[Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study]

BACKGROUND AND PURPOSE

In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type.

METHODS

We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models.

RESULTS

The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002).

CONCLUSIONS

In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.

Public healthcare expenditure and COVID-19 mortality in Spain and in Europe

OBJECTIVE

To analyze the association between public health expenditure per capita and the mortality rate due to COVID-19 in Europe and Spain.

MATERIAL AND METHODS

Pearson's correlation coefficient was used to compare and contrast the mortality rate due to COVID-19 between countries and autonomous communities with higher and lower public health expenditure per capita than the mean.

RESULTS

No correlation between the public health expenditure per capita and the mortality rate due to COVID-19 (r: 0.3; p = 0.14) was found among European countries or Spain's Autonomous Communities (r: 0.03; p = 0.91). No significant differences were found when comparing the mortality rate due to COVID-19 among the public health expenditure per capita groups.

CONCLUSIONS

The available evidence does not support association between «low» public healthcare expenditure and the poor outcomes observed in Spain during the COVID-19 pandemic. Increased funding for the Spanish National Health System should be earmarked for structural reforms to increase its social efficiency.

Incidence and outcomes of hospital treated acute myocarditis from 2003 to 2015 in Spain

BACKGROUND

There are no data on population-based epidemiological changes in acute myocarditis in Europe. Our aim was to evaluate temporal trends in incidence, clinical features and outcomes of hospital treated acute myocarditis (AM) in Spain from 2003 to 2015.

METHODS

We conducted a retrospective longitudinal study using information of all hospital discharges of the Spanish National Health System. All episodes with a discharge diagnosis of AM from 1 January 2003 to 31 December 2015 were included. The risk-standardized in-hospital mortality ratio (RSMR) was calculated using a multilevel risk-adjustment model developed by the Medicare and Medicaid Services. Temporal trends for in-hospital mortality were modelled using Poisson regression analysis.

RESULTS

A total of 11 147 episodes of AM were analysed, most of them idiopathic (94.7%). The rate of AM discharges increased along the period, from 13 to 30/million inhabitants/year (2003-2015), and this increase was statistically significant when weighted by age and sex (incidence rate ratio, IRR 1.06, 95% CI 1.04-1.08, P = .001). In-hospital crude mortality rate was 3.1%, diminishing significantly along 2003-2015 (IRR 0.95, 95% CI 0.92-0.99, P = .02). RSMR also significantly diminished along the period (IRR 0.95, 95% CI 0.92-0.99, P = .01). Renal failure (OR 7.03, 5.38-9.18, P = .001), liver disease (OR 4.61, 2.59-8.21, P = .001), pneumonia (OR 4.13, 2.75-6.20, P = .001) and heart failure (OR 1.91, 95% CI 1.47-2.47, P = .001) were the strongest independent factors associated with in-hospital mortality.

CONCLUSIONS

Acute myocarditis is an uncommon entity, although hospital discharges have increased in Spain along the study period. Most of AM were idiopathic. Adjusted mortality was low and seemed to decrease from 2003 to 2015, suggesting an improvement in AM management.

In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database

BACKGROUND

Mechanical complications represent an important cause of mortality in myocardial infarction (MI) patients. This is a nationwide study performed to evaluate possible changes in epidemiology or prognosis of these complications with current available strategies.

METHODS

Information was obtained from the minimum basis data set of the Spanish National Health System, including all hospitalizations for acute myocardial infarction (AMI) from 2010 to 2015. Risk-standardized in-hospital mortality ratio was calculated using multilevel risk adjustment models.

RESULTS

A total of 241,760 AMI episodes were analyzed, MI mechanical complications were observed in 842 patients: cardiac tamponade in 587, ventricular septal rupture in 126, and mitral regurgitation due to papillary muscle or chordae tendineae rupture in 155 (there was more than one complication in 21 patients). In-hospital mortality was 59.5%. On multivariate adjustment, variables with significant impact on in-hospital mortality were: age (OR 1.06; 95% CI 1.04-1.07; p < 0.001), ST-segment elevation AMI (OR 2.91; 95% CI 1.88-4.5; p < 0.001), cardiogenic shock (OR 2.35; 95% CI 1.66-3.32; p < 0.001), cardio-respiratory failure (OR 3.48; 95% CI 2.37-5.09; p < 0.001), and chronic obstructive pulmonary disease (OR 1.85; 95% CI 1.07-3.20; p < 0.001). No significant trends in risk-adjusted in-hospital mortality were detected (IRR 0.997; p = 0.109). Cardiac intensive care unit availability and more experience with mechanical complications management were associated with lower adjusted mortality rates (56.7 ± 5.8 vs. 60.1 ± 4.5; and 57 ± 6.1 vs. 59.9 ± 5.6, respectively; p < 0.001).

CONCLUSIONS

Mechanical complications occur in 3.5 per thousand AMI, with no significant trends to better survival over the past few years. Advanced age, cardiogenic shock and cardio-respiratory failure are the most important risk factors for in-hospital mortality. Higher experience and specialized cardiac intensive care units are associated with better outcomes.

[Public healthcare expenditure and COVID-19 mortality in Spain and in Europe]

Objective

To analyze the association between public health expenditure per capita and the mortality rate due to COVID-19 in Europe and Spain.

Material and methods

Pearson's correlation coefficient was used to compare and contrast the mortality rate due to COVID-19 between countries and autonomous communities with higher and lower public health expenditure per capita than the mean.

Results

No correlation between the public health expenditure per capita and the mortality rate due to COVID-19 (r: 0.3; p = 0.14) was found among European countries or Spain's Autonomous Communities (r: 0.03; p = 0.91). No significant differences were found when comparing the mortality rate due to COVID-19 among the public health expenditure per capita groups.

Conclusions

The available evidence does not support association between «low» public healthcare expenditure and the poor outcomes observed in Spain during the COVID-19 pandemic. Increased funding for the Spanish National Health System should be earmarked for structural reforms to increase its social efficiency.

RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed?

OBJECTIVES

To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014.

MATERIAL AND METHODS

We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity.

RESULTS

Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions.

CONCLUSIONS

During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes

Objective

To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service.

Design

Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs.

Setting

Spanish National Health Service.

Participants

One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges).

Main Outcome Measures

IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity.

Results

Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes.

Conclusions

We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

The Internal Medicine of the 21st century: Organizational and operational standards

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years.