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Martín-Sánchez FJ, Bermejo Boixareu C. [Comprehensive assessment in heart failure]. Med Clin (Barc) 2024; 162:228-230. [PMID: 38290871 DOI: 10.1016/j.medcli.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Universidad Complutense de Madrid, Madrid, España.
| | - Cristina Bermejo Boixareu
- Servicio de Geriatría, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autonóma de Madrid, Majadahonda, Madrid, España
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Aguirre NL, Gutiérrez SG, Miro O, Aguiló S, Jacob J, Alquézar-Arbé A, Burillo G, Fernandez C, Llorens P, Alonso CR, Lopez IT, Cañete M, Asensio PR, Díaz BP, Pizarro TP, Navarro RJDR, Viola NP, Hernández-Castells L, Soler AC, Sánchez Fernández-Linares E, Serrano JÁS, Ezponda P, Lorenzo AM, Liarte JVO, Ramón SS, Aranda AR, Martín-Sánchez FJ, del Castillo JG. Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach? Ann Geriatr Med Res 2024; 28:9-19. [PMID: 37963716 PMCID: PMC10982447 DOI: 10.4235/agmr.23.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. METHODS We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. RESULTS During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years-mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80-0.82) for 30-day mortality. CONCLUSION Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.
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Affiliation(s)
- Nere Larrea Aguirre
- Research Unit, Galdakao-Usansolo University Hospital, Vizcaya, Spain. Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Susana García Gutiérrez
- Research Unit, Galdakao-Usansolo University Hospital, Vizcaya, Spain. Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Faculty of Health Sciences, Medicine Department, University of Deusto, Bilbo, Spain
| | - Oscar Miro
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Guillermo Burillo
- Emergency Department, Hospital Universitario de Canarias, University of La Laguna, Tenerife, Spain
| | - Cesáreo Fernandez
- Emergency Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | | | | | - Mónica Cañete
- Emergency Department, Hospital Nuestra Señora del Prado de Talavera de la Reina, Toledo, Spain
| | | | | | | | | | | | | | | | | | | | - Patxi Ezponda
- Emergency Department, Hospital De Zumarraga, Guipuzcoa, Spain
| | | | | | | | | | | | | | - on behalf of the members of the SIESTA Network
- Research Unit, Galdakao-Usansolo University Hospital, Vizcaya, Spain. Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Faculty of Health Sciences, Medicine Department, University of Deusto, Bilbo, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
- Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Emergency Department, Hospital Universitario de Canarias, University of La Laguna, Tenerife, Spain
- Emergency Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Emergency Department, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
- Emergency Department, Hospital del Nalón, Langreo, Asturias, Spain
- Emergency Department, Hospital Virgen de Altagracia, Ciudad Real, Spain
- Emergency Department, Hospital Nuestra Señora del Prado de Talavera de la Reina, Toledo, Spain
- Emergency Department, Hospital Universitario Vinalopó, Alicante, Spain
- Emergency Department, Hospital Universitario de Móstoles, Madrid, Spain
- Emergency Department, Hospital Virgen del Rocio, Sevilla, Spain
- Emergency Department, Hospital General Universitario Dr. Peset, Valencia, Spain
- Emergency Department, Hospital Universitario Son Espases, Mallorca, Spain
- Emergency Department, Clinica Universitaria Navarra, Madrid, Spain
- Emergency Department, Clinico Universitario de Valencia, Valencia, Spain
- Emergency Department, Hospital Alvaro Cunqueiro, Pontevedra, Spain
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Emergency Department, Hospital De Zumarraga, Guipuzcoa, Spain
- Emergency Department, Hospital Virxe Da Xunqueira, A Coruña, Spain
- Emergency Department, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain
- Emergency Department, Hospital Universitario Río Ortega, Valladolid, Spain
- Emergency Department, Hospital Juan Ramón Jiménez, Huelva, Spain
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Yañez Palma MC, Roman F, Llopis-Roca F, Fragiel M, Julián Jiménez A, Martín-Sánchez FJ, González Del Castillo J. [Utility of the medial region of pro-adrenomodulin for the detection of true bacteremia in elderly patients treated in the emergency department for suspected infection]. Rev Esp Quimioter 2024; 37:78-87. [PMID: 38108264 PMCID: PMC10874664 DOI: 10.37201/req/110.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The prediction of bacteremia in the emergency department (ER) is important for initial decision-making. The elderly population is a diagnosis challenge. The objective was to evaluate the accuracy of mid regional pro-adrenomedullin (MR-proADM) to identify true bacteremia (BV) in elderly patients attended in 3 hospital emergency departments. METHODS Observational study including patients ≥75 years of age or older attended in the ER for suspected infection in whom a blood culture (BC) was extracted. Sociodemographic, comorbidity, hemodynamic and analytical variables, biomarkers [MR-proADM, procalcitonin (PCT), C-reactive protein (CRP) and lactate] and final diagnosis were collected. The primary outcome was a true positive on a blood culture. RESULTS A total of 109 patients with a mean age of 83 (SD: 5.5) years were included. A final diagnosis of BV was obtained in 22 patients (20.2%). The independent variables to predict it were PCT (OR: 13.9; CI95%: 2.702-71.703; p=0.002), MR-proADM (OR: 4.081; CI95%: 1.026-16.225; p=0.046) and temperature (OR: 2.171; CI95%: 1.109-4.248; p=0.024). Considering the cut-off point for MR-proADM (2.13 mg/dl), a sensitivity (Se) of 73%, specificity (E) of 71%, a positive predictive value (PPV) of 39%, a negative predictive value (NPV) of 91%, a positive likelihood ratio (LHR+) of 2.53 and a negative likelihood ratio (LHR-) of 0.38; for PCT (0.76 mg/dl) a Se of 90%, E of 65%, PPV of 40%, NPV of 96%, LHR+ 2,64 and a LHR- of 0.14 were obtained. When combining both, a Se of 69%, E of 84%, PPV of 52%, NPV of 91%, LHR+ of 4.24 and LHR- of 0.38 were observed. CONCLUSIONS Elevated levels of PCT and MR-proADM were independently associated with an increased risk of BV and the combination of both improves the accuracy to identify these patients.
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Affiliation(s)
| | | | | | | | | | | | - J González Del Castillo
- Juan González del Castillo, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain.
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Clemente C, Fuentes Ferrer ME, Ortega Heredia D, Julián Jiménez A, Martín-Sánchez FJ, González Del Castillo J. Usefulness of combining inflammatory biomarkers and clinical scales in an emergency department to stratify risk in patients with infections. Emergencias 2024; 36:9-16. [PMID: 38318737 DOI: 10.55633/s3me/04.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To determine whether combining biomarkers of inflammatory response and clinical scales can improve risk stratification of patients with suspected infection in a hospital emergency department (ED). MATERIAL AND METHODS Prospective observational study of ED patients treated for infections. We collected the following information on arrival: demographic and baseline clinical data, comorbidities, the focus of infection, and values for the following inflammatory biomarkers: leukocyte counts, and C-reactive protein, procalcitonin, and midregional proadrenomedullin (MR-proADM) concentrations. Scores on the following clinical scales were recorded based on the variables gathered: the SIRS (Systemic Inflammatory Response Syndrome) criteria, the qSOFA (Quick Sequential Organ Failure Assessment), and the NEWS (National Early Warning Score). The main outcome was a composite measure that included 30-day death or need for intensive care unit (ICU) admission. RESULTS A total of 473 patients with a mean (SD) age of 70.3 (19.2) years were included. The majority were men (257, 54.3%). Thirty-one (6.6%) died within 30 days and 16 (3.4%) were admitted to the ICU. The composite outcome (death or ICU admission) occurred in 45 patients (9.5%). The MR-proADM concentration, with an area under the receiver operating characteristic curve of 0.739 (95% CI, 0671-0.809) was a better predictor than the other biomarkers or clinical scales, although the differences between MR-proADM and either lactate concentration or the NEWS were not significant in the comparisons (P = .064). Combining the MR-proADM concentration with any of the scales did not significantly improve risk prediction. CONCLUSION Risk stratification of patients with infection is a key part of ED decision-making. MR-proADM concentration is superior to other biomarkers and clinical prediction scales for predicting short-term prognosis in the ED. Combining MR-proADM measurement with other scales or measures does not improve the yield.
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Affiliation(s)
- Carlota Clemente
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Dolores Ortega Heredia
- Servicio de Análisis Clínicos, Instituto de Medicina de Laboratorio, Hospital Clínico San Carlos, Madrid, España
| | | | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria (IdISSC), Madrid, España
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Povar-Echeverría M, Méndez-Bailón M, Martín-Sánchez FJ, Montero-Pérez-Barquero M, Trullàs JC, Miró Ò. Prognostic impact of metformin in patients with type 2 diabetes mellitus and acute heart failure: Combined analysis of the EAHFE and RICA registries. Rev Clin Esp 2023; 223:542-551. [PMID: 37717921 DOI: 10.1016/j.rceng.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/29/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients with diabetes mellitus (DM) and heart failure (HF) have a worse prognosis despite therapeutic advances in both diseases. Sodium-glucose co-transporter type 2 and GLP-1 receptor agonists have shown cardiovascular benefits and they have been positioned as the first step in the treatment of DM in patients with HF or high cardiovascular risk. However, in the pivotal trials the majority of patients receive concomitant treatment with metformin. Randomized clinical trials have not yet been developed to assess the prognostic impact of metformin at the cardiovascular level. Our objective has been centered in analyzing whether patients with DM and acute HF who receive treatment with metformin at the time of discharge may have a better prognosis at one year of follow-up. METHODS Prospective cohort trial using the combined analysis of the two main Spanish HF registries, the EAHFE Registry (Epidemiology of Acute Heart Failure in Emergency Departments) and the RICA (National Registry of Patients with Heart Failure). RESULTS 33% (1453) of a total of 4403 patients with DM type 2 received treatment with metformin. This group presents significantly lower mortality after one year of treatment (22 versus 32%; Log Rank test P < 0.001). In the adjusted analysis of mortality, patients receiving treatment with metformin have lower mortality at one year of follow-up regardless of the rest of the variables (RR 0,814; 95%IC 0,712-0,930; P < 0.01). CONCLUSIONS Patients with DM type 2 and acute HF who receive metformin have a better prognosis after one year of follow-up, so we believe that this drug should continue to be a fundamental pillar in the treatment of these patients.
