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Yañez Palma MC, Roman F, Llopis-Roca F, Fragiel M, Julián Jiménez A, Martín-Sánchez FJ, González Del Castillo J. [Utility of the medial region of pro-adrenomodulin for the detection of true bacteremia in elderly patients treated in the emergency department for suspected infection]. Rev Esp Quimioter 2024; 37:78-87. [PMID: 38108264 PMCID: PMC10874664 DOI: 10.37201/req/110.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The prediction of bacteremia in the emergency department (ER) is important for initial decision-making. The elderly population is a diagnosis challenge. The objective was to evaluate the accuracy of mid regional pro-adrenomedullin (MR-proADM) to identify true bacteremia (BV) in elderly patients attended in 3 hospital emergency departments. METHODS Observational study including patients ≥75 years of age or older attended in the ER for suspected infection in whom a blood culture (BC) was extracted. Sociodemographic, comorbidity, hemodynamic and analytical variables, biomarkers [MR-proADM, procalcitonin (PCT), C-reactive protein (CRP) and lactate] and final diagnosis were collected. The primary outcome was a true positive on a blood culture. RESULTS A total of 109 patients with a mean age of 83 (SD: 5.5) years were included. A final diagnosis of BV was obtained in 22 patients (20.2%). The independent variables to predict it were PCT (OR: 13.9; CI95%: 2.702-71.703; p=0.002), MR-proADM (OR: 4.081; CI95%: 1.026-16.225; p=0.046) and temperature (OR: 2.171; CI95%: 1.109-4.248; p=0.024). Considering the cut-off point for MR-proADM (2.13 mg/dl), a sensitivity (Se) of 73%, specificity (E) of 71%, a positive predictive value (PPV) of 39%, a negative predictive value (NPV) of 91%, a positive likelihood ratio (LHR+) of 2.53 and a negative likelihood ratio (LHR-) of 0.38; for PCT (0.76 mg/dl) a Se of 90%, E of 65%, PPV of 40%, NPV of 96%, LHR+ 2,64 and a LHR- of 0.14 were obtained. When combining both, a Se of 69%, E of 84%, PPV of 52%, NPV of 91%, LHR+ of 4.24 and LHR- of 0.38 were observed. CONCLUSIONS Elevated levels of PCT and MR-proADM were independently associated with an increased risk of BV and the combination of both improves the accuracy to identify these patients.
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Affiliation(s)
| | | | | | | | | | | | - J González Del Castillo
- Juan González del Castillo, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain.
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2
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Povar-Echeverría M, Méndez-Bailón M, Martín-Sánchez FJ, Montero-Pérez-Barquero M, Trullàs JC, Miró Ò. Prognostic impact of metformin in patients with type 2 diabetes mellitus and acute heart failure: Combined analysis of the EAHFE and RICA registries. Rev Clin Esp 2023; 223:542-551. [PMID: 37717921 DOI: 10.1016/j.rceng.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/29/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients with diabetes mellitus (DM) and heart failure (HF) have a worse prognosis despite therapeutic advances in both diseases. Sodium-glucose co-transporter type 2 and GLP-1 receptor agonists have shown cardiovascular benefits and they have been positioned as the first step in the treatment of DM in patients with HF or high cardiovascular risk. However, in the pivotal trials the majority of patients receive concomitant treatment with metformin. Randomized clinical trials have not yet been developed to assess the prognostic impact of metformin at the cardiovascular level. Our objective has been centered in analyzing whether patients with DM and acute HF who receive treatment with metformin at the time of discharge may have a better prognosis at one year of follow-up. METHODS Prospective cohort trial using the combined analysis of the two main Spanish HF registries, the EAHFE Registry (Epidemiology of Acute Heart Failure in Emergency Departments) and the RICA (National Registry of Patients with Heart Failure). RESULTS 33% (1453) of a total of 4403 patients with DM type 2 received treatment with metformin. This group presents significantly lower mortality after one year of treatment (22 versus 32%; Log Rank test P < 0.001). In the adjusted analysis of mortality, patients receiving treatment with metformin have lower mortality at one year of follow-up regardless of the rest of the variables (RR 0,814; 95%IC 0,712-0,930; P < 0.01). CONCLUSIONS Patients with DM type 2 and acute HF who receive metformin have a better prognosis after one year of follow-up, so we believe that this drug should continue to be a fundamental pillar in the treatment of these patients.
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Affiliation(s)
- M Povar-Echeverría
- Internal Medicine Service, Hospital Comarcal de Barbastro, Barbastro, Huesca, Spain.
| | - M Méndez-Bailón
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - F J Martín-Sánchez
- Internal Medicine Service, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISS), Madrid, Spain
| | - M Montero-Pérez-Barquero
- Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J C Trullàs
- Internal Medicine Service, Hospital d'Olot i Comarcal de la Garrotxa, Olot, Girona, Spain; Grupo de Investigación en Reparación y Regeneración Q2 Tisular (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central, Barcelona, Spain
| | - Ò Miró
- Emergencies Service, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Yufera-Sanchez A, Lopez-Ayala P, Nestelberger T, Wildi K, Boeddinghaus J, Koechlin L, Rubini Gimenez M, Sakiz H, Bima P, Miro O, Martín-Sánchez FJ, Christ M, Keller DI, Gualandro DM, Kawecki D, Rentsch K, Buser A, Mueller C. Combining glucose and high-sensitivity cardiac troponin in the early diagnosis of acute myocardial infarction. Sci Rep 2023; 13:14598. [PMID: 37670005 PMCID: PMC10480296 DOI: 10.1038/s41598-023-37093-1] [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: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 09/07/2023] Open
Abstract
Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up. The primary diagnostic endpoint was index non-ST-segment elevation MI (NSTEMI). Prognostic endpoints were all-cause death, and cardiovascular (CV) death or future AMI, all within 730-days. Among 5639 eligible patients, NSTEMI was the adjudicated final diagnosis in 1051 (18.6%) patients. Diagnostic accuracy quantified using the area under the receiver-operating characteristics curve (AUC) for the combination of glucose with hs-cTnT and glucose with hs-cTnI was very high, but not higher versus that of hs-cTn alone (glucose/hs-cTnT 0.930 [95% CI 0.922-0.937] versus hs-cTnT 0.929 [95% CI 0.922-0.937]; glucose/hs-cTnI 0.944 [95% CI 0.937-0.951] versus hs-cTnI 0.944 [95% CI 0.937-0.951]). In early-presenters, a dual-marker strategy (glucose < 7 mmol/L and hs-cTnT < 5/hs-cTnI < 4 ng/L) provided very high and comparable sensitivity to slightly lower hs-cTn concentrations (cTnT/I < 4/3 ng/L) alone, and possibly even higher efficacy. Glucose was an independent predictor of 730-days endpoints. Our results showed that a dual marker strategy of glucose and hs-cTn did not increase the diagnostic accuracy when used continuously. However, a cutoff approach combining glucose and hs-cTn may provide diagnostic utility for patients presenting ≤ 3 h after onset of symptoms, also providing important prognostic information.
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Affiliation(s)
- Ana Yufera-Sanchez
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
| | - Pedro Lopez-Ayala
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
- Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Luca Koechlin
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Rubini Gimenez
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiology Department, Heart Center Leipzig, Leipzig, Germany
| | - Hüseyin Sakiz
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
| | - Paolo Bima
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Oscar Miro
- GREAT Network, Basel, Switzerland
- Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - F Javier Martín-Sánchez
- GREAT Network, Basel, Switzerland
- Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Basel, Switzerland
| | - Damian Kawecki
- 2nd Department of Cardiology, School of Medicine in Zabrze, Medical University of Sielsia, Katowice, Poland
| | - Katharina Rentsch
- Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
- Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
- GREAT Network, Basel, Switzerland.
