Prognosis of acute heart failure in patients followed up in nursing homes in Spain: Results from the RICA registry

BACKGROUND

Patients with chronic diseases such as heart failure (HF) are at risk of hospital admission. We evaluated the impact of living in nursing homes (NH) on readmissions and all-cause mortality of HF patients during a one-year follow up.

METHODS

An observational and multicenter study from the Spanish National Registry of Heart Failure (RICA) was performed. We compared clinical and prognostic characteristics between both groups. Bivariate analyses were performed using Student's t-test and Tukey's method and a Kaplan-Meier survival at one-year follow up. A multivariate proportional hazards analysis of [Cox] regression by the conditional backward method was conducted for the variables being statistically significant related to the probability of death in the univariate.

RESULTS

There were 5644 patients included, 462 (8.2%) of whom were nursing home residents. There were 52.7% women and mean age was 79.7±8.8 years. NH residents had lower Barthel (74.07), Charlson (3.27), and Pfeiffer index (2.2), p<0.001). Mean pro-BNP was 6686pg/ml without statistical significance differences between groups. After 1-year follow-up, crude analysis showed no differences in readmissions 74.7% vs. 72.3%, p=0.292, or mortality 63.9% vs. 61.1%, p=0.239 between groups. However, after controlling for confounding variables, NH residents had a higher 1-year all-cause mortality (HR 1.153; 95% CI 1.011-1.317; p=0.034). Kaplan-Meier analysis showed worse survival in nursing home residents (log-rank of 7.12, p=0.008).

CONCLUSIONS

Nursing home residents with heart failure showed higher one-year mortality which could be due to worse functional status, higher comorbidity, and cognitive deterioration.

Nephrocalcinosis fortuitously discovered: the role of surreptitious self administration of diuretics

Background

Furosemide is a drug widely used for several medical conditions and could be used without medical prescription. Furosemide-related nephrocalcinosis can occur regardless of age, although the risk is higher in premature infants. The defining characteristic of nephrocalcinosis is generalized calcium deposition in the kidney. The most useful imaging studies for evaluation are ultrasonography and computed tomography (more effective in detecting calcification).

Case Presentation

A 32-year-old woman with a history of depressive syndrome was admitted for evaluation of fortuitously discovered nephrocalcinosis and hypokalemia. The studies performed revealed the presence of a metabolic alkalosis with discrete hyperreninism/hyperaldosteronism but normal ratio, normotension and urinary study showed elevated sodium, chloride, potassium and calcium fluctuating in different determinations. Surreptitious diuretic intake was suspected and urine analysis revealed doses equivalent to 80-120 mg. The patient was advised to discontinue all diuretic treatment; she was adequately supplemented with potassium and she was followed-up in outpatient clinics. During the follow-up, clinical and analytical improvement was noted, which led to the discontinuation of supplementation.

Conclusion

Surreptitious diuretic intake is a clinical condition to rule out in patients with chronic hypokalemia, metabolic alkalosis with elevated urinary sodium and chloride. The relation between surreptitious diuretic intake and nephrocalcinosis has not been fully elucidated in adults.

Salmonella Osteomyelitis of Unknown Origin: An Underestimated Infection

Salmonella osteomyelitis is an underdiagnosed pathology with unusual clinical presentations. The patient was a 24-year-old female with no previous medical history who presented to the emergency department with progressive pain in the left arm for several months. She was initially treated unsuccessful with augmentin for 7 days for suspicious cellulites. Standard elbow X-rays described a lesion initially considered as metastatic. Investigations were completed with magnetic resonance imaging (MRI) compatible with osteomyelitis. Following surgical sampling, salmonella enterica infection was diagnosed. The patient recovered full use of her limb after 8 days of IV antibiotic therapy with third-generation cephalosporin, and she completed 11 weeks of antibiogram-targeted PO fluoroquinolone therapy. Salmonella osteomyelitis could mimic other diseases, making diagnosis difficult.

LEARNING POINTS

A poor response to treatment should raise questions about the initial diagnosis.Isolated metastatic lesions in the upper limbs are rare and require proper clinical and radiological evaluation to arrive at a correct diagnosis.

Clinical Characteristics and Prognostic Impact of Short Physical Performance Battery in Hospitalized Patients with Acute Heart Failure-Results of the PROFUND-IC Registry

BACKGROUND

Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency.

OBJECTIVES

To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale.

METHODS

Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan-Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared.

RESULTS

A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60-29.80); OR: 3.9; 95%CI (1.30-11.60); OR: 6.01; 95%CI (1.90-18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05).

CONCLUSIONS

Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.

[Long COVID, diagnosis and management : a survey among general practitioners in the Bas Rhin in France]

The long COVID includes non-specific symptoms affecting patients of all ages.

