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Muñoz J. Impact of the COVID-19 pandemic on mechanical ventilation cases and mortality rates in non-SARS-CoV-2 patients: A nationwide analysis in Spain. Heart Lung 2024; 68:154-159. [PMID: 39003961 DOI: 10.1016/j.hrtlng.2024.06.017] [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: 11/21/2023] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The COVID-19 pandemic has presented unprecedented challenges for healthcare systems globally, impacting critical care resources and patient outcomes. Understanding its multifaceted effects is crucial for future crisis response. OBJECTIVE Analyze the repercussions of the COVID-19 pandemic on mechanical ventilation cases and mortality among non-SARS-CoV-2 patients. METHODS A nationwide database encompassing all patients receiving mechanical ventilation in Spain was used to compare the number of cases and clinical outcomes during COVID-19 (March 2020 - December 2021) to pre-pandemic cases (May 2018 - February 2020). Univariate and multivariate analyses were employed. RESULTS COVID-19 significantly reduced access to ventilation for non-COVID-19 patients. A 16 % decrease (12,099 fewer patients) was observed during the pandemic compared to pre-pandemic times. This reduction affected all analyzed conditions except self-inflicted injuries, coinciding with a rise in overall mortality risk (34.5% vs 35.6 %, OR 1.09, 95 %CI 1.06-1.12). The increased mortality was consistent across diverse admission types, including cancer (37.1% vs. 41.5 %, OR 1.18, 95 %CI 1.09-1.29), hemorrhagic strokes (55.4% vs. 56.6 %, OR 1.07, 95 %CI 1.02-1.20), acute myocardial infarction (35.6% vs. 38 %, OR 1.11, 95 %CI 1.01-1.21), non-SARS-CoV-2 pneumonia (44.5% vs. 45.8 %, OR 1.12, 95 %CI 1.02-1.24), septic shock (54.7% vs. 56.3 %, OR 1.10, 95 %CI 1.06-1.15), and prolonged ventilation (≥96 h) (37% vs. 38.2 %, OR 1.10, 95 %CI 1.06-1.10). CONCLUSIONS The findings underscore the profound impact of the COVID-19 pandemic on critical care utilization and patient outcomes among non-SARS-CoV-2 patients. As healthcare systems strive to mitigate future crises, these insights emphasize adaptable strategies for equitable access to life-saving treatments.
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Affiliation(s)
- Javier Muñoz
- ICU. Hospital General Universitario "Gregorio Marañón". Madrid. Spain.
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Camps-Vilaró A, Subirana I, Elosua R, Palomo I, Sanchis J, Tizón-Marcos H, Cainzos-Achirica M, Sala J, Masia R, Ramos R, Dégano IR, Marrugat J. Analysis of myocardial infarction incidence and case-fatality in the last three decades in the province of Girona. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:450-458. [PMID: 37981192 DOI: 10.1016/j.rec.2023.10.005] [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: 07/28/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019). METHODS The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression. RESULTS MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women. CONCLUSIONS In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.
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Affiliation(s)
- Anna Camps-Vilaró
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain
| | - Roberto Elosua
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, Spain
| | - Iván Palomo
- Centro de Investigación en Trombosis, Departmento de Bioquímica Clínica e Inmunohematología, Escuela de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Clínic de Valencia, Valencia, Spain
| | - Helena Tizón-Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital del Mar, Barcelona, Spain
| | | | - Joan Sala
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafael Masia
- Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafel Ramos
- Unitat de Recerca de Medicina Familiar-de Girona, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Irene R Dégano
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Barcelona, Spain.
