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Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res 2020; 20:964. [PMID: 33081776 PMCID: PMC7576860 DOI: 10.1186/s12913-020-05828-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Camps-Vilaró A, Delgado-Jiménez JF, Farré N, Tizón-Marcos H, Álvarez-García J, Cinca J, Dégano IR, Marrugat J. Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria. J Clin Med 2020; 9:jcm9072089. [PMID: 32635219 PMCID: PMC7408645 DOI: 10.3390/jcm9072089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain. Our literature review identified epidemiological studies whose objective was to quantify the prevalence of HF and its comorbidities in Spain. We estimated the prevalence of HF with reduced EF, of New York Heart Association (NYHA) functional class II–IV, and with a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m². In this population, we analysed the prevalence of diabetes using data from the REDINSCOR (Spanish Network for Heart Failure) registry. Our estimations indicate there are 594,684 patients ≥45 years old with HF in Spain (2.6% of this population age group), of which 52.4%, 84.0%, and 93.9% have reduced EF, are NYHA II–IV, and have a GFR ≥ 30 mL/min/1.73 m², respectively. By our calculations, approximately 245,789 Spanish patients would meet the DAPA-HF patient profile, and therefore could benefit from the protective cardiovascular effects of dapagliflozin.
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Affiliation(s)
- Anna Camps-Vilaró
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
| | - Juan F. Delgado-Jiménez
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Núria Farré
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (N.F.); (H.T.-M.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Jesús Álvarez-García
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Juan Cinca
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Irene R. Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
- Correspondence: (I.R.D.); (J.M.); Tel.: +349-3316-0714 (I.R.D.); +349-3316-0733 (J.M.)
| | - Jaume Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (J.F.D.-J.); (J.Á.-G.); (J.C.)
- Correspondence: (I.R.D.); (J.M.); Tel.: +349-3316-0714 (I.R.D.); +349-3316-0733 (J.M.)
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Merino M, Jiménez M, Manito N, Casariego E, Ivanova Y, González‐Domínguez A, San Saturnino M, Hidalgo‐Vega Á, Blanch C. The social return on investment of a new approach to heart failure in the Spanish National Health System. ESC Heart Fail 2020; 7:130-137. [PMID: 31916416 PMCID: PMC7083495 DOI: 10.1002/ehf2.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022] Open
Abstract
AIMS We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. CONCLUSIONS The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF.
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Affiliation(s)
- María Merino
- Department of Health Outcomes ResearchInstituto Max WeberMadridSpain
| | - Margarita Jiménez
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | - Nicolás Manito
- Department of Heart Failure and TransplantHospital Universitario de Bellvitge, Hospitalet de LlobregatBarcelonaSpain
| | - Emilio Casariego
- Department of Internal MedicineComplejo Hospitalario de LugoLugoSpain
| | - Yoana Ivanova
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | | | | | - Álvaro Hidalgo‐Vega
- Economy and Health Research SeminarUniversidad de Castilla‐La ManchaToledoSpain
| | - Carles Blanch
- Early Access & Health EconomicsNovartisBarcelonaSpain
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Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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García-Olmos L, Aguilar R, Lora D, Carmona M, Alberquilla A, García-Caballero R, Sánchez-Gómez L. Development of a predictive model of hospitalization in primary care patients with heart failure. PLoS One 2019; 14:e0221434. [PMID: 31419267 PMCID: PMC6697326 DOI: 10.1371/journal.pone.0221434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization in people over age 65. Predictive hospital admission models have been developed to help reduce the number of these patients. AIM To develop and internally validate a model to predict hospital admission in one-year for any non-programmed cause in heart failure patients receiving primary care treatment. DESIGN AND SETTING Cohort study, prospective. Patients treated in family medicine clinics. METHODS Logistic regression analysis was used to estimate the association between the predictors and the outcome, i.e. unplanned hospitalization over a 12-month period. The predictive model was built in several steps. The initial examination included a set of 31 predictors. Bootstrapping was used for internal validation. RESULTS The study included 251 patients, 64 (25.5%) of whom were admitted to hospital for some unplanned cause over the 12 months following their date of inclusion in the study. Four predictive variables of hospitalization were identified: NYHA class III-IV, OR (95% CI) 2.46 (1.23-4.91); diabetes OR (95% CI) 1.94 (1.05-3.58); COPD OR (95% CI) 3.17 (1.45-6.94); MLHFQ Emotional OR (95% CI) 1.07 (1.02-1.12). AUC 0.723; R2N 0.17; Hosmer-Lemeshow 0.815. Internal validation AUC 0.706.; R2N 0.134. CONCLUSION This is a simple model to predict hospitalization over a 12-month period based on four variables: NYHA functional class, diabetes, COPD and the emotional dimension of the MLHFQ scale. It has an acceptable discriminative capacity enabling the identification of patients at risk of hospitalization.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid, Spain
