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Barrionuevo-Sánchez MI, Ariza-Solé A, Viana-Tejedor A, Del Prado N, Rosillo N, Jorge-Pérez P, Sánchez-Salado JC, Lorente V, Alegre O, Llaó I, Martín-Asenjo R, Bernal JL, Fernández-Pérez C, Corbí-Pascual M, Pascual J, Marcos M, de la Cuerda F, Carmona J, Comin-Colet J, Elola FJ. Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in Spain. Rev Esp Cardiol (Engl Ed) 2024; 77:226-233. [PMID: 37925017 DOI: 10.1016/j.rec.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting. METHODS This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality. RESULTS A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047). CONCLUSIONS The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Jorge-Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Júlia Pascual
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
| | - Marta Marcos
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco de la Cuerda
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Carmona
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Zulet P, Olmos C, Fernández-Pérez C, Del Prado N, Rosillo N, Bernal JL, Gómez D, Vilacosta I, Elola FJ. Regional differences in infective endocarditis epidemiology and outcomes in Spain. A contemporary population-based study. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00038-0. [PMID: 38311023 DOI: 10.1016/j.rec.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION AND OBJECTIVES Our aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]). METHODS We conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed. RESULTS A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions. CONCLUSIONS We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. https://twitter.com/@pablozf0
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago, Santiago de Compostela, A Coruña, Spain; Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Barrionuevo-Sánchez MI, Viana-Tejedor A, Ariza-Solé A, Del Prado N, Rosillo N, Sánchez-Salado JC, Lorente V, Jorge-Pérez P, Noriega FJ, Ferrera C, Alegre O, Llaó I, Bernal JL, Triguero L, Fernández-Pérez C, González-Costello J, Marcos M, de la Cuerda F, Carmona J, Cequier A, Fernández-Ortiz A, Pérez-Villacastín J, Comin-Colet J, Elola FJ. Impact of annual volume of cases and Intensive Cardiac Care Unit availability on mortality of patients with acute myocardial infarction- related cardiogenic shock treated at revascularization capable centers. Eur Heart J Acute Cardiovasc Care 2023:7192937. [PMID: 37294681 DOI: 10.1093/ehjacc/zuad061] [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] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/02/2023] [Accepted: 06/07/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with high mortality. The purpose of this study was to assess the impact of Hospital structure-related variables on mortality in patients with CS treated at percutaneous and surgical revascularization capable centers (psRCC) from a large nationwide registry. METHODS Retrospective observational study including consecutive patients with main or secondary diagnosis of CS and ST elevation myocardial infarction (STEMI). Patients discharged from Spanish National Healthcare System psRCC were included (2016-2020). The association between the volume of CS cases attended by each center, availability of Intensive Cardiac Care Unit (ICCU) and heart transplantation (HT) programs and in-hospital mortality was assessed by multilevel logistic regression models. RESULTS The study population consisted of 3,074 CS-STEMI episodes, of whom 1,759 (57.2%) occurred in 26 centers with ICCU. A total of 17/44 hospitals (38.6%) were high-volume centers and 19/44 (43%) centers had HT programs availability. Treatment at HT centers was not associated with a lower mortality (p = 0.121). Both high volume of cases and ICCU showed a trend to an association with lower mortality in the adjusted model (OR: 0.87 and 0.88, respectively). The interaction between both variables was significantly protective (OR 0.72; p = 0.024). After propensity score matching, mortality was lower in high volume hospitals with ICCU [OR = 0.79; p = 0.007]. CONCLUSIONS Most CS-STEMI patients were attended at psRCC with high volume of cases and ICCU available. The combination of high-volume and ICCU availability showed the lowest mortality. These data should be taken into account when designing regional networks for CS management.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Albert Ariza-Solé
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Carlos Sánchez-Salado
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Jorge-Pérez
- Hospital Universitario de Canarias. La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Oriol Alegre
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Triguero
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago. Santiago de Compostela (A Coruña), Spain
| | - José González-Costello
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Marcos
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco de la Cuerda