| | - Jaume Marrugat
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Aguilar-Palacio I, Rabanaque M, Castel S, Maldonado L, González-García J, Compés L, Malo S. Cohort Profile: The CArdiovascular Risk factors for hEalth Services research (CARhES) cohort study. Int J Epidemiol 2024; 53:dyae015. [PMID: 38380446 PMCID: PMC10879753 DOI: 10.1093/ije/dyae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - MªJosé Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Sara Castel
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Lina Maldonado
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Applied Economics, University of Zaragoza, Zaragoza, Spain
| | - Juan González-García
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Biocomputing Unit, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
- Data Science for Health Services and Policy Research Group, Aragón Health Sciences Institute (IACS), Zaragoza, Spain
| | - Luisa Compés
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Sanidad de Aragón, Dirección General de Asistencia Sanitaria, Zaragoza, Spain
| | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
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Bernal JL, Bonilla-Palomas JL, Rosillo N, Bonanad C, Elola J, Anguita M. Validity of the minimum data set for outcomes research in patients hospitalized for heart failure in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:938-939. [PMID: 37437880 DOI: 10.1016/j.rec.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Affiliation(s)
- José L Bernal
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain; 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
| | - Clara Bonanad
- Servicio de Cardiología, Hospital San Juan de La Cruz, Úbeda, Jaén, Spain; Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica (IMIBIC), Córdoba, Spain
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5
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Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, Anguita-Gámez M, Rosillo N, Del Prado N, Bernal JL, Fernández-Pérez C, Fernández-Rozas I, Gómez-Doblas JJ, Pérez-Villacastin J, Elola FJ. One-year readmissions for circulatory diseases and in-hospital mortality after an index episode of heart failure in elderly patients. A nationwide data from public hospitals in Spain between 2016 and 2018. Clin Res Cardiol 2023:10.1007/s00392-023-02202-7. [PMID: 37041378 DOI: 10.1007/s00392-023-02202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of hospitalization and death in elderly patients. However, there is limited evidence on readmission and mortality 1-year after discharge for HF. METHODS Retrospective analysis of the Minimum Basic Data Set, including HF episodes, discharged from Spanish hospitals between 2016 and 2018 in ≥ 75 years. We calculated: (a) the rate of readmissions due to circulatory system diseases (CSD) 365 days after index episode; (b) in-hospital mortality in readmissions; and (c) predictors of mortality and readmission. RESULTS We included 178,523 patients (59.2% women) aged 85.1 ± 5.5 years. The most frequent comorbidities were arrhythmias (56.0%) and renal failure (39.5%). During the follow-up, 48,932 patients (27.4%) had at least one readmission for CSD and a crude rate of 40.2%, the most frequent one HF (52.8%). The median between the date of readmission and discharge from the last admission was 70 days [IQI 24; 171] for the first readmission. The most relevant predictors of the number of readmissions were valvular heart disease and myocardial ischemia. During the readmissions, 26,757 patients (79.1%) died, representing a cumulative in-hospital mortality of 47,945 (26.9%). The factors in the index episode predictors of mortality during readmissions were cardio-respiratory failure and stroke. The number of readmissions was a risk factor for in-hospital mortality (OR 1.13; 95% CI 1.11-1.14). CONCLUSIONS The readmission rate for CSD 1-year after the index episode of HF in patients ≥ 75 years was 28.4%. The cumulative in-hospital mortality rate during the readmissions was 26.9%, and the number of rehospitalizations was identified as one of the main predictors of mortality.
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Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain.
| | - Manuel Anguita-Sánchez
- Cardiology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Nicolás Rosillo
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - Náyade Del Prado
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - José Luis Bernal
- Management Control Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Preventive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
- Preventive Medicine Department, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
| | - Inmaculada Fernández-Rozas
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain
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Cequier Á, Bernal JL, Fernández Pérez C, Elola FJ. RECALCAR methodology. Some clarifications. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:74-75. [PMID: 36108996 DOI: 10.1016/j.rec.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Instituto de Investigaciones Sanitarias de Santiago (IDIS), Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, 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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Cequier Á, Bueno H, Macaya C, Bertomeu V, González-Juanatey JR, Íñiguez A, Anguita M, Cruz I, Calvo D, Gómez-Doblas JJ, de la Torre Hernández JM, Del Prado N, Rodríguez Padial L, Pérez-Villacastín J, Bernal JL, Fernández Pérez C, Elola J. Trends in cardiovascular care in the National Health System in Spain. Data from the RECALCAR project 2011-2020. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00318-8. [PMID: 36493955 DOI: 10.1016/j.rec.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. METHODS The study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. RESULTS The survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. CONCLUSIONS The information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.
