Jaime Fernández de Bobadilla

Hospital Universitario La Paz, Madrid, Madrid, Spain

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Publications (56)79.77 Total impact

  • Jaime Fernández de Bobadilla, Regina Dalmau, Enrique Galve
    Revista Espanola de Cardiologia 05/2014; 67(5):349-52. · 3.20 Impact Factor
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    ABSTRACT: Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions. Full English text available from:www.revespcardiol.org/en
    Revista Espa de Cardiologia 03/2014; · 3.20 Impact Factor
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    ABSTRACT: Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions.
    Revista Espanola de Cardiologia 03/2014; 67(3):203-10. · 3.20 Impact Factor
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    ABSTRACT: La enfermedad cardiovascular se establece de manera lenta y subclínica durante décadas, para a menudo manifestarse de modo abrupto e inesperado. El papel de la prevención, antes y después de la aparición de la clínica, es capital y existen numerosas pruebas de la eficacia y la eficiencia de las medidas dirigidas a detectar precozmente a los sujetos en riesgo y actuar mediante modificaciones en el estilo de vida o medidas farmacológicas, pero ello exige tiempo, constancia y actualización permanente. Este artículo resume las novedades de 2013 en los aspectos epidemiológicos relacionados con la prevención, incorpora relevantes contribuciones en materias como la dieta, las formas de control del peso (la obesidad ha pasado a ser considerada una enfermedad) y las recomendaciones sobre la actividad física (con advertencias sobre el riesgo del ejercicio extenuante), aborda los factores psicosociales tan relacionados con hábitos como el tabaquismo, actualiza aspectos emergentes como la genética, trata el ligamen de la enfermedad cardiovascular con otras como la renal, resume la aportación de nuevas guías que actualizan las previas (han visto la luz muy recientemente tres de ellas sobre aspectos de gran peso clínico: hipertensión, diabetes mellitus y enfermedad renal crónica) y analiza los avances farmacológicos, ciertamente no espectaculares, pero algunos, como en lípidos, prometedores, para acabar poniendo al día el siempre olvidado campo de la rehabilitación cardiaca. La lectura de esta actualización pone al día temas controvertidos, aporta novedades de interés y algunas sorprendentes, sedimenta viejos conocimientos de indudable aplicación en el ejercicio clínico y abre las puertas a aportaciones de futuro.
    Revista Española de Cardiología (English Edition). 01/2014;
  • Jaime Fernández de Bobadilla, Regina Dalmau, Enrique Galve
    Revista Espa de Cardiologia 01/2013; · 3.20 Impact Factor
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    ABSTRACT: Objectives To describe the management of patients suffering acute coronary syndrome (ACS) and to determine its clinical and economic consequences in a Spanish population.
    Revista Clinica Espanola - REV CLIN ESPAN. 12/2011;
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    ABSTRACT: To describe the management of patients suffering acute coronary syndrome (ACS) and to determine its clinical and economic consequences in a Spanish population. A multicenter, retrospective claim database study including patient medical records from 6 primary care centers, two hospitals and two years of follow-up was carried out. Patients ≥30 years, suffering a first acute coronary syndrome (ACS), between 2003 and 2007, were included. Groups: acute coronary syndrome with and without ST segment elevation. Variables: socio-demographic, co-morbidities, metabolic syndrome (MS), biochemical parameters, drugs, cumulative incidence (total mortality and cardiovascular events (CVE: including myocardial infarction, stroke and peripheral artery disease) and total costs. Statistical analysis: logistic regression, Kaplan-Meier curves and ANCOVA; (P<.05). A total of 1020 patients were included. Mean age: 69 years; males: 65%. Groups: ST segment elevation ACS (N=632; 62%). Co-morbidities: hypertension (56%), dyslipidemia (46%) and diabetes (38%). Prevalence of MS: 59% (CI 95%: 56-62%). All biochemical parameters had improved after two years of follow-up. The average total cost per patient was €14,069 (87% direct costs; 13% productivity loss costs). Direct costs: primary care (20%), specialty care (67%); hospitalization costs represented 63% of total costs. The average total cost for patients presenting more than one CVE was 22,750€ vs 12,380€ for those patients who suffered only one (P<.001). Cumulative incidence: total mortality 14%; CVE: 16%. In the current clinical practice, and despite the clinical efforts carried out, patients with an ACS are still at a high risk of suffering further CVE, representing a high cost burden to the health care system.