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Carmona
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angel Cequier
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
| | | | | | - Josep Comin-Colet
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, Anguita-Gámez M, García M, Bernal JL, Prado ND, Fernández-Pérez C, Pérez-Villacastin J, Gómez-Doblas JJ, Elola FJ. Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals. J Geriatr Cardiol 2023; 20:247-255. [PMID: 37122985 PMCID: PMC10139925 DOI: 10.26599/1671-5411.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The prevalence of heart failure (HF) increases with age, and it is one of the leading causes of hospitalization and death in older patients. However, there are little data on in-hospital mortality in patients with HF ≥ 75 years in Spain. METHODS A retrospective analysis of the Spanish Minimum Basic Data Set was performed, including all HF episodes discharged from public hospitals in Spain between 2016 and 2019. Coding was performed using the International Classification of Diseases, 10th Revision. Patients ≥ 75 years with HF as the principal diagnosis were selected. We calculated: (1) the crude in-hospital mortality rate and its distribution according to age and sex; (2) the risk-standardized in-hospital mortality ratio; and (3) the association between in-hospital mortality and the availability of an intensive cardiac care unit (ICCU) in the hospital. RESULTS We included 354,792 HF episodes of patients over 75 years. The mean age was 85.2 ± 5.5 years, and 59.2% of patients were women. The most frequent comorbidities were renal failure (46.1%), diabetes mellitus (35.5%), valvular disease (33.9%), cardiorespiratory failure (29.8%), and hypertension (26.9%). In-hospital mortality was 12.7%, and increased with age [odds ratio (OR) = 1.07, 95% CI: 1.07-1.07, P < 0.001] and was lower in women (OR = 0.96, 95% CI: 0.92-0.97, P < 0.001). The main predictors of mortality were the presence of cardiogenic shock (OR = 19.5, 95% CI: 16.8-22.7, P < 0.001), stroke (OR = 3.5, 95% CI: 3.0-4.0, P < 0.001) and advanced cancer (OR = 2.6, 95% CI: 2.5-2.8, P < 0.001). In hospitals with ICCU, the in-hospital risk-adjusted mortality tended to be lower (OR = 0.85, 95% CI: 0.72-1.00, P = 0.053). CONCLUSIONS In-hospital mortality in patients with HF ≥ 75 years between 2016 and 2019 was 12.7%, higher in males and elderly patients. The main predictors of mortality were cardiogenic shock, stroke, and advanced cancer. There was a trend toward lower mortality in centers with an ICCU.
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Affiliation(s)
| | | | | | | | - María García
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Department of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
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Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, Anguita-Gámez M, Rosillo N, Del Prado N, Bernal JL, Fernández-Pérez C, Fernández-Rozas I, Gómez-Doblas JJ, Pérez-Villacastin J, Elola FJ. One-year readmissions for circulatory diseases and in-hospital mortality after an index episode of heart failure in elderly patients. A nationwide data from public hospitals in Spain between 2016 and 2018. Clin Res Cardiol 2023:10.1007/s00392-023-02202-7. [PMID: 37041378 DOI: 10.1007/s00392-023-02202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of hospitalization and death in elderly patients. However, there is limited evidence on readmission and mortality 1-year after discharge for HF. METHODS Retrospective analysis of the Minimum Basic Data Set, including HF episodes, discharged from Spanish hospitals between 2016 and 2018 in ≥ 75 years. We calculated: (a) the rate of readmissions due to circulatory system diseases (CSD) 365 days after index episode; (b) in-hospital mortality in readmissions; and (c) predictors of mortality and readmission. RESULTS We included 178,523 patients (59.2% women) aged 85.1 ± 5.5 years. The most frequent comorbidities were arrhythmias (56.0%) and renal failure (39.5%). During the follow-up, 48,932 patients (27.4%) had at least one readmission for CSD and a crude rate of 40.2%, the most frequent one HF (52.8%). The median between the date of readmission and discharge from the last admission was 70 days [IQI 24; 171] for the first readmission. The most relevant predictors of the number of readmissions were valvular heart disease and myocardial ischemia. During the readmissions, 26,757 patients (79.1%) died, representing a cumulative in-hospital mortality of 47,945 (26.9%). The factors in the index episode predictors of mortality during readmissions were cardio-respiratory failure and stroke. The number of readmissions was a risk factor for in-hospital mortality (OR 1.13; 95% CI 1.11-1.14). CONCLUSIONS The readmission rate for CSD 1-year after the index episode of HF in patients ≥ 75 years was 28.4%. The cumulative in-hospital mortality rate during the readmissions was 26.9%, and the number of rehospitalizations was identified as one of the main predictors of mortality.