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Affiliation(s)
- Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Macaya
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Vicente Bertomeu
- Servicio de Cardiología, Instituto Cardiovascular de la Universidad Católica de Murcia (UCAM), Alicante, Spain
| | - José R González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Andrés Íñiguez
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, Vigo, Pontevedra, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica (IMIBIC), Córdoba, Spain
| | - Ignacio Cruz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - David Calvo
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan José Gómez-Doblas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José M de la Torre Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación en Santander (IDIVAL), Santander, Cantabria, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | | | | | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
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Alfonso F, Fernández-Pérez C, García-Márquez M, García-Guimaraes M, Bernal JL, Bastante T, Del Val D, Del Prado N, Elola J. Spontaneous coronary artery dissection in Spain: a study using the minimum data set of the Spanish National Health System. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:903-910. [PMID: 35716909 DOI: 10.1016/j.rec.2022.04.017] [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: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We sought to compare the results on in-hospital mortality and 30-day readmission rates among patients with AMI-SCAD vs AMI due to other causes (AMI-non-SCAD). METHODS Risk-standardized in-hospital mortality (rIMR) and risk-standardized 30-day readmission ratios (rRAR) were calculated using the minimum dataset of the Spanish National Health System (2016-2019). RESULTS A total of 806 episodes of AMI-SCAD were compared with 119 425 episodes of AMI-non-SCAD. Patients with AMI-SCAD were younger and more frequently female than those with AMI-non-SCAD. Crude in-hospital mortality was lower (3% vs 7.6%; P<.001) and rIMR higher (7.6±1.7% vs 7.4±1.7%; P=.019) in AMI-SCAD. However, after propensity score adjustment (806 pairs), the mortality rate was similar in the 2 groups (AdjOR, 1.15; 95%CI, 0.61-2,2; P=.653). Crude 30-day readmission rates were also similar in the 2 groups (4.6% vs 5%, P=.67) whereas rRAR were lower (4.7±1% vs 4.8%±1%; P=.015) in patients with AMI-SCAD. Again, after propensity score adjustment (715 pairs) readmission rates were similar in the 2 groups (AdjOR, 1.14; 95%CI, 0.67-1.98; P=.603). CONCLUSIONS In-hospital mortality and readmission rates are similar in patients with AMI-SCAD and AMI-non-SCAD when adjusted for the differences in baseline characteristics. These findings underscore the need to optimize the management, treatment, and clinical follow-up of patients with SCAD.
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Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - María García-Márquez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar-Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Del Val
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
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Cequier Á, Bueno H, Macaya C, Bertomeu V, González-Juanatey JR, Íñiguez A, Anguita M, Cruz I, Calvo D, Gómez-Doblas JJ, de la Torre Hernández JM, del Prado N, Rodríguez Padial L, Pérez-Villacastín J, Bernal JL, Fernández Pérez C, Elola J. Evolución de la asistencia cardiovascular en el Sistema Nacional de Salud de España. Datos del proyecto RECALCAR 2011-2020. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Fernández-Ortiz A, Bas Villalobos MC, García-Márquez M, Bernal Sobrino JL, Fernández-Pérez C, del Prado González N, Viana Tejedor A, Núñez-Gil I, Macaya Miguel C, Elola Somoza FJ. Identificación y cuantificación del efecto fin de semana y festivos en la atención del síndrome coronario agudo en el Sistema Nacional de Salud. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Fernández-Ortiz A, Bas Villalobos MC, García-Márquez M, Bernal Sobrino JL, Fernández-Pérez C, Del Prado González N, Viana Tejedor A, Núñez-Gil I, Macaya Miguel C, Elola Somoza FJ. The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:756-762. [PMID: 35067469 DOI: 10.1016/j.rec.2021.10.022] [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: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays. METHODS Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non-ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018. RESULTS A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS. CONCLUSIONS WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays.
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Affiliation(s)
- Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Marian Cristina Bas Villalobos
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | | | - José Luis Bernal Sobrino
- 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 y Salud Pública, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Ana Viana Tejedor
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Iván Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Carlos Macaya Miguel
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
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13
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Cequier Á, Bernal JL, Fernández Pérez C, Elola FJ. Precisiones sobre la metodología de RECALCAR. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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14
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Ribera A, Marsal JR, Faixedas MT, Rosas A, Tizón-Marcos H, Rojas S, Labata C, Cárdenas M, Homs S, Tomás-Querol C, García-Picart J, Roura G, Masotti M, Mauri J, Pijoan JI, Barrabés JA, Ferreira-González I. Revascularized ST-segment elevation myocardial infarction. Temporal trends in contemporary therapies and impact on outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:659-668. [PMID: 34887210 DOI: 10.1016/j.rec.2021.10.011] [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: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes. METHODS Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models. RESULTS Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization. CONCLUSIONS Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes.
