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Lorenzo González J, Farráis Villalba M, López Ferraz C, Huertas Nieto S, Martín Velasco M, Hernández Afonso J. Impact of an integrated cardiology-intensive care medicine model on mortality in STEMI. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00210-X. [PMID: 38986932 DOI: 10.1016/j.rec.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Javier Lorenzo González
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Marcos Farráis Villalba
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Cristina López Ferraz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Sergio Huertas Nieto
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Mar Martín Velasco
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Julio Hernández Afonso
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
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Barrionuevo-Sánchez MI, Ariza-Solé A, Viana-Tejedor A, Del Prado N, Rosillo N, Jorge-Pérez P, Sánchez-Salado JC, Lorente V, Alegre O, Llaó I, Martín-Asenjo R, Bernal JL, Fernández-Pérez C, Corbí-Pascual M, Pascual J, Marcos M, de la Cuerda F, Carmona J, Comin-Colet J, Elola FJ. Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:226-233. [PMID: 37925017 DOI: 10.1016/j.rec.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting. METHODS This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality. RESULTS A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047). CONCLUSIONS The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Jorge-Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Júlia Pascual
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
| | - Marta Marcos
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco de la Cuerda
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Carmona
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Impact of shock aetiology and hospital characteristics on the clinical profile, management and prognosis of patients with non ACS-related cardiogenic shock. Hellenic J Cardiol 2023; 69:16-23. [PMID: 36334704 DOI: 10.1016/j.hjc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/08/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database. METHODS We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU). RESULTS A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p < 0.001). The most common main diagnosis among non ACS-CS was acute decompensation of chronic heart failure (ADCHF) (35.4%). A lower risk-adjusted in-hospital mortality rate was observed in high volume hospitals (52.6% vs. 56.7%; p < 0.001), as well as in centers with ICCU (OR: 0.71; CI 95%: 0.58-0.87; p < 0.001). CONCLUSIONS More than a half of cases of CS were due to non-ACS causes. Non ACS-CS cases are a very heterogeneous group, with different clinical profile and management. Management at high-volume hospitals and availability of ICCU were associated with lower risk adjusted mortality among non ACS-CS patients.
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Sinha SS, Bohula EA, Diepen SVAN, Leonardi S, Mebazaa A, Proudfoot AG, Sionis A, Chia YW, Zampieri FG, Lopes RD, Katz JN. The Intersection Between Heart Failure and Critical Care Cardiology: An International Perspective on Structure, Staffing, and Design Considerations. J Card Fail 2022; 28:1703-1716. [PMID: 35843489 DOI: 10.1016/j.cardfail.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
The overall patient population in contemporary cardiac intensive care units (CICUs) has only increased with respect to patient acuity, complexity, and illness severity. The current population has more cardiac and noncardiac comorbidities, a higher prevalence of multiorgan injury, and consumes more critical care resources than previously. Patients with heart failure (HF) now occupy a large portion of contemporary tertiary or quaternary care CICU beds around the world. In this review, we discuss the core issues that relate to the care of critically ill patients with HF, including global perspectives on the organization, designation, and collaboration of CICUs regionally and across institutions, as well as unique models for provisioning care for patients with HF within a health care setting. The latter includes a discussion of traditional and emerging models, specialized HF units, the makeup and implementation of multidisciplinary team-based decision-making, and cardiac critical care admission and triage practices. This article illustrates the ways in which critically ill patients with HF have helped to shape contemporary CICUs throughout the world and explores how these very patients will similarly help to inform the future maturation of these specialized critical care units. Finally, we will critically examine broad, contemporary, international models of HF and cardiac critical care delivery in North America, Europe, South America, and Asia, and conclude with opportunities for the further investigation and generation of evidence for care delivery.