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Espinosa B, Martín-Sánchez FJ, López-Díez MP. [Mortality considerations and hospitalized patient care during the weekends]. J Healthc Qual Res 2023; 38:321-322. [PMID: 36863939 DOI: 10.1016/j.jhqr.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Affiliation(s)
- B Espinosa
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - M P López-Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
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5
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Enríquez-Vázquez D, Quintanilla JG, García-Escolano A, Couselo-Seijas M, Simón-Chica A, Lee P, Alfonso-Almazán JM, Mahía P, Redondo-Rodríguez A, Modrego J, Ortega-Hernández A, Marcos-Alberca P, Magni R, Calvo E, Gómez-Gordo R, Yan P, La Rosa G, Bustamante-Madrión J, Pérez-García CN, Martín-Sánchez FJ, Calvo D, de la Hera JM, García-Torrent MJ, García-Osuna Á, Ordonez-Llanos J, Vázquez J, Pérez-Villacastín J, Pérez-Castellano N, Loew LM, Sánchez-González J, Gómez-Garre D, Filgueiras-Rama D. Non-invasive electromechanical assessment during atrial fibrillation identifies underlying atrial myopathy alterations with early prognostic value. Nat Commun 2023; 14:4613. [PMID: 37542075 PMCID: PMC10403561 DOI: 10.1038/s41467-023-40196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
Electromechanical characterization during atrial fibrillation (AF) remains a significant gap in the understanding of AF-related atrial myopathy. This study reports mechanistic insights into the electromechanical remodeling process associated with AF progression and further demonstrates its prognostic value in the clinic. In pigs, sequential electromechanical assessment during AF progression shows a progressive decrease in mechanical activity and early dissociation from its electrical counterpart. Atrial tissue samples from animals with AF reveal an abnormal increase in cardiomyocytes death and alterations in calcium handling proteins. High-throughput quantitative proteomics and immunoblotting analyses at different stages of AF progression identify downregulation of contractile proteins and progressive increase in atrial fibrosis. Moreover, advanced optical mapping techniques, applied to whole heart preparations during AF, demonstrate that AF-related remodeling decreases the frequency threshold for dissociation between transmembrane voltage signals and intracellular calcium transients compared to healthy controls. Single cell simulations of human atrial cardiomyocytes also confirm the experimental results. In patients, non-invasive assessment of the atrial electromechanical relationship further demonstrate that atrial electromechanical dissociation is an early prognostic indicator for acute and long-term rhythm control.
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Affiliation(s)
- Daniel Enríquez-Vázquez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Servicio de Cardiología, Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jorge G Quintanilla
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alba García-Escolano
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marinela Couselo-Seijas
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ana Simón-Chica
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Peter Lee
- Essel Research and Development Inc., Toronto, ON, Canada
| | - José Manuel Alfonso-Almazán
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Patricia Mahía
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Andrés Redondo-Rodríguez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier Modrego
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adriana Ortega-Hernández
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Marcos-Alberca
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ricardo Magni
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Enrique Calvo
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rubén Gómez-Gordo
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ping Yan
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Giulio La Rosa
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - José Bustamante-Madrión
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - F Javier Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Calvo
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jesús M de la Hera
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Álvaro García-Osuna
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca de l'Hospital Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques, IIB Sant Pau, Barcelona, Spain
| | - Jordi Ordonez-Llanos
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universidad Autónoma, Barcelona, Spain
- Foundation for Clinical Biochemistry & Molecular Pathology, Madrid, Spain
| | - Jesús Vázquez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Leslie M Loew
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Dulcenombre Gómez-Garre
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Filgueiras-Rama
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurología (English Edition) 2023; 38:270-277. [PMID: 37030513 DOI: 10.1016/j.nrleng.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/14/2020] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the emergency department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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7
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Jiménez-Méndez C, Díez-Villanueva P, Bonanad C, Ortiz-Cortés C, Barge-Caballero E, Goirigolzarri J, Esteban-Fernández A, Pérez-Rivera Á, Cobo M, López J, Sanz-García A, Guerrero C, Pardo HG, Robles C, Iglesias D, Pinilla JMG, Rodríguez LL, Formiga F, Martín-Sánchez FJ, Vidán MT, Ariza A, Martínez-Sellés M, Alfonso F. Frailty and prognosis of older patients with chronic heart failure. Rev Esp Cardiol (Engl Ed) 2022; 75:1011-1019. [PMID: 35718066 DOI: 10.1016/j.rec.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.
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Affiliation(s)
| | | | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carolina Ortiz-Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josebe Goirigolzarri
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Ángel Pérez-Rivera
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier López
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-García
- Unidad de Análisis de Datos, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Guerrero
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Carolina Robles
- Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - José Manuel García Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Francesc Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
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Martín-Sánchez FJ, Bermejo Boixareu C. EDEN - the Emergency Department and Elder Needs project - is a chance to understand and improve a whole-system approach to elder care in Spanish emergency departments. Emergencias 2022; 34:409-410. [PMID: 36625687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España. Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Cristina Bermejo Boixareu
- Servicio de Geriatría, Hospital Universitario Puerta de Hierro, Madrid, España. Instituto de Investigación Sanitaria Puerta de Hierro - Segovia Arana, Madrid, España. Facultad de Medicina, Universidad Autónoma, Madrid, España
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9
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Ratmann PD, Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Huré G, Gehrke J, Koechlin L, Wildi K, Mueller P, Bima P, Wussler D, Gisler N, Miro O, Martín-Sánchez FJ, Christ M, Gualandro DM, Twerenbold R, Gimenez MR, Keller DI, Buser A, Mueller C. Extending the no objective testing rules to patients triaged by the European Society of Cardiology 0/1-hour algorithms. Eur Heart J Acute Cardiovasc Care 2022; 11:834-840. [PMID: 36179255 DOI: 10.1093/ehjacc/zuac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
AIMS After rule-out of non-ST elevation myocardial infarction (NSTEMI) with the European Society of Cardiology (ESC) 0/1 h-algorithms, it is unclear which patients require further anatomical or functional cardiac testing. To test the safety and efficacy of the no-objective-testing (NOT)-rules after NSTEMI rule-out by the ESC 0/1 h-algorithms. METHODS AND RESULTS International, prospective, diagnostic multicentre study enrolling adult patients presenting with chest pain to the emergency department. Central adjudication of final diagnosis by two independent cardiologists using information including cardiac imaging. Primary endpoints were the safety and efficacy of the NOT-rules for the rule-out of major adverse cardiovascular events (MACE). Secondary endpoints included 365-day and 2-year MACE. Among 4804 and 4569 patients with available 0/1 h high-sensitivity cardiac troponin (hs-cTn)T-Elecsys or hs-cTnI-Architect concentrations, 2783 (58%) and 2252 (49%) were eligible for application of the NOT-rules after rule-out of NSTEMI by the ESC hs-cTnT/I-0/1h-algorithm. The first rule identified 26% of patients with a sensitivity of 100% (95%CI 98.3-100%) and a negative predictive value (NPV) of 100% (95% CI, n.c.). The second and third rules both identified 31% of patients with a sensitivity of 99.5% (95% CI 97.4-99.9%) and a NPV of 99.9% (95% CI 99.2-99.9%). Similar findings emerged for hs-cTnI. High safety was confirmed for rule-out of 365-day and 2-year MACE and proven to be superior to the HEART Score. CONCLUSION All three NOT-rules performed very well for rule-out of MACE. The third NOT-rule best balanced feasibility, safety, and efficacy by identifying nearly one out of three patients as low-risk and may not require further cardiac testing. https://clinicaltrials.gov/ct2/show/NCT00470587.
