Introduction and Objectives
Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound has shown to be highly ...sensitive for detecting PC in HF. The aim of this study is to evaluate whether lung ultrasound–guided therapy improves 6-month outcomes in patients with HF compared with conventional treatment.
Materials and Methods
Randomized, multicenter, single-blind clinical trial in patients discharged from Internal Medicine Departments after hospitalization for decompensated HF. Participants will be assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus clinical assessment of congestion. The primary outcome is the combination of cardiovascular death and readmission for HF at 6 months.
Conclusions
The results of this study will provide more evidence about the impact of lung ultrasound on treatment monitoring in patients with chronic HF.
Introduction L’insuffisance cardiaque (IC) est un problème de santé en Espagne dont l’incidence croissante est en rapport avec le vieillissement de la population, et présente des taux de mortalité et ...de réadmissions hospitalières élevées. Evaluer les caractéristiques cliniques des patients souffrant d’IC qui entrent en médecine interne et les facteurs associés à la réadmission et la mortalité intrahospitalière. Méthodes étude transversale, descriptive et rétrospective de révision des dossiers cliniques de patients ayant un diagnostic principal d’IC dans l’Ensemble Minimal de Base de Données (CMBD, Conjunto Mínimo Básico de Datos), qui abandonnèrent le Service de Médecine Interne de l’Hôpital Clinique San Carlos (HCSC) en 2014. Résultats Cent quatre-vingt-dix-neuf (199) patients y furent inclus, âge moyen 82,7 ans et 61,8% de femmes; 85% présentaient une FEVG (Fraction d’Ejection du Ventricule Gauche) > 40%, avec un pro-BNP moyen de 9.101,3 pg/ml; 64,3% des patients présentèrent une fibrillation auriculaire permanente. 30,2% revinrent en < 30 jours avec une moyenne de réadmissions/an de 1,45(±0,86). 25% des patients moururent intra hospitalièrement pendant le suivi. Parmi les facteurs associés à la mortalité intrahospitalière l’âge avancé fut une variable associée OR 1,050 (1,002-1,101) (p = 0.04). Quant aux facteurs associés à la réadmission précoce, la polypharmacie (p = 0,024) ainsi que les critères de pluripathologie d’Ollero 4,974 (1,396-17,730) (p = 0,024) furent les plus importants. Les patients hospitalisés pour cause d’IC dans notre milieu sont des patients âgés et sous polymédication. Conclusion Les patients hospitalisés pour insuffisance cardiaque sont âgés, présentant pluripathologie et polypharmacie. Son pronostic à court terme est associé à des taux élevés de réintégration et de mortalité à l'hôpital principalement pour ceux souffrant d’affection rénale et/ou neurologique.
Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study ...was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission.
A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient's International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event.
In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59;
< 0.001) and INR (6 vs. 5.31;
< 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL;
< 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16-3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance.
Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.
Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher ...risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.
The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing ...cholecystectomy in the Spanish National Health System (SNHS).
We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007-2015 were included. Demographic and administrative variables related to patients' diseases as well as procedures were collected.
478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (
< 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (
< 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (
< 0.001), except stroke (
= 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (
< 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8;
< 0.001). Risk-adjusted in-hospital mortality models' discrimination was high in both cases, with AUROC values = 0.963 (0.960-0.965) in the APRG-DRG model and AUROC = 0.965 (0.962-0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals.
The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).
Eur J Clin Invest 2011; 41 (5): 521–526
Background and Objective Increased carotid intima‐media thickness (CIMT) is associated with cardiovascular events. The purpose of this study was to identify ...advanced subclinical atherosclerosis in patients who are at low or intermediate risk.
Methods Thousand hundred and eighteen Spanish subjects were prospectively enrolled in an ambulatory screening of cardiovascular risk (CVR). Three hundred and twenty patients aged over 30 years with low‐intermediate CVR according to European SCORE function underwent carotid ultrasonography. Carotid IMT and plaque assessment were performed using high‐resolution B‐mode ultrasonography. Participants with abnormal CIMT were reclassified to high CVR.
Results According to SCORE function, 104 patients (32·5%) were of low CVR and 216 (67·5%) of intermediate CVR. Mean carotid IMT was 0·62 ± 0·13 mm, and carotid plaque was found in 35 (10·9%) patients. Carotid ultrasonography changed the risk stratum in 59 (18·4%) patients, who were reclassified to high CVR. Reclassification was more frequent in the intermediate CVR group than in the low CVR group (22·7% vs. 9·6%, P = 0·005) and was associated to age (P = 0·002), history of arterial hypertension (P < 0·001) and increased systolic blood pressure (P = 0·05).
Conclusions CIMT calculated by high‐resolution B‐mode ultrasonography could become an important tool in preventive medicine. Measuring CIMT may be useful in identifying asymptomatic individuals with subclinical atherosclerosis not detected by the actual CVR functions.