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Affiliation(s)
- M Povar-Echeverría
- Internal Medicine Service, Hospital Comarcal de Barbastro, Barbastro, Huesca, Spain.
| | - M Méndez-Bailón
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - F J Martín-Sánchez
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - M Montero-Pérez-Barquero
- Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J C Trullàs
- Internal Medicine Service, Hospital d'Olot i Comarcal de la Garrotxa, Olot, Girona, Spain; Grupo de Investigación en Reparación y Regeneración Q2 Tisular (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central, Barcelona, Spain
| | - Ò Miró
- Emergencies Service, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Candel FJ, Salavert M, Basaras M, Borges M, Cantón R, Cercenado E, Cilloniz C, Estella Á, García-Lechuz JM, Garnacho Montero J, Gordo F, Julián-Jiménez A, Martín-Sánchez FJ, Maseda E, Matesanz M, Menéndez R, Mirón-Rubio M, Ortiz de Lejarazu R, Polverino E, Retamar-Gentil P, Ruiz-Iturriaga LA, Sancho S, Serrano L. Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review. J Clin Med 2023; 12:6864. [PMID: 37959328 PMCID: PMC10649000 DOI: 10.3390/jcm12216864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, IdISSC & IML Health Research Institutes, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, La Fe (IIS) Health Research Institute, University Hospital La Fe, 46015 Valencia, Spain
| | - Miren Basaras
- Immunology, Microbiology and Parasitology Department, Faculty of Medicine and Nursing, University of País Vasco, 48940 Bizkaia, Spain;
| | - Marcio Borges
- Multidisciplinary Sepsis Unit, Intensive Medicine Department, University Hospital Son Llàtzer, 07198 Palma de Mallorca, Spain;
- Instituto de Investigación Sanitaria Islas Baleares (IDISBA), 07198 Mallorca, Spain
| | - Rafael Cantón
- Clinical Microbiology Service, University Hospital Ramón y Cajal, Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain;
- CIBER of Infectious Diseases (CIBERINFEC), National Institute of Health San Carlos III, 28034 Madrid, Spain;
| | - Emilia Cercenado
- Clinical Microbiology & Infectious Diseases Service, University Hospital Gregorio Marañón, 28009 Madrid, Spain;
| | - Catian Cilloniz
- IDIBAPS, CIBERES, 08007 Barcelona, Spain;
- Faculty of Health Sciences, Continental University, Huancayo 15304, Peru
| | - Ángel Estella
- Intensive Care Unit, INIBiCA, University Hospital of Jerez, Medicine Department, University of Cádiz, 11404 Jerez, Spain
| | | | - José Garnacho Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, 41013 Sevilla, Spain;
| | - Federico Gordo
- Intensive Medicine Department, University Hospital of Henares, 28802 Madrid, Spain;
| | - Agustín Julián-Jiménez
- Emergency Department, University Hospital Toledo, University of Castilla La Mancha, 45007 Toledo, Spain;
| | | | - Emilio Maseda
- Anesthesiology Department, Hospital Quirón Salud Valle del Henares, 28850 Madrid, Spain;
| | - Mayra Matesanz
- Hospital at Home Unit, Clinic University Hospital San Carlos, 28040 Madrid, Spain;
| | - Rosario Menéndez
- Pneumology Service, La Fe (IIS) Health Research Institute, University Hospital La Fe, 46015 Valencia, Spain;
| | - Manuel Mirón-Rubio
- Hospital at Home Service, University of Torrejón, Torrejón de Ardoz, 28006 Madrid, Spain;
| | - Raúl Ortiz de Lejarazu
- National Influenza Center, Clinic University Hospital of Valladolid, University of Valladolid, 47003 Valladolid, Spain;
| | - Eva Polverino
- Pneumology Service, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health San Carlos III, 28029 Madrid, Spain
| | - Pilar Retamar-Gentil
- CIBER of Infectious Diseases (CIBERINFEC), National Institute of Health San Carlos III, 28034 Madrid, Spain;
- Infectious Diseases & Microbiology Clinical Management Unit, University Hospital Virgen Macarena, IBIS, University of Seville, 41013 Sevilla, Spain
| | - Luis Alberto Ruiz-Iturriaga
- Pneumology Service, University Hospital Cruces, 48903 Barakaldo, Spain; (L.A.R.-I.); (L.S.)
- Faculty of Medicine and Nursing, University of País Vasco, 48940 Bizkaia, Spain
| | - Susana Sancho
- Intensive Medicine Department, University Hospital La Fe, 46015 Valencia, Spain;
| | - Leyre Serrano
- Pneumology Service, University Hospital Cruces, 48903 Barakaldo, Spain; (L.A.R.-I.); (L.S.)
- Faculty of Medicine and Nursing, University of País Vasco, 48940 Bizkaia, Spain
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Miró Ò, Gil-Rodrigo A, García-Martínez A, Aguiló S, Alemany X, Nickel CH, Jacob J, Llorens P, Herrero P, Torres-Machado V, Cenjor R, Coll-Vinent B, Martínez-Nadal G, Del Nogal ML, Peacock F, Martín-Sánchez FJ. Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry. J Am Geriatr Soc 2023; 71:2715-2725. [PMID: 37224385 DOI: 10.1111/jgs.18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND To investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall. METHODS This was a secondary analysis of the FALL-ER registry, a cohort of patients ≥65 years with an unintentional fall presenting to one of 5 Spanish EDs during 52 predefined days (one per week during one year). We collected 18 independent patient baseline and fall-related variables. Patients were followed for 6 months and all-cause mortality recorded. The association between biological sex and mortality was expressed as unadjusted and adjusted hazard ratios (HR) with the 95% confidence interval (95% CI), and subgroup analyses were performed by assessing the interaction of sex with all baseline and fall-related mortality risk variables. RESULTS Of 1315 enrolled patients (median age 81 years), 411 were men (31%) and 904 women (69%). The 6-month mortality was higher in men (12.4% vs. 5.2%, HR = 2.48, 95% CI = 1.65-3.71), although age was similar between sexes. Men had more comorbidity, previous hospitalizations, loss of consciousness, and an intrinsic cause for falling. Women more frequently lived alone, with self-reported depression, and the fall results in a fracture and immobilization. Nonetheless, after adjustment for age and these eight divergent variables, older men aged 65 and over still showed a significantly higher mortality (HR = 2.19, 95% CI = 1.39-3.45), with the highest risk observed during the first month after ED presentation (HR = 4.18, 95% CI = 1.31-13.3). We found no interaction between sex and any patient-related or fall-related variables with respect to mortality (p > 0.05 in all comparisons). CONCLUSIONS Male sex is a risk factor for death following ED presentation for a fall in the older population adults aged 65 and over. The causes for this risk should be investigated in future studies.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
- University of Barcelona, Catalonia, Spain
| | - Adriana Gil-Rodrigo
- Emergency Department, Short Stay Unit and Hospitalization at Home, Dr. Balmis General University Hospital, Alicante, Spain
- Institute for Health and Biomedical Research, Alicante, Spain
| | | | - Sira Aguiló
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Xavier Alemany
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, Dr. Balmis General University Hospital, Alicante, Spain
- Institute for Health and Biomedical Research, Alicante, Spain
- Miguel Hernández University, Elche, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | - Victoria Torres-Machado
- Emergency Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Raquel Cenjor
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | | | | | | | - Frank Peacock
- Henry JN Taub Emergency Department, Baylor College of Medicine, Houston, Texas, USA
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Espinosa B, Martín-Sánchez FJ, López-Díez MP. [Mortality considerations and hospitalized patient care during the weekends]. J Healthc Qual Res 2023; 38:321-322. [PMID: 36863939 DOI: 10.1016/j.jhqr.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Affiliation(s)
- B Espinosa
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - M P López-Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
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Miró Ò, Llorens P, Gil V, López Díez MP, Jacob J, Herrero P, Llauger L, Tost J, Aguirre A, Bibiano C, Fuentes M, López Grima ML, Romero R, Martín Mojarro E, Alquézar Arbé A, Alonso H, Martín-Sánchez FJ. Decisions to admit vs. discharge patients with acute heart failure from the emergency department: consistency with a measure of severity of decompensation and the impact on prognosis. Emergencias 2023; 35:261-269. [PMID: 37439419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To analyze the consistency between decisions to discharge or admit patients with acute heart failure (AHF) treated in emergency departments (EDs) and the level of risk of adverse events, and to analyze the impact of decisions to discharge patients. MATERIAL AND METHODS Prospective study of baseline clinical data collected from patients diagnosed with AHF in 16 Spanish emergency departments. Patients were stratified by severity of decompensated AHF based on MEESSI assessment (Multiple Estimation of Risk Based on the Spanish Emergency Department Score). The distribution of severity was described for patients who were hospitalized (overall and for departments receiving the largest number of admissions) and for discharged patients. We analyzed the data for discharged patients for associations with the following quality-of-care indicators: all-cause mortality of less than 2% at 30 days, revisits to the ED for AHF in less than 10% of patients within 7 days of discharge, and revisits to the ED or admission for AHF in less than 20% within 30 days of discharge. RESULTS We included 2855 patients with a median (interquartile range) age of 84 (76-88) years. Fifty-four percent were women, 1042 (36.5%) were classified as low risk, 1239 (43.4%) as intermediate risk, 301 (10.5%) as high risk, and 273 (9.6%) as very high risk. Thirty-day mortality rates by level of low to very high risk were 1.9%, 9.3%, 15.3%, and 38.4%, respectively. One-year mortality rates by risk level were 15.4%, 35.6%, 52.0%, and 74.2%. Admission rates by risk level were 62.2%, 77.4%, 87.0%, and 88.3%. Overall, 47.1% o patients discharged from the ED were in the 3 higher-risk categories (intermediate to very high), and 30.7% were in the lowest risk category. The 5 hospital areas receiving the most admissions, in order of lowest-to-highest risk classification, were internal medicine, the short-stay unit, cardiology, intensive care, and geriatrics. Rates and 95% CIs for quality-of-care indicators in patients discharged from EDs were as follows: 30-day mortality, 4.3% (3.0%-6.1%); ED revisits within 7 days, 11.4% (9.2%-14.0%), and ED revisits or admissions within 30 days, 31.5% (28.0%-35.1%). In patients classified as low risk on ED discharge, these percentages were lower, as follows, respectively: 0.5% (0.1%-1.8%), 10.5% (7.6%-14.0%), and 29.5% (26.6%-32.6%). CONCLUSION We detected disparity between severity of AHF decompensation and the decision to discharge or admit patients. Outcomes in patients discharged from EDs do not reach the recommended quality-of-care standards. Reducing inconsistencies between severity of decompensation and ED decisions could help to improve quality targets.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España
| | - Josep Tost
- Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, España
| | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Carlos Bibiano
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, España
| | - Marta Fuentes
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | | | - Rodolfo Romero
- Servicio de Urgencias, Hospital de Getafe, Universidad Europea, Madrid, España
| | | | - Aitor Alquézar Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Héctor Alonso
- Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
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10
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Sánchez-Marcos C, Jacob J, Llorens P, López-Díez MP, Millán J, Martín-Sánchez FJ, Tost J, Aguirre A, Juan MÁ, Garrido JM, Rodríguez RC, Pérez-Llantada E, Díaz E, Sánchez-Nicolás JA, Mir M, Rodríguez-Adrada E, Herrero P, Gil V, Roset A, Peacock F, Miró Ò. Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes. Intern Emerg Med 2023; 18:1159-1168. [PMID: 36810965 PMCID: PMC10326134 DOI: 10.1007/s11739-023-03197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637-1.107) or adverse events (1.035, 0.914-1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409-1.397; and 0.858, 0.645-1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.