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Affiliation(s)
- Paul David Ratmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Pedro Lopez-Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Gabrielle Huré
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Juliane Gehrke
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Luca Koechlin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Critical Care Research Group, The Prince Charles Hospital, Brisbane and the University of Queensland, 627 Rode Rd, Chermside Queensland 4032, Australia
| | - Philip Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Paolo Bima
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Nicolas Gisler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Oscar Miro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Emergency Department, Hospital Clinic, C. de Villarroel 170, 08036 Barcelona, Spain
| | - F Javier Martín-Sánchez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Emergency Department, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Spitalstrasse 16, CH-6000 Luzern, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- Cardiology Department, Heart Center Leipzig, Strümpellstraße 39, D-04289 Leipzig, Germany
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Schmelzbergstrasse 8, CH-8091 Zurich, Switzerland
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, Hebelstrasse 10, CH-4056 Basel, Switzerland
- Department of Hematology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
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10
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Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
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Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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11
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Coscia T, Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Koechlin L, Miró Ò, Keller DI, Strebel I, Yufera Sanchez A, Okamura B, Wussler D, Shrestha S, Hausknecht K, Martín-Sánchez FJ, Christ M, Kawecki D, Twerenbold R, Wildi K, Rubini Gimenez M, Mueller C. Characteristics and Outcomes of Type 2 Myocardial Infarction. JAMA Cardiol 2022; 7:427-434. [PMID: 35262640 PMCID: PMC8908230 DOI: 10.1001/jamacardio.2022.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/30/2022]
Abstract
Question What are the characteristics and outcomes of type 2 myocardial infarction (T2MI) compared with type 1 myocardial infarction (T1MI) in patients presenting to the emergency department (ED) with acute chest discomfort? Findings In this cohort study 6253 patients, 251 patients (4.0%) and 1027 patients (16.4%) were diagnosed with T2MI and T1MI, respectively, and had comparable all-cause and cardiovascular mortality at 2 years. Tachyarrhythmia and hypertension were responsible for more than two-thirds of patients with T2MI and had lower mortality compared with patients with hypotension, hypoxemia, or anemia. Meaning Improved understanding of the specifics of patients with T2MI should help improve management strategies. Importance In contrast to type 1 myocardial infarction (T1MI) caused by atherothrombosis, characteristics and outcomes of type 2 myocardial infarction (T2MI) caused by supply-demand mismatch are incompletely understood. Objective To explore the characteristics and outcomes of patients with T2MI compared with those with T1MI. Design, Setting, and Participants In a prospective, international, multicenter cohort study including 12 emergency departments (EDs) in 5 European countries, unselected patients presenting with acute chest discomfort were enrolled from April 2006 to April 2018. Follow-up was done by telephone or in written form 3, 12, and 24 months after hospital discharge. Data were analyzed from April 2006 to April 2020. Interventions The final diagnoses of T2MI and T1MI were centrally adjudicated according to the Fourth Universal Definition of Myocardial Infarction by 2 independent cardiologists, including the pathophysiological trigger of T2MI. Main Outcomes and Measures Patient characteristics and outcomes, including 2-year all-cause and cardiovascular mortality and future T2MI and T1MI events. Results Of 6253 included patients, 2078 (33.2%) were women, and the median (IQR) age was 61 (48-74) years. Among 6253 patients with acute chest discomfort, the final adjudicated diagnosis was T2MI in 251 patients (4.0%), with tachyarrhythmia and hypertension responsible for two-thirds of cases, and T1MI in 1027 patients (16.4%). All-cause and cardiovascular mortality were comparable at 2 years (T2MI: adjusted hazard ratio, 1.0; 95% CI, 0.7-1.5; T1MI: adjusted hazard ratio, 0.7; 95% CI, 0.4-1.1). Patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI was more likely among patients with index T2MI compared with patients with index T1MI (hazard ratio, 3.2; 95% CI, 1.4-7.5). Similarly, future T1MI was more likely to occur among patients with index T1MI (hazard ratio, 3.0; 95% CI, 1.2-7.4). Conclusions and Relevance Among patients with T2MI, tachyarrhythmia and hypertension were responsible for more than two-thirds of T2MI cases. While T2MI and T1MI had comparable all-cause and cardiovascular mortality at 2 years, patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI occurred 3-fold more frequently among patients with T2MI vs T1MI as the index event. Improved understanding of the specifics of patients with T2MI should help improve management strategies.
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Affiliation(s)
- Tania Coscia
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Emergency Department, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Ana Yufera Sanchez
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Bernhard Okamura
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Katharina Hausknecht
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - F Javier Martín-Sánchez
- Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Hospital Clínico San Carlos, Madrid, Spain
| | - Michael Christ
- Emergency Department, Kantonsspital Luzern, Lucerne, Switzerland
| | - Damian Kawecki
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Critical Care Research Group, The Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Australia
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
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López-Ayala P, Alcaraz-Serna A, Valls Carbó A, Cuadrado Cenzual MÁ, Torrejón Martínez MJ, López Picado A, Martínez Valero C, Miranda JD, Díaz Del Arco C, Cozar López G, Suárez-Cadenas MDM, Jerez Fernández P, Angós B, Rodríguez Adrada E, Cardassay E, Del Toro E, Chaparro D, Montalvo Moraleda MT, Espejo Paeres C, García Briñón MÁ, Hernández Martín-Romo V, Ortega L, Fernández Pérez C, Martínez-Novillo M, González Armengol JJ, González Del Castillo J, Mueller CE, Martín-Sánchez FJ. Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level. Emergencias 2022; 34:119-127. [PMID: 35275462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. MATERIAL AND METHODS Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves. RESULTS We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. CONCLUSION PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.
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Affiliation(s)
- Pedro López-Ayala
- Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Suiza
| | - Ana Alcaraz-Serna
- Hospital Universitario de Lausanne (CHUV), Departamento de Medicine, Servicio de Inmunología y Alergología, Lausanne, Suiza
| | | | - Mª Ángeles Cuadrado Cenzual
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | | | | | | | | | | | | | - María Del Mar Suárez-Cadenas
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Beatriz Angós
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Enrique Del Toro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - David Chaparro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Miguel Ángel García Briñón
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Luis Ortega
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, España
| | | | - Mercedes Martínez-Novillo
- Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España
| | - Juan Jorge González Armengol
- Facultad de Medicina, Universidad Complutense de Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - Juan González Del Castillo
- Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | - Christian E Mueller
- Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Suiza
| | - F Javier Martín-Sánchez
- Facultad de Medicina, Universidad Complutense de Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
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13
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Valls Carbó A, González Del Castillo J, Miró O, Lopez-Ayala P, Jimenez S, Jacob J, Bibiano C, Martín-Sánchez FJ. Increased severity in SARS-CoV-2 infection of minorities in Spain. Rev Esp Quimioter 2021; 34:664-667. [PMID: 34622269 PMCID: PMC8638765 DOI: 10.37201/req/099.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. Material and methods A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. Results There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). Conclusions COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed.
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Affiliation(s)
| | | | | | | | | | | | | | - F J Martín-Sánchez
- Francisco Javier Martín Sanchez, Emergency Department. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain.
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14
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Martín-Sánchez FJ, Valls Carbó A, Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, García-Lamberechts JE, Jacob J, Alquézar A, Martínez-Valero C, Miranda JDD, López Picado A, Arrebola JP, López ME, Parviainen A, González Del Castillo J, Miró O, Jimenez S, Ferreras Amez JM, Rubio Díaz R, Gamazo Del Rio JJ, Alonso H, Herrero P, Ruiz de Lobera N, Ibero C, Mayan P, Peinado R, Navarro Bustos C, Manzanares JÁ, Román F, Piñera P, Burillo G, Jacob J, Bibiano C. Socio-Demographic Health Determinants Are Associated with Poor Prognosis in Spanish Patients Hospitalized with COVID-19. J Gen Intern Med 2021; 36:3737-3742. [PMID: 34240284 PMCID: PMC8266293 DOI: 10.1007/s11606-020-06584-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Social vulnerability is a known determinant of health in respiratory diseases. Our aim was to identify whether there are socio-demographic factors among COVID-19 patients hospitalized in Spain and their potential impact on health outcomes during the hospitalization. METHODS A multicentric retrospective case series study based on administrative databases that included all COVID-19 cases admitted in 19 Spanish hospitals from 1 March to 15 April 2020. Socio-demographic data were collected. Outcomes were critical care admission and in-hospital mortality. RESULTS We included 10,110 COVID-19 patients admitted to 18 Spanish hospitals (median age 68 (IQR 54-80) years old; 44.5% female; 14.8% were not born in Spain). Among these, 779 (7.7%) cases were admitted to critical care units and 1678 (16.6%) patients died during the hospitalization. Age, male gender, being immigrant, and low hospital saturation were independently associated with being admitted to an intensive care unit. Age, male gender, being immigrant, percentile of average per capita income, and hospital experience were independently associated with in-hospital mortality. CONCLUSIONS Social determinants such as residence in low-income areas and being born in Latin American countries were associated with increased odds of being admitted to an intensive care unit and of in-hospital mortality. There was considerable variation in outcomes between different Spanish centers.
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Affiliation(s)
- F Javier Martín-Sánchez
- Department of Emergency, Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain.
- Faculty of de Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Institute for Health Research of Hospital San Carlos, Madrid, Spain.