Introduction: The increase in life expectancy and the aging of the population are associated with an increase in the prevalence of chronic diseases. Comorbidities have an important impact on ...prognosis and functional capacity leading to a progressive deterioration of autonomy and quality of life and an increase in demand for medical care. Establishment of an accurate prognosis constitutes one of the primary objectives in healthcare. An accurate estimate of prognosis helps clinicians make diagnostic and therapeutic decisions, prevent iatrogenesis, and consider palliative care strategy as needed. It also allows the patient and family members to organize their preferences and priorities. Objective: To evaluate the PROFUND scale in patients with heart failure from a prognostic point of view. Methods: A multicenter cohort study including patients admitted for heart failure to internal medicine departments over a 6-month period will be carried out. Inclusion criteria are patients with a diagnosis of heart failure and at least two criteria of multipathological patients and NT-proBNP >1500 pg/ml upon admission. The PROFUND scale will be applied to all patients. Patients will be then stratified into four groups according to the PROFUND scale: low, moderate, moderate-high and high mortality risk. Conclusion: Our work is a prospective study that aims to apply the PROFUND scale to patients with heart failure in the hospital setting with the purpose of helping in decision-making with our patients, which could lead to improvements in the management of resources in our health system.
No safe blood lead concentration in children has been identified. Lead can affect nearly every system in the body and is especially harmful to the developing central nervous system of children.
The ...aim of this study is to analyze blood lead in a population of children and its association with sociodemographic variables, biochemical parameters, copper, iron, selenium and zinc.
We recruited 155 children (86 boys and 69 girls) with a mean age of 7.3 (SD:4.1). Blood lead and serum selenium concentrations were measured by electrothermal atomic absorption spectrometry. Serum copper and zinc concentrations were measured by flame atomic absorption spectrometry. Serum iron levels were determined by colorimetric assay. A risk exposure questionnaire for lead was administered to the participants.
The median blood lead level was 1.1 (IQR 0.7–1.6) μg/dL. Regarding risk exposure factors, the youngest children (<2 years) who played outdoors presented a median blood lead concentration of 1.1 μg/dL IQR: 0.48–1.48, compared to the median of 0.3 μg/dL IQR:0.2-0.48 in the children who stated they played at home (p = 0.024). Significant differences were also found when taking into account those parents who smoked (median 1.3 IQR 0.8–1.9 μg/dL vs 0.9 IQR 0.5–1.4 μg/dL of non-smokers, p = 0.002). Children who drank tap water had higher blood lead levels (median 1.2 IQR 0.7–1.6 μg/dL) than those who drank bottled water (median 0.7 IQR 0.2–1.3 μg/dL p = 0.014). In addition, children whose mothers had not finished school had higher blood lead levels (median 1.7 IQR 1.2–2.3 μg/dL) than those whose mothers had finished school (median 1.2 IQR 0.7–1.7 μg/dL) and those whose mothers had gone to university (median 0.9 IQR 0.5–1.4 μg/dL) p = 0.034. In the multivariate lineal regression analysis we continue to observe the association between mother’s higher level of education and lower blood levels (p = 0.04) and the interaction between age and outdoor play (p = 0.0145).
In spite of the decline in blood lead concentrations, associated risk factors continue to exist in vulnerable populations such as children.
We aimed to develop and validate a prediction model, based on clinical history and examination findings on initial diagnosis of coronavirus disease 2019 (COVID-19), to identify patients at risk of ...critical outcomes.
We used data from the SEMI-COVID-19 Registry, a cohort of consecutive patients hospitalized for COVID-19 from 132 centres in Spain (23rd March to 21st May 2020). For the development cohort, tertiary referral hospitals were selected, while the validation cohort included smaller hospitals. The primary outcome was a composite of in-hospital death, mechanical ventilation, or admission to intensive care unit. Clinical signs and symptoms, demographics, and medical history ascertained at presentation were screened using least absolute shrinkage and selection operator, and logistic regression was used to construct the predictive model.
There were 10 433 patients, 7850 in the development cohort (primary outcome 25.1%, 1967/7850) and 2583 in the validation cohort (outcome 27.0%, 698/2583). The PRIORITY model included: age, dependency, cardiovascular disease, chronic kidney disease, dyspnoea, tachypnoea, confusion, systolic blood pressure, and SpO2 ≤93% or oxygen requirement. The model showed high discrimination for critical illness in both the development (C-statistic 0.823; 95% confidence interval (CI) 0.813, 0.834) and validation (C-statistic 0.794; 95%CI 0.775, 0.813) cohorts. A freely available web-based calculator was developed based on this model (https://www.evidencio.com/models/show/2344).
The PRIORITY model, based on easily obtained clinical information, had good discrimination and generalizability for identifying COVID-19 patients at risk of critical outcomes.
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