Una cosa es predicar (promoción de la salud) y otra dar trigo (resultados en salud)

Los profesionales sanitarios dedicamos mucho tiempo a tratar de promocionar la salud. Tiempo de consulta en el que aconsejamos a nuestros pacientes sobre hábitos de vida y otros aspectos. Pero ¿qué ocurriría si todo este esfuerzo no sirviera para nada?

Acaba de salir publicado el Inter99 un estudio poblacional randomizado que analiza 59 616 personas en un suburbio de Copenhague analizando el efecto de medir factores de riesgo cardiovascular y proporcionar consejo repetido para prevenirlo durante 10 años. Pese a todos los esfuerzos que se hicieron en este sentido no mejoró la salud cardiovascular de la población.


Tal vez tengamos que pensar más las causas de las causas como mi amigo Rafa Cofiño no se cansa de explicar. Tal vez tengamos que dejar de hacer cosas en el sistema sanitario y dedicarnos a otras(@enriquegavilan), como también venimos diciendo desde hace años.


Una cosa es decirle al paciente lo que tiene que hacer para mejorar su salud y otra que éste pueda o quiera hacerlo. 

Me aplico la autocrítica, con frecuencia no me pongo suficientemente en los zapatos del paciente y en otras muchas ocasiones no conozco su casa (por no haber hecho ninguna visita a su domicilio) por lo que conozco verdadéramente poco de él. Mientras el sistema sanitario no cruce esta barrera (y para eso me necesita a mí y a la enfermera comunitaria) no tendremos ni idea de quién es el paciente y qué es lo que necesita. Ya podremos hincharnos a tecnología, apps, telemonitorización, uniades de alta resolución y juegos de salud... no funcionará.

Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3617 (Published 9 June 2014)

Cite this as: BMJ 2014;348:g3617

Objective To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level.

Design Randomised controlled community based trial.

Setting Suburbs of Copenhagen, Denmark

Participants 59 616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n=11 629) and a control group (n=47 987).

Intervention The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening.

Main outcome measures The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality.

Results 6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58 308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58 940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09).

Conclusion A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.

 Puedes ver el artículo completo aquí.