Trends in Diabetes-Related Potentially Preventable Hospitalizations in Adult Population in Spain, 1997⁻2015: A Nation-Wide Population-Based Study.

We aimed to assess national trends in the rates of diabetes-related potentially preventable hospitalizations (overall and by preventable condition) in the total adult population of Spain. We performed a population-based study of all adult patients with diabetes who were hospitalized from 1997 to 2015. Overall potentially preventable hospitalizations and hospitalizations by diabetes-related preventable conditions (short-term complications, long-term complications, uncontrolled diabetes, and lower-extremity amputations) were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. Over 19-years-period, 424,874 diabetes-related potentially preventable hospitalizations were recorded. Overall diabetes-related potentially preventable hospitalizations decreased significantly, with an average annual percentage change of 5.1 (95%CI: -5.6-(-4.7%); ptrend < 0.001). Among preventable conditions, the greatest decrease was observed in uncontrolled diabetes (-5.6%; 95%CI: -6.7-(-4.7%); ptrend < 0.001), followed by short-term complications (-5.4%; 95%CI: -6.1-(-4.9%); ptrend < 0.001), long-term complications (-4.6%; 95%CI: -5.1-(-3.9%); ptrend < 0.001), and lower-extremity amputations (-1.9%; 95%CI: -3.0-(-1.3%); ptrend < 0.001). These reductions were observed in all age strata for overall DM-related PPH and by preventable condition but lower-extremity amputations for those <65 years old. There was a greater reduction in overall DM-related PPH, uncontrolled DM, long-term-complications, and lower extremity amputations in females than in males (all p < 0.01). No significant difference was shown for short-term complications (p = 0.101). Our study shows a significant reduction in national trends for diabetes-related potentially preventable hospitalizations in Spain. These findings could suggest a sustained improvement in diabetes care in Spain, despite the burden of these diabetes-related complications and the increase in the diabetes mellitus prevalence.

National trends in diabetes mellitus hospitalization in Spain 1997-2010: Analysis of over 5.4 millions of admissions.

AIMS: To analyze national trends in the rates of hospitalizations (all-cause and by principal discharge diagnosis) in total diabetic population of Spain. METHODS: We carried out a nation-wide population-based study of all diabetic patients hospitalized between 1997 and 2010. All-cause hospitalizations, hospitalizations by principal discharge diagnosis, mean age, Charlson Comorbidity Index, readmission rates and length of hospital stay were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. RESULTS: Over 14-years-period, all-cause hospitalizations of diabetic patients increased significantly, with an average annual percentage change of 2.5 (95%CI: 1.5-3.5; Ptrend < 0.01). The greatest increase was observed in heart failure (5.4; 95%CI: 4.8-6.0; Ptrend < 0.001), followed by neoplasms (4.9; 95%CI: 3.6-5.8; Ptrend < 0.001), pneumonia (2.7; 95%CI: 2.0-4.0; Ptrend < 0.001), stroke (2.4; 95%CI: 1.6-3.4; Ptrend < 0.001), chronic obstructive pulmonary disease (2.0; 95%CI: 1.4-3.4; Ptrend < 0.001) and coronary artery disease (1.6; 95%CI: 1.1-2.3; Ptrend < 0.01). The adjusted number of all-cause hospitalizations of patients with diabetes per 100,000 inhabitants increased 2.6-fold. The increase in hospitalizations was significantly higher among patients ≥75 years old. Males experienced a greater increase in all-cause, neoplasm, heart failure, chronic obstructive pulmonary disease, and pneumonia hospitalizations (p < 0.01 for all). Hospitalized diabetic patients were progressively older and had more comorbidities, higher readmission rates and shorter hospital stays (p < 0.05 for all). CONCLUSIONS: Hospitalizations of diabetic patients more than doubled in Spain during the study period. Heart failure and neoplasms experienced the greatest annual increases and remained the principal causes of hospitalization, probably associated with advanced age and comorbidities of hospitalized diabetics. Coronary and cerebrovascular diseases experienced a lower annual increase, suggesting an improvement in cardiovascular care in diabetes in Spain.

Use of Linagliptin for the Management of Medicine Department Inpatients with Type 2 Diabetes in Real-World Clinical Practice (Lina-Real-World Study).

The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100⁻140 mg/dL (standardized difference = 0.017) and >200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies.

Tendencias nacionales en hospitalización por insuficiencia cardiaca de pacientes con diabetes mellitus: periodo 1997-2010 / National trends in heart failure hospitalization rates in patients with diabetes mellitus: 1997-2010

No disponible

The frequency and impact of hypoglycemia among hospitalized patients with diabetes: A population-based study.