METHODS

Monocentric, prospective, quantitative and descriptive study interested in comparing the knowledge of general practitioners in Alsace (France) with the positioning and recommendations of the World Health Organisation (WHO) on long COVID in the period November 2022-February 2023. A multiple-choice questionnaire was elaborated based on the WHO positioning and recommendations on the long COVID.

RESULTS

126 questionnaires were received, 65 (51.6 %) women, 42 % aged between 25-35 years. 84.9 % had knowledge about long COVID. The need for an impact on daily life, unexplained symptomatology and symptoms persisting at two months were criteria retained (84.9 %, 91.3 % and 82.5 %, respectively). A history of anxiety disorders (86.5 %) and severe acute forms of COVID-19 (57.9 %) were considered as risk factors. Fatigue, dyspnea, joint pain, headache and cough were associated with long COVID in 65.9 % of responders. About 74,6 % performed a complete blood test, 96.03 % recommended rehabilitation, 76.2 % referred to the pulmonologist and 71.4 % were in favour of a consensus document.

CONCLUSIONS

General practitioners are aware of the existence of long COVID as a pathology and agree with the recommendations of scientific societies, among which those of WHO. However, this study has some limitations so that this topic deserves further dedicated investigations.

Focal Myositis of the Sternocleidomastoid Muscle: A Rare and Uncommon Cause of Cervical Mass

We report on a 70-year-old male patient admitted to the internal medicine department for evaluation of a right cervical mass. He had been treated with antibiotics as an outpatient by his primary care doctor. Upon admission the patient was asymptomatic, but within a few hours his cervical mass enlarged; this enlargement was confined to the right sternocleidomastoid muscle. Complete blood investigations including serology and autoimmunity were negative. The neck scan and MRI were in favour of myositis. No other lesions were found either in the nasal fibre-optic exam or in the thoracic-abdominal-pelvic scan. The biopsy of the muscle showed a lymphoplasmacytic inflammatory infiltrate of the perimysium. The diagnosis of focal myositis was made. The patient clinically improved during hospitalisation with complete resolution of symptoms without any specific intervention.

LEARNING POINTS

A thorough clinical examination is essential in the evaluation and characterisation of cervical masses.The diagnostic approach must be rigorous in order not to ignore potentially serious diseases.A high level of clinical suspicion is needed in the diagnosis of focal myositis.

[Emphysematous cystitis: an uncommon cause of abdominal pain]

An 82-year-old woman with a previous medical history of hypertension and hypothyroidism was admitted to the emergency department for abdominal pain, diarrhea, confusion and changes in her overall condition over several days. At the emergency department, the patient was febrile and her blood tests showed elevated C-reactive protein without leukocytosis (8.9 × 10^9/L). In the current context, a nasopharyngeal swab for SARS was performed and was negative. With these results, the initial suspicion was that of an infectious condition of gastrointestinal origin. The urine sample was oul-smelling with presence of leukocytes and nitrites and was sent out for culture. In the setting of probable urinary tract infection, empirical antibiotic treatment was started with a third generation cephalosporin. It was decided to perform a total body scanner in order to evaluate the presence of other infectious foci. The study described the presence of emphysematous cystitis, a rare pathology in a patient without any of the classic risk factors for this entity. Urine and blood cultures were positive for Escherichia coli sensitive to the empiric antibiotic which was continued to complete 7 days. The clinical course was favorable.

[A particular state of shock: spontaneous rupture of a heterotopic pregnancy]

Heterotopic pregnancy is a rare pathology. It is defined as the coexistence of an intrauterine pregnancy and an extrauterine pregnancy, whatever its location. The presence of an intrauterine pregnancy in a woman of childbearing age does not therefore exclude the presence of an associated ectopic pregnancy. Late diagnosis can lead to fatal consequences for the mother, subsequent fertility as well as for the intrauterine pregnancy. We report the case of a 28-year old female patient, without any notion of assisted reproduction, who was admitted to the emergency department for hemorrhagic shock. The diagnosis of ruptured tubal heterotopic pregnancy was made intraoperatively.

[Floating thrombus in the aortic arch, a rare cause of lower limb ischemia]

Acute arterial occlusion of the lower limbs is a medical and surgical emergency due to its morbi-mortality. We present the case of a 59-year-old man admitted to the emergency department for acute and diffuse pain in the left lower limb caused by extensive obstructive clots in the arteries of this limb. Since atheromatous cause was unlikely after angioscopy of the lower limbs, a cardiac origin was suspected. Echocardiogram was normal, however, thoracic angiotomography revealed a floating thrombus in the aortic arch. The patient was treated surgically with placement of an aortic endoprosthesis without complications.

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial

Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC.