    Revista Clínica Española 11/2011; 211(11):560-71. · 2.01 Impact Factor
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    ABSTRACT: To evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics. Epidemiologic, cross-sectional and multicentre study. Primary Care. Every investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria. The 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events. 10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40±5.3) vs. non-smokers (1.9±2.5) (P<.0001). Risk stratification: low (< 3%) [78.0% non-smokers vs. 60.7% smokers (P<.0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers (P<.001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers (P<.001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P<.0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P=.0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P=.0507). Smoking is related to a high risk of fatal cardiovascular disease. Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality.
    Atención Primaria 03/2011; 43(11):595-603. · 0.96 Impact Factor
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    ABSTRACT: AimTo evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics.
    Atencion Primaria - ATEN PRIM. 01/2011; 43(11):595-603.
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    ABSTRACT: Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects. A retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects. A total of 11,104 were included in the analysis; 68.0+/-11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8-1.9) and 1.6 (0.9-2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8-2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3-2.4), p<0.001]. Hypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain.
    Atención Primaria 08/2010; 42(8):420-30. · 0.96 Impact Factor
  • M De Salas, J Fernández De Bobadilla, B Ferro, J Rejas
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    ABSTRACT: To carry out a Budget Impact Analysis (BIA) of the inclusion of the administration, within the Spanish National Health System (SNS), of the fixed combination (FC) of amlodipine 5 or 10mg and atorvastatin 10mg for approved indications. A BIA was carried out from the SNS perspective for a 3 year period (2009-2011). A tree type decision model was designed (tree of patients), based on epidemiological data and scientific literature, to estimate the hypertensive population that could be treated with a FC. The total per annum BIA was calculated by attributing the retail price- VAT of the FC to the number of patients to be treated, and deducting the cost of the treatment for hypertension that was replaced and the updated average cost per patient of cardiovascular events (CVEs) prevented by the use of the FC by the SNS during the period of study. The patient population susceptible to treatment with the FC was 51,104 patients (1(st) year), with a growth rate of between 1-2% over the following years, which means an annual cost (euro) of 15.9M (2009), 19.9M (2010) and 24.1M (2011), with a total of 60.0M. The BIA was compensated showing negative impact values for the SNS when the cost of replaced antihypertensive treatment and prevented CVEs was deducted, with savings of euro69.9M over 3 years. The BIA of a FC of atorvastatin and amlodipine shows that the use of this medication for approved indications could generate net savings for the SNS of euro9.9M for the period 2009-2011.
    Farmacia Hospitalaria 04/2010; 34(4):170-80.
  • J Fernandez De Bobadilla, P Garrido, E López De Sá, V Sanz-De-Burgoa
    Journal of Hypertension 01/2010; 28. · 4.22 Impact Factor
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    Marina de Salas, Jaime Fernández de Bobadilla, Belén Ferro, Javier Rejas-Gutiérrez