We aimed to evaluate the frequency of hypoglycemia and its impact on the length of stay and all-cause in-hospital mortality in hospitalized patients with diabetes. We used data from the Basic Minimum Data Set of the Spanish National Health System. Hypoglycemia was defined as having an ICD-9-CM code 250.8, 251.0, 251.1, and 251.2, and categorized as primary if it was the main cause of admission and secondary if it occurred during the hospital stay. The association between hypoglycemia and the study outcomes was evaluated in two cohorts - with and without secondary hypoglycemia - matched by propensity scores and using multivariate models. Among the 5,447,725 discharges with a diagnosis of diabetes recorded from January 1997 to December 2010, there were 92,591 (1.7%) discharges with primary hypoglycemia and 154,510 (2.8%) with secondary hypoglycemia. The prevalence of secondary hypoglycemia increased from 1.1% in 1997 to a peak of 3.8% in 2007, while the prevalence of primary hypoglycemia remained fairly stable. Primary hypoglycemia was associated with reduced in-hospital mortality (Odds ratio [OR] 0.06; 95% Confidence interval [CI], 0.03-0.10) and a significant decrease in time to discharge (Hazard ratio [HR] 2.53; 95% CI, 2.30-2.76), while secondary hypoglycemia was associated with an increased likelihood of in-hospital mortality (OR 1.12; 95% CI, 1.09-1.15) and a significant increase in time to discharge (HR 0.80; 95% CI, 0.79-0.80). In conclusion, the prevalence of secondary hypoglycemia is increasing in patients with diabetes and is associated with an increased likelihood of in-hospital mortality and a longer hospital stay.

Seasonal variability of glycated hemoglobin in a diabetic population from southern Europe.

AIMS: To analyze the seasonal variations in A1c levels among a southern European diabetic population. METHODS: We examined all monthly-grouped A1c determinations from diabetic patients during the period 2006-2011, in a region of southern Spain. RESULTS: There were 61,329 records available. The mean A1c value was 56mmol/mol (7.2%±1.7%) (95% CI, 55-56mmol/mol (7.2%-7.3%), with a range of 0.2%. The highest value was in February and the lowest in July (56mmol/mol (7.3%) and 54mmol/mol (7.1%), respectively) (P<0.01). However, spectral analysis and correlation coefficients did not reach significance, and the series presented no seasonal pattern. CONCLUSIONS: In our area, although the A1C levels have some monthly fluctuation they show no significant seasonal pattern. Thus, the seasonal fluctuation of HbA1c is not a limitation for decision making in clinical practice.

Riesgo de enfermedad tromboembólica venosa en pacientes hospitalizados no quirúrgicos. Grado de acuerdo entre la guía PRETEMED y las recomendaciones de la viii conferencia del American College of Chest Physicians / Assessment of venous thromboembolism risk in hospitalized medical patients. Concordance between PRETEMED guide and the recommendations of the viii conference of the American College of Chest Physicians

Fundamento y objetivo: El objetivo de este estudio es evaluar el grado de adecuación de tromboprofilaxis en pacientes médicos hospitalizados aplicando 2 guías de práctica clínica y analizar el grado de acuerdo entre ambas. Pacientes y método: Estudio de corte transversal en servicios médicos de un hospital de tercer nivel. Calculamos el riesgo tromboembólico y la adecuación de tromboprofilaxis aplicando las recomendaciones de la viii conferencia de la American College of Chest Physicians (ACCP) y la Guía de Profilaxis de Patología Tromboembólica en Patología Médica (PRETEMED), así como su concordancia. Resultados: Se analizaron 128 pacientes. Según la guía PRETEMED, el 34,4% de los pacientes tenían riesgo bajo, un 6,3% moderado y un 59,4% alto; la tromboprofilaxis fue adecuada en el 72,7% (intervalo de confianza del 95% [IC 95%] 64,4-79,9), fueron infratratados el 18,8% (IC 95% 12,7-26,2) y sobretratados el 8,6% (IC 95% 4,6-14,4). Según las recomendaciones de la ACCP, un 50% tenían bajo riesgo y un 50% alto; la tromboprofilaxis fue adecuada en el 74,2% (IC 95% 66,1-81,2), fueron infratratados el 10,9% (IC 95% 6,4-17,3) y sobretratados el 14,8% (IC 95% 9,4-21,8). Agrupando el riesgo PRETEMED en bajo o moderado-alto frente a riesgo ACCP bajo o alto, el índice de concordancia entre guías fue de 0,68 (IC 95% 0,56-0,81). Agrupando el riesgo PRETEMED en bajo-moderado o alto frente a riesgo ACCP bajo o alto el índice de concordancia fue de 0,81 (IC 95% 0,71-0,91). Conclusiones: Alrededor de un cuarto de los pacientes médicos hospitalizados no recibieron tromboprofilaxis adecuada, demostrándose un importante margen de mejora. La guía PRETEMED y los criterios de la ACCP presentan diferencias en la valoración del riesgo debido principalmente a que PRETEMED sobrestima el riesgo de enfermedad tromboembólica venosa al contemplar más factores de riesgo (AU)