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Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain.
| | - Manuel Anguita-Sánchez
- Cardiology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Nicolás Rosillo
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - Náyade Del Prado
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - José Luis Bernal
- Management Control Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Preventive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
- Preventive Medicine Department, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
| | - Inmaculada Fernández-Rozas
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain
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Cequier Á, Bernal JL, Fernández Pérez C, Elola FJ. RECALCAR methodology. Some clarifications. Rev Esp Cardiol (Engl Ed) 2023; 76:74-75. [PMID: 36108996 DOI: 10.1016/j.rec.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Instituto de Investigaciones Sanitarias de Santiago (IDIS), Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain
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Rosillo N, Vicent L, Martín de la Mota Sanz D, Elola FJ, Moreno G, Bueno H. Time trends in the epidemiology of nonrheumatic aortic valve disease in Spain, 2003-2018. Rev Esp Cardiol (Engl Ed) 2022; 75:1020-1028. [PMID: 35662678 DOI: 10.1016/j.rec.2022.06.005] [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: 02/27/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES The impact of therapeutic improvements in nonrheumatic aortic valve disease (NRAVD) has been assessed at the patient level but not in the whole population with the disease. Our objective was to assess temporal trends in hospitalization rates, treatment and fatality rates in patients with a main or secondary NRAVD diagnosis. METHODS Retrospective analysis of administrative claims from patients hospitalized with a main or secondary NRAVD diagnosis between 2003 and 2018 in Spain. Time trends in age- and sex-standardized hospitalization and procedure rates, baseline characteristics and case fatality rates by diagnosis type were assessed by Poisson regression and joinpoint analysis. RESULTS Hospital admissions in patients with NRAVD increased from 69 213 in 2003 to 136 185 in 2018. The crude in-hospital fatality rate increased from 6.7% to 8.7% (IRR, 1.015; 95%CI, 1.012-1.018; P <.001) without changes after adjustment. Adjusted fatality rates decreased in patients with a main NRAVD diagnosis (5.5% to 3.5%; IRR, 0.953; 95%CI, 0.942-0.964) but increased in those with a secondary diagnosis (8.0% to 8.8%; IRR, 1.005; 95%CI, 1.002-1.009). Aortic valve replacements increased from 10.5 to 17.1 procedures per 100 000 population (IRR, 1.033; 95%CI, 1.030-1.037), mainly driven by transcatheter procedures (IRR, 1.345; 95%CI, 1.302-1.389). CONCLUSIONS Hospitalizations in patients with NRAVD are increasing, with most being secondary diagnoses. The use of aortic valve replacement is increasing with a reduction in fatality rates but only in patients with a main diagnosis.
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Affiliation(s)
- Nicolás Rosillo
- Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | | | | | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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8
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Anguita Gamez M, Esteban A, Bonilla JL, Garcia M, Bernal JL, Del Prado N, Fernandez Perez C, Gomez Doblas JJ, Perez Villacastin J, Marin F, Elola FJ, Anguita Sanchez M. Clinical features and short-term prognosis in the very elderly, >90 year-old, patients hospitalized with heart failure. A population-based study (2016–2019). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is a main health problem in western countries, and a major cause of hospitalizations and death, particularly in older people. Few data are available about clinical features and prognosis of very old patients, those aged 90 or more years.
Purpose
To analyse the clinical features and short-term prognosis (in-hospital mortality and 30-day readmission rate) of patients aged 90 or more years hospitalized with HF in Spain in the last years.
Methods
We conducted a retrospective analysis of patients discharged with an ICD-10 main diagnosis of HF from the Spanish National Health System (SNHS) public hospitals between 2016 and 2019, using as source of data the Minimum Basic Data Set of the SNHS. A comparison of clinical profile, in-hospital mortality and 30-day cardiovascular readmission rate between patients aged 75 to 89 years and those with 90 or more years was performed.