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Affiliation(s)
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Instituto de Investigación Sanitaria Y Biómedica de Alicante (ISABIAL), Short Stay Unit and Hospital at Home, Hospital General de Alicante, Miguel Hernández University, Alicante, Spain
| | | | - Javier Millán
- Emergency Department, Hospital Universitario La Fe, Valencia, Spain
| | | | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, Barcelona, Catalonia, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | | | | | | | | | - Elena Díaz
- Emergency Department, Hospital Sant Joan, Alicante, Spain
| | | | - María Mir
- Emergency Department, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - Pablo Herrero
- Emergency Department, Hospital Central Asturias, Oviedo, Spain
| | - Víctor Gil
- Digital Cultures & Societies, University of Queensland, Mianjin/Brisbane, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Frank Peacock
- Emergency Department, Baylor College of Medicine, Houston, TX, USA
| | - Òscar Miró
- Digital Cultures & Societies, University of Queensland, Mianjin/Brisbane, Spain.
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Fernández Alonso C, Del Arco Galán C, Torres Garate R, Madrigal Valdés JF, Romero Pareja R, Bibiano Guillén C, Rodríguez Miranda B, Ruiz Grinspan MS, Gutiérrez Gabriel S, Del Rey Ubago A, Fuentes Ferrer ME, Martín-Sánchez FJ. Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. Emergencias 2023; 35:196-204. [PMID: 37350602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index - eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). MATERIAL AND METHODS Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. RESULTS A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P .001. CONCLUSION All 3 scales studied - the CFS, the FIM and the ISAR - are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.
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Affiliation(s)
| | | | - Raquel Torres Garate
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | | | | | | | | | | | - Ana Del Rey Ubago
- Servicio de Urgencias, Hospital Universitario de la Princesa, Madrid, España
| | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
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12
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López-Díez MP, Alquézar-Arbé A, Jacob J, Llorens P, Llauger L, Herrero P, Gil V, Núñez J, Martín-Sánchez FJ, Miró Ò. Hospital development of heart failure follow-up units and short-term prognosis after acute decompensation in Spain. Int J Cardiol 2023; 378:64-70. [PMID: 36804513 DOI: 10.1016/j.ijcard.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To investigate whether the existence of heart failure units (HFU) and link nurse units (LNU) in the hospital improve short-term outcomes of acute heart failure (AHF) episodes. METHODS Patients with AHF diagnosed in 45 Spanish emergency departments were analysed according to whether the hospital had a complete development of follow-up units (HFU + LNU), partial (HFU or LNU) or none. The outcomes were: 30-day mortality, hospitalization, in-hospital mortality, >7 days admission, and adverse event (death, rehospitalisation, or reconsultation to the emergency department) at 30 days post-discharge. Outcomes were adjusted for baseline and AHF episode characteristics. RESULTS 19,947 patients were included, median age was 82 years (IQR 76--87), women were 55%. It was 20% of patients attended in hospitals with null development, 28% with partial development and 52% with complete development. Mortality at 30 days was 10.1% (null/partial/complete development: 10.5%/9.5%/10.4%; p=0.880), hospitalization 74.6% (72.7%/72.7%/75.7%; p<0.001), in-hospital mortality 7.4% (7.6%/7.0%/7.5%; p=0.995), prolonged hospitalization 47.4% (51.1%/52.4%/43.5%; p<0.001) and adverse events 30 days post-hospitalization 30.3% (36.2%/28.9%/30.3%; p < 0.001). In the adjusted analysis, hospital with complete development of follow-up units was not associated with mortality, but with increased hospitalization (OR= 1.172; 95%CI 1.069-1.285) and lower prolonged hospitalization (OR = 0.725; 95%CI 0.660-0.797) and adverse events at 30 days post-discharge (OR=0.831; 95%CI 0.755-0.916). Partial development was only associated with decreased post-discharge adverse events (OR= 0.782; 95%CI 0.702-0.871). CONCLUSION The development of follow-up units is not associated with 30-day mortality, but is associated with less prolonged hospitalization and fewer post-discharge adverse events in patients with AHF.
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Affiliation(s)
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospital at Home, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Miguel Hernández University, Alicante, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central Asturia, Oviedo, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico de Valencia, Valencia, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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13
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Benito-Lozano M, López-Ayala P, Rodríguez S, Llorens P, Domínguez-Rodríguez A, Aguirre A, Alquézar A, Jacob J, Gil V, Martín-Sánchez FJ, Mir M, Andueza JA, Burillo-Putze G, Miró Ò. Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid). Med Clin (Barc) 2023:S0025-7753(23)00143-4. [PMID: 37055253 DOI: 10.1016/j.medcli.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES To analyze whether the high levels of air pollutants are related to a greater severity of decompensated heart failure (HF). METHOD Patients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona and 3 in Madrid were included. Clinical data (age, sex, comorbidities, baseline functional status), atmospheric (temperature, atmospheric pressure) and pollutant data (SO2, NO2, CO, O3, PM10, PM2.5) were collected in the city on the day of emergency care. The severity of decompensation was estimated using 7-day mortality (primary indicator) and the need for hospitalization, in-hospital mortality, and prolonged hospitalization (secondary indicators). The association adjusted for clinical, atmospheric and city data between pollutant concentration and severity was investigated using linear regression (linearity assumption) and restricted cubic spline curves (no linearity assumption). RESULTS A total of 5292 decompensations were included, with a median age of 83 years (IQR=76-88) and 56% women. The medians (IQR) of the daily pollutant averages were: SO2=2.5μg/m3 (1.4-7.0), NO2=43μg/m3 (34-57), CO=0.48mg/m3 (0.35-0.63), O3=35μg/m3 (25-48), PM10=22μg/m3 (15-31) and PM2.5=12μg/m3 (8-17). Mortality at 7 days was 3.9%, and hospitalization, in-hospital mortality, and prolonged hospitalization were 78.9, 6.9, and 47.5%, respectively. SO2 was the only pollutant that showed a linear association with the severity of decompensation, since each unit of increase implied an OR for the need for hospitalization of 1.04 (95% CI 1.01-1.08). The restricted cubic spline curves study also did not show clear associations between pollutants and severity, except for SO2 and hospitalization, with OR of 1.55 (95% CI 1.01-2.36) and 2.71 (95% CI 1.13-6.49) for concentrations of 15 and 24μg/m3, respectively, in relation to a reference concentration of 5μg/m3. CONCLUSION Exposure to ambient air pollutants, in a medium to low concentration range, is generally not related to the severity of HF decompensations, and only NO2 may be associated with an increased need for hospitalization.
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Affiliation(s)
| | - Pedro López-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Basel, Suiza
| | - Sergio Rodríguez
- Instituto de Productos Naturales y Agrobiología (IPNA), CSIC, La Laguna, Santa Cruz de Tenerife, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | | | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Aitor Alquézar
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
| | | | - María Mir
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, España
| | - Juan Antonio Andueza
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, España.
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
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14
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurología (English Edition) 2023; 38:270-277. [PMID: 37030513 DOI: 10.1016/j.nrleng.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/14/2020] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the emergency department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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15
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Albert A, Llorens P, Aguirre A, Martín-Sánchez FJ, Mínguez S, Moreno O, Ferré C, Valls A, Espinosa B, Murillo O, Cirera I, Gil A, Rivera S, Llopis F, Malchair P, Gonzalez del Castillo J, Jacob J. [Revisit after discharge from the emergency department in a cohort of patients with COVID-19 pneumonia and analysis based on the healthcare resource used for follow-up. RESALSEVID study]. J Healthc Qual Res 2023; 38:26-34. [PMID: 35739038 PMCID: PMC9174143 DOI: 10.1016/j.jhqr.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION COVID-19 pneumonia is a manifestation of SARS-CoV-2 infection and in most cases involves hospital admission. There are recommendations according to which these patients can be discharged without hospital admission, but there is no evidence regarding the revisit and the most appropriate type of follow-up. The objective of the RESALSEVID study was to investigate the variables associated with the 30-day revisit (Rev30d) in a group of patients discharged directly from 4 emergency departments (ED) with COVID-19 pneumonia, and analyze whether there were differences based on 4 different tracking devices. METHOD Analysis of a prospective cohort of patients discharged directly from the ED with COVID-19 pneumonia in 4 hospital with different models of follow-up at discharge (primary care, hospitalization at home [HaH] phone and in person, HaH phone, hospital phone). RESULTS Five hundred twenty patients were included, with a mean age of 50.1 years and 51% men. Rev30d was 18.3% and was related only to immunosuppression, odds ratio 4.49 (95% confidence interval 1.10-18.24); p=0.022. There was no difference in Rev30d based on the follow-up model used at discharge from the ED. CONCLUSIONS There are some recommendations that allow the safe discharge of patients with COVID-19 pneumonia, with no differences in Rev30d depending on the type of follow-up.
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Affiliation(s)
- Arantxa Albert
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | - Pere Llorens
- Unidad de Corta Estancia y Hospitalización a Domicilio, Servicio de Urgencias, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Alfons Aguirre
- Servicio de Urgencias, Parc de Salut Mar, Barcelona, España
| | | | - Silvia Mínguez
- Servicio de Urgencias, Parc de Salut Mar, Barcelona, España
| | - Oscar Moreno
- Servicio de Endocrinología y Nutrición, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Alicante, España
| | - Carles Ferré
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | - Adrián Valls
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - Begoña Espinosa
- Unidad de Corta Estancia y Hospitalización a Domicilio, Servicio de Urgencias, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Oscar Murillo
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | - Isabel Cirera
- Servicio de Urgencias, Parc de Salut Mar, Barcelona, España
| | - Adriana Gil
- Unidad de Corta Estancia y Hospitalización a Domicilio, Servicio de Urgencias, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Samuel Rivera
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | - Ferran Llopis
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | - Pierre Malchair
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España,Autor para correspondencia
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García-Martínez A, Gil-Rodrigo A, Placer A, Alemany X, Aguiló S, Torres-Machado V, Jacob J, Herrero P, Llorens P, Martín-Sánchez FJ, Miró Ò. Probability of new falls and factors associated with them in aged patients treated in emergency departments after falling: data from the FALL-ER registry. Emergencias 2022; 34:444-451. [PMID: 36625694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To identify characteristics associated with a new fall in a patient who received emergency department care after an accidental fall and to develop a risk model to predict repeated falls. MATERIAL AND METHODS The FALL-ER registry included accidental falls in patients over the age of 65 years treated in 5 Spanish emergency departments. Independent variables analyzed were patient characteristics at baseline, fall characteristics, immediate consequences, and functional status on discharge. Patients were followed with telephone interviews for 6 months to record the occurrence of new falls. Multivariate regression analysis was used to identify variables associated with falling again and to develop a risk model. We identified 3 levels of risk for new falls (low, intermediate, and high). RESULTS A total of 1313 patients were studied; 147 patients (11.2%) reported having another fall. Variables associated with risk of falling again were having had a fall in the 12 months before the index fall, neurological disease, anemia, use of non-opioid analgesics, falling at home, falling at night, head injury on falling, and need for help when rising from a chair. The probability of falling again was 3.5%, 10.5%, and 23.3%, respectively, in patients at low, intermediate, and high risk. The model's ability to discriminate was moderate: the area under the receiver operating characteristic curve was 0.688 (95% CI, 0.640-0.736). CONCLUSION One in 9 older adults treated in an emergency department for an accidental fall will fall again within 6 months. It is possible to identify patients at higher risk for whom preventive measures should be implemented.