Severe Hydrocephalus due to Obstructive Basilar Dolichoectasia of the Third Ventricle

Vertebro-basilar dolichoectasia (VBD) is a rare pathology of unknown aetiology. Its clinical presentation is wide and prognosis is generally poor with a high mortality rate. Cerebral magnetic resonance imaging is the gold standard for diagnosis.

We report an unusual case of intracranial dolichoectasia. VBD was revealed during investigation of a patient with altered mental status. CT brain imaging demonstrated severe obstructive hydrocephalus secondary to compression of the third ventricle. Management is always challenging and depends on the location and the mode of presentation. Our patient died despite surgical management with placement of an external ventricular shunt.

Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs-Analysis of the EPICTER Study

Introduction: There are studies that evaluate the association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality in elderly patients with acute and advanced HF and the clinical manifestations and management from a palliative point of view. Methods: The EPICTER study (“Epidemiological survey of advanced heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF <20%, intractable angina, HF despite optimal treatment), and general terminal criteria (estimated survival <6 months, patient/family acceptance of palliative approach, and one of the following: evidence of HF progression, multiple Emergency Room visits or admissions in the last six months, 10% weight loss in the last six months, and functional impairment) were collected. Terminal HF was considered if the patient met at least one organ-dependent criterion and all the general criteria. Both groups (HF with COPD and without COPD) were compared. A Kaplan−Meier survival analysis was performed to evaluate the presence of COPD on the vital prognosis of patients with HF. Results: A total of 3100 patients were included of which 812 had COPD. In the COPD group, dyspnea and anxiety were more frequently observed (86.2% vs. 75.3%, p = 0.001 and 35.4% vs. 31.2%, p = 0.043, respectively). In patients with a history of COPD, presentation of HF was in the form of acute pulmonary edema (21% vs. 14.4% in patients without COPD, p = 0.0001). Patients with COPD more frequently suffered from advanced HF (28.9% vs. 19.4%; p < 0.001). Consultation with the hospital palliative care service during admission was more frequent when patients with HF presented with associated COPD (94% vs. 6.8%; p = 0.036). In-hospital and six-month follow-up mortality was 36.5% in patients with COPD vs. 30.7% in patients without COPD, p = 0.005. The mean number of hospital admissions during follow-up was higher in patients with HF and COPD than in those with isolated HF (0.63 ± 0.98 vs. 0.51 ± 0.84; p < 0.002). Survival analysis showed that patients with a history of COPD had fewer survival days during follow-up than those without COPD (log Rank chi-squared 4.895 and p = 0.027). Conclusions: patients with HF and COPD had more severe symptoms (dyspnea and anxiety) and also a worse prognosis than patients without COPD. However, the prognosis of patients admitted to our setting is poor and many patients with HF and COPD may not receive the assessment and palliative care support they need. Palliative care is necessary in chronic non-oncologic diseases, especially in multipathologic and symptom-intensive patients. This is a clinical care aspect to be improved and evaluated in future research studies.

Clinical Characteristics and Prognostic Relevance of Different Types of Caregivers for Elderly Patients with Acute Heart Failure-Analysis from the RICA Registry

Background: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p < 0.05. Results: A total of 2147 patients were enrolled in this study; women represented 52.4%, and the mean age was 81 years. The partner was the caregiver for 703 patients, children were caregivers for 1097 patients, 199 patients had a professional caregiver, and only 148 patients were their own caregivers. Women were more frequently cared for by their children (65.8%) or a professional caregiver (61.8%); men were more frequently cared for by their spouses (68.7%) and more frequently served as their own caregivers (59.5%) (p < 0.001). No statistically significant differences were observed in relation to readmissions or mortality at one year of follow-up between the different groups. A lower probability of readmission and death was observed for patients who received care from a partner or children/relative, with log-rank scores of 11.2 with p= 0.010 and 10.8 with p = 0.013. Conclusions: Our study showed that the presence of a family caregiver for elderly patients with heart failure was associated with a lower readmission rate and a lower mortality rate at 120 days of follow-up. Our study also demonstrated that elderly patients with good cognitive and functional status can be their own caregivers, as they obtained good health outcomes in terms of readmission and mortality. More prospective studies and clinical trials are needed to evaluate the impact of different types of caregivers on the outcomes of patients with heart failure.

[Spontaneous non-traumatic splenic rupture as a presentation form of light chain amyloidosis. Report of one case]

We report a 35-year-old sportive man who was admitted to the emergency department for worsening of acute spontaneous abdominal pain appearing at rest. He only referred having lifted a tree trunk the day before, but he was used to perform such physical efforts. The clinical course at the emergency department was marked by the development of severe anemia secondary to a progressive splenic hematoma and acute pulmonary distress. The patient benefited from total splenectomy. Laboratory data showed hypogammaglobulinemia, proteinuria and the anatomopathological examinations of both spleen and kidneys were consistent with light chain amyloidosis.

Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry

Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410−2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality.

Spinal Cord Compression Secondary to a Spontaneous Cervical Epidural Haematoma

We report the case of an 86-year-old female patient with chronic neck pain who presented with an initial misleading clinical picture suggesting an ischaemic stroke. No recent or previous anticoagulation treatment or fall history was reported. The patient developed a paraplegia of the upper limbs needing magnetic resonance imaging which revealed a compressive cervical haematoma. The patient benefitted from cervical laminectomy and evacuation of the cervical haematoma. Motricity in upper extremities was recovered but paresis in the lower extremities persisted 1 week after surgical intervention.

LEARNING POINTS

Insidious spontaneous cervical haematoma can mimic ischaemic stroke.Early recognition and treatment of cervical haematoma can improve prognosis.

Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review

Pulmonary ultrasound is a simple diagnostic tool with immediate results for the assessment of pulmonary congestion in patients with heart failure (HF), allowing optimization of treatment by monitoring the dynamic changes identified. We aimed to evaluate the prognostic significance of the presence of B lines detected by lung ultrasound during hospitalization for heart failure. A search was conducted for scientific articles in PubMed, Embase, Google Scholar, and Cochrane databases including clinical trials, reviews, systematic reviews, and original articles that were related to the prognostic value of lung ultrasound in patients with HF in the last 5 years from 2016 to 2021. Studies including individuals aged ≥18 years evaluating the prognostic value of lung ultrasound in HF were included. Fourteen articles met inclusion criteria for analysis (three reviews, three systematic reviews with meta-analysis, six prospective studies, and two retrospective studies). The presence of more than 30-40 B lines at admission were considered a risk factor for readmission or mortality as was persistent pulmonary congestion with the presence of ≥15 B-lines. The presence of pulmonary congestion detected by lung ultrasound in acute heart failure has prognostic significance in terms of mortality and hospital readmission. Clinical trials are needed to evaluate whether diuretic therapy guided by lung ultrasound and the presence of B lines can reduce readmission and mortality in these patients.

Parvovirus Infection Triggering Still’s Disease

We present the case of a 59-year-old man with acute B19 parvovirus infection who developed a systemic inflammatory reaction similar to adult-onset Still's disease (AOSD). We discuss the clinical challenge due to overlapping symptoms to distinguish between a primary B19 viral infection and the autoimmune disease it can trigger.

Cancer Impacts Prognosis on Mortality in Patients with Acute Heart Failure: Analysis of the EPICTER Study

Introduction: Heart failure (HF) and cancer are currently the leading causes of death worldwide, with an increasing incidence with age. Little is known about the treatment received and the prognosis of patients with acute HF and a prior cancer diagnosis. Objective: to determine the clinical characteristics, palliative treatment received, and prognostic impact of patients with acute HF and a history of solid tumor. Methods: The EPICTER study (“Epidemiological survey of advanced heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted for acute HF in 74 Spanish hospitals. Patients were classified into two groups according to whether they met criteria for acute HF with and without solid cancer, and the groups were subsequently compared. A multivariable logistic regression analysis was conducted, using the forward stepwise method. A Kaplan–Meier survival analysis was performed to evaluate the impact of solid tumor on prognosis in patients with acute HF. Results: A total of 3127 patients were included, of which 394 patients (13%) had a prior diagnosis of some type of solid cancer. Patients with a history of cancer presented a greater frequency of weight loss at admission: 18% vs. 12% (p = 0.030). In the cancer group, functional impairment was noted more frequently: 43% vs. 35%, p = 0.039). Patients with a history of solid cancer more frequently presented with acute HF with preserved ejection fraction (65% vs. 58%, p = 0.048) than reduced or mildly reduced. In-hospital and 6-month follow-up mortality was 31% (110/357) in patients with solid cancer vs. 26% (637/2466), p = 0.046. Conclusion: Our investigation demonstrates that in-hospital mortality and mortality during 6-month follow-up in patients with acute HF were higher in those subjects with a history of concomitant solid tumor cancer diagnosis.

Ceftriaxone-induced Encephalopathy: A Pharmacokinetic Approach

We report a case of ceftriaxone-induced encephalopathy correlated with a high concentration of the drug in cerebrospinal fluid (CSF). Cephalosporin neurotoxicity is increasingly reported, especially in association with fourth-generation cephalosporins. The factors influencing CSF concentration are plasma concentration, liposolubility, ionization, molecular weight, protein binding and efflux. In our patient, high levels of ceftriaxone (27.9 mg/l) were found in CSF. β-Lactam-associated neurotoxicity is mainly due to similarities between GABA and the β-lactam ring. Because of differences in CSF/plasma ratios and blood-brain barrier efflux among patients, plasma drug monitoring cannot be used to estimate CSF concentration. As far as we know, this is the first reported case of ceftriaxone-induced encephalopathy associated with a high CSF concentration.