Results
From 2016 to 2019, 354,792 episodes of people older than 74-year and principal diagnosis of HF were included, being 59.2% female. Mean age of the whole population was 85.2±5.5 years, crude in-hospital mortality rate was 12.7% and crude cardiovascular 30-day readmission rate, 11.8%. The very older patients' subgroup (90 or more year-old) comprised 78.777 patients (22.2%). Table 1 shows the differences in clinical features between these patients and those aged 75 to 89 (77.8%). Patients aged 90 or more years were female in a higher proportion and showed a higher prevalence of cognitive impairment and renal failure, but a lower prevalence of most comorbidities (coronary artery revascularization, valve heart disease, cancer, diabetes mellitus, chronic liver disease). The diagnosis of previous myocardial infarction, stroke and systemic hypertension was similar in both groups (Table 1). Crude 30-day cardiovascular readmission rate was slightly but significantly lower in the oldest subgroup (10.9% vs 12%, p<0.001), while crude in-hospital mortality was higher (18.5% vs 11%, p<0.001).
Conclusions
Patients aged 90 or more years represents almost a fourth part of elderly patients hospitalized with HF in Spain within the last years. In general, prevalence of comorbidities and associated heart disease was similar or lower, but in-hospital mortality was twice higher, as compared with less older patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Esteban
- University Hospital Severo Ochoa, Cardiology , Leganes , Spain
| | - J L Bonilla
- Hospital San Juan de la Cruz, Cardiology , Ubeda , Spain
| | - M Garcia
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - J L Bernal
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - N Del Prado
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - C Fernandez Perez
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - J J Gomez Doblas
- Virgin of Victory University Hospital, Cardiology , Malaga , Spain
| | | | - F Marin
- University Hospital Virgen de la Arrixaca, Cardiology , Murcia , Spain
| | - F J Elola
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
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9
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Esteban Fernandez A, Anguita M, Bonilla JL, Anguita M, Ruesgas R, Molina M, Garcia M, Bernal JL, Del Prado N, Fernandez Perez C, Marin F, Perez Villacastin J, Gomez Doblas JJ, Fernandez Rozas I, Elola FJ. 1-year hospital readmissions due to cardiovascular causes after a heart failure episode in elderly patients in Spain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prevalence of heart failure (HF) increases with age, one of the leading causes of hospitalization and death in the elderly. However, there are little data about the long-term readmission rate of elderly patients after an episode of HF admission in Spain.
Purpose
Study 1-year hospital readmissions due to cardiovascular causes in patients ≥75 years discharged to a hospital due to HF in Spain.
Methods
We performed a retrospective analysis of the Minumum basic dataset of Spain, including all episodes of HF discharged from public hospitals in Spain between 2016 and 2019. The codification was made with ICD-10. We selected patients ≥75 years with HF as the principal diagnosis. We analyzed predictors of readmissions 365 days after the index episode of HF hospitalization with Poisson regression.
Results
236,463 index episodes of HF in>75 years were included. 59.1% were female, and the mean age was 85 (SD 5.6) years. 35.0% had HF-pef, 4.3% HF-ref, and 60.7% had unknown LVEF HF.
39.6% of patients had at least one readmission (mean 1.7 readmissions by year for these patients), with no differences in sex or age. Patients with non-cardiovascular comorbidities (renal failure, chronic lung disorders, and severe hematological disorders) as well as coronary atherosclerosis and diabetes were more likely to be readmitted (Table 1).