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Alicante, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pascual Piñera
- Emergency Department, Hospital Reina Sofía, Murcia, Spain
| | | | - Alfonso Martín
- Emergency Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - Jorge E García-Lamberechts
- Department of Emergency, Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain
- Institute for Health Research of Hospital San Carlos, Madrid, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | | | | | | | - Juan Pedro Arrebola
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Marta Esteban López
- Centro Nacional de Sanidad Ambiental, Majadahonda, Instituto de Salud Carlos III, Madrid, Spain
| | - Annika Parviainen
- Instituto Andaluz de Ciencias de la Tierra, Universidad de Granada (UGR-CSIC), Granada, Spain
| | - Juan González Del Castillo
- Department of Emergency, Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain
- Institute for Health Research of Hospital San Carlos, Madrid, Spain
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15
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Alquézar-Arbé A, Miró Ò, Piñera P, Jacob J, Martín A, Agra Montava I, Llorens P, Jiménez S, Burillo-Putze G, García-Lamberechts EJ, Martín-Sánchez FJ, González Del Castillo J, Siesta RDI. [Analysis of the evolution of patients attended in Spanish emergency departments during the first wave of the pandemic]. An Sist Sanit Navar 2021; 44:243-252. [PMID: 34142985 PMCID: PMC10019547 DOI: 10.23938/assn.0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To describe the number of visits (total and per COVID-19) attended by the Spanish hospital emergency departments (EDs) during the first wave of the pandemic (March-April 2020) compared to the same period in 2019, and to calculate the quantitative changes in healthcare activity and investigate the possible influence of hospital size and COVID-19 seroprevalence. METHOD Cross-sectional study that analyzes the number of visits to Spanish public EDs, reported through a survey of ED chiefs during the study periods. Changes in healthcare activity were described in each autonomous community and com-pared according to hospital size and the provincial impact of the pandemic. RESULTS A total of 187 (66?%) of the 283 Spanish EDs participated in the study. The total number of patients attended de-creased to 49.2?% (<?30?% in the Castilla-La Mancha region), with a 60?% reduction in non-COVID-19 patients (reduction <?50?% in the regions of Asturias and Extremadura). While there were no differences in changes of healthcare activity according to the size of the hospital, there were differences in relation to the provincial impact of the pandemic, with a direct correla-tion related to the decrease in non-COVID-19 activity (the greater the impact, the greater the decrease; R2?=?0.05; p?=?0.002) and an inverse correlation to the overall activity (the greater the impact, the lesser the decrease; R2?=?0.05; p?=?0.002). CONCLUSION There was a very significant decrease in the number of ED visits during the first pandemic wave, although this decrease cannot be explained solely by the local incidence of the pandemic.
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Affiliation(s)
- A Alquézar-Arbé
- Servicio de Urgencias. Hospital de la Santa Creu i Sant Pau. Barcelona. España..
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16
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Rubini Giménez M, Wildi K, Wussler D, Koechlin L, Boeddinghaus J, Nestelberger T, Badertscher P, Sedlmayer R, Puelacher C, Zimmermann T, du Fay de Lavallaz J, Lopez-Ayala P, Leu K, Rentsch K, Miró Ò, López B, Martín-Sánchez FJ, Bustamante J, Kawecki D, Parenica J, Lohrmann J, Kloos W, Buser A, Keller DI, Reichlin T, Twerenbold R, Mueller C. Cinética temprana de troponina en pacientes con sospecha de infarto agudo de miocardio. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Julián-Jiménez A, González Del Castillo J, García-Lamberechts EJ, Rubio Díaz R, Huarte Sanz I, Navarro Bustos C, Martín-Sánchez FJ, Candel FJ. [Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. Rev Esp Quimioter 2021; 34:376-382. [PMID: 34032112 PMCID: PMC8329573 DOI: 10.37201/req/043.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.
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Affiliation(s)
- A Julián-Jiménez
- Agustín Julián-Jiménez, Servicio de Urgencias-Coordinador de Docencia, Formación, Investigación y Calidad. Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
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18
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Ratmann PD, Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Koechlin L, Wildi K, Miro O, Martín-Sánchez FJ, Christ M, Twerenbold R, Rubini Gimenez M, Keller DI, Mueller C. External Validation of the No Objective Testing Rules in Acute Chest Pain. J Am Heart Assoc 2021; 10:e020031. [PMID: 33977760 PMCID: PMC8200689 DOI: 10.1161/jaha.120.020031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul David Ratmann
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Pedro Lopez-Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Luca Koechlin
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy.,Department of Cardiac Surgery University Hospital BaselUniversity of Basel Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy.,Critical Care Research Group The Prince Charles Hospital Brisbane Australia.,University of Queensland Brisbane Australia
| | - Oscar Miro
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy.,Emergency Department Hospital Clinic Barcelona, Catalonia Spain
| | - F Javier Martín-Sánchez
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy.,Emergency Department Hospital Clínico San Carlos Madrid Spain
| | - Michael Christ
- Department of Emergency Medicine Luzerner Kantonsspital Luzern Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,Cardiology Department Heart Center Leipzig Leipzig Germany
| | - Dagmar I Keller
- Emergency Department University Hospital Zurich Zurich Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
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19
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Altali Alhames K, Martín-Sánchez FJ, Ruiz-Artacho P, Ayuso FJ, Trenchs V, Martínez Ortiz de Zarate M, Navarro C, Fuentes Ferrer M, Fernández C, González Del Castillo J, Bodas A. Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments. Rev Esp Quimioter 2021; 34:220-227. [PMID: 33926180 PMCID: PMC8179944 DOI: 10.37201/req/008.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. METHODS This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. RESULTS A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0).. CONCLUSIONS CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.
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Affiliation(s)
| | - F J Martín-Sánchez
- Francisco Javier Martín-Sánchez. Emergency Department. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid. Spain.
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20
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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21
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Delgado JF, Cepeda JM, Llorens P, Jacob J, Comín J, Montero M, Miró Ò, López de Sá E, Manzano L, Martín-Sánchez FJ, Formiga F, Masip J, Pérez-Calvo JI, Herrero-Puente P, Manito N. Consensus on improving the comprehensive care of patients with acute heart failure. Rev Clin Esp 2021; 221:163-168. [PMID: 38108502 DOI: 10.1016/j.rce.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
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Affiliation(s)
- J F Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Facultad de Medicina UCM, CIBERCV, Madrid, España.
| | - J M Cepeda
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Alicante), España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; ISABIAL Alicante; Universitat Miguel Hernández, Elche (Alicante), España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Comín
- Servicio de Cardiología, Hospital del Mar (IMAS), Barcelona, España
| | - M Montero
- IMIBIC, Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ò Miró
- Área de Urgencias, Hospital Clínic de Barcelona; Grupo de Investigación Urgencias: Procesos y Patologías, IDIBAPS; Universitat de Barcelona, Barcelona, España
| | - E López de Sá
- Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario La Paz, Madrid, España
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Masip
- Unidad de Cuidados Intensivos, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Universidad de Barcelona, Sant Joan Despí (Barcelona), España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Central Universitario Lozano Blesa, Zaragoza, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - N Manito
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
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22
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Delgado J, Cepeda JM, Llorens P, Jacob J, Comín J, Montero M, Miró Ò, López de Sá E, Manzano L, Martín-Sánchez FJ, Formiga F, Masip J, Pérez-Calvo JI, Herrero-Puente P, Manito N. Consensus on improving the comprehensive care of patients with acute heart failure. Rev Clin Esp 2021; 221:163-168. [PMID: 33998466 DOI: 10.1016/j.rceng.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
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Affiliation(s)
- J Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Facultad de Medicina UCM, CIBERCV, Madrid, Spain.