LEARNING POINTS

Ceftriaxone dose adjustment and clinical surveillance are strongly recommended in patients with renal failure.Measuring ceftriaxone cerebrospinal fluid concentration could be useful for confirming ceftriaxone-induced encephalopathy.

An Unusual Case of Acute Dyspnoea: Acute Intrathoracic Gastric Volvulus with Probable Tension Gastrothorax

Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. Intrathoracic gastric volvulus can lead to tension gastrothorax, which is defined as the presence of a massive gastric distension in the chest cavity causing a mediastinal shift with haemodynamic instability and a risk of cardiorespiratory arrest. We report a case of intrathoracic gastric volvulus with probable tension gastrothorax. Early diagnosis of gastrothorax with computed tomography and immediate insertion of a nasogastric tube resulted in rapid clinical improvement. Surgical intervention is the treatment of choice.

LEARNING POINTS

Tension gastrothorax should be suspected in the presence of abdominal and chest pain, vomiting and haemodynamic instability.Prompt diagnosis and treatment are necessary to reduce morbidity and mortality.

Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure

Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/− 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/− 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508–0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results.

Chronic Onset Form of Anti-HMG-CoA Reductase Myopathy

We report a case of anti-HMGCR myopathy mimicking limb-girdle muscular dystrophy in a 27-year-old male patient with no history of statin intake and presenting with a chronic onset form over 3 years. Treatment with prednisone and methotrexate was initiated with an insufficient response, so intravenous immunoglobulin was added. One year after initial treatment was started, as levels of creatine kinase (CK) were >1000 U/l, treatment with rituximab was added. Despite a 3-year delay before treatment, muscle strength improved even though CK levels remain elevated.

Frostbite and Cold Agglutinin Disease: Coexistence of Two Entities Leading to Poor Clinical Outcomes

An 83-year-old woman was admitted to the emergency department for a 7-day history of fatigue and progressive cyanosis in the feet and hands after cold exposure despite physical protective measures. Upon arrival, the patient presented with necrotic cutaneous lesions in both hands and distal lower extremities. Upon admission, hemoglobin was 7.6 g/dL and laboratory tests were consistent with cold agglutinin disease (CAD), the presence of monoclonal IgM, and flow cytometry consistent with lymphoplasmacytic lymphoma, but MYD88 L265P mutation was negative. The patient required blood transfusion, resulting in stabilized hemoglobin and a decrease in markers of hemolysis. Treatment with aspirin 250 mg daily and intravenous iloprost 0.5 mL/h was initiated with a poor clinical response at day 4. Amputation was required. Plasma exchange was performed and chemotherapy with rituximab and bendamustine was initiated. The clinical course was marked by further necrosis, prompting discussions regarding an additional amputation that was not performed considering the high surgical risk and refusal by the patient. Supportive treatment was initiated, and the patient expired one month after hospital admission.

Spinal Cord Compression Secondary to a Spontaneous Spinal Haematoma in a Patient Newly Treated with Rivaroxaban

A 74-year-old patient anticoagulated with rivaroxaban for chronic atrial fibrillation presented to the emergency department with acute lumbar pain with progressive weakness of the lower limbs and inability to stand up. No previous trauma was reported. Neurological examination was consistent with a complete spinal cord syndrome at the level of T6. Magnetic resonance imaging showed the presence of spinal cord compression associated with signs of extensive intramedullary inflammation secondary to a haematoma. The patient underwent thoracic laminectomy with evacuation of an intradural haematoma. No intraoperative complications were described, but no clinical improvement had been achieved 15 days after the surgical intervention.

LEARNING POINTS

Apixaban could be preferred as the first choice for direct oral anticoagulation (DOAC) in older patients.DOACs can have important side effects even if the switch from vitamin K antagonist to this group is correctly carried out.

Acute Confusional State Revealing Moyamoya Disease in the Emergency Department: A Rare Entity

A 54-year-old woman was admitted to the emergency department for an acute, fluctuating altered mental status and reduced perceptual awareness of her surroundings as well as disorganized thinking. Blood tests, including for drugs, were normal. A CT scan of the brain was normal. Magnetic resonance imaging and CT angiography of the supra-aortic vessels were both were consistent with moyamoya disease. The patient was hospitalized for further investigations.