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
| | - Río Aguilar
- Cardiology Department, La Princesa University Teaching Hospital, Madrid, Spain
| | - David Lora
- Clinical Research Unit (imas12-CIBERESP), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Montse Carmona
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Agency for Health Technology Assessment, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | - Angel Alberquilla
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Multiprofessional Education Unit for Family and Community Care (Centre), Madrid, Spain
| | | | - Luis Sánchez-Gómez
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Agency for Health Technology Assessment, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
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Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez JA, Abellán-Pérez MV, Hernández-Vicente Á, Pascual-Figal DA. Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival. ACTA ACUST UNITED AC 2018; 72:740-748. [PMID: 30262426 DOI: 10.1016/j.rec.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Affiliation(s)
- Lucía Fernández-Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Lauro Hernando-Arizaleta
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - María Victoria Abellán-Pérez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Delgado JF, Oliva J, Llano M, Pascual-Figal D, Grillo JJ, Comín-Colet J, Díaz B, Martínez de La Concha L, Martí B, Peña LM. Costes sanitarios y no sanitarios de personas que padecen insuficiencia cardiaca crónica sintomática en España. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Health care and nonhealth care costs in the treatment of patients with symptomatic chronic heart failure in Spain. ACTA ACUST UNITED AC 2014; 67:643-50. [PMID: 25037543 DOI: 10.1016/j.rec.2013.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 12/02/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Chronic heart failure is associated with high mortality and utilization of health care and social resources. The objective of this study was to quantify the use of health care and nonhealth care resources and identify variables that help to explain variability in their costs in Spain. METHODS This prospective, multicenter, observational study with a 12-month follow-up period included 374 patients with symptomatic heart failure recruited from specialized cardiology clinics. Information was collected on the socioeconomic characteristics of patients and caregivers, health status, health care resources, and professional and nonprofessional caregiving. The monetary cost of the resources used in caring for the health of these patients was evaluated, differentiating among functional classes. RESULTS The estimated total cost for the 1-year follow-up ranged from € 12,995 to € 18,220, depending on the scenario chosen (base year, 2010). The largest cost item was informal caregiving (59.1%-69.8% of the total cost), followed by health care costs (26.7%- 37.4%), and professional care (3.5%). Of the total health care costs, the largest item corresponded to hospital costs, followed by medication. Total costs differed significantly between patients in functional class II and those in classes III or IV. CONCLUSIONS Heart failure is a disease that requires the mobilization of a considerable amount of resources. The largest item corresponds to informal care. Both health care and nonhealth care costs are higher in the population with more advanced disease.
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Carmona M, García-Olmos LM, García-Sagredo P, Alberquilla Á, López-Rodríguez F, Pascual M, Muñoz A, Salvador CH, Monteagudo JL, Otero-Puime Á. Heart failure in primary care: co-morbidity and utilization of health care resources. Fam Pract 2013; 30:520-4. [PMID: 23776041 PMCID: PMC3782063 DOI: 10.1093/fampra/cmt024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. OBJECTIVE To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. METHODS Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. RESULTS One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). CONCLUSIONS Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.
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Affiliation(s)
- Montserrat Carmona
- Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain
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