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Affiliation(s)
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Universitario de Alicante, España
| | - Arrate Placer
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | - Xavier Alemany
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | - Sira Aguiló
- Servicio de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Universitario de Alicante, España. Universidad Miguel Hernández, Elche, Alicante, España
| | | | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, Barcelona, España. Universidad de Barcelona, España
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Jacob J, Haro A, Tost J, Rossello X, Llorens P, Herrero P, Martín-Sánchez FJ, Gil V, López-Grima ML, Millán J, Aguirre A, Garrido JM, Calvo-Rodríguez R, Pérez-Llantada E, Sánchez-Nicolás JA, Mir M, Rodríguez-Adrada E, Fuentes-De Frutos M, Roset A, Miró Ò. Short-term outcomes by chronic betablocker treatment in patients presenting to emergency departments with acute heart failure: BB-EAHFE. Eur Heart J Acute Cardiovasc Care 2022; 11:761-771. [PMID: 36018216 DOI: 10.1093/ehjacc/zuac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
AIMS To evaluate the association between chronic treatment with betablockers (BB) and the severity of decompensation and short-term outcomes of patients with acute heart failure (AHF). METHODS AND RESULTS We consecutively included all patients presenting with AHF to 45 Spanish emergency departments (ED) during six different time-periods between 2007 and 2018. Patients were stratified according to whether they were on chronic treatment with BB at the time of ED consultation. Those receiving BB were compared (adjusted odds ratio-OR-with 95% confidence interval-CI-) with those not receiving BB group in terms of in-hospital and 7-day all-cause mortality, need for hospitalization, and prolonged length of stay (≥7 days). Among the 17 923 recruited patients (median age: 80 years; 56% women), 7795 (43%) were on chronic treatment with BB. Based on the MEESSI-AHF risk score, those on BB were at lower risk. In-hospital mortality was observed in 1310 patients (7.4%), 7-day mortality in 765 (4.3%), need for hospitalization in 13 428 (75.0%), and prolonged length of stay (43.3%). After adjustment for confounding, those on chronic BB were at lower risk for in-hospital all-cause mortality (OR = 0.85, 95% CI = 0.79-0.92, P < 0.001); 7-day all-cause mortality (OR = 0.77, 95% CI = 0.70-0.85, P < 0.001); need for hospitalization (OR = 0.89, 95% CI = 0.85-0.94, P < 0.001); prolonged length of stay (OR = 0.90, 95% CI = 0.86-0.94, P < 0.001). A propensity matching approach yielded consistent findings. CONCLUSION In patients presenting to ED with AHF, those on BB had better short-term outcomes than those not receiving BB.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Antoni Haro
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, 08227 Terrassa, Barcelona, Spain
| | - Xavier Rossello
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, 07010 Palma, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospital at Home, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Miguel Hernández University, 03010 Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central Asturias, 33011 Oviedo, Spain
| | | | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | | | - Javier Millán
- Emergency Department, Hospital Universitario La Fe, 46009 Valencia, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Rafael Calvo-Rodríguez
- Emergency Department, Hospital Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | | | - María Mir
- Emergency Department, Hospital Infanta Leonor, 28031 Madrid, Spain
| | | | | | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), University of Barcelona (UB), Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
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18
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López Díez MP, Llorens P, Martín-Sánchez FJ, Gil V, Jacob J, Herrero P, Llauger L, Tost J, Aguirre A, Garrido JM, Vega JA, Fuentes M, Alonso MI, López Grima ML, Piñera P, Romero R, Lucas-Imbernón FJ, Andueza JA, Povar J, Richard F, Sánchez C, Miró Ò. Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis. Emergencias 2022; 34:345-351. [PMID: 36217929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To analyze whether short-term outcomes are affected when patients diagnosed with acute heart failure (AHF) spend time in an emergency department observation unit (EDOU) before hospital admission. MATERIAL AND METHODS Baseline and emergency episode data were collected for patients diagnosed with AHF in the EDs of 15 Spanish hospitals. We analyzed crude and adjusted associations between EDOU stay and 30-day mortality (primary outcome) and in-hospital mortality and a prolonged hospital stay of more than 7 days (secondary outcomes). RESULTS A total of 6597 patients with a median (interquartile range) age of 83 (76-88 years) were studied. Fifty-five percent were women. All were hospitalized for AHF (50% in internal medicine wards, 23% in cardiology, 11% in geriatrics, and 16 in other specialties. Of these patients, 3241 (49%) had had EDOU stays and 3350 (51%) had been admitted immediately, with no EDOU stay. Having an EDOU stay was associated with female sex, dementia or chronic obstructive pulmonary disease, long-term treatment with certain drugs for heart failure, greater baseline deterioration in function, and a higher degree of decompensation. Patients in the EDOU group were more often admitted to an internal medicine ward and had shorter stays; cardiology, geriatric, and intensive care admissions were less likely to have had an EDOU stay. Overall, 30-day mortality was 12.6% (13.7% in the EDOU group and 11.4% in the no-EDOU group; P = .004). In-hospital mortality was 10.4% overall (EDOU, 11.1% and no-EDOU, 9.6%; P = .044). Prolonged hospitalization occurred in 50.0% (EDOU, 48.7% and no-EDOU, 51.2%; P = .046). After adjusting for between-group differences, the EDOU stay was not associated with 30-day mortality (hazard ratio, 1.14; 95% CI, 0.99-1.31). Odds ratios for associations between EDOU stay and in-hospital mortality and prolonged hospital stay, respectively, were 1.09 (95% CI, 0.92-1.29) and 0.91 (95% CI, 0.82-1.01). CONCLUSION Although mortality higher in patients hospitalized for AHF who spend time in an EDO, the association seems to be accounted for by their worse baseline situation and the greater seriousness of the decompensation episode, not by time spent in the EDOU.
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Affiliation(s)
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | | | - Víctor Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España
| | - Josep Tost
- Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, España
| | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | | | - Juan Antonio Vega
- Servicio de Urgencias, Hospital Universitario Reina Sofía, Córdoba, España
| | - Marta Fuentes
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | | | | | - Pascual Piñera
- Servicio de Urgencias, Hospital Universitario Reina Sofía, Murcia, España
| | - Rodolfo Romero
- Servicio de Urgencias, Hospital Universitario de Getafe, Universidad Europea, Madrid, España
| | | | - Juan Antonio Andueza
- Servicio de Urgencias, Hospital Universitario Dr. Gregorio Marañón, Madrid, España
| | - Javier Povar
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Fernando Richard
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
| | - Carolina Sánchez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, España
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19
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Jiménez S, Miró Ò, Alquézar-Arbé A, Piñera P, Jacob J, Llorens P, García-Lamberechts EJ, Martín-Sánchez FJ, González Del Castillo J, Burillo-Putze G. Quality of hospital emergency department care for patients with COVID-19 during the first wave in 2020: the CALUR-COVID-19 study. Emergencias 2022; 34:369-376. [PMID: 36217932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To define quality of care indicators and care process standards for treating patients with COVID-19 in hospital emergency departments (EDs), to determine the level of adherence to standards during the first wave in 2020, and to detect factors associated with different levels of adherence. MATERIAL AND METHODS We selected care indicators and standards by applying the Delphi method. We then analyzed the level of adherence in the SIESTA cohort (registered by the Spanish Investigators in Emergency Situations Team). This cohort was comprised of patients with COVID-19 treated in 62 Spanish hospitals in March and April 2020. Adherence was compared according to pandemic-related ED caseload pressure, time periods during the wave (earlier and later), and age groups. RESULTS Fourteen quality indicators were identified. Three were adhered to in less than 50% of the patients. Polymerase chain reaction testing for SARS-CoV-2 infection was the indicator most often disregarded, in 29% of patients when the caseload was high vs 40% at other times (P .001) and in 30% of patients in the later period vs 37% in the earlier period (P = .04). Adherence to the following indicators was better in the later part of the wave: monitoring of oxygen saturation (100% vs 99%, P = .035), electrocardiogram monitoring in patients treated with hydroxychloroquine (87% vs 65%, P .001), and avoiding of lopinavir/ritonavir treatment in patients with diarrhea (79% vs 53%, P .001). No differences related to age groups were found. CONCLUSION Adherence to certain quality indicators deteriorated during ED treatment of patients with COVID-19 during the first wave of the pandemic. Pressure from high caseloads may have exacerbated this deterioration. A learning effect led to improvement. No differences related to patient age were detected.
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Affiliation(s)
- Sònia Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
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20
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García-Azorín D, Abelaira-Freire J, González-García N, Rodriguez-Adrada E, Schytz HW, Barloese M, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Sensitivity of the SNNOOP10 list in the high-risk secondary headache detection. Cephalalgia 2022; 42:1521-1531. [PMID: 36003002 DOI: 10.1177/03331024221120249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the diagnostic accuracy of the SNNOOP10 list in the detection of high-risk headaches. METHODS Patients that visited the Hospital Clínico San Carlos (Madrid) emergency department due to headache that were allocated to a Manchester Triage System level between critical and urgent were prospectively included but retrospectively analysed. A researcher blind to the patients' diagnosis administered a standardised questionnaire and afterwards a neurologist blind to the questionnaire results diagnosed the patient according to the International Classification of Headache Disorders. The primary endpoint was to assess the sensitivity of the SNNOOP10 list in the detection of high-risk headaches. Secondary endpoints included the evaluation of the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of each SNNOOP10 item. RESULTS Between April 2015 and October 2021, 100 patients were included. Patients were 44 years old (inter-quartile range: 33.6-64.7) and 57% were female. We identified 37 different diagnoses. Final diagnosis was a primary headache in 33%, secondary headache in 65% and cranial neuralgia in 2%. There were 46 patients that were considered as having high-risk headache. Patients from the primary headache group were younger and more frequently female. Sensitivity of SNNOOP10 list was 100% (95% confidence interval: 90.2%-100%). The items with higher sensitivity were neurologic deficit or disfunction (75.5%), pattern change or recent onset of the headache (64.4%), onset after 50 years (64.4%). The most specific items were posttraumatic onset of headache (94.5%), neoplasm in history (89.1%) and systemic symptoms (89%). The area under the curve of the SNNOOP10 list was 0.66 (95% CI: 0.55-0.76). CONCLUSION The red flags from the SNNOOP10 list showed a 100% sensitivity in the detection of high-risk headache disorders.