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    ABSTRACT: Objective To carry out a Budget Impact Analysis (BIA) of the inclusion of the administration, within the Spanish National Health System (SNS), of the fixed combination (FC) of amlodipine 5 or 10mg and atorvastatin 10mg for approved indications.
    Farmacia hospitalaria: órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria, ISSN 1130-6343, Vol. 34, Nº. 4, 2010, pags. 170-180. 01/2010;
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    ABSTRACT: Objectives Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects.
    Atencion Primaria - ATEN PRIM. 01/2010; 42(8):420-430.
  • A Sicras, J Fernández de Bobadilla, R Navarro, J Rejas
    Value in Health 10/2009; 12(7). · 2.19 Impact Factor
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    ABSTRACT: A cost-effectiveness model was developed to evaluate the efficiency of different preventive strategies in familial hypercholesterolemia (FH) in comparison with routine clinical practice (CP): atorvastatin monotherapy, 40 mg (A40) or 80 mg (A80, and atorvastatin combined with ezetimibe, 10 mg (A40+E10 or A80+E10). A longitudinal population model with a time horizon for life-expectancy was developed within the context of the Spanish public healthcare system. Life tables for the Spanish population (2002) were modified using the standardized mortality rate for individuals with FH. Effectiveness was expressed in life-years gained (LYG), after taking into account reductions for risk (ie, Framingham risk score) and cardiovascular mortality. The costs (in 2005 terms) of the intervention (CI) and care (CC) were discounted at 6%, while effects were discounted at 3%. Routine CP, based on the Spanish FH registry: 1.97 LYG per patient vs. no treatment; CI euro5321, CC euro23,389. A40: 2.59 LYG; reduction in CC compared with CP 4.5%; total costs (TC) euro30 569. A80: 2.75 LYG; reduction in CC 6.4%; TC euro30 133. A40+E10: 3.38 LYG; reduction in CC 14.3%; TC euro36 104. A80+E10: 3.62 LYG; reduction in CC 17.6%; TC euro35 317. From most to least efficient strategy, the incremental cost-effectiveness per LYG compared with CP was: a) A80: euro1821; b) A40: euro3012; c) A80+E10: euro4021, and d) A40+E10: euro5250. Preventive treatment of FH with atorvastatin was cost-effective. The greatest cost-effectiveness was obtained with atorvastatin monotherapy, 80 mg. The addition of ezetimibe could produce further benefits at an acceptable incremental cost.
    Revista Espa de Cardiologia 05/2008; 61(4):382-93. · 3.20 Impact Factor
  • Jose-Luis Pinto-Prades, Veronica Farreras, Jaime Fernandez de Bobadilla
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    ABSTRACT: In order to allocate health care resources more efficiently, it is necessary to relate health improvements provided by new medicines to their cost. It is necessary to ascertain when the additional cost of introducing a new health technology is justified by the additional health gain produced. Eplerenone is a new medicine that reduces the risk of death after myocardial infarction (MI) but produces additional cost to the health system. The contingent valuation approach can be used to measure the monetary value of this risk reduction and to estimate society's willingness to pay (WTP) for a new medicine that reduces the risk of death after MI by 2% points. We used a contingent valuation approach to evaluate WTP amongst members of the general population. We used the ex-ante and the ex-post approach. In the ex-ante approach, subjects are asked if they would accept an increase in their taxes in order to have access to eplerenone should they need it in the future. In the ex-post approach, subjects are asked if they would pay a certain amount of money as co-payment per month during 5 years if they suffered an MI. We used the dichotomous choice method, using five bids in each approach. The WTP was estimated using both single-bound and double-bound dichotomous choice (SBDC, DBDC). Extensive piloting (n = 187) preceded the final survey (n = 350). The WTP in the ex-ante case was euro 58 per year under both SBDC and DBDC. In the ex-post case, monthly WTP was euro 141 for the SBDC and euro 85 for the DBDC. Subjects with higher income and subjects with a higher perception of risk showed a higher WTP (P 0.05). Society is willing to pay an additional amount of money in order to give eplerenone to present and future patients. We estimate that euro 85 per month is a conservative estimate of the monetary value of a 2% risk reduction in mortality after MI and to spend this additional amount of money in Eplerenone can be considered an efficient policy.