LEARNING POINTS

Moyamoya disease should be considered in the differential diagnosis of middle-aged patients presenting with an acute confusional state of unknown aetiology in the emergency department.The absence of focal examination findings does not exclude neurological disease as the cause of acute confusion, requiring further neuroimaging tests.

Trends and Clinical Impact of Gastrointestinal Endoscopic Procedures on Acute Heart Failure in Spain (2002-2017)

Introduction: Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions. Objectives: The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy. Methods: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy. Results: A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04–1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41–0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55–0.64). Conclusion: In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitalized HF population seen over the course of the study could have contributed to this. Both procedures seemed to be associated with lower in-hospital mortality, but in the case of colonoscopy, the risk of in-hospital mortality was higher in elderly patients with heart failure and associated neoplasms. Colonoscopy and EGD seemed not to increase IHM in patients with heart failure.

Interleukin-6 Could Be a Potential Prognostic Factor in Ambulatory Elderly Patients with Stable Heart Failure: Results from a Pilot Study

INTRODUCTION

Inflammation is a fundamental phenomenon in heart failure, but the prognostic or therapeutic role of markers such as interleukin-6 (IL-6) has not yet been clarified. The objective of this study is to describe the clinical profile of patients with elevated IL-6 and determine if they have worse clinical outcomes.

METHODS

A retrospective c.ohort observational study including 78 patients with heart failure followed up at the Heart Failure Outpatient Clinic of the Internal Medicine Department. IL-6 was determined in all patients, who were then assigned into two groups according to IL-6 level (normal or high). Clinical and prognostic data were collected to determine the differences in both groups.

RESULTS

The average age was 79 years, 60% female. A total of 53.8% of the patients had elevated IL-6 (group 2). Patients with elevated IL-6 presented more frequently with anemia mellitus (64.3% vs. 41.7%; p = 0.046), atrial fibrillation (83.3% vs. 61.9% p = 0.036), dyslipidemia (76.2% vs. 58.2%; p = 0.03), higher creatinine levels (1.35 mg/dL vs. 1.08 mg/dL; p = 0.024), lower glomerular filtration rate (43.6 mL/min/m2 vs. 59.9 mL/min/m2; p = 0.007), and anemia 25% vs. 52.4% p = 0.014. The factors independently associated with the increase in IL-6 were anemia 3.513 (1.163-10.607) and renal failure 0.963 (0.936-0.991), p < 0.05. Mortality was higher in the group with elevated IL-6 levels (16% vs. 2%; p = 0.044) with a log-rank p = 0.027 in the Kaplan-Meier curve.

CONCLUSION

Patients with heart failure and elevated IL-6 most often have atrial fibrillation, diabetes mellitus, dyslipidemia, anemia, and renal failure. In addition, mortality was higher and a tendency of higher hospital admission was observed in stable HF patients with elevated IL-6.

[Cervical myelopathy secondary to recreational nitrous oxide use: an emergent pathology]

We describe the case of a 27-year-old female patient who presented to the emergency ward with hypoesthesia and paresthesia developing over the last two months, initially in both feet and progressing to the knees in a few days without associated gait disorders. Dystonia in the thumb and index finger of both hands was noted. Blood tests including toxic drugs were negative. The spinal magnetic resonance imaging was consistent with (C3-C5) myelopathy or myelitis without other abnormalities suggestive of systemic diseases. The biochemical and bacteriological analysis of the cerebrospinal fluid was normal. Because of these findings, the patient was re-interviewed to determine the consumption of unusual drugs, and nitrous oxide consumption was referred. The patient was admitted for further studies, which confirmed the diagnosis.

The Influence of Sex on Clinical Outcomes after Surgical Mitral Valve Replacement in Spain (2001-2015)

(1) Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries. Mitral valve (MV) disease is a common cause of heart failure and a leading cause of morbidity and mortality in the U.S.A. and Europe. (2) Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–2015. We included patients that had surgical mitral valve replacement (SMVR) listed as a procedure in their discharge report. We sought to (i) examine trends in incidence of SMVR among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic). The incidence of SMVR was higher in women (IRR 1.51; 95% CI 1.48–1.54). The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes. Men who underwent mechanical and bioprosthetic SMVR had higher comorbidity than women. IHM was significantly lower in women who underwent SMVR than in men (10% vs. 12% p < 0.001 for mechanical and 14% vs. 16% p = 0.025 for bioprosthetic valve, respectively). Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly lower in women who underwent mechanical and bioprosthetic SMVR. A significant reduction in both in-hospital MACCEs and IHM was observed over the study period regardless of sex. After multivariable logistic regression, male sex was associated with increased IHM only in bioprosthetic SMVR (OR 1.28; 95% CI 1.1–1.5). (4) Conclusions: This nationwide analysis over 15 years of sex-specific outcomes after SMVR showed that incidences are significantly higher in women than men for mechanical and bioprosthetic SMVR. IHM and MACCE have improved over time for SMVR in both sexes. Male sex was independently associated with higher mortality after bioprosthetic SMVR.