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Affiliation(s)
- Aida Ribera
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Josep R Marsal
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Sergio Rojas
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - Carlos Labata
- Servicio de Cardiología, Hospital German Trias i Pujol, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Josep Trueta, Girona, Spain
| | - Silvia Homs
- Servicio de Cardiología, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Josepa Mauri
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - José Ignacio Pijoan
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Unidad de Epidemiología Clínica, Hospital Universitario Cruces/Instituto de Investigación BioCruces-Bizkaia, Barakaldo, Bizkaia, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Ignacio Ferreira-González
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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15
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Alfonso F, Fernández-Pérez C, García-Márquez M, García-Guimaraes M, Bernal JL, Bastante T, del Val D, del Prado N, Elola J. Disección coronaria espontánea en España: un estudio sobre bases administrativas realizado a partir del Conjunto Mínimo Básico de Datos español. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Infarto de miocardio con elevación del segmento ST revascularizado. Tendencias temporales de los tratamientos contemporáneos y su impacto en los resultados. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Impacto de las diferencias de sexo y los sistemas de red en la mortalidad hospitalaria de pacientes con infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Bueno H, Rossello X, Bardají A. Has the Fourth Universal Definition of Myocardial Infarction led to better diagnosis and risk stratification? Eur Heart J 2021; 42:2562-2564. [PMID: 32647857 DOI: 10.1093/eurheartj/ehaa486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department. Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Cardiology Department. Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | - Alfredo Bardají
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain.,Rovira Virgili University, Tarragona, Spain.,Instituto de Investigación Sanitaria Pere Virgili, Tarragona, Spain
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19
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Rodríguez-Padial L, Fernández-Pérez C, Bernal JL, Anguita M, Sambola A, Fernández-Ortiz A, Elola FJ. Diferencias en mortalidad intrahospitalaria tras IAMCEST frente a IAMSEST por sexo. Tendencia durante once años en el Sistema Nacional de Salud. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Sex Differences in the Incidence and Outcomes of Acute Myocardial Infarction in Spain, 2016-2018: A Matched-Pair Analysis. J Clin Med 2021; 10:jcm10081795. [PMID: 33924190 PMCID: PMC8074598 DOI: 10.3390/jcm10081795] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Our aim was to analyze the incidence, procedures, and in-hospital outcomes of myocardial infarction (MI) in Spain (2016–2018) according to sex. (2) Methods: We estimated the incidence of an ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to sex using the Spanish National Hospital Discharge Database. A matched-pair analysis was used. (3) Results: MI was coded in 156,826 patients aged ≥18 years (111,842 men and 44,984 women). Men showed higher incidence rates (205.0 vs. 77.8 per 100,000; p < 0.001; IRR = 2.81(95%CI:2.78–2.84)). After matching, the use of coronary artery by-pass grafting (CABG) (1.0% vs. 0.7%; p < 0.001) and percutaneous coronary intervention (PCI) (57.8% vs. 52.3%; p < 0.001) was higher among men with an STEMI, whereas the in-hospital mortality (IHM) remained higher among women (11.2% vs. 10.1%; p < 0.001). Likewise, CABG (1.9% vs. 3.3%; p < 0.001) and PCI (33.8% vs. 41.9%; p < 0.001) were less often used among women with an NSTEMI, but no sex-related differences were found in IHM. After adjusting for confounders, IHM was more than twofold higher for both men and women with an STEMI than those with an NSTEMI. Women with an STEMI had a 21% higher mortality risk than men (OR = 1.21(95%CI:1.13–1.29). (4) Conclusion: Men had higher incidence rates of MI than women. Women underwent invasive procedures less often and had a higher IHM when admitted for an STEMI.
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21
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Gorostiza A, Arrospide A, Larrañaga I, Barandiarán A, Ruiz de Austri A, Ibarrondo O, Mar J. Dynamic evaluation of the comparative effectiveness of an integrated program for heart failure care. J Eval Clin Pract 2021; 27:134-142. [PMID: 32367623 DOI: 10.1111/jep.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES An integrated care program for heart failure (HF) was developed in the Basque Country in 2013. The objective of this research was to evaluate its effectiveness through the number of hospital admissions in three integrated healthcare organizations (IHOs), taking into account the longitudinal nature of the disease and the intensity of the implementation. METHODS A retrospective observational study was carried out, based on data entered in administrative and clinical databases between 2014 and 2018 for a total population of 230 000. In addition to conventional statistical analyses, Andersen-Gill models for recurrent events were used, incorporating dynamic variables that allowed assessment of the intervention's intensity before each hospitalization. RESULTS A total of 6768 patients were analysed. Age (hazard ratio [HR] = 1.016; 95% confidence interval [CI] 1.011-1.022), the Charlson index (HR = 1.067, 95% CI 1.047-1.087), and the number of previous hospitalizations (HR = 1.632, 95% CI 1.557-1.712) were risk factors for readmission. Differences between IHOs were also statistically significant. Greater intervention intensity was associated with a lower hospitalization rate (HR = 0.995, 95% CI 0.990-1.000). As indicated by the interaction between intervention intensity and IHO, differences between IHOs disappeared when intensity rose. No inequities in hospitalization were found as a function of deprivation index or sex. Nonetheless, inequity in the implementation of the program by sex was clear, women with HF receiving less intense intervention than men with the same level of comorbidity and age. CONCLUSIONS The extent of program implementation measured by intervention intensity is a main driver of the effectiveness of an educational and monitoring program for HF. The evaluation of HF program effectiveness on readmissions must take into account the entire natural history of the disease. Implementation intensity explains differences between IHOs.