    The European Journal of Health Economics 03/2008; 9(1):69-78. · 2.10 Impact Factor
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    ABSTRACT: Objetivo: Medir la morbilidad y los costes asociados al síndrome depresivo (SD) en sujetos con ictus en población atendida por equipos de atención primaria y en condiciones de práctica clínica habitual. Método: Estudio transversal de carácter retrospectivo. Se incluyeron pacientes adultos con presencia de ictus y de SD atendidos por 5 equipos de atención primaria durante el año 2006. Se formó una cohorte comparativa con el resto de pacientes sin SD. Las principales medidas fueron: edad, sexo, historial/comorbilidad, índice de Charlson, parámetros clínicos y costes totales (visitas, pruebas complementarias, derivaciones y medicamentos). Se efectuó un análisis de regresión logística y de ANCOVA para la corrección de los modelos. Resultados: El total de pacientes atendidos con ictus fue de 2.566. Un 17,7% (intervalo de confianza del 95%, 16,2-19,2%) se identificaron con SD; promedio de edad: 69,5 años (desviación estándar: 12,6); el 57,2% eran mujeres. En la corrección del modelo, el sexo femenino (odds ratio [OR]: 2,1), la obesidad (OR: 1,1) y las neuropatías (OR: 2,2) se asociaron significativamente al SD en sujetos con ictus. Los costes totales ajustados del SD fueron superiores en la mayoría de sus componentes, 2.037,55 frente a 1.498,24 �, p < 0,001. El 73,4% de los costes se derivó de los medicamentos. Conclusiones: La prevalencia del SD en sujetos con ictus es elevada, se asocia al sexo femenino y a la presencia de obesidad y neuropatías. Los costes de estos pacientes son altos y ocasionan un elevado consumo de recursos sanitarios.
    Farmacia hospitalaria: órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria, ISSN 1130-6343, Vol. 32, Nº. 6, 2008, pags. 309-314. 01/2008;
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    ABSTRACT: Introduction and objectives A cost-effectiveness model was developed to evaluate the efficiency of different preventive strategies in familial hypercholesterolemia (FH) in comparison with routine clinical practice (CP): atorvastatin monotherapy, 40 mg (A40) or 80 mg (A80), and atorvastatin combined with ezetimibe, 10 mg (A40+E10 or A80+E10). Methods A longitudinal population model with a time horizon for life-expectancy was developed within the context of the Spanish public healthcare system. Life tables for the Spanish population (2002) were modified using the standardized mortality rate for individuals with FH. Effectiveness was expressed in life-years gained (LYG), after taking into account reductions for risk (ie, Framingham risk score) and cardiovascular mortality. The costs (in 2005 terms) of the intervention (CI) and care (CC) were discounted at 6%, while effects were discounted at 3%. Results Routine CP, based on the Spanish FH registry: 1.97 LYG per patient vs. no treatment; CI €5321, CC €23,389. A40: 2.59 LYG; reduction in CC compared with CP 4.5%; total costs (TC) €30 569. A80: 2.75 LYG; reduction in CC 6.4%; TC €30 133. A40+E10: 3.38 LYG; reduction in CC 14.3%; TC €36 104. A80+E10: 3.62 LYG; reduction in CC 17.6%; TC €35 317. From most to least efficient strategy, the incremental cost-effectiveness per LYG compared with CP was: a) A80: €1821; b) A40: €3012; c) A80+E10: €4021, and d) A40+E10: €5250. Conclusions Preventive treatment of FH with atorvastatin was cost-effective. The greatest costeffectiveness was obtained with atorvastatin monotherapy, 80 mg. The addition of ezetimibe could produce further benefits at an acceptable incremental cost.
    Revista Espanola De Cardiologia - REV ESPAN CARDIOL. 01/2008; 61(4):382-393.
  • Atherosclerosis Supplements - ATHEROSCLER SUPPL. 01/2008; 9(1):250-250.

Publication Stats

36 Citations
79.77 Total Impact Points

Institutions

  • 2008–2014
    • Hospital Universitario La Paz
      • Servicio de Cardiología
      Madrid, Madrid, Spain
    • TAISS - Técnicas Avanzadas de Investigación en Servicios de Salud
      Madrid, Madrid, Spain
    • Universidad Pablo de Olavide
      Hispalis, Andalusia, Spain
  • 2008–2010
    • Badalona Serveis Assistencials
      Badalona, Catalonia, Spain