| | - J M Cepeda
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Alicante), Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; ISABIAL Alicante; Universitat Miguel Hernández, Elche (Alicante), Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J Comín
- Servicio de Cardiología, Hospital del Mar (IMAS), Barcelona, Spain
| | - M Montero
- IMIBIC, Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic de Barcelona; Grupo de Investigación Urgencias: Procesos y Patologías, IDIBAPS; Universitat de Barcelona, Barcelona, Spain
| | - E López de Sá
- Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario La Paz, Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J Masip
- Unidad de Cuidados Intensivos, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Universidad de Barcelona, Sant Joan Despí (Barcelona), Spain
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Central Universitario Lozano Blesa, Zaragoza, Spain
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - N Manito
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
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23
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Miró Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile and results of patients with acute heart failure transferred directly to home hospitalisation from emergency departments. Rev Clin Esp 2021; 221:1-8. [PMID: 32560917 DOI: 10.1016/j.rce.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU: 68/979/384). The HH rate was 4.7% (95% CI, 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p=.106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p<.001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI, 0.73-1.14) or SSU (HR, 0.77; 95% CI, 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI, 0.25-0.97) and SSU (HR, 0.37; 95% CI, 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Universitat Miguel Hernández, Elx, Alicante, España
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, España
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
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24
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Mirò Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile, and outcomes of patients with acute heart failure transferred directly to home hospitalization from emergency departments. Rev Clin Esp 2020; 221:1-8. [PMID: 33998472 DOI: 10.1016/j.rceng.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU:68/979/384). The HH rate was 4.7% (95% CI 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p = .106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p < .001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI 0.73-1.14) or SSU (HR, 0.77; 95% CI 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI 0.25-0.97) and SSU (HR, 0.37; 95% CI 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Mirò
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universitat Miguel Hernández, Elx, Alicante, Spain
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, Spain
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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25
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurologia 2020; 38:S0213-4853(20)30275-9. [PMID: 33268106 DOI: 10.1016/j.nrl.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
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26
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Martín-Sánchez FJ, Llopis García G. Author's reply. Emergencias 2020; 32:148. [PMID: 32125123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España. Universidad Complutense de Madrid, España
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27
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Miró Ò, Alquézar-Arbé A, Llorens P, Martín-Sánchez FJ, Jiménez S, Martín A, Burillo-Putze G, Jacob J, García-Lamberechts EJ, Piñera P, Del Castillo JG. [Comparison of the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals based on whether they were or were not admitted to an intensive care unit]. Med Intensiva 2020; 45:14-26. [PMID: 33158594 PMCID: PMC7522623 DOI: 10.1016/j.medin.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Objetivo Describir las características demográficas y de comorbilidad de los pacientes con COVID-19 fallecidos en hospitales españoles durante el brote pandémico de 2020 y compararlas según si ingresaron o no en una Unidad de Cuidados Intensivos (UCI) antes del fallecimiento. Métodos Análisis secundario de los pacientes de la cohorte SIESTA (formada por pacientes COVID de 62 hospitales españoles) fallecidos durante la hospitalización. Se recogieron sus características demográficas y comorbilidades, individuales y globalmente, estimadas mediante el índice de comorbilidad de Charlson (ICC). Se identificaron los factores independientes relacionados con ingreso en UCI, y se realizaron diversos análisis de sensibilidad para contrastar la consistencia de los hallazgos del análisis principal. Resultados Se incluyeron los 338 pacientes de la cohorte SIESTA fallecidos; de ellos, 77 (22,8%) accedieron a una UCI previamente al fallecimiento. En el análisis multivariable, tres de las 20 características basales analizadas se asociaron independientemente con ingreso en UCI de los pacientes fallecidos: demencia (no hubo pacientes fallecidos con demencia que ingresasen en UCI; OR = 0, IC 95% = no calculable), cáncer activo (OR = 0,07, IC 95% = 0,02-0,21) y edad (< 70 años: OR = 1, referencia; 70-74 años: OR = 0,21, IC 95% = 0,08-0,54; 75-79 años: OR = 0,21, IC 95% = 0,08-0,54; ≥ 80 años: OR = 0,02, IC 95% = 0,01-0,05). La probabilidad de ingreso en UCI de los pacientes que fallecieron disminuyó significativamente al aumentar el ICC, incluso tras ajustarla por edad (ICC 0 puntos: OR = 1, referencia; ICC 1 punto: OR = 0,36, IC 95% = 0,16-0,83; ICC 2 puntos: OR = 0,36, IC 95% = 0,16-0,83; ICC > 2 puntos: OR = 0,09, IC 95% = 0,04-0,23). Los análisis de sensibilidad no mostraron diferencias destacables respecto al análisis principal. Conclusiones El perfil de los pacientes COVID fallecidos sin ingresar en UCI se ajustó a lo observado en la práctica médica habitual antes de la pandemia, y las características basales que limitaron su ingreso fueron la edad y la carga de comorbilidad global, especialmente la demencia y el cáncer activo.
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Affiliation(s)
- Ò Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Llorens
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - S Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - A Martín
- Servicio de Urgencias, Hospital Universitario de Móstoles, Madrid, España
| | - G Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - E J García-Lamberechts
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - P Piñera
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | - J González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
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28
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Núñez-Gil IJ, Estrada V, Fernández-Pérez C, Feltes G, Vedia O, Vergara-Uzcategui CE, Moreno-Menguía VH, Cerrato E, D'Ascenzo F, Raposeiras-Roubin S, Martín-Sánchez FJ, Alfonso-Rodríguez E, Huang J, Ramakrishna H, Gil-Higes E, Fernández-Ortiz A, Macaya C. Health Outcome Predictive Evaluation for COVID 19 international registry (HOPE COVID-19), rationale and design. Contemp Clin Trials Commun 2020; 20:100654. [PMID: 32989425 PMCID: PMC7510540 DOI: 10.1016/j.conctc.2020.100654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/17/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
The disease produced by the new coronavirus known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), named COVID-19 (Coronavirus Disease-2019) has recently been classified as a pandemic by the World Health Organization (WHO). However, scarce clinical data is available and generally limited to the Chinese population due to the first cases were identified in Wuhan (Hubei, China). This article describes the rationale and design of the HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) registry (ClinicalTrials.gov Identifier: NCT04334291). With an ambispective cohort design, eligible patients are those discharged, deceased or alive, from any hospital center with a confirmed diagnosis or a COVID-19 high suspicion. With a current recruitment of more than 7000 cases, in 46 hospitals in 8 countries, since it is not possible to estimate the sample size based on literature reports, the investigators will try to get the maximum numbers of patients possible. The study primary objective is all cause mortality and aims to characterize the clinical profile of patients infected in order to develop a prognostic clinical score allowing, rapid logistic decision making. As secondary objectives, the analysis of other clinical events, the risk-adjusted influence of treatments and previous comorbidities of patients infected with the disease will be performed. The results of HOPE COVID-19 will contribute to a better understanding of this condition. We aim to describe the management of this condition as well as the outcomes in relation to the therapy chosen, in order to gain insight into improving patient care in the coming months. Clinical Trial registration ClinicalTrials.gov. Unique identifier: NCT04334291.
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Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Hospital Clínico San Carlos, Madrid, Spain.,Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | | | | | | | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy.,San Giovanni Battista, Turin, Italy
| | | | | | | | | | - Jia Huang
- Second Affiliated Hospital of Southern University of Science and Technology (The Third People's Hospital of Shenzhen), Shenzhen, China
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29
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Llopis García G, Munck Sánchez S, García Briñón MÁ, Fernández Alonso C, González Del Castillo J, Martín-Sánchez FJ. Physical frailty and its impact on long-term outcomes in older patients with acute heart failure after discharge from an emergency department. Emergencias 2020; 31:413-416. [PMID: 31777214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To study the frequency of physical frailty and explore whether its presence in older patients with acute heart failure (AHF) is associated with adverse outcomes in the year after discharge from a emergency department (ED). MATERIAL AND METHODS Prospective observational cohort study in patients with AHF aged 75 years or older who were discharged from our ED. Physical frailty was defined by a score of 7 or less on the Short Physical Performance Battery. The outcome was the development of a composite event (ED revisit for AHF, hospital readmission for AHF, or all-cause mortality) within 365 days of discharge from the ED. RESULTS Eighty-six patients with a mean (SD) age of 84 (6) years were included; 59.3% were women. Frailty was identified in 49 patients (57%). The composite outcome was observed in 46.5% within 365 days. Physical fragility was an independent predictor of the outcome (adjusted odds ratio, 3.6; 95% CI, 1.0-12.9; P=.047). CONCLUSION Frailty in older patients with AHF may predict a poor outcome during the year following discharge from an emergency department.
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Affiliation(s)
| | | | - Miguel Ángel García Briñón
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
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Martín-Sánchez FJ, Valls Carbó A, López Picado A, Martínez-Valero C, Miranda JD, Leal Pozuleo JM, González Del Castillo J. [Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid]. Rev Esp Quimioter 2020; 33:274-277. [PMID: 32517463 PMCID: PMC7374031 DOI: 10.37201/req/053.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. METHODS This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSIONS The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.
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Affiliation(s)
- F J Martín-Sánchez
- Francisco Javier Martín-Sánchez, Emergency Department, Hospital Clínico San Carlos. Profesor Martín Lagos s/n. 28400. Madrid. Spain.
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Martín-Sánchez FJ, González Del Castillo J, Valls Carbó A, López Picado A, Martínez-Valero C, D Miranda J, Chacón A, López-Ayala P, Chaparro D, Cozar López G, Suárez-Cadenas MDM, Jerez Fernández P, Del Toro E, Cardassay E, Angós B, Díaz Del Arco C, Rodríguez Adrada E, Montalvo Moraleda MT, Espejo Paeres C, Elvira C, García Briñón MÁ, Leal Pozuelo JM, Ortega L, Fernández Pérez C, González Armengol JJ. Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department. Emergencias 2020; 32:242-252. [PMID: 32692001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. MATERIAL AND METHODS Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases. CONCLUSION COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.