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Affiliation(s)
- Ania Gorostiza
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain
| | - Arantzazu Arrospide
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
| | - Igor Larrañaga
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
| | - Aitziber Barandiarán
- Goierri-Alto Urola Integrated Health Care Organization, Health Management Unit, Zumarraga, Gipuzkoa, Spain
| | - Adolfo Ruiz de Austri
- Alto Deba Integrated Health Care Organization, Arrasate-Mondragón Primary Care Unit, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Oliver Ibarrondo
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain
| | - Javier Mar
- Alto Deba Integrated Health Care Organization, AP-OSIs Gipuzkoa Research Unit, Arrasate-Mondragón, Spain.,Biodonostia Health Research Institute, Public Health Area, Donostia-SanSebastián, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Public Health Area, Bilbao, Spain
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22
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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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Aguilar-Palacio I, Rabanaque MJ, Maldonado L, Chaure A, Abad-Díez JM, León-Latre M, Casasnovas JA, Malo S. New Male Users of Lipid-Lowering Drugs for Primary Prevention of Cardiovascular Disease: The Impact of Treatment Persistence on Morbimortality. A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207653. [PMID: 33092211 PMCID: PMC7593937 DOI: 10.3390/ijerph17207653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022]
Abstract
The objective of this study was to analyse persistence to lipid-lowering drug use for primary prevention of cardiovascular disease (CVD) in a new users cohort, to explore all-cause and cardiovascular related morbidity, comorbidity and mortality in this group and, finally, to study the relationship between persistence and morbimortality. We selected subjects who started lipid-lowering treatment for primary prevention of CVD between 1 January 2010 and 31 December 2017 (N = 1424), and classified them as treatment-persistent or -nonpersistent. Bivariate analyses were performed to compare sociodemographic and clinical variables, morbimortality and time to event between groups. The association between morbidities was explored using comorbidity network analysis. The effect of persistence was analysed using logistic regression and Cox survival analyses. Only 38.7% of users were persistent with treatment. Persistent and nonpersistent users had similar sociodemographic and clinical profiles, although differed in age, smoking status, and glycemia. Comorbidity networks revealed that the number of co-occurring diagnoses was higher in nonpersistent than persistent users. Adjusted analyses indicated a protective effect of treatment persistence, especially against major adverse cardiovascular events (MACE), but this effect was not statistically significant. Observational studies are crucial to characterize real-world effectiveness.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (M.J.R.); (S.M.)
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (M.L.-L.); (J.A.C.)
- GRISSA Research Group, 50009 Zaragoza, Spain; (A.C.); (J.M.A.-D.)
- Correspondence:
| | - María José Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (M.J.R.); (S.M.)
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (M.L.-L.); (J.A.C.)
- GRISSA Research Group, 50009 Zaragoza, Spain; (A.C.); (J.M.A.-D.)
| | - Lina Maldonado
- Department of Economic Structure, Economic History and Public Economics, University of Zaragoza, 50005 Zaragoza, Spain;
| | - Armando Chaure
- GRISSA Research Group, 50009 Zaragoza, Spain; (A.C.); (J.M.A.-D.)
| | - José María Abad-Díez
- GRISSA Research Group, 50009 Zaragoza, Spain; (A.C.); (J.M.A.-D.)
- Department of Health, Aragon Health Service (SALUD), 50017 Zaragoza, Spain
| | - Montse León-Latre
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (M.L.-L.); (J.A.C.)
| | - José Antonio Casasnovas
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (M.L.-L.); (J.A.C.)
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), 28029 Madrid, Spain
| | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain; (M.J.R.); (S.M.)