Conclusions
After a hospital discharge for HF in patients ≥75 years, the crude ratio of readmission due to cardiovascular causes at 1-year was 39.6%. Readmissions were more likely in patients with non-cardiovascular comorbidities, predominantly renal, hematological, and chronic respiratory disorders, and those with diabetes and coronary atherosclerosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Anguita
- University Hospital Reina Sofia , Cordoba , Spain
| | - J L Bonilla
- Hospital San Juan de la Cruz , Ubeda , Spain
| | - M Anguita
- Hospital Clinico San Carlos , Madrid , Spain
| | - R Ruesgas
- Severo Ochoa Hospital , Leganes , Spain
| | - M Molina
- Severo Ochoa Hospital , Leganes , Spain
| | | | | | | | | | - F Marin
- Virgen of the Arrixaca University Hospital , Murcia , Spain
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10
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Cequier Á, Bernal JL, Fernández Pérez C, Elola FJ. Precisiones sobre la metodología de RECALCAR. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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11
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Rosillo N, Vicent L, Martín de la Mota Sanz D, Elola FJ, Moreno G, Bueno H. Epidemiología de las enfermedades valvulares aórticas no reumáticas en España, 2003-2018. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.016] [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: 11/28/2022]
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12
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Sambola A, Rodríguez-Padial L, Bernal JL, Elola FJ. Gender and ST-elevation myocardial infarction. Rev Esp Cardiol (Engl Ed) 2021; 74:724. [PMID: 33279416 DOI: 10.1016/j.rec.2020.09.030] [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: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Antonia Sambola
- Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
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13
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Sambola A, Elola FJ, Buera I, Fernández C, Bernal JL, Ariza A, Brindis R, Bueno H, Rodríguez-Padial L, Marín F, Barrabés JA, Hsia R, Anguita M. Sex bias in admission to tertiary-care centres for acute myocardial infarction and cardiogenic shock. Eur J Clin Invest 2021; 51:e13526. [PMID: 33621347 DOI: 10.1111/eci.13526] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 02/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are limited data on sex-specific outcomes and management of cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). We investigated whether any sex bias exists in the admission to revascularization capable hospitals (RCH) or intensive cardiac care units (ICCU) and its impact on in-hospital mortality. METHODS We used the Spanish National Health System Minimum Basic Data from 2003 to 2015 to identify patients with CS-STEMI. The primary outcome was sex differences in in-hospital mortality. RESULTS Among 340 490 STEMI patients, 20 262 (6%) had CS and 29.2% were female. CS incidence was higher in women than in men (7.9% vs 5.1%, P = .001). Women were older and had more hypertension and diabetes, and were less often admitted to RCH than men (from 58.7% in 2003 to 79.6% in 2015; and from 61.9% in 2003 to 85.3% in 2015; respectively, P = .01), and to ICCU centres (25.7% vs 29.2%, P = .001). Adjusted mortality was higher in women than men over time (from 79.5 ± 4.3% to 65.8 ± 6.5%; and from 67.8 ± 6% to 58.1 ± 6.5%; respectively, P < .001). ICCU availability was associated with higher use of Percutaneous coronary intervention (PCI) in women (46.8% to 67.2%; P < .001) but was even higher in men (54.8% to 77.4%; P < .001). In ICCU centres, adjusted mortality rates decreased in both sexes, but lower in women (from 74.9 ± 5.4% to 66.3 ± 6.6%) than in men (from 67.8 ± 6.0% to 58.1 ± 6.5%, P < .001). Female sex was an independent predictor of mortality (OR 1.18 95% CI 1.10-1.27, P < .001). CONCLUSIONS Women with CS-STEMI were less referred to tertiary-care centres and had a higher adjusted in-hospital mortality than men.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | | | - Irene Buera
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Cristina Fernández
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Department of Preventive Medicine, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - José Luis Bernal
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Albert Ariza
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Heart Diseases Institute, Hospital Universitario de Bellvitge -IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ralph Brindis
- Department of Medicine & The Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Héctor Bueno
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francisco Marín
- Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - José Antonio Barrabés
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Renee Hsia
- Health Policy Studies in the Department of Emergency Medicine at University of California, San Francisco, CA, USA
| | - Manuel Anguita
- Department of Cardiology, Hospital Universitario Reina Sofía de Cordoba, Córdoba, Spain
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14
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Elola FJ. Indicadores de gestión clínica en el área cardiovascular. Un apunte para el debate. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.08.021] [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: 11/30/2022]
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15