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Affiliation(s)
- Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean VAN Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Pavia, Italy
| | - Alexandre Mebazaa
- Université de Paris, Inserm 942 MASCOT, APHP Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Clinic For Anaesthesiology & Intensive Care, Charité-Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Univesität zu, Berlin, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Yew Woon Chia
- Cardiac Intensive Care Unit, Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Fernando G Zampieri
- HCor Research Institute, São Paulo, Brazil Intensive Care Unit, Federal University of São Paulo, Brazil
| | - Renato D Lopes
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Brazilian Clinical Research Institute (BCRI), Sao Paulo, Brazil
| | - Jason N Katz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Solís-Marquínez MN, Rondán-Murillo JJ, Pérez-Otero M, Vegas-Valle JM, Lozano Martínez-Luengas Í, Morís-de la Tassa J. Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital. Rev Clin Esp 2021; 221:187-197. [PMID: 32113647 DOI: 10.1016/j.rce.2019.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program METHODS: We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality.
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Affiliation(s)
- M N Solís-Marquínez
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España.
| | - J J Rondán-Murillo
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, España
| | - M Pérez-Otero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Vegas-Valle
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, España
| | | | - J Morís-de la Tassa
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España; Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, España
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6
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Cubero-Gallego H, Avanzas P. Implementation of a primary angioplasty programme in a hospital district: moving towards the future. Rev Clin Esp 2021; 221:226-227. [PMID: 32473726 DOI: 10.1016/j.rce.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Affiliation(s)
- H Cubero-Gallego
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | - P Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España.
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7
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Impact of creating a hemodynamics room, a coronary care unit, and a primary angioplasty program on the prognosis of acute coronary syndrome in a district hospital. Rev Clin Esp 2021; 221:187-197. [PMID: 33998497 DOI: 10.1016/j.rceng.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/20/2019] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program. METHODS We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events, and mortality.
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Cubero-Gallego H, Avanzas P. Implementation of a primary angioplasty program in a district hospital: Moving towards the future. Rev Clin Esp 2021; 221:226-227. [PMID: 33998502 DOI: 10.1016/j.rceng.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Héctor Cubero-Gallego
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
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9
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González-Juanatey JR, Virgós Lamela A, García-Acuña JM, Pais Iglesias B. [Clinical management in cardiology. Measurement as a means to improvement]. Rev Esp Cardiol 2021; 74:8-14. [PMID: 32836662 PMCID: PMC7332256 DOI: 10.1016/j.recesp.2020.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- José R González-Juanatey
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Alejandro Virgós Lamela
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - José M García-Acuña
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Beatriz Pais Iglesias
- Subdirección de Calidad, Xerencia de Xestión Integrada de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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10
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González-Juanatey JR, Virgós Lamela A, García-Acuña JM, Pais Iglesias B. Clinical management in cardiology. Measurement as a means to improvement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:8-14. [PMID: 32798151 PMCID: PMC9981242 DOI: 10.1016/j.rec.2020.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- José R. González-Juanatey
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain,Corresponding author: Servicio de Cardiología, Hospital Clínico Universitario, Travesía da Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Alejandro Virgós Lamela
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M. García-Acuña
- Unidad de Críticos Cardiológicos, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Beatriz Pais Iglesias
- Subdirección de Calidad, Xerencia de Xestión Integrada de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17:604-611. [PMID: 33224179 PMCID: PMC7657943 DOI: 10.11909/j.issn.1671-5411.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. Results A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). Conclusions Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
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Sánchez-Salado JC, Burgos V, Ariza-Solé A, Sionis A, Canteli A, Bernal JL, Fernández C, Castrillo C, Ruiz-Lera M, López-de-Sá E, Lidón RM, Worner F, Martínez-Sellés M, Segovia J, Viana-Tejedor A, Lorente V, Alegre O, Llaó I, González-Costello J, Manito N, Cequier Á, Bueno H, Elola J. Tendencias en el tratamiento del shock cardiogénico e impacto pronóstico del tipo de centros tratantes. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uribarri A, San Román JA. Redes asistenciales para el tratamiento del shock cardiogénico. Código shock. ¿Dónde y cómo implementarlo? Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Uribarri A, San Román JA. Critical care networks for the treatment of cardiogenic shock. Where and how should the shock code be implemented? ACTA ACUST UNITED AC 2020; 73:524-526. [PMID: 32192874 DOI: 10.1016/j.rec.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Aitor Uribarri
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain.