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (M.L.-L.); (J.A.C.)
- GRISSA Research Group, 50009 Zaragoza, Spain; (A.C.); (J.M.A.-D.)
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Sambola A, Elola FJ, Ferreiro JL, Murga N, Rodríguez-Padial L, Fernández C, Bueno H, Bernal JL, Cequier Á, Marín F, Anguita M. Impact of sex differences and network systems on the in-hospital mortality of patients with ST-segment elevation acute myocardial infarction. ACTA ACUST UNITED AC 2020; 74:927-934. [PMID: 32888884 DOI: 10.1016/j.rec.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Network systems have achieved reductions in both time to reperfusion and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the data have not been disaggregated by sex. The aim of this study was to analyze the influence of network systems on sex differences in primary percutaneous coronary intervention (pPCI) and in-hospital mortality from 2005 to 2015. METHODS The Minimum Data Set of the Spanish National Health System was used to identify patients with STEMI. Logistic multilevel regression models and Poisson regression analysis were used to calculate risk-standardized in-hospital mortality ratios and incidence rate ratios (IRRs). RESULTS Of 324 998 STEMI patients, 277 281 were selected after exclusions (29% women). Even when STEMI networks were established, the use of reperfusion therapy (PCI, fibrinolysis, and CABG) was lower in women than in men from 2005 to 2015: 56.6% vs 75.6% in men and 36.4% vs 57.0% in women, respectively (both P<.001). pPCI use increased from 34.9% to 68.1% in men (IRR, 1.07) and from 21.7% to 51.7% in women (IRR, 1.08). The crude in-hospital mortality rate was higher in women (9.3% vs 18.7%; P<.001) but decreased from 2005 to 2015 (IRRs, 0.97 for men and 0.98 for women; both P < .001). Female sex was an independent risk factor for mortality (adjusted OR, 1.23; P<.001). The risk-standardized in-hospital mortality ratio was lower in women when STEMI networks were in place (16.9% vs 19.1%, P<.001). pPCI and the presence of STEMI networks were associated with lower in-hospital mortality in women (adjusted ORs, 0.30 and 0.75, respectively; both P<.001). CONCLUSIONS Women were less likely to receive pPCI and had higher in-hospital mortality than men throughout the 11-year study period, even with the presence of a network system for STEMI.
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Affiliation(s)
- Antonia Sambola
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain
| | - José Luis Ferreiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nekane Murga
- Consejería de Salud del Gobierno Vasco, Vitoria, Álava, Spain
| | | | - Cristina Fernández
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Mestres G, Díaz MA, Fierro A, Yugueros X, Tripodi P, Riambau V. Climatic influence on the risk of abdominal aortic aneurysm rupture. Vasc Med 2020; 25:443-449. [PMID: 32644915 DOI: 10.1177/1358863x20923399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our aim is to examine the effects of climatic conditions on the incidence of ruptured abdominal aortic aneurysms (rAAA) in Catalonia, Spain. We combined clinical data from the Public Health official registries in Catalonia, Spain (HD-MBDS) of all rAAA with local climatic data obtained from the closest meteorological station (69 stations, National Meteorological Service: MeteoCat) from 2008 to 2017. We analyzed the median, maximum, minimum, and variability of atmospheric pressure (hPa) and air temperature (°C), solar irradiation (MJ/m2), humidity (%), accumulated precipitation (mm), median wind, and maximum flaw direction and velocity (°, m/s), recorded on the days of events, the previous day, and mean results for 3, 7, and 30 days before, as well as seasonality. Seventy-five control days were randomly selected in a 1-year period around every rAAA day at the same meteorological station, and compared. A total of 717 days and locations with rAAA were identified, and 53,775 controls were randomly selected. For the rAAA days, there were significantly lower temperatures, lower solar global irradiation, and higher mean humidity levels in all time periods (p < 0.001, p < 0.001, p < 0.05); higher atmospheric pressure variability during 1 week and 1 month before (p = 0.011, p = 0.007); and they often occurred during autumn/winter (57.6%, p < 0.001). Logistic regression identified low mean temperatures on the days of ruptures and high mean humidity the week before as independent rupture predictors. In conclusion, low median temperatures the same day and high humidity during 1 week before were identified as independent predictors of rAAA occurrence. The role of climate on pathophysiologic mechanisms may require further investigation.