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Elola FJ. Clinical management indicators for the cardiovascular area. A note for the debate. Rev Esp Cardiol (Engl Ed) 2021; 74:201-202. [PMID: 33097445 DOI: 10.1016/j.rec.2020.08.025] [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: 08/11/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
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16
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Sambola A, Rodríguez-Padial L, Bernal JL, Elola FJ. Sexo e infarto agudo de miocardio con elevación del ST. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.09.029] [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: 10/23/2022]
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17
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Sambola A, Elola FJ, Ferreiro JL, Murga N, Rodríguez-Padial L, Fernández C, Bueno H, Bernal JL, Cequier Á, Marín F, Anguita M. Impact of sex differences and network systems on the in-hospital mortality of patients with ST-segment elevation acute myocardial infarction. ACTA ACUST UNITED AC 2020; 74:927-934. [PMID: 32888884 DOI: 10.1016/j.rec.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Network systems have achieved reductions in both time to reperfusion and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the data have not been disaggregated by sex. The aim of this study was to analyze the influence of network systems on sex differences in primary percutaneous coronary intervention (pPCI) and in-hospital mortality from 2005 to 2015. METHODS The Minimum Data Set of the Spanish National Health System was used to identify patients with STEMI. Logistic multilevel regression models and Poisson regression analysis were used to calculate risk-standardized in-hospital mortality ratios and incidence rate ratios (IRRs). RESULTS Of 324 998 STEMI patients, 277 281 were selected after exclusions (29% women). Even when STEMI networks were established, the use of reperfusion therapy (PCI, fibrinolysis, and CABG) was lower in women than in men from 2005 to 2015: 56.6% vs 75.6% in men and 36.4% vs 57.0% in women, respectively (both P<.001). pPCI use increased from 34.9% to 68.1% in men (IRR, 1.07) and from 21.7% to 51.7% in women (IRR, 1.08). The crude in-hospital mortality rate was higher in women (9.3% vs 18.7%; P<.001) but decreased from 2005 to 2015 (IRRs, 0.97 for men and 0.98 for women; both P < .001). Female sex was an independent risk factor for mortality (adjusted OR, 1.23; P<.001). The risk-standardized in-hospital mortality ratio was lower in women when STEMI networks were in place (16.9% vs 19.1%, P<.001). pPCI and the presence of STEMI networks were associated with lower in-hospital mortality in women (adjusted ORs, 0.30 and 0.75, respectively; both P<.001). CONCLUSIONS Women were less likely to receive pPCI and had higher in-hospital mortality than men throughout the 11-year study period, even with the presence of a network system for STEMI.
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Affiliation(s)
- Antonia Sambola
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain
| | - José Luis Ferreiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nekane Murga
- Consejería de Salud del Gobierno Vasco, Vitoria, Álava, Spain
| | | | - Cristina Fernández
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Caneiro B, Abuassi E, Bernal JL, Raposeiras-Roubin S, Elola FJ, Fernandez C, Cobas Paz RJ, Munoz Pousa I, Cespon Fernandez M, Dominguez Rodriguez LM, Dominguez Erquicia P, Fernandez Barbeira S, Castineiras M, Iniguez Romo A. P5488Temporal trends and prognostic impact of hospital length of three or less days in uncomplicated myocardial infarction after primary percutaneous coronary intervention in Spain. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and objectives
There is scarce data on the safety of hospital stay length in uncomplicated ST- elevation myocardial infarction (STEMI). We studied the trends of the hospital stay and the safety of short (≤3 days) vs. long hospital stay, in Spain.
Methods
Using data from the Minimum Basic Data set of Spanish taxpayer-funded health system. We identified patients with uncomplicated STEMI undergoing coronary angioplasty and who were discharged alive. The mean length of stay was calculated by multilevel Poisson regression with mixed-effects, including patients from 2003–15. The effect of short stay on cardiac diseases readmissions at 30 days and 1 year was evaluated by multilevel logistic regression, including patients from 2003–14. Thirty-day and 1-year cardiac diseases risk-standardized readmissions and mortality rates (RSRRs and RSMRs), respectively, were also compared.
Results
The adjusted mean length of stay was significantly reduced (incidence rate ratio <1; p<0.001) for each year since 2003. The percentage of short stay increased from 14.3% in 2003 to 19.5% in 2015 (p<0.001). In none of the specified models short stay was statistically significant (p>0.05). The RSRRs at 30 days and 1 year as well as RSMRs at 30 days, did not differ significantly between groups. 1-year RSMRs was significantly higher in the short stay group, although probably without clinical significance (0.103% vs. 0.109%, p<0.001). See Table.
Diff mean of RSRRs and RSMRs at 30 days & 1 year Stay length N Mean Standard deviation p-value RSRRs at 30-day ≤3 days 6,486 2.541 0.74 0.20 >3 days 31,651 2.554 0.72 RSRRs at 1 year ≤3 days 6,486 5.306 1.22 0.42 >3 days 31,651 5.292 1.14 RSMRs at 30-day ≤3 days 6,486 0.109 0.04 <0.001 >3 days 31,651 0.103 0.03 RSMRs at 1 year ≤3 days 6,486 0.429 0.13 0.25 >3 days 31,651 0.427 0.13 RSRRs = risk-standardized readmission rates; RSMRs = risk-standardized readmission mortality rates.