| | - José A San Román
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
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Monedero P, Paz-Martín D, Barturen F, Fernández-Quero Bonilla L, Cardona Peretó J, Sánchez Pérez CA, Ferrando Ortolá C, Cabadas Avión R, García-Montoto Pérez F, González Celdrán R, López Sánchez C, Ojeda Betancor N, Padrón Ruiz OM, Pérez Carbonell A, Soria Gulina C, Tamayo Gómez E, Torres Pedrós V, Varela Durán M, Heredia Rodríguez M, Peyró García R. Intensive care in Spain. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:147-152. [PMID: 32093920 DOI: 10.1016/j.redar.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/01/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Affiliation(s)
- P Monedero
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - D Paz-Martín
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - F Barturen
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitari Son Espases, Palma, Illers Balears, España
| | - L Fernández-Quero Bonilla
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Cardona Peretó
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesia y UCI, Hospital de Denia-Marina Salud, Denia, Alicante, España
| | - C A Sánchez Pérez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital General Universitario de Elda, Elda, Alicante, España
| | - C Ferrando Ortolá
- Revista Española de Anestesiología y Reanimación (REDAR). SEDAR. Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Cabadas Avión
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Povisa, Vigo, España
| | - F García-Montoto Pérez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; UCI de Anestesia, Hospital Universitario de Cáceres, Cáceres, España
| | - R González Celdrán
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital General Universitario Reina Sofía, Murcia, España
| | - C López Sánchez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitario Marqués de Valdecilla, Santander, España
| | - N Ojeda Betancor
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - O M Padrón Ruiz
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - A Pérez Carbonell
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital General Universitario de Elche, Elche, España
| | - C Soria Gulina
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; UCI de Anestesia, Complejo Asistencial Universitario de León, León, España
| | - E Tamayo Gómez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - V Torres Pedrós
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitari Son Espases, Palma, Illers Balears, España
| | - M Varela Durán
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | | | - R Peyró García
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Trends in cardiogenic shock management and prognostic impact of type of treating center. ACTA ACUST UNITED AC 2019; 73:546-553. [PMID: 31780424 DOI: 10.1016/j.rec.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Current guidelines recommend centralizing the care of patients with cardiogenic shock in high-volume centers. The aim of this study was to assess the association between hospital characteristics, including the availability of an intensive cardiac care unit, and outcomes in patients with ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). METHODS Discharge episodes with a diagnosis of STEMI-related CS between 2003 and 2015 were selected from the Minimum Data Set of the Spanish National Health System. Centers were classified according to the availability of a cardiology department, catheterization laboratory, cardiac surgery department, and intensive cardiac care unit. The main outcome measured was in-hospital mortality. RESULTS A total of 19 963 episodes were identified. The mean age was 73.4±11.8 years. The proportion of patients with CS treated at hospitals with a catheterization laboratory and cardiac surgery department increased from 38.4% in 2005 to 52.9% in 2015 (P <.005). Crude- and risk-adjusted mortality rates decreased over time, from 82% to 67.1%, and from 82.7% to 66.8%, respectively (both P <.001). Coronary revascularization, either percutaneous or coronary artery bypass grafting, was independently associated with a lower mortality risk (OR, 0.29 and 0.25; both P <.001, respectively). Intensive cardiac care unit availability was associated with lower adjusted mortality rates (65.3%±7.9 vs 72±11.7; P <.001). CONCLUSIONS The proportion of patients with STEMI-related CS treated at highly specialized centers increased while mortality decreased during the study period. Better outcomes were associated with the increased performance of revascularization procedures and access to intensive cardiac care units over time.