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Affiliation(s)
- Gaspar Mestres
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Alejandra Díaz
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alejandro Fierro
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Paolo Tripodi
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Utilización de datos administrativos y el volumen de cirugía coronaria. Una nota de precaución. Respuesta. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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28
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Rodríguez-Padial L, Fernández-Pérez C, Bernal JL, Anguita M, Sambola A, Fernández-Ortiz A, Elola FJ. Differences in in-hospital mortality after STEMI versus NSTEMI by sex. Eleven-year trend in the Spanish National Health Service. ACTA ACUST UNITED AC 2020; 74:510-517. [PMID: 32561143 DOI: 10.1016/j.rec.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/23/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Conflicting results have been reported on the possible existence of sex differences in mortality after myocardial infarction (MI). There is also a scarcity of data on the impact of sex on outcomes after ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). The aim of this study was to analyze sex difference trends in sex-related differences in mortality for STEMI and NSTEMI. METHODS A retrospective analysis of 445 145 episodes of MI (2005-2015) was carried out using information from the Spanish National Health System. The incidence rates were expressed as events per 10 000 person-years. The denominators (age-specific groups) were obtained from the nationwide census. We calculated crude and adjusted (multilevel logistic regression) mortality. Poisson regression analysis was used to study temporal trends for in-hospital mortality. RESULTS A total of 69.8% episodes occurred in men. The mean age in men was 66.1±13.3 years, which was significantly younger than in women, 74.9±12.1 (P<.001). A total of 272 407 (61.2%) episodes were STEMI, and 172 738 (38.8%) were NSTEMI. Women accounted for 28.8% of STEMI and 33.9% of NSTEMI episodes (P <.001). The effect of female sex on risk-adjusted models for in-hospital mortality was the opposite in STEMI (OR for women, 1.18; 95%CI, 1.14-1.22; P <.001) and NSTEMI (OR for women, 0.85; 95%CI, 0.81-0.89; P <.001). MI hospitalization rates were higher in men than in women for all age groups [20 vs 7.7 per 10 000 individuals aged 35-94 years (P <.001)], with a trend to diminish in both sexes. CONCLUSIONS Women had a slight but significantly increased risk of in-hospital mortality after MI, but the effect of sex depended on MI type, with women exhibiting higher mortality for STEMI and lower mortality for NSTEMI.
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Affiliation(s)
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Antonia Sambola
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antonio Fernández-Ortiz
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
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Tendencias e impacto pronóstico de la duración de la estancia hospitalaria en el infarto de miocardio con elevación del segmento ST no complicado en España. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Elola FJ, Fernández Pérez C, Bernal JL, Goicolea Ruigómez FJ. Administrative data and volume of surgical revascularization volume. A note of caution. Response. ACTA ACUST UNITED AC 2020; 73:600-601. [PMID: 32376226 DOI: 10.1016/j.rec.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Cristina Fernández Pérez
- Fundación IMAS, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - José L Bernal
- Fundación IMAS, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Javier Goicolea Ruigómez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Abu-Assi E, Bernal JL, Raposeiras-Roubin S, Elola FJ, Fernández Pérez C, Íñiguez-Romo A. Temporal trends and prognostic impact of length of hospital stay in uncomplicated ST-segment elevation myocardial infarction in Spain. ACTA ACUST UNITED AC 2019; 73:479-487. [PMID: 31839414 DOI: 10.1016/j.rec.2019.09.016] [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: 01/14/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES There are few data on the safety of length of stay in uncomplicated ST-segment elevation myocardial infarction. We studied trends in hospital stay and the safety of short (≤ 3 days) vs long hospital stay in Spain. METHODS Using data from the Minimum Basic Data Set, we identified patients with uncomplicated ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and who were discharged alive between 2003 and 2015. The mean length of stay was adjusted by multilevel Poisson regression with mixed effects. The effect of short length of stay on 30-day readmission for cardiac diseases was evaluated in episodes from 2012 to 2014 by propensity score matching and multilevel logistic regression. We also compared risk-standardized readmissions for cardiac diseases and mortality rates. RESULTS The adjusted length of stay decreased significantly (incidence rate ratio <1; P <.001) for each year after 2003. Short length of stay was not an independent predictor of 30-day readmission (OR, 1.10; 95%CI, 0.92-1.32) or mortality (OR, 1.94; 95%CI, 0.93-14.03). After propensity score matching, no significant differences were observed between short and long hospital stay (OR, 1.26; 95%CI, 0.98-1.62; and OR, 1.50; 95%CI, 0.48-5.13), respectively. These results were confirmed by comparisons between risk-standardized readmissions for cardiac disease and mortality rates, except for the 30-day mortality rate, which was significantly higher, although probably without clinical significance, in short hospital stays (0.103% vs 0.109%; P <.001). CONCLUSIONS In Spain, hospital stay ≤ 3 days significantly increased from 2003 to 2015 and seems a safe option in patients with uncomplicated ST-segment elevation myocardial infarction.