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Affiliation(s)
- David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Nuria González-García
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Henrik Winther Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Barloese
- Center for Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ángel Luis Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.,Institute of Biomedical Research of Salamanca (Ibsal), Salamanca, Spain
| | - Jesús Porta-Etessam
- Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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21
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Masip J, Povar-Echeverría M, Peacock WF, Jacob J, Gil V, Herrero P, Llorens P, Alquézar-Arbé A, Sánchez C, Martín-Sánchez FJ, Miró Ò. Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients. Intern Emerg Med 2022; 17:1503-1516. [PMID: 35352299 DOI: 10.1007/s11739-022-02965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/26/2022] [Indexed: 11/05/2022]
Abstract
The impact of diabetes mellitus (DM) and hyperglycemia on short-term prognosis in patients with acute heart failure (AHF) remains controversial as most data comes from series of hospitalized patients. Our purpose was to analyze outcomes in a nation-wide registry of AHF patients attended in emergency department (ED). ED AHF patients were prospectively enrolled, with the index event and the vulnerable post-discharge phase outcomes recorded. The influence of presenting hyperglycemia (> 180 mg/dL) and DM treatment on prognosis were also investigated. All results were adjusted (a) for baseline characteristics. Of 9192 enrolled AHF patients, 4544 (49,4%) were diabetic, with 24% of diabetics and 25.1% of non-diabetic (p = 0.247) directly discharged from the ED also included. Diabetics had higher rates of comorbidities, but were slightly younger and had lower in-hospital and 30 day all-cause mortality than non-diabetics (a-OR = 0.827, 95% CI = 0.690-0980; and a-HR = 0.850, 95% CI = 0.814-1.071, respectively). Conversely, hyperglycemia on-arrival was associated with increased in-hospital, and 30 day all-cause mortality, in both DM (a-OR = 1.933, 95% CI = 1.378-2.712, and a-HR = 1.590, 95% CI = 1.304-1.938, respectively) and non-DM patients (a-OR = 1.498, 95% CI = 1.175-1.909, and a-HR = 1.719, 95% CI = 1.306-2.264, respectively). However, during the vulnerable phase, diabetics had worse short-term outcomes, with higher rates of ED-revisit and rehospitalization. These worse outcomes seemed to be unrelated to the severity of DM. In patients with AHF attended in ED, diabetes was associated with lower index event case fatality, but higher rates of rehospitalization and re-consultation in the vulnerable post-discharge period. Conversely, hyperglycemia at hospital arrival was strongly associated with early mortality, regardless of diabetes status.
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Affiliation(s)
- Josep Masip
- Research Department, Consorci Sanitari Integral, University of Barcelona, Av. Josep Molins, 29, L'Hospitalet de Llobegat, 08096, Barcelona, Catalonia, Spain.
| | | | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Carolina Sánchez
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain
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22
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Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
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Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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23
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Bueno H, Bernal JL, Jiménez-Jiménez V, Martín-Sánchez FJ, Rossello X, Moreno G, Goñi C, Gil V, Llorens P, Naranjo N, Jacob J, Herrero-Puente P, Garrote S, Silla-Castro JC, Pocock SJ, Miró Ò. The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients. Rev Esp Cardiol (Engl Ed) 2022; 75:585-594. [PMID: 34688580 DOI: 10.1016/j.rec.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Composite endpoints are widely used but have several limitations. The Clinical outcomes, healthcare resource utilization and related costs (COHERENT) model is a new approach for visually displaying and comparing composite endpoints including all their components (incidence, timing, duration) and related costs. We aimed to assess the validity of the COHERENT model in a patient cohort. METHODS A color graphic system displaying the percentage of patients in each clinical situation (vital status and location: at home, emergency department [ED] or hospital) and related costs at each time point during follow-up was created based on a list of mutually exclusive clinical situations coded in a hierarchical fashion. The system was tested in a cohort of 1126 patients with acute heart failure from 25 hospitals. The system calculated and displayed the time spent in each clinical situation and health care resource utilization-related costs over 30 days. RESULTS The model illustrated the times spent over 30 days (2.12% in ED, 23.6% in index hospitalization, 2.7% in readmissions, 65.5% alive at home, and 6.02% dead), showing significant differences between patient groups, hospitals, and health care systems. The tool calculated and displayed the daily and cumulative health care-related costs over time (total, €4 895 070; mean, €144.91 per patient/d). CONCLUSIONS The COHERENT model is a new, easy-to-interpret, visual display of composite endpoints, enabling comparisons between patient groups and cohorts, including related costs. The model may constitute a useful new approach for clinical trials or observational studies, and a tool for benchmarking, and value-based health care implementation.
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Affiliation(s)
- Héctor Bueno
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - José L Bernal
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Víctor Jiménez-Jiménez
- Laboratorio de Mecanoadaptación y Biología de Caveolas, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Clara Goñi
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Víctor Gil
- Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
| | - Nerea Naranjo
- Facultad de Ingeniería Biomédica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Javier Jacob
- Servei d'Urgències, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Sergio Garrote
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Juan Carlos Silla-Castro
- Unidad de Bioinformática, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Stuart J Pocock
- Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Òscar Miró
- Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Anguita E, Chaparro A, Candel FJ, Ramos-Acosta C, Martínez-Micaelo N, Amigó N, Torrejón MJ, Llopis-García G, del Mar Suárez-Cadenas M, Matesanz M, del Castillo JG, Martín-Sánchez FJ. Biomarkers of stable and decompensated phases of heart failure with preserved ejection fraction. Int J Cardiol 2022; 361:91-100. [DOI: 10.1016/j.ijcard.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/03/2022] [Accepted: 05/02/2022] [Indexed: 12/14/2022]
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Mirò Ò, Sabaté M, Jiménez S, Mebazaa A, Martínez-Nadal G, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, Jacob J, Alquézar-Arbé A, García-Lamberechts EJ, Llorens P, González Del Castillo J. A case-control, multicentre study of consecutive patients with COVID-19 and acute (myo)pericarditis: incidence, risk factors, clinical characteristics and outcomes. Emerg Med J 2022; 39:402-410. [PMID: 35304388 PMCID: PMC8948081 DOI: 10.1136/emermed-2020-210977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/30/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate incidence, risk factors, clinical characteristics and outcomes of acute (myo)pericarditis (AMP) in patients with COVID-19. METHODS Case-control, retrospective review, consecutive case inclusion performed in 62 Spanish EDs. All COVID-19 patients with AMP (cases) were compared in clinical characteristics and outcomes with COVID-19 without AMP (control group A) and non-COVID patients with AMP (control group B). We estimated unadjusted standardised incidence (SI, not adjusted by population's age/sex) of AMP in COVID-19 and non-COVID populations (per 100 000/year). RESULTS We identified 67 AMP in COVID-19 patients (SI=56.5, OR with respect to non-COVID patients=4.43, 95% CI=3.98 to 4.94). Remarkably, COVID-19 cases presented with chest pain less frequently than non-COVID patients and had less typical ECG changes, higher NT-proBNP (N-terminal prohormone of brain natriuretic peptide), more left and right ventricular dysfunction in echocardiography and more need of inotropic/vasopressor drugs. Admission to intensive care was higher than control group A (OR=3.22, 95% CI=1.43 to 7.23), and in-hospital mortality was higher than control group B (OR=7.75, 95% CI=2.77 to 21.7). CONCLUSION AMP is unusual as a form of COVID-19 presentation (about 1‰ cases), but SI is more than fourfold higher than non-COVID population, and it is less symptomatic, more severe and has higher in-hospital mortality; therefore, rapid recognition, echocardiographic assessment of myopericardial inflammation/dysfunction and treatment with vasoactive drugs when needed are recommended in AMP in patients with COVID-19.
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Affiliation(s)
- Òscar Mirò
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Hospital Clínic, Barcelona, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Gemma Martínez-Nadal
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pascual Piñera
- Emergency Department, Hospital Reina Sofia de Murcia, Murcia, Spain
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, Spain
| | - Alfonso Martín
- Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Pere Llorens
- Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain
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Ferré C, Llopis F, Martín-Sánchez FJ, Cabello I, Albert A, García-Lamberechts EJ, Del Castillo JG, Martínez C, Jacob J. The utility of the Barthel index as an outcome predictor in older patients with acute infection attending the emergency department. Australas Emerg Care 2022; 25:316-320. [PMID: 35398013 DOI: 10.1016/j.auec.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional decline and frailty are common in older adults and influence the risk of adverse outcomes. We aimed to assess the value of a Barthel index at the Emergency Department (ED-BI) score in predicting 30-day mortality and ED reconsultation among older patients with acute infection. METHODS We performed a prospective multicentre cohort study of older patients (≥75 years) diagnosed with acute infection in 69 Spanish EDs. Demographic, comorbidities, functional status, clinical and analytical data were collected. Unadjusted and adjusted logistic regression models were used to assess the association between ED-BI score, mortality and ED reconsultation. RESULTS In total 1596 patients with a mean age of 84.7 years were included in the study and 51.7% female. The most frequent focus of infection was respiratory in 918 patients (57.5%). Patients with an ED-BI< 60 points were significantly older, predominantly female, more likely institutionalized and more urinary infections. When comparing patients with an ED-BI score ≥ 60 points with those< 60 points no differences were found in ED reconsultation but in the latter group mortality at 30-days was higher (p < 0.001). CONCLUSION An ED-BI score< 60 points appears to be a strong predictor of mortality at the 30-day follow up in older patients with acute infection. DATA AVAILABILITY The data used to support the findings of this study are included within the article.
