is associated with medical complications in patients with non-valvular atrial fibrillation (NVAF). However, data for elderly patients are scarce. Thus, the main objectives of the present study were to analyze the characteristics of elderly patients with NVAF and acute or chronic renal disease, describe their management in real-life conditions, and detect factors associated with complications. The NONAVASC registry includes patients > 75 years with NVAF, hospitalized by any cause in 64 Spanish Internal Medicine departments. Patients were categorized into acute kidney injury (AKI), chronic kidney disease (CKD) or preserved renal function (PRF). All variables associated with in-hospital mortality with P < 0.10 in univariate analysis were included to develop a multivariate logistic-regression model. The study included 804 patients (53.9% women), 352 (43.8%) of whom met diagnostic criteria for CKD. AKI was detected in 119 (14.8%) patients. AKI was associated wit...
European journal of internal medicine, Oct 20, 2018
The association between chronic kidney disease (CKD) and functional status may change as a functi... more The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes. We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed. We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longi...
Revista espanola de cardiologia (English ed.), Jan 18, 2018
International journal of cardiology, Jan 18, 2018
Thrombosis research, Jan 22, 2018
Ticagrelor and prasugrel are recommended as first line therapy in patients with acute coronary sy... more Ticagrelor and prasugrel are recommended as first line therapy in patients with acute coronary syndromes (ACS). However, patients with anemia are commonly treated with clopidogrel in routine clinical practice. The RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction) included ACS patients treated with prasugrel or ticagrelor at hospital discharge. The aim of this study was to analyze the prevalence of anemia and characteristics and outcomes of these patients according to anemia status. Consecutive patients with ACS from 11 centers were included. All patients underwent percutaneous coronary intervention (PCI). Anemia was defined as hemoglobin <130 g/L in men and <120 g/L in women. The incidence of ischemic and bleeding events and all-cause mortality were assessed at one year. From 4424 patients included, 405 (9.2%) fulfilled criteria of anemia. Patients with anemia were significantly older, had a higher prevalence of peripheral arte...
Journal of electrocardiology, Jan 18, 2018
Thrombosis and haemostasis, Jan 3, 2018
A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported ... more A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine-Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and th...
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Papers by Francesc Formiga