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Affiliation(s)
- Emad Abu-Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain.
| | | | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Cristina Fernández Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain
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Mortalidad hospitalaria y reingresos por insuficiencia cardiaca en España. Un estudio de los episodios índice y los reingresos por causas cardiacas a los 30 días y al año. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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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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de Miguel Díez J, López de Andrés A, Jiménez García R. The Minimum Basic Data Set (MBDS), Our Big Data for the Epidemiological Investigation of Respiratory Diseases. Arch Bronconeumol 2019; 56:267-268. [PMID: 31640902 DOI: 10.1016/j.arbres.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Javier de Miguel Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España.
| | - Ana López de Andrés
- Departamento de Medicina Preventiva y Salud Pública, Faculta de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Rodrigo Jiménez García
- Departamento de Medicina Preventiva y Salud Pública, Faculta de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Bernal JL, Barrabés JA, Fernández-Pérez C, Elola FJ. Validez del Conjunto Mínimo Básico de Datos para la investigación de resultados en la atención al síndrome coronario agudo. Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Validez del Conjunto Mínimo Básico de Datos para la investigación de resultados en la atención al síndrome coronario agudo. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bernal JL, Barrabés JA, Fernández-Pérez C, Elola FJ. Validity of the Minimum Basic Data Set for Research Into Outcomes of the Care of Acute Coronary Syndrome. Response. ACTA ACUST UNITED AC 2019; 72:697-698. [PMID: 31175068 DOI: 10.1016/j.rec.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- José Luis Bernal
- Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron (VHIR), CIBERCV, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Elola Consultores, Madrid, Spain
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Calle-Urra JE, Parra-Hidalgo P, Pinar-Bermúdez E, López-Rojo C. Validity of the Minimum Basic Data Set for Research Into Outcomes of the Care of Acute Coronary Syndrome. ACTA ACUST UNITED AC 2019; 72:696-697. [PMID: 31164284 DOI: 10.1016/j.rec.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- José Eduardo Calle-Urra
- Subdirección General de Calidad Asistencial, Seguridad y Evaluación, Servicio Murciano de Salud, Murcia, Spain.
| | - Pedro Parra-Hidalgo
- Subdirección General de Calidad Asistencial, Seguridad y Evaluación, Servicio Murciano de Salud, Murcia, Spain
| | - Eduardo Pinar-Bermúdez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Concepción López-Rojo
- Subdirección General de Calidad Asistencial, Seguridad y Evaluación, Servicio Murciano de Salud, Murcia, Spain
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In-hospital Mortality and Readmissions for Heart Failure in Spain. A Study of Index Episodes and 30-Day and 1-year Cardiac Readmissions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:998-1004. [PMID: 30930253 DOI: 10.1016/j.rec.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major health care problem in Spain. Epidemiological data from hospitalized patients are scarce and the association between hospital characteristics and patient outcomes is largely unknown. The aim of this study was to identify the factors associated with in-hospital mortality and readmissions and to analyze the relationship between hospital characteristics and outcomes. METHODS A retrospective analysis of discharges with HF as the principal diagnosis at hospitals of the Spanish National Health System in 2012 was performed using the Minimum Basic Data Set. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) and in-hospital mortality at 30 days and 1 year after discharge by using a multivariate mixed model. RESULTS We included 77 652 HF patients. Mean age was 79.2±9.9 years and 55.3% were women. In-hospital mortality during the index episode was 9.2%, rising to 14.5% throughout the year of follow-up. The 1-year cardiovascular readmissions rate was 32.6%. RSMR were lower among patients discharged from high-volume hospitals (> 340 HF discharges) (in-hospital RSMR, 10.3±5.6%; 8.6±2.2%); P <.001). High-volume hospitals had higher 1-year RSRR (32.3±3.7%; 33.7±4.5%; P=.006). The availability of a cardiology department at the hospital was associated with better outcomes (in-hospital RSMR, 9.9±3.8%; 9.2±2.4%; P <.001). CONCLUSIONS High-volume hospitals and the availability of a cardiology department were associated with lower in-hospital mortality.
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