Background and objective: The aim of this study is to evaluate the use of venous thromboembolism prophylaxis in hospitalized medical patients using 2 clinical practice guidelines and to analyze the agreement between them. Patients and methods: Cross-sectional study of medical services in a third level hospital. We calculated the thromboembolic risk and the thromboprophylaxis adequacy by implementing the recommendations of viii conference of the American College of Chest Physicians (ACCP) and PRETEMED guide as well as their agreement. Results: One hundred and twenty eight patients were included in the study. According to the PRETEMED guide, 34.4% of patients were low risk, 6.3% moderate and 59.4% high, with appropriate prophylaxis in 72.7% of patients (CI95%: 64.4-79.9), 18.8% (CI95%: 12.7-26.2) were undertreated and 8.6% (CI95%: 4.6-14.4) overtreated. According to ACCP recommendations, 50% of patients were low risk and 50% high, with appropriate prophylaxis in 74.2% of patients (CI95%: 66.1-81.2), 10.9% (CI95%: 6.4-17.3) were undertreated and 14.8% (CI95%: 9.4-21.8) overtreated. When PRETEMED risk was classified into low or moderate-high group versus ACCP risk low or high, the grade of concordance between both guides was 0.68 (CI95%: 0.56-0.81). When PRETEMED risk was classified into low-moderate or high group versus ACCP risk low or high, the grade of concordance between both guides was 0.81 (CI95%: 0.71-0.91). Conclusions: About a quarter of hospitalized medical patients did not receive adequate prophylaxis, showing an important room for improvement. PRETEMED guide and ACCP recommendations differ in risk assessment mainly because PRETEMED guide overestimates the risk of venous thromboembolism since it includes more risk factors (AU)

Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica mayor. Papel de los nuevos anticoagulantes / Prophylaxis of venous thromboembolism in orthopedic surgery. Role of the new anticoagulants

Los pacientes sometidos a un recambio articular de cadera o rodilla presentan un riesgo elevado de tromboembolia en el período postoperatorio, riesgo que se mantiene tras el alta del hospital, por lo que se recomienda que reciban tromboprofilaxis durante 10-35 días. Sin embargo, a pesar de que las mejoras en las técnicas quirúrgicas y la utilización de anticoagulantes de forma generalizada han disminuido su incidencia, la enfermedad tromboembólica venosa continúa siendo una complicación temible y la embolia de pulmón es todavía la principal causa de muerte en estos pacientes. Hasta ahora, las heparinas de bajo peso molecular han sido el tratamiento de elección, aunque su administración parenteral supone un inconveniente y crea problemas de adherencia al tratamiento en algunos pacientes. En los últimos años se ha desarrollado un nuevo grupo de anticoagulantes con diferentes mecanismos de acción, administración oral, dosis fija, escasas interacciones y un efecto predecible. En la actualidad, 1 inhibidor de la trombina (dabigatran) y 2 fármacos inhibidores del factor Xa (rivaroxaban y apixaban) están ya disponibles para la prevención de la enfermedad tromboembólica venosa tras una artroplastia de cadera o rodilla, habiendo demostrado en diversos estudios en fase III una eficacia igual o superior a la enoxaparina, con un nivel de seguridad equiparable. Estos nuevos anticoagulantes pueden suponer una importante mejora en la prevención a largo plazo, particularmente en el ámbito extrahospitalario (AU)

Patients undergoing a total hip or total knee arthroplasty are at high risk of thromboembolism in the postoperative period and after hospital discharge; consequently, clinical guidelines recommended thromboprophylaxis for 10-35 days. Although improved surgical techniques and widespread use of anticoagulants have substantially reduced the incidence of thromboembolic events, venous thromboembolic disease is still a dangerous complication and, in these patients, pulmonary embolism remains the main cause of death. Low molecular weight heparins have long been the mainstay of prevention. However, parenteral administration is inconvenient for many patients, which can sometimes cause poor treatment adherence. In recent years, a new class of oral, fixed-dose anticoagulants, with different mechanisms of action, few interactions and a predictable effect, has been developed. At present, a thrombin inhibitor (dabigatran) and two FXa inhibitors (rivaroxaban and apixaban) are available for prophylaxis in patients after total knee or total hip arthroplasty. In several phase III clinical trials, these drugs have been shown to have equal or superior efficacy and a similar degree of safety to conventional therapy with enoxaparin. These new drugs can significantly improve long-term prevention, particularly in the community setting (AU)

Réplica / Reply

No disponible

[Prophylaxis of venous thromboembolism in orthopedic surgery. Role of the new anticoagulants]. / Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica mayor. Papel de los nuevos anticoagulantes.