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Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina. Universidad Complutense de Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | | | - Amanda López Picado
- Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | | | | | - Ana Chacón
- Servicio de Admisión y Documentación Clínica, Hospital Clínico San Carlos, Madrid, España
| | - Pedro López-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Suiza
| | - David Chaparro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - María Del Mar Suárez-Cadenas
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | | | - Enrique Del Toro
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | - Beatriz Angós
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | - Carlos Elvira
- Servicio de Admisión y Documentación Clínica, Hospital Clínico San Carlos, Madrid, España
| | - Miguel Ángel García Briñón
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | | | - Luis Ortega
- Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Madrid, España
| | | | - Juan Jorge González Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina. Universidad Complutense de Madrid, España. Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
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Rubini Giménez M, Wildi K, Wussler D, Koechlin L, Boeddinghaus J, Nestelberger T, Badertscher P, Sedlmayer R, Puelacher C, Zimmermann T, du Fay de Lavallaz J, Lopez-Ayala P, Leu K, Rentsch K, Miró Ò, López B, Martín-Sánchez FJ, Bustamante J, Kawecki D, Parenica J, Lohrmann J, Kloos W, Buser A, Keller DI, Reichlin T, Twerenbold R, Mueller C. Early kinetics of cardiac troponin in suspected acute myocardial infarction. ACTA ACUST UNITED AC 2020; 74:502-509. [PMID: 32451223 DOI: 10.1016/j.rec.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/02/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Release kinetics of high-sensitivity cardiac troponin (hs-cTn) T and I in patients with acute myocardial infarction (AMI) are incompletely understood. We aimed to assess whether hs-cTnT/I release in early AMI is near linear. METHODS In a prospective diagnostic multicenter study the acute release of hs-cTnT and hs-cTnI within 1 and 2hours from presentation to the emergency department was quantified using 3 hs-cTnT/I assays in patients with suspected AMI. The primary endpoint was correlation between hs-cTn changes from presentation to 1 hour vs changes from presentation to 2hours, among all AMI patients and different prespecified subgroups. The final diagnosis was adjudicated by 2 independent cardiologists, based on serial hs-cTnT from the serial study blood samples and additional locally measured hs-cTn values. RESULTS Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). For hs-cTnT, the correlation coefficient between 0- to 1-hour change and 0- to 2 hour change was 0.931 (95%CI, 0.916-0.944), P <.001. Similar findings were obtained with hs-cTnI (Architect) with correlation coefficients between 0- to 1-hour change and 0- to 2 hour change of 0.969 and hs-cTnI (Centaur) of 0.934 (P <.001 for both). Findings were consistent among type 1 and type 2 AMI and in the subgroup of patients presenting very early after chest pain onset. CONCLUSIONS Patients presenting with early AMI showed a near linear release of hs-cTnT and hs-cTnI. This near linearity provides the pathophysiological basis for rapid diagnostic algorithms using 0- to 1-hour changes as surrogates for 0- to 2 hour or 0- to 3 hour changes. Registered at ClinicalTrials.gov (Identifier: NCT00470587).
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Affiliation(s)
- María Rubini Giménez
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Critical Care Research Institute, the Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Australia
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Heart Surgery, University Hospital Basel, Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Cardiology, University of Illinois at Chicago, Chicago, United States
| | - Raphael Sedlmayer
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Zimmermann
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Pedro Lopez-Ayala
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Kathrin Leu
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | | | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - Beatriz López
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | | | - José Bustamante
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - Damian Kawecki
- 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jens Lohrmann
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Wanda Kloos
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland and Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
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Affiliation(s)
- F Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain.
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Rubini Gimenez M, Badertscher P, Twerenbold R, Boeddinghaus J, Nestelberger T, Wussler D, Miró Ò, Martín-Sánchez FJ, Reichlin T, Mueller C. Impact of the US Food and Drug Administration-Approved Sex-Specific Cutoff Values for High-Sensitivity Cardiac Troponin T to Diagnose Myocardial Infarction. Circulation 2019; 137:1867-1869. [PMID: 29685935 DOI: 10.1161/circulationaha.117.031940] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Rubini Gimenez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.).,Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany (R.T.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Desiree Wussler
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Òscar Miró
- Emergency Department, Hospital Clinic, University of Barcelona, Spain (O.M.)
| | | | - Tobias Reichlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (M.R.G., P.B., R.T., J.B., T.N., D.W., T.R., C.M.).
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González Del Castillo J, García Lamberechts EJ, Martín-Sánchez FJ, Núñez-Orantos MJ. [Isolation of the patient from the emergency department: improvement strategy]. J Healthc Qual Res 2019; 34:159-160. [PMID: 30871946 DOI: 10.1016/j.jhqr.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Affiliation(s)
- J González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España.
| | - E J García Lamberechts
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, España
| | - M J Núñez-Orantos
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, España
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cupa J, Strebel I, Badertscher P, Abächerli R, Twerenbold R, Schumacher L, Boeddinghaus J, Nestelberger T, Maechler P, Kozhuharov N, Giménez MR, Wildi K, Du Fay de Lavallaz J, Sabti Z, Sazgary L, Puelacher C, Mueller D, Bianci C, Miró Ò, Fuenzalida C, Calderón S, Martín-Sánchez FJ, Iglesias SL, Morawiec B, Kawecki D, Parenica J, Keller DI, Geigy N, Osswald S, Mueller C, Reichlin T. Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction. Cardiol J 2018; 25:601-610. [DOI: 10.5603/cj.a2018.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/23/2018] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
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Martín-Sánchez FJ, Perdigones J, Ferré Losa C, Llopis F, Navarro Bustos C, Borraz Ordas C, Llorens Soriano P, Sempere Montes G, Fernández Alonso C, Fuentes Ferrer M, Juan Pastor A. 180-day risk of mortality in older patients admitted to short-stay units: the 6-Month Short-Stay Unit (6M UCE) Score. Emergencias 2018; 30:315-320. [PMID: 30260115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.
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Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Javier Perdigones
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Carles Ferré Losa
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, España
| | - Ferrán Llopis
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, España
| | | | - Carmen Borraz Ordas
- Unidad de Corta Estancia, Hospital Universitario Dr. Peset, Valencia, España
| | - Pere Llorens Soriano
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital General Universitario de Alicante, España
| | | | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Manuel Fuentes Ferrer
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid, España
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González Del Castillo J, Candel FJ, de la Fuente J, Gordo F, Martín-Sánchez FJ, Menéndez R, Mujal A, Barberán J. [Integral approach to the acute exacerbation of chronic obstructive pulmonary disease]. Rev Esp Quimioter 2018; 31:461-484. [PMID: 30284414 PMCID: PMC6194861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022]
Abstract
Chronic obstructive pulmonary disease is a set of clinical processes that have in common a chronic and progressive obstruction to airflow, with episodes of exacerbation. These exacerbations are more frequent and severe over time, deteriorating the lung function. The main cause of exacerbations is bacterial infection. There are multiple guidelines and documents that statement the management of this pathology. However, they focus primarily on the treatment during the stable phase. This document addresses the problem of acute exacerbation due to an infection from a multidisciplinary perspective, focusing on the integral approach to the process, and including etiology, microbiological studies, resistance to antimicrobials, risk stratification and initial empirical therapeutic management (antibiotic and concomitant). In addition, it includes an approach to more complex aspects such as the management of special populations (elderly and immunosuppressed) or therapeutic failure. Finally, more controversial topics such as prophylaxis of infection or palliative treatment are specifically discussed.
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Affiliation(s)
- J González Del Castillo
- Juan González del Castillo, Servicio de Urgencias. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid. Spain.
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Fernández-Guerrero IM, Hidalgo-Rodríguez A, de Las Mercedes Leal-Lobato M, Rivilla-Doce C, Martín-Sánchez FJ, Miró Ò. Presentations at 29 conferences of the Spanish Society of Emergency Medicine (SEMES) from 1988 to 2017: a descriptive analysis. Emergencias 2018; 30:303-314. [PMID: 30260114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To gain greater understanding of the development of emergency medicine in Spain by analyzing the presentations at conferences of the Spanish Society of Emergency Medicine (SEMES) over the past 30 years (1988-2017). MATERIAL AND METHODS We examined the programs of all SEMES conferences and described the characteristics of both presentations and presenters. We also analyzed changes occurring between 1988 and 2017 of some of the characteristics observed. The Web of Science was searched to evaluate the scientific productivity of the most frequent presenters and to calculate h-indexes for those presenters to assesstheir scientific relevance. RESULTS SEMES did not hold a conference in 1992. The total of 29 conferences included 2182 presentations (112 listing presenters from abroad) given by 1410 presenters (89 from abroad). The presenters' affiliations named 616 centers. The number of presentations and presenters increased linearly during the first period and then leveled off. The number increased exponentially in the final phase. Men gave 79.6% of the presentations; 70.6% of the presenters were physicians, 11.9% were nurses and 4.0% were ambulance staff. Specialists in emergency medicine accounted for 60.8% of the presenters who were physicians. Presenters from the Spanish autonomous community organizing the conference gave 29.8% of the presentations. The contributions of presenters from the local organizing community were nearly always more numerous than the average number of contributions from that community in all 29 conferences overall. Conference contributions from some autonomous communities (Extremadura, Andalusia, and Catalonia) were considerably fewer than would be expected given the scientific productivity of those communities. However, communities (Murcia, Balearic Islands, Asturias, Castile-Leon, Madrid), gave many more presentations than their productivity metrics would predict. Analysis of the 59 most frequent presenters (at 5 conferences or more) showed that 64.4% of them had published at least 20 articles and that 71.2% had an h-index of 5 or higher. The number of women on the program increased significantly between 1988 and 2017. Likewise, geographic diversity increased significantly (presentations from centers outside the local organizing area) as did the participation of hospitalbased emergency medicine specialists. CONCLUSION SEMES conference programs have attracted significantly more presentations and presenters over the years. We also detected changes in descriptive characteristics. The analysis of those characteristics can help future SEMES conference planners to plan ways to correct aspects such as scarce geographic diversity, low international participation, and few women among presenters.