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Affiliation(s)
- Carles Ferré
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Llopis
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Irene Cabello
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa Albert
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Concepción Martínez
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Miró Ò, López-Díez MP, Cardozo C, Moreno LA, Gil V, Jacob J, Herrero P, Llorens P, Escoda R, Richard F, Alquézar-Arbé A, Masip J, García-Álvarez A, Martín-Sánchez FJ. Impact of hospital and emergency department structural and organizational characteristics on outcomes of acute heart failure. Rev Esp Cardiol (Engl Ed) 2022; 75:39-49. [PMID: 33712347 DOI: 10.1016/j.rec.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine whether structural/organizational characteristics of hospitals and emergency departments (EDs) affect acute heart failure (AHF) outcomes. METHODS We performed a secondary analysis of the EAHFE Registry. Six hospital/ED characteristics were collected and were related to 7 postindex events and postdischarge outcomes, adjusted by the period of patient inclusion, baseline patient characteristics, AHF episode features, and hospital and ED characteristics. The relationship between discharge directly from the ED (DDED) and outcomes was assessed, and interaction was analyzed according to the hospital/ED characteristics. RESULTS We analyzed 17 974 AHF episodes included by 40 Spanish EDs. Prolonged stays were less frequent in high-technology hospitals and those with hospitalization at home and with high-inflow EDs, and were more frequent in hospitals with a heart failure unit (HFU) and an ED observation unit. In-hospital mortality was lower in high-technology hospitals (OR, 0.78; 95%CI, 0.65-0.94). Analysis of 30-day postdischarge outcomes showed that hospitals with a short-stay unit (SSU) had higher hospitalization rates (OR, 1.19; 95%CI, 1.02-1.38), high-inflow EDs had lower mortality (OR, 0.73; 95%CI, 0.56-0.96) and fewer combined events (OR, 0.87; 95%CI, 0.76-0.99), while hospitals with HFU had fewer ED reconsultations (OR, 0.83; 95%CI, 0.76-0.91), hospitalizations (OR, 0.85; 95%CI, 0.75-0.97), and combined events (OR, 0.84; 95%CI, 0.77-0.92). The higher the percentage of DDED, the fewer the prolonged stays. Among other interactions, we found that more frequent DDED was associated with more 30-day postdischarge reconsultations, hospitalizations and combined events in hospitals without SSUs, but not in hospitals with an SSU. CONCLUSIONS AHF outcomes were significantly affected by the structural/organizational characteristics of hospitals and EDs and their aggressiveness in ED management.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | | | - Carlos Cardozo
- Servicio de Urgencias, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Luis Arturo Moreno
- Servicio de Urgencias, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Rosa Escoda
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Richard
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Masip
- Servicio de Cardiología, Hospital Sanitas CIMA, Barcelona, Spain
| | - Ana García-Álvarez
- Servicio de Cardiología, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Benito Lozano M, Miró Ò, Llorens P, Travería L, Pavón Monzó JM, Noval de la Torre A, Domínguez Rodríguez A, Jacob J, Tost J, Alquézar-Arbé A, Gil V, Martín-Sánchez FJ, Herrero P, Burillo-Putze G. Acute heart failure in subtropical climates: clinical characteristics, management, and outcomes in the Canary Islands versus continental Spain - the CANAR-ICA study results. Emergencias 2021; 33:413-420. [PMID: 34813187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine whether there are differences in the clinical characteristics, management, and outcome of episodes of acute heart failure (AHF) in residents of the Canary Islands, where the climate is subtropical, and episodes in continental Spain. MATERIAL AND METHODS Cases were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments and categorized as in the Canary Islands or continental Spain. Data for 38 demographic, baseline, clinical, and therapeutic variables were extracted. We analyzed statistics for in-hospital and 30-day mortality, long hospital stay (more than 7 days), and a composite outcome after discharge (revisits or death within 30 days). The results for island and continental patients were compared and adjusted for between-group differences. RESULTS A total of 18 390 patients were studied, 697 islanders (3.8%) and 17 673 continental patients (96.2%). Comparisons showed that the islanders were younger; more often women; and more likely to have hypertension, diabetes, and a prior AHF episode. Their New York Heart Association functional class was also likely to be higher. However, their rates of dyslipidemia, valve disease, and functional dependence were lower, and they were also less likely to be on reninangiotensin system blockers. Although the severity of cardiac decompensation was similar in island and continental patients, the islanders received more intravenous treatments in the emergency department and were admitted less often. The adjusted risk of a long hospital stay was higher for the islanders (odds ratio [OR], 2.36; 95% CI, 1.52-3.02) but their risk for mortality and the composite outcome did not differ: in-hospital mortality, OR 0.97 (95% CI, 0.68-1.37); 30-day mortality, OR, 0.9 (95% CI, 0.67-1.27); and the post-discharge composite, OR, 1.19 (95% CI, 0.93-1.53). CONCLUSION Baseline patient characteristics and clinical management of AHF episodes differ between the subtropical region and those in southern continental Europe. Hospitalization was required less often, but hospital stays were longer.
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Affiliation(s)
- Miguel Benito Lozano
- Servicio de Urgencias, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universidad Miguel Hernández, Alicante, España
| | - Lissete Travería
- Servicio de Urgencias, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | | | | | - Alberto Domínguez Rodríguez
- Servicio de Cardiología, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España. Universidad Europea de Canarias, Tenerife, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Josep Tost
- Servicio de Urgencias, Hospital de Terrassa, Barcelona, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - Guillermo Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
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Valls Carbó A, González Del Castillo J, Miró O, Lopez-Ayala P, Jimenez S, Jacob J, Bibiano C, Martín-Sánchez FJ. Increased severity in SARS-CoV-2 infection of minorities in Spain. Rev Esp Quimioter 2021; 34:664-667. [PMID: 34622269 PMCID: PMC8638765 DOI: 10.37201/req/099.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. Material and methods A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. Results There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). Conclusions COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed.
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Affiliation(s)
| | | | | | | | | | | | | | - F J Martín-Sánchez
- Francisco Javier Martín Sanchez, Emergency Department. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain.
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Bueno H, Bernal JL, Jiménez-Jiménez V, Martín-Sánchez FJ, Rossello X, Moreno G, Goñi C, Gil V, Llorens P, Naranjo N, Jacob J, Herrero-Puente P, Garrote S, Silla-Castro JC, Pocock SJ, Miró Ò. El modelo Clinical outcomes, healthcare resource utilization, and related costs (COHERENT). Aplicación en pacientes con insuficiencia cardiaca. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miró Ò, Llorens P, Freund Y, Davison B, Takagi K, Herrero-Puente P, Jacob J, Martín-Sánchez FJ, Gil V, Rosselló X, Alquézar-Arbé A, Jiménez-Fábrega FX, Masip J, Mebazaa A, Cotter G. Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry. Int J Cardiol 2021; 344:127-134. [PMID: 34543690 DOI: 10.1016/j.ijcard.2021.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. METHODS We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. RESULTS We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower in-hospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. CONCLUSIONS Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global Research in Acute Contditions Team) Network, Via Antonio Serra 54, 00191, Roma, Italy.
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux 18 de Paris (APHP), Sorbonne Université, Paris, France
| | - Beth Davison
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
| | - Koji Takagi
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Xavier Rosselló
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | | | - Josep Masip
- Consultant Research Direction, University of Barcelona, Catalonia, Spain
| | - Alexandre Mebazaa
- The GREAT (Global Research in Acute Contditions Team) Network, Via Antonio Serra 54, 00191, Roma, Italy; INSERM U-942 (Biotherapy in the critically ill), Paris, France; Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France
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Tost J, Llorens P, Cotter G, Davison B, Jacob J, Gil V, Herrero P, Martín-Sánchez FJ, Donea R, Rodríguez B, Lucas-Imbernon FJ, Andueza JA, Mecina AB, Torres-Gárate R, Piñera P, Alquézar-Arbé A, Espinosa B, Mebazaa A, Chioncel O, Miró Ò. Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation. Eur J Intern Med 2021; 94:73-84. [PMID: 34446316 DOI: 10.1016/j.ejim.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
AIMS To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes. METHODS We included consecutive HFpEF patients (left ventricular ejection fraction ≥50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated. RESULTS We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45.8%). The 1-year mortality was 26.9% (adjusted HR for ANHD patients:1.17, 95%CI=0.98-1.38) and the 90-day combined adverse event was 54.4% (HR=1.14, 95%CI=0.99-1.31). ED revisit was significantly increased by ANHD (HR=1.15, 95%CI=1.01-1.32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0.73, 98%CI=0.56-0.96). CONCLUSION 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF.
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Affiliation(s)
- Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalitation at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, United States
| | - Beth Davison
- Momentum Research, Durham, North Carolina, United States
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Ruxandra Donea
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - Beatriz Rodríguez
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Juan Antonio Andueza
- Emergency Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Sapin
| | | | | | - Pascual Piñera
- Emergency Department, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalitation at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, INSERM U-942, Paris, France.; The GREAT network, Rome, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases, Prof. C. C. Iliescu, 1 University of Medicine Carol Davila, Bucharest, Romania
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; The GREAT network, Rome, Italy.
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de Freitas RF, Torres SC, Martín-Sánchez FJ, Carbó AV, Lauria G, Nunes JPL. Syncope and COVID-19 disease - A systematic review. Auton Neurosci 2021; 235:102872. [PMID: 34500351 PMCID: PMC8393505 DOI: 10.1016/j.autneu.2021.102872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/08/2021] [Accepted: 08/21/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Syncope is not a common manifestation of COVID-19, but it may occur in this context and it can be the presenting symptom in some cases. Different mechanisms may explain the pathophysiology behind COVID-19 related syncope. In this report, we aimed to examine the current frequency and etiology of syncope in COVID-19. METHODS A systematic review across PubMed, ISI Web of Knowledge and SCOPUS was performed, according to PRISMA guidelines, in order to identify all relevant articles regarding both COVID-19 and syncope. RESULTS We identified 136 publications, of which 99 were excluded. The frequency of syncope and pre-syncope across the selected studies was 4.2% (604/14,437). Unexplained syncope was the most common type (87.9% of the episodes), followed by reflex syncope (7.8% of the cases). Orthostatic hypotension was responsible for 2.2% of the cases and syncope of presumable cardiac cause also accounted for 2.2% of cases. Arterial hypertension was present in 52.0% of syncope patients. The use of angiotensin receptor blockers or angiotensin converting enzyme inhibitors were not associated with an increased incidence of syncope (chi-square test 1.07, p 0.30), unlike the use of beta-blockers (chi-square test 12.48, p < 0.01). CONCLUSION Syncope, although not considered a typical symptom of COVID-19, can be associated with it, particularly in early stages. Different causes of syncope were seen in this context. A reevaluation of blood pressure in patients with COVID-19 is suggested, including reassessment of antihypertensive therapy, especially in the case of beta-blockers.
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Affiliation(s)
| | - Sofia Cardoso Torres
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Adrián Valls Carbó
- Departments of Emergency and of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - Giuseppe Lauria
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - José Pedro L Nunes
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal.
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Carriel Mancilla J, Jiménez Hernández S, Martín-Sánchez FJ, Jiménez D, Lecumberri R, Alonso Valle H, Beddar Chaib F, Ruiz-Artacho P. Profiles of patients with venous thromboembolic disease in the emergency department and their medium-term prognosis: data from the ESPHERIA registry. Emergencias 2021; 33:107-114. [PMID: 33750051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To assess the 180-day prognosis for patients of different profiles diagnosed with venous thromboembolism (VTE) in emergency departments (EDs). Secondary aims were to assess all-cause mortality and readmission rates and to describe the clinical characteristics and forms of presentation of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in each patient profile. MATERIAL AND METHODS Secondary analysis of data from the ESPHERIA registry (Spanish acronym for Risk Profile of Patients with VTE Attended in Spanish Emergency Departments), which includes consecutive patients with symptomatic VTE treated in 53 EDs. The cases were divided according to 4 profiles: 1) unprovoked DVT, 2) DVT provoked by transient risk factors, 3)patients with cancer, and 4) patients with low cardiopulmonary reserve. The primary outcome was a composite of 180-day all-cause mortality or readmission. RESULTS We studied 773 patients: 450 (58.2%) were classified as profile 1, 128 (16.6%) as profile 2, 115 (14.9%) as profile 3 , a nd 8 0 ( 10.3%) a s p rofile 4. We fo und di fferences be tween th e 4 pr ofiles in demographics, com orbidity, clinical presentation, type of DVT and location, management, and outcomes. One hundred ninety-five p atients (25.2%) had at least one of the adverse events included in the composite within 180 days: 69 (8.9%) died and 179 (23.2%) were readmitted. Hazard ratios (HR) indicated that DVT with low cardiopulmonary reserve (HR, 1.73; 95% CI, 1.12-2.68; P = .01)) or DVT with cancer (HR, 3.10; 95% CI, 2.22-4.34; P .001) were the profiles t hat w ere independently associated with the 180-day composite outcome. CONCLUSION Classifying patients with DVT according to 4 profiles ( unprovoked, provoked by t ransient r isk f actors, associated with cancer, and associated with low cardiopulmonary reserve) when making the diagnosis is useful for assessing prognosis for all-cause mortality or readmission within 180 days. This classification could be useful for establishing a care and follow-up plan when discharging patients with DVT from the ED.