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Cordero A, Bertomeu-González V, Moreno-Arribas J, Marco A, Sánchez A, Pomares A, Torroba G, Martínez Rey-Rañal E, Moreno MJ, Quiles J, Valero R, Bertomeu-Martínez V. Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rccl.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ramírez Vélez A, Gaviria Valencia S, Jaramillo Gómez N, Contreras Martínez H, Cardona Vélez J. Accesos vasculares femoral y radial en intervenciones coronarias percutáneas en síndrome coronario agudo y enfermedad crónica inestabilizada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Íñiguez Romo A, Bertomeu Martínez V, Rodríguez Padial L, Anguita Sánchez M, Ruiz Mateas F, Hidalgo Urbano R, Bernal Sobrino JL, Fernández Pérez C, Macaya de Miguel C, Elola Somoza FJ. Proyecto RECALCAR. La atención al paciente en las unidades de cardiología del Sistema Nacional de Salud, 2011-2014. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.12.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Monedero P, Paz-Martín D, Cardona-Pereto J, Barturen F, Fernández-Quero L, Aguilera-Celorrio L, Canet J, Gómez-Herreras JI, Peyró R, Sánchez C, Valía JC. Intensive Care of Anaesthesia: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:282-285. [PMID: 28258746 DOI: 10.1016/j.redar.2016.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Affiliation(s)
- P Monedero
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España.
| | - D Paz-Martín
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J Cardona-Pereto
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - F Barturen
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - L Fernández-Quero
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - L Aguilera-Celorrio
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J Canet
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J I Gómez-Herreras
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - R Peyró
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - C Sánchez
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J C Valía
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
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Íñiguez Romo A, Bertomeu Martínez V, Rodríguez Padial L, Anguita Sánchez M, Ruiz Mateas F, Hidalgo Urbano R, Bernal Sobrino JL, Fernández Pérez C, Macaya de Miguel C, Elola Somoza FJ. The RECALCAR Project. Healthcare in the Cardiology Units of the Spanish National Health System, 2011 to 2014. ACTA ACUST UNITED AC 2017; 70:567-575. [PMID: 28457812 DOI: 10.1016/j.rec.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 12/15/2022]
Abstract
The RECALCAR project (Spanish acronym for Resources and Quality in Cardiology Units) uses 2 data sources: a survey of cardiology units and an analysis of the Minimum Basic Data set of all hospital discharges of the Spanish National Health System. From 2011 to 2014, there was marked stability in all indicators of the availability, utilization, and productivity of cardiology units. There was significant variability between units and between the health services of the autonomous communities. There was poor implementation of process management (only 14% of the units) and scarce development of health care networks (17%). Structured cardiology units tended to have better results, in terms of both quality and efficiency. No significant differences were found between the different types of unit in the mean length of stay (5.5±1.1 days) or the ratio between successive and first consultations (2:1). The mean discharge rate was 5/1000 inhabitants/y and the mean rate of initial consultations was 16±4/1000 inhabitants/y. No duty or on-call cardiologist was available in 30% of cardiology units with 24 or more beds; of these, no critical care beds were available in 45%. Our findings support the recommendation to regionalize cardiology care and to promote the development of cardiology unit networks.
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Affiliation(s)
- Andrés Íñiguez Romo
- Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | | | | | | | - Rafael Hidalgo Urbano
- Unidad de Gestión Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Cristina Fernández Pérez
- Unidad Transversal de Apoyo a la Investigación, Hospital Clínico Universitario San Carlos, Madrid, Spain
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Competencias profesionales y trabajo en equipo en pacientes con enfermedades cardiacas agudas y críticas. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Worner F, San Román A, Luis Sánchez P, Viana Tejedor A, González-Juanatey JR. Competencias profesionales y trabajo en equipo en pacientes con enfermedades cardiacas agudas y críticas. Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Worner F, San Román A, Luis Sánchez P, Viana Tejedor A, González-Juanatey JR. Professional Competence and Teamwork in the Treatment of Patients With Acute and Critical Heart Disease. Response. ACTA ACUST UNITED AC 2016; 69:633. [PMID: 27118412 DOI: 10.1016/j.rec.2016.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Fernando Worner
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Instituto de Investigación Biomédica de Lleida, Lleida (IRB LLEIDA), Spain.
| | - Alberto San Román
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Pedro Luis Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ana Viana Tejedor
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Martín Delgado MC, García Garmendia JL, Fuset Cabanes MP, Fernández-Mondéjar E. Professional Competence and Teamwork in the Treatment of Patients With Acute and Critical Heart Disease. ACTA ACUST UNITED AC 2016; 69:632. [PMID: 27118527 DOI: 10.1016/j.rec.2016.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- María Cruz Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain.
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