Conclusions
In Spain, short hospital stay increased significantly from 2003 to 2015 and seems a safety option in uncomplicated STEMI patients.
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Affiliation(s)
- B Caneiro
- Hospital Άlvaro Cunqueiro, Cardiology, Vigo, Spain
| | - E Abuassi
- Hospital Άlvaro Cunqueiro, Cardiology, Vigo, Spain
| | - J L Bernal
- University Hospital 12 de Octubre, Control Service, Madrid, Spain
| | | | - F J Elola
- Spanish Cardiology Society, Madrid, Spain
| | - C Fernandez
- Hospital Άlvaro Cunqueiro, Cardiology, Vigo, Spain
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Bernal JL, Barrabés JA, Fernández-Pérez C, Elola FJ. Validez del Conjunto Mínimo Básico de Datos para la investigación de resultados en la atención al síndrome coronario agudo. Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Bernal JL, Barrabés JA, Fernández-Pérez C, Elola FJ. Validity of the Minimum Basic Data Set for Research Into Outcomes of the Care of Acute Coronary Syndrome. Response. ACTA ACUST UNITED AC 2019; 72:697-698. [PMID: 31175068 DOI: 10.1016/j.rec.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- José Luis Bernal
- Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron (VHIR), CIBERCV, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Elola Consultores, Madrid, Spain
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Bernal JL, Barrabés JA, Íñiguez A, Fernández-Ortiz A, Fernández-Pérez C, Bardají A, Elola FJ. Datos clínicos y administrativos en la investigación de resultados del síndrome coronario agudo en España. Validez del Conjunto Mínimo Básico de Datos. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bernal JL, Barrabés JA, Íñiguez A, Fernández-Ortiz A, Fernández-Pérez C, Bardají A, Elola FJ. Clinical and Administrative Data on the Research of Acute Coronary Syndrome in Spain. Minimum Basic Data Set Validity. ACTA ACUST UNITED AC 2018; 72:56-62. [PMID: 29747944 DOI: 10.1016/j.rec.2018.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/05/2017] [Accepted: 01/17/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Health outcomes research is done from clinical registries or administrative databases. The aim of this work was to evaluate the concordance of the Minimum Basic Data Set (MBDS) with the DIOCLES (Descripción de la Cardiopatía Isquémica en el Territorio Español) registry and to analyze the implications of use of the MBDS in the study of acute coronary syndrome in Spain. METHODS Through indirect identifiers, DIOCLES was linked with MBDS and unique matches were selected. Some of most relevant variables for risk adjustment of in-hospital mortality due to acute myocardial infarction were considered. Kappa coefficient was used to evaluate the concordance; sensitivity, specificity and positive and negative predictive values to measure the validity of the MBDS, and the area under ROC (receiver operating characteristic) curve to calculate its discrimination. The results were compared among hospitals quintiles according to their contribution to DIOCLES. The influence of unmatched episodes on results was assessed by a sensitivity analysis, using looser linking criteria. RESULTS Overall, 1539 (60.85%) unique matches were achieved. The prevalence was higher in DIOCLES (acute myocardial infarction: 71.09%; Killip 3-4: 9.17%; cerebrovascular accident: 0.97%; thrombolysis: 8.64%; angioplasty: 61.92% and coronary bypass: 1.75%) than in the MBDS (P < .001). The agreement level observed was almost perfect (κ = 0.863). The MBDS showed a sensitivity of 85.10% and a specificity of 98.31%. Most results were confirmed by using sensitivity analysis (79.95% episodes matched). CONCLUSIONS The MBDS can be a useful tool for outcomes research of acute coronary syndrome in Spain. The contrast of DIOCLES and MBDS with medical records could verify their validity.
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Affiliation(s)
- José Luis Bernal
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron, Institut de Recerca (VHIR), CIBER-CV, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Andrés Íñiguez
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universidad Rovira Virgili, Tarragona, Spain
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Elola Consultores, Madrid, Spain
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