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Affiliation(s)
| | | | | | - Celia Rivilla-Doce
- Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) de Madrid, Facultad de Medicina de la Universidad Complutense de Madrid, España
| | - Òscar Miró
- Àrea de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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Martín-Sánchez FJ, Díez-Villanueva P, Vidán MT. Authors' reply. Emergencias 2018; 30:363-364. [PMID: 30260131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico, Madrid, España
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón,IisGM, Universidad Complutense de Madrid, CIBERFES (CIBER de Fragilidad y Envejecimiento Saludable), Madrid, España
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. ACTA ACUST UNITED AC 2018; 72:63-71. [PMID: 30269913 DOI: 10.1016/j.rec.2018.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.
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Affiliation(s)
| | - Albert Arizá-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Ruiz Ros
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, Spain
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Del Arco Galán C, Rodríguez Miranda B, González Del Castillo J, Carballo C, Bibiano Guillén C, Artillo S, Miró Ò, Martín-Sánchez FJ. [Physical structure, human resources, and health care quality indicators in public hospital emergency departments in the autonomous communities of Madrid and Catalonia: a comparative study]. Emergencias 2018; 29:373-383. [PMID: 29188911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the general, structural, and organizational characteristics of public hospital emergency departments in the Spanish autonomous communities of Madrid and Catalonia. MATERIAL AND METHODS Descriptive survey-based study covering 3 areas of inquiry: general hospital features (18 questions), structural features of the emergency department (14 questions), and organizational and work-related policies of the emergency department (30 questions). Hospitals were grouped according to complexity: local hospitals (level 1), high-technology or referral hospitals (levels 2-3). RESULTS We studied 26 hospital departments in Madrid (21, levels 2-3; 5, level 1) and 55 in Catalonia (24, levels 2-3; 31, level 1). Hospitals in Madrid are in newer buildings (P=.002), have more beds on conventional wards and in critical care units (P<.001, both comparisons), are more often affiliated with a university (P<.001), and serve larger populations (P=.027). The emergency departments in Madrid have larger surface areas available for clinical care and more cubicles for preliminary evaluations and observation beds (P=.001, all comparisons). Hospitals in Madrid also attended a larger median number of emergencies (P<.001). More physicians were employed in Catalonia overall, but the numbers of physician- and nurse-hours per hospital were higher in Madrid, where it was more usual for physicians to work exclusively in the emergency department (92.5% in Madrid vs 56.8% in Catalonia, P<.001). However, fewer of the employed physicians had permanent contracts in Madrid (30.5% vs 75.1% in Catalonia, P<.001). The ratio of resident physicians to staff physicians differs between the 2 communities on afternoon/evening, night, and holiday shifts (3:1 in Madrid; 1:1 in Catalonia). CONCLUSION The physical and functional structures of hospital emergency departments in the communities of Madrid and Catalonia differ significantly. The differences cannot be attributed exclusively to geographic location.
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Affiliation(s)
- Carmen Del Arco Galán
- Servicio de Urgencias, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria del Hospital de la Princesa, Facultad de Medicina, Universidad Autónoma de Madrid
| | | | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - César Carballo
- Servicio de Urgencias, Hospital Universitario La Paz, Hospital Carlos III y Hospital Cantoblanco, Madrid, España
| | | | - Santiago Artillo
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Òscar Miró
- Área de Urgencias, Área de Urgencias, Hospital Clínic, Barcelona; Facultad de Medicina, Universitat de Barcelona, España
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Díez-Villanueva P, Ariza-Solé A, López J, García-Pardo H, Martín-Sánchez FJ, Martínez-Sellés M. Selection of the Best of 2017 in Heart Failure in Elderly Patients. Rev Esp Cardiol (Engl Ed) 2018; 71:120-121. [PMID: 29223375 DOI: 10.1016/j.rec.2017.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico de Valladolid, Valladolid, Spain
| | - Héctor García-Pardo
- Servicio de Cardiología, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
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Marttini Abarca J, Fernández Arana L, Martín-Sánchez FJ, Lueje Alonso E, Pérez Rodriguez A, Wu Lai T, Fuentes-Ferrer M, Nazario Arancibia JC, Gil Gregorio P. In-hospital mortality risk score for very old patients hospitalized with decompensated chronic heart failure. Eur Geriatr Med 2018; 9:61-69. [PMID: 34654269 DOI: 10.1007/s41999-017-0008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To derive a risk score to predict in-hospital mortality for very old patients with decompensated chronic heart failure (DCHF). METHODOLOGY Retrospective cohort study that included patients ≥ 80 years admitted to a Geriatric Acute Care Unit with DCHF between January 2012 and December 2014. We analyzed 70 candidate risk factors and in-hospital mortality. We derived a risk model using multivariate logistic regression model and constructed a scale for scoring risk. We used bootstrapping techniques for the internal validation. RESULTS We included 629 patients with mean age of 90 (SD5) years, 470 (73.1%) being women. Eighty-six (13.7%) patients died during the hospitalization. Factors included in the final risk model were NYHA class III-IV, severe functional dependence (Katz activities of daily living index < 2), infection as cause of exacerbation of heart failure, number of medications ≥ 8, albumin < 3 mg/dL, glomerular filtration rate < 60 mL/min, level of potassium in blood > 5.5 mEq/L and red blood cell distribution width (RDW) > 17%. In-hospital mortality in risk groups was 3.0, 4.6, 9.5, 15.1 and 36.3%, respectively. The area under ROC curve risk for score after bootstrapping was 0.77 (95%: CI 0.70-0.83). CONCLUSION This risk score could be useful for stratifying risk for in-hospital mortality among very old patients admitted to hospital for DCHF.
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Affiliation(s)
| | | | - F Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain.
| | - E Lueje Alonso
- Geriatric Department, Clínico San Carlos Hospital, Madrid, Spain
| | | | - T Wu Lai
- Geriatric Department, Clínico San Carlos Hospital, Madrid, Spain
| | - M Fuentes-Ferrer
- Methodological Support to the Research Unit, Preventive Medicine Department, Clínico San Carlos Hospital, Madrid, Spain
| | - J C Nazario Arancibia
- Innovation Support Unit, Foundation for Biomedical Research, Clínico San Carlos Hospital, Madrid, Spain
| | - P Gil Gregorio
- Geriatric Department, Clínico San Carlos Hospital, Madrid, Spain
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Twerenbold R, Badertscher P, Boeddinghaus J, Nestelberger T, Wildi K, Puelacher C, Sabti Z, Rubini Gimenez M, Tschirky S, du Fay de Lavallaz J, Kozhuharov N, Sazgary L, Mueller D, Breidthardt T, Strebel I, Flores Widmer D, Shrestha S, Miró Ò, Martín-Sánchez FJ, Morawiec B, Parenica J, Geigy N, Keller DI, Rentsch K, von Eckardstein A, Osswald S, Reichlin T, Mueller C. 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction. Circulation 2018; 137:436-451. [PMID: 29101287 PMCID: PMC5794234 DOI: 10.1161/circulationaha.117.028901] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. Because patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in the absence of non-ST-segment elevation myocardial infarction, concern has been raised regarding the performance of the 0/1-hour algorithm in RD. METHODS In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected non-ST-segment elevation myocardial infarction to the emergency department, we assessed the diagnostic performance of the European Society of Cardiology 0/1-hour algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2, and compared it to patients with normal renal function. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including cardiac imaging. Safety was quantified as sensitivity in the rule-out zone, accuracy as the specificity in the rule-in zone, and efficacy as the proportion of the overall cohort assigned to either rule-out or rule-in based on the 0- and 1-hour sample. RESULTS Among 3254 patients, RD was present in 487 patients (15%). The prevalence of non-ST-segment elevation myocardial infarction was substantially higher in patients with RD compared with patients with normal renal function (31% versus 13%, P<0.001). Using hs-cTnT, patients with RD had comparable sensitivity of rule-out (100.0% [95% confidence interval {CI}, 97.6-100.0] versus 99.2% [95% CI, 97.6-99.8]; P=0.559), lower specificity of rule-in (88.7% [95% CI, 84.8-91.9] versus 96.5% [95% CI, 95.7-97.2]; P<0.001), and lower overall efficacy (51% versus 81%, P<0.001), mainly driven by a much lower percentage of patients eligible for rule-out (18% versus 68%, P<0.001) compared with patients with normal renal function. Using hs-cTnI, patients with RD had comparable sensitivity of rule-out (98.6% [95% CI, 95.0-99.8] versus 98.5% [95% CI, 96.5-99.5]; P=1.0), lower specificity of rule-in (84.4% [95% CI, 79.9-88.3] versus 91.7% [95% CI, 90.5-92.9]; P<0.001), and lower overall efficacy (54% versus 76%, P<0.001; proportion ruled out, 18% versus 58%, P<0.001) compared with patients with normal renal function. CONCLUSIONS In patients with RD, the safety of the European Society of Cardiology 0/1-hour algorithm is high, but specificity of rule-in and overall efficacy are decreased. Modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the 0/1-hour algorithm. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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Affiliation(s)
- Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Germany (R.T.)
