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Polanco D, González J, Gracia-Lavedan E, Pinilla L, Plana R, Molina M, Pardina M, Barbé F. Multidisciplinary virtual management of pulmonary nodules. Pulmonology 2024; 30:239-246. [PMID: 35115280 DOI: 10.1016/j.pulmoe.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. MATERIALS AND METHODS Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. RESULTS A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). CONCLUSIONS During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.
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Affiliation(s)
- D Polanco
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - J González
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - E Gracia-Lavedan
- Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - L Pinilla
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - R Plana
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - M Molina
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - M Pardina
- Department of Radiology, Arnau de Vilanova University Hospital, IRBLleida
| | - F Barbé
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
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Solelhac G, Sánchez-de-la-Torre M, Berger M, Hirotsu C, Marchi N, Waeber A, Gracia-Lavedan E, Zapater A, Bernadi G, Betta M, Marques-Vidal P, Vollenweider P, Vaucher J, Siclari F, Barbé F, Heinzer R. Pulse wave amplitude drops (PWAD) : a new biomarker of cardiovascular risk in patients with obstructive sleep apnea in HypnoLaus and ISAACC cohorts. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Aldoma A, Manuel Sanchez-De-La-Torre M, Gracia-Lavedan E, Benitez ID, Zapater A, Torres G, Sanchez-De-La-Torre A, De Batlle J, Targa A, Minguez O, Pascual L, Cortijo A, Martinez D, Dalmases M, Barbe-Illa F. Long-term effect of obstructive sleep apnea and CPAP treatment on blood pressure control in patients after acute coronary syndrome. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Instituto de Salud Carlos III (ISCIII) (PI10/02763, PI10/02745, PI18/00449, PI19/00907), co-funded by FEDER “Una manera de hacer Europa”, SEPAR, Catalonian Cardiology Society, ResMed Ltd. (Australia), EsteveTeijin (Spain), Oxigen Salud (Spain), Associació Lleidatana de Respiratori (ALLER), CIBERES. MS received financial support from a "Ramón y Cajal" grant (RYC2019-027831-I) from the“Ministerio de Ciencia e Innovación - Agencia Estatal de Investigación” co-funded by the European Social Fund (ESF)/“Investing in your future”. AZ held the predoctoral fellowship “Ajuts 2021 de Promoció de la Recerca en Salut-9ª edició” from IRBLleida/Diputació de Lleida. JdB acknowledges receiving financial support from ISCIII (Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund (ESF), “Investing in your future”.
Rationale
Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients and is a cause of secondary hypertension.
Objectives
To evaluate the long-term effects of OSA and CPAP treatment on blood pressure (BP) control in patients discharged after an ACS.
Methods
Post hoc analysis of the ISAACC study included 1803 patients admitted for ACS (NCT01335087). Patients with OSA (apnea-hypopnea index ≥15 events/h) were randomly assigned to receive either CPAP or/and usual care and followed up for one to 5 years. Office BP was determined at each visit.
Measurements and Main Results
We included 596 patients without OSA, 605 patients in the CPAP group, and 602 patients in the usual care group. 52% of the patients had a diagnosis of hypertension at baseline. Median age and body mass index were 59 [52.0;67.0] years and 28.2 [25.6;31.2] kg/m2, respectively. After a median [25th;75th percentile] follow-up of 41.2 [18.3;59.6] months, BP changes were similar between OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI>40 events/h) with a maximum difference in mean BP of +3.3 mmHg at 30 months. OSA patients with good CPAP adherence (≥4 hours/night) reduced mean BP after 18 months compared to non-OSA and poor CPAP adherence patients, maximum mean difference (95% CI) of -4.7 (-6.7,-2.7) mmHg. In patients with severe OSA we observed a maximum mean difference of -7.1 (-10.3,-3.8) mmHg.
Conclusions
In patients discharged after an ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence.
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Affiliation(s)
- A Aldoma
- University Hospital Arnau de Vilanova, Cardiology, Lleida, Spain
| | - M Manuel Sanchez-De-La-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida,, Institut de Recerca Biomedica, Lleida, Spain
| | - E Gracia-Lavedan
- Primary Care Centre DE SANTA MARIA, Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - ID Benitez
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - A Zapater
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida,, Institut de Recerca Biomedica, Lleida, Spain
| | - G Torres
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida,, Institut de Recerca Biomedica, Lleida, Spain
| | - A Sanchez-De-La-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida,, Institut de Recerca Biomedica, Lleida, Spain
| | - J De Batlle
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida,, Institut de Recerca Biomedica, Lleida, Spain
| | - A Targa
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - O Minguez
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - L Pascual
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - A Cortijo
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - D Martinez
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - M Dalmases
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
| | - F Barbe-Illa
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, I, Institut de Recerca Biomedica, Lleida, Spain
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