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Affiliation(s)
- Jorge Carriel Mancilla
- Unidad de Hospitalización, Hospital de Emergencias Enfermera Isabel Zendal, Madrid, España
| | | | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid. Facultad de Medicina, Universidad Complutense de Madrid. Madrid, España
| | - David Jiménez
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España. Departamento de Medicina, Universidad de Alcalá (IRYCIS), Alcalá de Henares, Madrid, España. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España
| | - Ramón Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, España. CIBER-CV, Pamplona, Navarra, España
| | - Héctor Alonso Valle
- Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. Grupo Salud Comunitaria del Instituto de Investigación Sanitaria Valdecilla (IDIVAL)
| | | | - Pedro Ruiz-Artacho
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España. Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, España. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, España
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Julián-Jiménez A, García-Lamberechts EJ, González del Castillo J, Rubio Díaz R, Huarte Sanz I, Navarro Bustos C, Guardiola Tey JM, Perales Pardo R, Llopis-Roca F, Piñera Salmerón P, Martínez-Ortiz de Zarate M, Álvarez-Manzanares J, Gamazo-Del Rio JJ, Álvarez López O, Ferreras Amez JM, Sousa Reviriego MDM, Martín-Sánchez FJ, Beneyto Martín P, Candel González FJ. Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente anciano. Infect 2021. [DOI: 10.22354/in.v26i2.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: Analizar la utilidad del modelo predictivo de bacteriemia (5MPB-Toledo) en los mayores de 65 años atendidos por infección en el servicio de urgencias (SU). Material y Método: Estudio observacional prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 65 años atendidos por infección en 66 SU españoles desde el 1 de diciembre de 2019 hasta el 30 de abril de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico de los puntos de corte (PC) del modelo elegido con los cálculos de la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo. Resultados: Se incluyeron 2.401 episodios de HC extraídos. De ellos, se consideró como bacteriemia verdadera a 579 (24,11%) y como HC negativo a 1.822 (75,89%). Entre los negativos, 138 (5,74%) se consideraron contaminados. Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,2%, 18,1% y 80,7%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,908 (IC 95%: 0,897-0,924). El rendimiento diagnóstico del modelo, considerando un PC ? 5 puntos, obtiene una sensibilidad de 94% (IC 95%:92-96), especificidad de 77% (IC 95%:76-79) y un valor predictivo negativo de 97% (IC 95%:96-98). Conclusión: El modelo 5MPB-Toledo es de utilidad para predecir bacteriemia en los mayores de 65 años atendidos en el SU por un episodio de infección.
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Julián-Jiménez A, González Del Castillo J, García-Lamberechts EJ, Huarte Sanz I, Navarro Bustos C, Rubio Díaz R, Guardiola Tey JM, Llopis-Roca F, Piñera Salmerón P, de Martín-Ortiz de Zarate M, Álvarez-Manzanares J, Gamazo-Del Rio JJ, Álvarez Alonso M, Mora Ordoñez B, Álvarez López O, Ortega Romero MDM, Sousa Reviriego MDM, Perales Pardo R, Villena García Del Real H, Marchena González MJ, Ferreras Amez JM, González Martínez F, Martín-Sánchez FJ, Beneyto Martín P, Candel González FJ, Díaz-Honrubia AJ. A bacteraemia risk prediction model: development and validation in an emergency medicine population. Infection 2021; 50:203-221. [PMID: 34487306 DOI: 10.1007/s15010-021-01686-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Design a risk model to predict bacteraemia in patients attended in emergency departments (ED) for an episode of infection. METHODS This was a national, prospective, multicentre, observational cohort study of blood cultures (BC) collected from adult patients (≥ 18 years) attended in 71 Spanish EDs from October 1 2019 to March 31, 2020. Variables with a p value < 0.05 were introduced in the univariate analysis together with those of clinical significance. The final selection of variables for the scoring scale was made by logistic regression with selection by introduction. The results obtained were internally validated by dividing the sample in a derivation and a validation cohort. RESULTS A total of 4,439 infectious episodes were included. Of these, 899 (20.25%) were considered as true bacteraemia. A predictive model for bacteraemia was defined with seven variables according to the Bacteraemia Prediction Model of the INFURG-SEMES group (MPB-INFURG-SEMES). The model achieved an area under the curve-receiver operating curve of 0.924 (CI 95%:0.914-0.934) in the derivation cohort, and 0.926 (CI 95%: 0.910-0.942) in the validation cohort. Patients were then split into ten risk categories, and had the following rates of risk: 0.2%(0 points), 0.4%(1 point), 0.9%(2 points), 1.8%(3 points), 4.7%(4 points), 19.1% (5 points), 39.1% (6 points), 56.8% (7 points), 71.1% (8 points), 82.7% (9 points) and 90.1% (10 points). Findings were similar in the validation cohort. The cut-off point of five points provided the best precision with a sensitivity of 95.94%, specificity of 76.28%, positive predictive value of 53.63% and negative predictive value of 98.50%. CONCLUSION The MPB-INFURG-SEMES model may be useful for the stratification of risk of bacteraemia in adult patients with infection in EDs, together with clinical judgement and other variables independent of the process and the patient.
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Affiliation(s)
- Agustín Julián-Jiménez
- Emergency Department, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla La Mancha, Toledo, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín Lagos Calle Profesor Martín Lagos, 28040, Madrid, Spain. .,Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain.
| | - Eric Jorge García-Lamberechts
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín Lagos Calle Profesor Martín Lagos, 28040, Madrid, Spain.,Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain
| | - Itziar Huarte Sanz
- Emergency Department, Hospital Universitario de Donostia, San Sebastian, Spain
| | | | - Rafael Rubio Díaz
- Emergency Department, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla La Mancha, Toledo, Spain
| | | | - Ferrán Llopis-Roca
- Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Ramón Perales Pardo
- Emergency Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | | | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín Lagos Calle Profesor Martín Lagos, 28040, Madrid, Spain.,Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain
| | | | | | - Antonio Jesús Díaz-Honrubia
- Biomedical Technology Center - E.T.S. of Computer Engineers, Universidad Politécnica de Madrid, Madrid, Spain
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Alquézar-Arbé A, Miró Ò, Piñera P, Jacob J, Martín A, Agra Montava I, Llorens P, Jiménez S, Burillo-Putze G, García-Lamberechts EJ, Martín-Sánchez FJ, González Del Castillo J, Siesta RDI. [Analysis of the evolution of patients attended in Spanish emergency departments during the first wave of the pandemic]. An Sist Sanit Navar 2021; 44:243-252. [PMID: 34142985 PMCID: PMC10019547 DOI: 10.23938/assn.0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To describe the number of visits (total and per COVID-19) attended by the Spanish hospital emergency departments (EDs) during the first wave of the pandemic (March-April 2020) compared to the same period in 2019, and to calculate the quantitative changes in healthcare activity and investigate the possible influence of hospital size and COVID-19 seroprevalence. METHOD Cross-sectional study that analyzes the number of visits to Spanish public EDs, reported through a survey of ED chiefs during the study periods. Changes in healthcare activity were described in each autonomous community and com-pared according to hospital size and the provincial impact of the pandemic. RESULTS A total of 187 (66?%) of the 283 Spanish EDs participated in the study. The total number of patients attended de-creased to 49.2?% (<?30?% in the Castilla-La Mancha region), with a 60?% reduction in non-COVID-19 patients (reduction <?50?% in the regions of Asturias and Extremadura). While there were no differences in changes of healthcare activity according to the size of the hospital, there were differences in relation to the provincial impact of the pandemic, with a direct correla-tion related to the decrease in non-COVID-19 activity (the greater the impact, the greater the decrease; R2?=?0.05; p?=?0.002) and an inverse correlation to the overall activity (the greater the impact, the lesser the decrease; R2?=?0.05; p?=?0.002). CONCLUSION There was a very significant decrease in the number of ED visits during the first pandemic wave, although this decrease cannot be explained solely by the local incidence of the pandemic.
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Affiliation(s)
- A Alquézar-Arbé
- Servicio de Urgencias. Hospital de la Santa Creu i Sant Pau. Barcelona. España..
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Miró Ò, Alquézar-Arbé A, Piñera P, Jacob J, Martín A, Llorens P, Jiménez S, González Del Castillo J, García-Lamberechts EJ, Martín-Sánchez FJ, Burillo-Putze G. [ENCOVUR-2 study: Analysis of the protocols of action, management and availability of intensive care resources for patients with severe COVID-19 attended in spanish Emergency Departments during the first peak of the pandemic.]. Rev Esp Salud Publica 2021; 95:e202108103. [PMID: 34376632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE During the first wave of the COVID-19 pandemic, the availability of a critical care bed was insufficient. The aim of this work was to evaluate the presence of protocols, management in the emergency department (ED) and the availability of intensive care unit (ICU) beds for severe COVID-19 patients attended in Spanish hospital EDs during the first peak of the 2020 pandemic. METHODS Questionnaire collecting data regarding ED care in March-April 2020 aimed at all Spanish public health care EDs. The respondents were the Chiefs of EDs. The variables of interest were: 1) Presence and of compliance with ED protocols for decision making and adequacy of therapeutic effort; 2) management of COVID-19 patients with non-invasive mechanical ventilation (NIMV) or high flow nasal cannula (HFNC) in the ED; and 3) ICU bed accessibility for ED patients. The results were compared based on the characteristics of the hospital, impact of the pandemic and autonomous community. A descriptive and inferential analysis of the variables studied was performed using the chi-square test and analysis of variance. RESULTS A total of 246 questionnaires (89%) were received. Protocols were available in 136 EDs (57.1%). Globally, the protocol was applied in >95% of the EDs, although this was less frequent (76%) in EDs with high impact of the pandemic. 53% of the EDs managed patients with severe COVID-19 with NIMV/HFNC in the ED itself, and 19.4% suffered from lack of ICU beds. The lack of ICU beds for severe COVID-19 patients in the ED significantly differed among periods, and more marked in hospitals with ICU and with high pandemic impact. CONCLUSIONS It is needed to generalize the implementation of protocols in EDs for the management of severe COVID-19 patients and improve the capacity of the ICUs to homogeneously adjust to the needs.