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Karin Wildi
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Christian Puelacher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Zaid Sabti
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Sandra Tschirky
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Lorraine Sazgary
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Deborah Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Tobias Breidthardt
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Ivo Strebel
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Dayana Flores Widmer
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.)
| | | | - Beata Morawiec
- 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.)
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Czech Republic (J.P.)
- Medical Faculty, Masaryk University, Brno, Czech Republic (J.P.)
| | - Nicolas Geigy
- Emergency Department, Kantonsspital Liestal, Switzerland (N.G.)
| | - Dagmar I Keller
- Emergency Department, University Hospital Zürich, Switzerland (D.I.K.)
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland (K.R.)
| | | | - Stefan Osswald
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T., P.B., J.B., T.N., K.W., C.P., Z.S., M.R.G., S.T., J.d.F.d.L., N.K., L.S., D.M., T.B., I.S., D.F.W., S.S., S.O., T.R., C.M.)
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47
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González-Del Castillo J, Teja-Marina J, Candel FJ, Barberán J, Moreno-Cuervo A, Chiarella F, López-González L, Ramos-Cordero P, Martín-Sánchez FJ. BAHNG score: predictive model for detection of subjects with the oropharynx colonized by uncommon microorganisms. Rev Esp Quimioter 2017; 30:422-428. [PMID: 29115367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Pneumonia is most frequently produced by the microaspiration of flora that colonizes the oropharynx. Etiological diagnosis of pneumonia is infrequent in clinical practise and empirical treatment should be prescribed. The aims of the present study were to determine the factors associated with oropharynx colonization by uncommon microorganisms (UM) and to develop a predictive model. METHODS A cross-sectional study that included all pa-tients living in one long-term care facilities was developed. Demographic, comorbidities, basal functional status and clinical data were collected. To determinate the oropharyngeal colonization, a single sample of pharynx was obtained for each subject using a cotton swab. RESULTS A total of 221 subjects were included, mean age 86.27 (SD 8.05) years and 157 (71%) were female. In 32 (14.5%) subjects UM flora was isolated, Gram-negative bacilli in 16 (7.2%) residents, and Staphylococcus aureus in 16 (7.2%). The predictive model included the presence of hypertension, neuromuscular disease, Barthel <90 and use of PEG. The BAHNG score (BArthel, Hypertension, Neuromuscular, Gastrostomy), showed an area under the curve of 0.731 (CI 95% 0.643-0.820; p<0.001). We have classified patients according to this score in low (0-2 points), intermediate (3-5 points) and high risk (≥ 6). The probability of UM colonization in the oropharyngeal based on this classification is 4.1%, 15.8% and 57.1% for low, intermediate and high risk, respectively. CONCLUSIONS The BAHNG score could help in the identifications of elderly patients with high risk of colonization by UM. In case of pneumonia the evaluation of the subject through this score could help in the initial decisions concerning antibiotic treatment.
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Affiliation(s)
- J González-Del Castillo
- Juan González del Castillo, Emergency Department. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain.
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48
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Kaier TE, Twerenbold R, Puelacher C, Marjot J, Imambaccus N, Boeddinghaus J, Nestelberger T, Badertscher P, Sabti Z, Giménez MR, Wildi K, Hillinger P, Grimm K, Loeffel S, Shrestha S, Widmer DF, Cupa J, Kozhuharov N, Miró Ò, Martín-Sánchez FJ, Morawiec B, Rentsch K, Lohrmann J, Kloos W, Osswald S, Reichlin T, Weber E, Marber M, Mueller C. Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction. Circulation 2017; 136:1495-1508. [PMID: 28972002 PMCID: PMC5642333 DOI: 10.1161/circulationaha.117.028084] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiac myosin-binding protein C (cMyC) is a cardiac-restricted protein that is more abundant than cardiac troponins (cTn) and is released more rapidly after acute myocardial infarction (AMI). We evaluated cMyC as an adjunct or alternative to cTn in the early diagnosis of AMI. METHODS Unselected patients (N=1954) presenting to the emergency department with symptoms suggestive of AMI, concentrations of cMyC, and high-sensitivity (hs) and standard-sensitivity cTn were measured at presentation. The final diagnosis of AMI was independently adjudicated using all available clinical and biochemical information without knowledge of cMyC. The prognostic end point was long-term mortality. RESULTS Final diagnosis was AMI in 340 patients (17%). Concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 237 ng/L versus 13 ng/L, P<0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.924), hs-cTnT (AUC, 0.927), and hs-cTnI (AUC, 0.922) and superior to cTnI measured by a contemporary sensitivity assay (AUC, 0.909). The combination of cMyC with hs-cTnT or standard-sensitivity cTnI (but not hs-cTnI) led to an increase in AUC to 0.931 (P<0.0001) and 0.926 (P=0.003), respectively. Use of cMyC more accurately classified patients with a single blood test into rule-out or rule-in categories: Net Reclassification Improvement +0.149 versus hs-cTnT, +0.235 versus hs-cTnI (P<0.001). In early presenters (chest pain <3 h), the improvement in rule-in/rule-out classification with cMyC was larger compared with hs-cTnT (Net Reclassification Improvement +0.256) and hs-cTnI (Net Reclassification Improvement +0.308; both P<0.001). Comparing the C statistics, cMyC was superior to hs-cTnI and standard sensitivity cTnI (P<0.05 for both) and similar to hs-cTnT at predicting death at 3 years. CONCLUSIONS cMyC at presentation provides discriminatory power comparable to hs-cTnT and hs-cTnI in the diagnosis of AMI and may perform favorably in patients presenting early after symptom onset. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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Affiliation(s)
- Thomas E Kaier
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Raphael Twerenbold
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Christian Puelacher
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jack Marjot
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Nazia Imambaccus
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jasper Boeddinghaus
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Thomas Nestelberger
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Patrick Badertscher
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Zaid Sabti
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Maria Rubini Giménez
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Karin Wildi
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Petra Hillinger
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Karin Grimm
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Sarah Loeffel
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Samyut Shrestha
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Dayana Flores Widmer
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Janosch Cupa
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Nikola Kozhuharov
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Òscar Miró
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - F Javier Martín-Sánchez
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Beata Morawiec
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Katharina Rentsch
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Jens Lohrmann
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Wanda Kloos
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Stefan Osswald
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Tobias Reichlin
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Ekkehard Weber
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
| | - Michael Marber
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.).
| | - Christian Mueller
- From King's College London BHF Centre, Rayne Institute, St Thomas' Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.)
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49
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Twerenbold R, Badertscher P, Boeddinghaus J, Nestelberger T, Wildi K, Rubini Gimenez M, Miró Ò, Martín-Sánchez FJ, Reichlin T, Mueller C. Effect of the FDA Regulatory Approach on the 0/1-h Algorithm for Rapid Diagnosis of MI. J Am Coll Cardiol 2017; 70:1532-1534. [DOI: 10.1016/j.jacc.2017.07.746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 01/12/2023]
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50
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González Del Castillo J, Clemente C, Candel FJ, Martín-Sánchez FJ. New sepsis criteria: do they replace or complement what is known in the approach to the infectious patient? Rev Esp Quimioter 2017; 30 Suppl 1:48-51. [PMID: 28882016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There have recently been profound changes in both the definitions of sepsis and septic shock and the diagnostic criteria established for daily clinical practice. In addition, a new screening tool known as qSOFA has been introduced to identify patients at risk of a poor short-term outcome. This score has been accompanied by some controversy due to presenting a lower sensitivity than the systemic inflammatory response criteria previously used to identify such patients. In this article, we shall summarise and analyse the most important recently published studies in relation to these new criteria.
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Affiliation(s)
- J González Del Castillo
- Juan González del Castillo, Emergency Department. Hospital Universitario Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain.
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