Jaime Fernández de Bobadilla

Hospital Universitario La Paz, Madrid, Madrid, Spain

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Publications (67)161.82 Total impact

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    ABSTRACT: As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.
    Revista Española de Cardiología. 01/2015;
  • Jaime Fernández de Bobadilla, Regina Dalmau, Esteve Saltó
    Revista Espa de Cardiologia 12/2014; · 3.34 Impact Factor
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    Jaime Fernández de Bobadilla, Regina Dalmau, Esteve Saltó
    Revista Espanola de Cardiologia 12/2014; · 3.34 Impact Factor
  • Jaime Fernández de Bobadilla, Regina Dalmau, Enrique Galve
    Revista Espanola de Cardiologia 05/2014; 67(5):349-52. · 3.34 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; · 3.34 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. · 3.34 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;
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    ABSTRACT: Objetivos: El objetivo de este estudio es analizar el impacto presupuestario de la financiación de los tratamientos farmacológicos para ayudar a dejar de fumar por parte del Sistema Nacional de Salud en España. Métodos: Se adaptó un modelo de Markov para analizar las repercusiones sobre el presupuesto farmacéutico de distintas intervenciones para dejar de fumar. Las probabilidades del modelo fueron tomadas de la literatura y de ensayos clínicos controlados, y se utilizaron para estimar la efectividad de las opciones incluidas (vareniclina, bupropión, terapia de sustitución nicotínica y ausencia de tratamiento farmacológico). El análisis se realizó desde la perspectiva del Sistema Nacional de Salud, considerando sólo costes farmacológicos, y descontando los costes con una tasa del 3% anual. Resultados: Los resultados del análisis muestran que el coste farmacológico total de la eventual financiación de los tratamientos farmacológicos del tabaquismo en España sería de 16,0 millones de euros en el año 2008, y 31,3, 48,5, y 67,1 millones de euros para el período 2009–2011, lo que supondría entre un 0,2% y un 0,5% del gasto total farmacéutico. Conclusiones: Las terapias farmacológicas para el cese del tabaquismo son una opción eficiente y su inclusión en la financiación pública del sistema nacional de salud supondría un coste limitado y asumible en nuestro país.
    Pharmacoeconomics - Spanish Research Articles 04/2013; 5(2).
  • Jaime Fernández de Bobadilla, Regina Dalmau, Enrique Galve
    Revista Espa de Cardiologia 01/2013; · 3.34 Impact Factor
  • Jaime Fernández de Bobadilla, Mercedes García Vargas
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    ABSTRACT: Objetivo: PROVE-IT fue el primer estudio que comparó un tratamiento hipolipemiante intensivo con atorvastatina 80 mg vs. Pravastatina 40 mg tras un síndrome coronario agudo (SCA) a los dos años de seguimiento medio. Hubo significativamente menos morbimortalidad con atorvastatina 80 mg que con pravastatina 40 mg: 22,4% vs. 26,3% (p = 0,005). El objetivo de esta evaluación económica es calcular la eficiencia de atorvastatina 80 mg vs. Pravastatina 40 mg. con costes españoles a partir de los resultados del PROVE-IT. Métodos: Se ha realizado un análisis coste-efectividad usando la perspectiva del Sistema Nacional de Salud (SNS) español, mediante un modelo de árbol de decisión proyectado a largo plazo, estimando la esperanza de vida media a partir de la cohorte de Framingham. Se computaron únicamente los costes de adquisición y los costes directos. Los resultados están expresados en euros del año 2005. Como medida de efectividad se ha empleado el número de eventos primarios evitados (mortalidad por cualquier causa, IAM, AI, revascularización € ictus) y los años de vida ganados (AVG). Se ha calculado el coste medio por paciente y los ratios coste-efectividad incremental: coste por evento evitado y por AVG. Se realizó un análisis de sensibilidad univariado para distintos costes de los eventos agudos. Resultados: El coste medio esperado por paciente durante los 2 años de estudio fue de 3.180 € para atorvastatina 80 mg y de 3.210 € para pravastatina 40 mg. El ahorro incremental con atorvastatina 80 mg vs. Pravastatina 40 mg fue de 30 € por paciente, ya que el ahorro de recursos por eventos evitados con atorvastatina, supera su mayor coste de adquisición. El beneficio del tratamiento con atorvastatina 80 mg vs. Pravastatina 40 mg fue de 0,103 años de vida por paciente. El cociente coste-efectividad incremental de atorvastatina 80 mg vs. Pravastatina 40 mg fue — 543 € por evento evitado y de — 296 € por AVG. Estos resultados fueron robustos al análisis de sensibilidad. Conclusiones: Bajo la perspectiva del SNS español y de acuerdo a un modelo basado en el estudio PROVE-IT, el tratamiento intensivo con atorvastatina 80 mg. resulta una opción más efectiva y menos costosa que pravastatina 40 mg. en el síndrome coronario agudo. Por lo tanto, el tratamiento con atorvastatina 80 mg es una estrategia dominante: que ahorra costes con mayor eficacia, lo cual permite que los recursos sean utilizados en otros tratamientos.
    Pharmacoeconomics - Spanish Research Articles 01/2013; 3(1).
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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 Clínica Española 12/2011; · 1.31 Impact Factor
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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: AimTo evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics.
    Atención Primaria 11/2011; 43(11):595-603. · 0.89 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: 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.
    Atención Primaria 08/2010; 42(8):420-430. · 0.89 Impact Factor
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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
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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 07/2010;
  • 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
  • A Sicras, J Fernández de Bobadilla, R Navarro, J Rejas
    Value in Health 10/2009; 12(7). · 2.89 Impact Factor

Publication Stats

79 Citations
161.82 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
  • 2008–2010
    • Badalona Serveis Assistencials
      Badalona, Catalonia, Spain
  • 1995–1997
    • Hospital General Universitario Gregorio Marañón
      • Department of Cardiology
      Madrid, Madrid, Spain