Ninety days post-hospitalization evaluation of residual COVID-19 symptoms through a phone call check list

An observational and descriptive study including patients discharged for COVID-19 was carried out by the COVID-19 Working Group of the Hospital Clínico San Carlos (HCSC). We aimed to identify the main symptoms after 90 days of hospital discharged. A structured interview was conducted, through a “checklist” that included symptoms within the 90 days post-discharge. A total of 134 patients were enrolled. The most frequently referred symptoms were asthenia, dyspnea and weight loss. Anxiety was the most frequent psychological symptom found through the GAD-7 scale.

[Frailty of the elderly and physical activity in general practice: A prospective study]

INTRODUCTION

Frailty is a transient and reversible condition that can lead to significant morbidity and mortality and to the loss of autonomy. It is one of the key issues in public health and the prevention of addiction. Physical activity is often described as a protective factor against addiction and as a factor in limiting frailty. Our goal is to analyze the relationship between physical activity and frailty among the elderly METHODS: A cross-sectional observational study was carried out in three general practice clinics located in the French department of Eure. Patients aged 65 and over were included during a consultation with their GP. Dependent patients under the ADL scale were excluded. Level of physical activity was assessed by the Ricci and Gagnon questionnaire, which defines an active profile as a score≥18 points. Frailty was sought out by the Fried scale and the SEGA A grid. Multivariate analysis was performed to adjust frailty scores to age, gender, and level of physical activity.

RESULTS

Out of the 70 patients included, 36 were active (51%) and 34 inactive (49%). They were predominantly female with 47 women (67%). Average age was 75.3years. Twelve patients were diagnosed as frail (17%) with the Fried scale and 24 (34%) with the SEGA A grid. Bivariate analysis revealed a greater frailty according to the Fried criteria in the inactive than in the active patients (mean for active patients 0.56 IC95 [0.31; 0.80], compared to 1.76 [1.21; 2.32] in the inactive patients, p<0.0001). The difference in mean was likewise significant regarding the SEGA A score (6.42 IC95 [5.34, 7.49] in the active population, as opposed to 8.65 IC95 [7.15, 10.15] among the inactive, p=0.017). In multivariate analysis, the Fried scale was primarily influenced by age and ADL, while the SEGA score was impacted by female gender and level of physical activity.

CONCLUSION

Physical activity seems to have a positive effect on frailty. It would be interesting to propose systematic screening for frailty in general medicine and to institute preventive measures, including physical activity. Initiatives encouraging and promoting seniors' physical activity should be strengthened.

Thrombocytopenia in the Course of COVID-19 Infection

We report three cases of severe thrombocytopenia during COVID-19 infection associated with either cutaneous purpura or mucosal bleeding. The initial investigations ruled out other causes of thrombocytopenia. Two of the patients were treated with intravenous immunoglobulins and eltrombopag, while the third recovered spontaneously. A good clinical and biological response was achieved in all patients leading to hospital discharge.

Evaluation of the French National Program on Home Return of Patients with Chronic Heart Failure (PRADO-IC): Pilot Study of 91 Patients During Its Deployment in the Bas Rhin Area

Objective: The main objective of this study was to evaluate the impact of the French national program on home return of chronic heart failure patients (PRADO-IC) in terms of re-hospitalizations for heart failure (HF) during its deployment in the Bas-Rhin (France). Patients and methods: This was a pilot, descriptive, quantitative, retrospective, and bi-centric study (University Hospitals of Strasbourg and Haguenau Hospital Center, France). It included all patients included in the PRADO-IC program from these centers between January 1, 2015 and December 31, 2015. The primary endpoint of our study was the evaluation of the number of 1-year, 6-month, and 30-day re-admissions to the hospital in relation to an acute HF episode, before and after the inclusion of patients in the PRADO-IC program. The secondary endpoints were the number of overall re-hospitalizations (all-cause); the number of days of hospitalization for HF; the time to first re-hospitalization and the average length of hospital stay, before and after inclusion in PRADO-IC; and the overall and cardiovascular mortality rates. Results: 91 patients out of 271 (33,6%) with a mean age of 79.2 years (67–94) were included. They all had chronic HF, essentially class II-III NYHA (90.1%), mostly of ischemic origin (41.9%), with altered left ventricular ejection fraction in 71.4% of cases. A reduction in the mean number of hospitalizations for HF per patient at 30 days, 6 months and 1 year was observed, respectively, from 0.18 ± 0.42 per patient before inclusion to 0.15 ± 0.36 after inclusion (p = 0.56); 0.98 ± 1.04 hospitalizations to 0.53 ± 0.81 at 6 months (p < 0.01); and 1.64 ± 1.14 hospitalizations 1.04 ± 1.05 at 1 year (p < 0.001). Patients were hospitalized less overall after inclusion in the PRADO-IC program. The number of days of hospitalization for HF was reduced after inclusion of patients from 18.02 ± 7.78 days before inclusion to 14.28 ± 11.57 days for the 6 month follow-up (p = 0.006), and from 22.07 ± 10.33 days before inclusion to 16.39 ± 15.94 days for the 1 year follow-up (p < 0.001). In contrast, inclusion in PRADO-IC statistically increased the mean time to first re-hospitalization for HF from mean 99.36 ± 72.39 days before inclusion to 148.11 ± 112.77 days after inclusion (p < 0.001). Conclusion: This study seems to demonstrate that the PRADO-IC program could improve the management of chronic HF patients in ambulatory care, particularly regarding HF re-hospitalization. However, due to the limitations of the methodology used and the small number of patients, it is advisable to consolidate its initial results with a randomized controlled study on a larger number of patients. In our opinion, its results need to be communicated because, to our knowledge, no equivalent study exists.

Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center

BACKGROUND

The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. Methods: The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. Results: The mean patient age was 61.7 years old (range: 20-87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 109/L (range: 0-0.3). Regarding the patients' hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome-in 13.3%, and septic shock-in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 109/L) was seen at 8.3 days (range: 2-24), but faster in those receiving hematopoietic growth factors (4.9 days, p = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. Conclusions: Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality.

[Physical activity among seniors : what benefits on geriatric criteria ?]

The elderly population is growing in our societies. Prevention policies are strongly supported by public authorities and one of them is the promotion of physical activity. We propose to detail, through a literature review, the impact of physical activity on the main geriatric criteria.

Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study)

INTRODUCTION AND OBJECTIVES

Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound has shown to be highly sensitive for detecting PC in HF. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF compared with conventional treatment.

MATERIALS AND METHODS

Randomized, multicenter, single-blind clinical trial in patients discharged from Internal Medicine Departments after hospitalization for decompensated HF. Participants will be assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus clinical assessment of congestion. The primary outcome is the combination of cardiovascular death and readmission for HF at 6 months.

CONCLUSIONS

The results of this study will provide more evidence about the impact of lung ultrasound on treatment monitoring in patients with chronic HF.

Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period

BACKGROUND

To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain.

METHODS

Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately.

RESULTS

The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001-03 vs. 79.4 ± 10.78 years in 2013-15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001-03 vs. 2.46 ± 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis.

CONCLUSIONS

This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.

Type 2 diabetes increases the risk of hospital admission for heart failure and reduces the risk of in hospital mortality in Spain (2001-2015)

BACKGROUND

To compare trends in incidence, clinical characteristics and outcomes of heart failure (HF) hospitalizations among patients with or without type 2 diabetes (T2DM) in Spain (2001-2015).

METHODS

We used national hospital discharge data to select hospital admissions for HF as primary diagnosis. Incidence, comorbidities, diagnostic and therapeutic procedures, and in hospital mortality (IHM) were analyzed.

RESULTS

We identified a total of 1,501,811 admissions for HF (36.87% with T2DM). Incidences were higher among those with T2DM than those without diabetes. The adjusted incidence of HF among T2DM patients was 4.93 higher than for non-diabetic subjects (IRR 4.93;95%CI 4.91-4.95). Jointpoint analysis showed that sex-age-adjusted admissions in T2DM patients with HF increased by 7.12% per year from 2001 to 2007 and stabilized afterwards. For non-diabetic patients a constant increase overtime of around 1% was found. Patients with T2DM were significantly younger than patients without diabetes (77.22 vs. 79.36 years) and had more coexisting medical conditions according to the Charlson Comorbidity Index (mean CCI 1.99 ± 0.88 vs. 1.90 ± 0.86). For the total time period, crude IHM was lower for T2DM patients than for non-diabetic people (8.35% vs, 10.57%; p < 0.05) and the association remained significant after multivariable adjustment ((OR, 0.84; 95%CI 0.83-0.86).). Female sex, older age and multiple comorbidities were significant risk factors for IHM.

CONCLUSIONS

T2DM increases the risk of admission for HF by five-fold. Our study demonstrates an increase in hospitalization for HF in diabetic patients from 2001 to 2007 and stabilization afterwards. T2DM was associated with a lower IHM after hospitalization for HF.

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014-2015)

Background

Type 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures.

Methods

We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).

Results

We identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR).

Conclusions

T2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.

Electronic supplementary material

The online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.