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Affiliation(s)
- Òscar Miró
- Servicio de Urgencias. Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias. Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | - Pascual Piñera
- Servicio de Urgencias. Hospital General Universitario Reina Sofía. Murcia. España
| | - Javier Jacob
- Servicio de Urgencias. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat (Barcelona). España
| | - Alfonso Martín
- Servicio de Urgencias. Hospital Universitario de Móstoles. Móstoles (Madrid). España
| | - Pere Llorens
- Servicio de Urgencias. Hospital General Universitario de Alicante. Universidad Miguel Hernández (Elche). Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). España
| | - Sònia Jiménez
- Servicio de Urgencias. Hospital Clínic. IDIBAPS. Universitat de Barcelona. Barcelona. España
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Fernández-Guerrero IM, Ruiz Allende AM, Moll Tudurí C, Contreras Briones L, Martín-Sánchez FJ, Miró Ò. Authors' reply. Emergencias 2021; 33:327. [PMID: 34251152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | | | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, España
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Martínez-Sellés M, Martín-Sánchez FJ. Medical associations in the 21st century. Reflections in the wake of the agreement between the Spanish Heart Foundation and the Official Physicians Association of Madrid. Rev Esp Cardiol (Engl Ed) 2021; 74:727-728. [PMID: 34172406 DOI: 10.1016/j.rec.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain.
| | - Francisco Javier Martín-Sánchez
- Facultad de Medicina, Universidad Complutense, Madrid, Spain; Ilustre Colegio Oficial de Médicos de Madrid, Madrid, Spain; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Miró Ò, Jiménez S, Mebazaa A, Freund Y, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberechts EJ, Alquézar-Arbé A, Jacob J, Llorens P, Piñera P, Gil V, Guardiola J, Cardozo C, Mòdol Deltell JM, Tost J, Aguirre Tejedo A, Palau-Vendrell A, LLauger García L, Adroher Muñoz M, Del Arco Galán C, Agudo Villa T, López-Laguna N, López Díez MP, Beddar Chaib F, Quero Motto E, González Tejera M, Ponce MC, González Del Castillo J. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur Heart J 2021; 42:3127-3142. [PMID: 34164664 PMCID: PMC8344714 DOI: 10.1093/eurheartj/ehab314] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/21/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
Aims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51–9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65–1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97–2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66–4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. Conclusions PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP Rue Ambroise Paré, 75010 Paris, France
| | - Yonathan Freund
- Emergency Department, HôpitalPitié-Salpêtrière, Assistance Publique-Hôpitaux 18 de Paris (APHP), Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alfonso Martín
- Emergency Department, Hospital Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Eric Jorge García-Lamberechts
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Calle Pintor Baeza, 11, 03010 Alicante, Spain
| | - Pascual Piñera
- Emergency Department, Hospital General Universitario Reina Sofía. Av. Intendente Jorge Palacios, 1, 30003 Murcia, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Josep Guardiola
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Carlos Cardozo
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Josep Maria Mòdol Deltell
- Emergency Department, Hospital Universitari Germans Trias i Pujol de Badalona, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Carretera Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - Alfons Aguirre Tejedo
- Emergency Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Anna Palau-Vendrell
- Emergency Department, Hospital Universitari Joan XXIII, Carrer Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Lluís LLauger García
- Emergency Department, Hospital Universitari de Vic, Carrer de Francesc Pla el Vigatà, 1, 08500 Vic Barcelona, Spain
| | - Maria Adroher Muñoz
- Emergency Department, Hospital Universitari de Girona Dr JosepTrueta, Avinguda de França, S/N, 17007 Girona, Spain
| | - Carmen Del Arco Galán
- Emergency Department, Hospital Universitario de la Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Teresa Agudo Villa
- Emergency Department, Hospital Universitario Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
| | - Nieves López-Laguna
- Emergency Department, Clínica Universidad Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain
| | - María Pilar López Díez
- Emergency Department, Hospital Universitario de Burgos. Av. Islas Baleares, 3, 09006 Burgos, Spain
| | - Fahd Beddar Chaib
- Emergency Department, Complejo Asistencial de Soria, Paseo Sta. Bárbara, 42005 Soria, Spain
| | - Eva Quero Motto
- Emergency Department, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Matilde González Tejera
- Emergency Department, Hospital General Universitario de Elche. Carrer Almazara, 11, 03203 Elche, Alicante, Spain
| | - María Carmen Ponce
- Emergency Department, Hospital de la Vega Baja Orihuela. Carretera Orihuela - Almoradí, S/N, Orihuela, Alicante, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
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Guemes-Villahoz N, Burgos-Blasco B, Vidal-Villegas B, Donate-López J, Martín-Sánchez FJ, Porta-Etessam J, López-Guajardo L, Martín JLR, González-Armengol JJ, García-Feijoó J. Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection. ACTA ACUST UNITED AC 2021; 156:541-546. [PMID: 34109275 PMCID: PMC8178962 DOI: 10.1016/j.medcle.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
Purpose To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters. Methods Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation < 92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP). Results 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer ≥ 500 ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH ≥ 500 U/L, CRP ≥ 10 mg/L and hypoxemia. Conclusions COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.
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Affiliation(s)
- Noemi Guemes-Villahoz
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Barbara Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Beatriz Vidal-Villegas
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Juan Donate-López
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Jesús Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Lorenzo López-Guajardo
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Juan Jorge González-Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Julián García-Feijoó
- Profesor y jefe de servicio de Oftalmología, Hospital Clínico San Carlos; Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
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Güemes-Villahoz N, Burgos-Blasco B, Martín-Sánchez FJ. Eye protection in the emergency department: SARS-CoV-2 transmission through the ocular surface. Emergencias 2021; 33:248. [PMID: 33978349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Francisco Javier Martín-Sánchez
- Departamento de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC). Universidad Complutense de Madrid, Madrid, España
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Martín-Sánchez FJ, Parra Esquivel P, Llopis García G, González Del Castillo J, Rodríguez Adrada E, Espinosa B, López Díez MP, Romero Pareja R, Rizzi Bordigoni MA, Pérez-Durá MJ, Bibiano C, Ferrer C, Aguiló S, Martín Mojarro E, Aguirre A, Piñera P, López-Picado A, Llorens P, Jacob J, Gil V, Herrero P, Fernández Pérez C, Gil P, Calvo E, Rosselló X, Bueno H, Burillo G, Miró Ò. Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial. Emergencias 2021; 33:165-173. [PMID: 33978329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. MATERIAL AND METHODS Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. RESULTS We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). CONCLUSION Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Guillermo Llopis García
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Begoña Espinosa
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - María Pilar López Díez
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Burgos, Burgos, España
| | | | | | | | - Carlos Bibiano
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Vallecas, Madrid, España
| | - Carles Ferrer
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | | | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofía, Murcia, España
| | - Amanda López-Picado
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital de Santa Tecla, Tarragona, España
| | - Cristina Fernández Pérez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Enfermería, Universidad de Enfermería, Madrid, España
| | - Pedro Gil
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Geriatría, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Elpidio Calvo
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España. Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), España
| | - Xavier Rosselló
- Servicio de Cardiología, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| | - Guillermo Burillo
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
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Julián-Jiménez A, González Del Castillo J, García-Lamberechts EJ, Rubio Díaz R, Huarte Sanz I, Navarro Bustos C, Martín-Sánchez FJ, Candel FJ. [Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. Rev Esp Quimioter 2021; 34:376-382. [PMID: 34032112 PMCID: PMC8329573 DOI: 10.37201/req/043.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.
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Affiliation(s)
- A Julián-Jiménez
- Agustín Julián-Jiménez, Servicio de Urgencias-Coordinador de Docencia, Formación, Investigación y Calidad. Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
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Martínez-Sellés M, Martín-Sánchez FJ. Los colegios de médicos en el siglo XXI. Reflexiones a raíz del acuerdo de la Fundación Española del Corazón y el Ilustre Colegio Oficial de Médicos de Madrid. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Güemes-Villahoz N, Burgos-Blasco B, Martín-Sánchez FJ, Garcia-Feijoo J. [Conjunctivitis in primary care: Possible clinical presentation of COVID-19]. Aten Primaria 2021; 53:102012. [PMID: 33743361 PMCID: PMC7966929 DOI: 10.1016/j.aprim.2021.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Noemi Güemes-Villahoz
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Madrid, España.
| | - Barbara Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Madrid, España
| | - Francisco Javier Martín-Sánchez
- Departamento de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Madrid, España
| | - Julian Garcia-Feijoo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Madrid, España
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Altali Alhames K, Martín-Sánchez FJ, Ruiz-Artacho P, Ayuso FJ, Trenchs V, Martínez Ortiz de Zarate M, Navarro C, Fuentes Ferrer M, Fernández C, González Del Castillo J, Bodas A. Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments. Rev Esp Quimioter 2021; 34:220-227. [PMID: 33926180 PMCID: PMC8179944 DOI: 10.37201/req/008.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. METHODS This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. RESULTS A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0).. CONCLUSIONS CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.
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Affiliation(s)
| | - F J Martín-Sánchez
- Francisco Javier Martín-Sánchez. Emergency Department. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid. Spain.
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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Burgos-Blasco B, Güemes-Villahoz N, Vidal-Villegas B, Martinez-de-la-Casa JM, Donate-Lopez J, Martín-Sánchez FJ, González-Armengol JJ, Porta-Etessam J, Martin JLR, Garcia-Feijoo J. Optic nerve and macular optical coherence tomography in recovered COVID-19 patients. Eur J Ophthalmol 2021; 32:628-636. [PMID: 33719624 DOI: 10.1177/11206721211001019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate the peripapillary retinal nerve fiber layer thickness (RNFLT), macular RNFLT, ganglion cell layer (GCL), and inner plexiform layer (IPL) thickness in recovered COVID-19 patients compared to controls. METHODS Patients previously diagnosed with COVID-19 were included, while healthy patients formed the historic control group. All patients underwent an ophthalmological examination, including macular and optic nerve optical coherence tomography. In the case group, socio-demographic data, medical history, and neurological symptoms were collected. RESULTS One hundred sixty patients were included; 90 recovered COVID-19 patients and 70 controls. COVID-19 patients presented increases in global RNFLT (mean difference 4.3; CI95% 0.8 to 7.7), nasal superior (mean difference 6.9; CI95% 0.4 to 13.4), and nasal inferior (mean difference 10.2; CI95% 2.4 to 18.1) sectors of peripapillary RNFLT. Macular RNFL showed decreases in COVID-19 patients in volume (mean difference -0.05; CI95% -0.08 to -0.02), superior inner (mean difference -1.4; CI95% -2.5 to -0.4), nasal inner (mean difference -1.1; CI95% -1.8 to -0.3), and nasal outer (mean difference -4.7; CI95% -7.0 to -2.4) quadrants. COVID-19 patients presented increased GCL thickness in volume (mean difference 0.04; CI95% 0.01 to 0.07), superior outer (mean difference 2.1; CI95% 0.8 to 3.3), nasal outer (mean difference 2.5; CI95% 1.1 to 4.0), and inferior outer (mean difference1.2; CI95% 0.1 to 2.4) quadrants. COVID-19 patients with anosmia and ageusia presented an increase in peripapillary RNFLT and macular GCL compared to patients without these symptoms. CONCLUSIONS SARS-CoV-2 may affect the optic nerve and cause changes in the retinal layers once the infection has resolved.
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Affiliation(s)
| | | | | | | | - Juan Donate-Lopez
- Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Juan Jorge González-Armengol
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | | | | | - Julian Garcia-Feijoo
- Ophthalmology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense, Madrid, Spain
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