Patients undergoing a total hip or total knee arthroplasty are at high risk of thromboembolism in the postoperative period and after hospital discharge; consequently, clinical guidelines recommended thromboprophylaxis for 10-35 days. Although improved surgical techniques and widespread use of anticoagulants have substantially reduced the incidence of thromboembolic events, venous thromboembolic disease is still a dangerous complication and, in these patients, pulmonary embolism remains the main cause of death. Low molecular weight heparins have long been the mainstay of prevention. However, parenteral administration is inconvenient for many patients, which can sometimes cause poor treatment adherence. In recent years, a new class of oral, fixed-dose anticoagulants, with different mechanisms of action, few interactions and a predictable effect, has been developed. At present, a thrombin inhibitor (dabigatran) and two FXa inhibitors (rivaroxaban and apixaban) are available for prophylaxis in patients after total knee or total hip arthroplasty. In several phase III clinical trials, these drugs have been shown to have equal or superior efficacy and a similar degree of safety to conventional therapy with enoxaparin. These new drugs can significantly improve long-term prevention, particularly in the community setting.

[Assessment of venous thromboembolism risk in hospitalized medical patients. Concordance between PRETEMED guide and the recommendations of the viii conference of the American College of Chest Physicians]. / Riesgo de enfermedad tromboembólica venosa en pacientes hospitalizados no quirúrgicos. Grado de acuerdo entre la guía PRETEMED y las recomendaciones de la viii conferencia del American College of Chest Physicians.

BACKGROUND AND OBJECTIVE: The aim of this study is to evaluate the use of venous thromboembolism prophylaxis in hospitalized medical patients using 2 clinical practice guidelines and to analyze the agreement between them. PATIENTS AND METHODS: Cross-sectional study of medical services in a third level hospital. We calculated the thromboembolic risk and the thromboprophylaxis adequacy by implementing the recommendations of viii conference of the American College of Chest Physicians (ACCP) and PRETEMED guide as well as their agreement. RESULTS: One hundred and twenty eight patients were included in the study. According to the PRETEMED guide, 34.4% of patients were low risk, 6.3% moderate and 59.4% high, with appropriate prophylaxis in 72.7% of patients (CI95%: 64.4-79.9), 18.8% (CI95%: 12.7-26.2) were undertreated and 8.6% (CI95%: 4.6-14.4) overtreated. According to ACCP recommendations, 50% of patients were low risk and 50% high, with appropriate prophylaxis in 74.2% of patients (CI95%: 66.1-81.2), 10.9% (CI95%: 6.4-17.3) were undertreated and 14.8% (CI95%: 9.4-21.8) overtreated. When PRETEMED risk was classified into low or moderate-high group versus ACCP risk low or high, the grade of concordance between both guides was 0.68 (CI95%: 0.56-0.81). When PRETEMED risk was classified into low-moderate or high group versus ACCP risk low or high, the grade of concordance between both guides was 0.81 (CI95%: 0.71-0.91). CONCLUSIONS: About a quarter of hospitalized medical patients did not receive adequate prophylaxis, showing an important room for improvement. PRETEMED guide and ACCP recommendations differ in risk assessment mainly because PRETEMED guide overestimates the risk of venous thromboembolism since it includes more risk factors.

Papel de los biomarcadores cardíacos en la estratificación del riesgo de tromboembolia pulmonar / Role of cardiac biomarkers in risks tratification of pulmonary embolism

No disponible

No disponible

[Epidemiology of venous thromboembolie disease in Spain]. / Epidemiología hospitalaria de la enfermedad tromboembólica venosa en España.

The results of epidemiological studies of venous thromboembolic disease (VTD) vary widely, depending both on the geographical area and study type. In Spain, there are no data on the incidence and distribution of VTD. To determine the incidence and distribution of this disease, we analyzed the hospital discharges codified by the Spanish national health system. The results of the analysis showed that VTD represented 0.82% (0.69%-0.92%) of all hospital discharges in Spain between 1999 and 2005. The rate of diagnoses for all hospital discharges in 2005 was 103/100,000 inhabitants, with an estimated number of total diagnoses in Spain (hospitalized or not) of 154/100,000. Fifty-three percent were pulmonary embolisms (PE), which showed a tendency to increase, and 47% were deep venous thrombosis (DVT), which showed a tendency to decrease. The mean age was 65 years in men (51% of cases) and 68 years in women, with the incidence increasing exponentially with age. The mean age in patients with PE was 70 years vs 64 years in DVT. Mortality associated with PE was 11.6% vs 2.3% with DVT. DVT occurred during admission in 4% (3-4.7) of persons hospitalized for any cause, 74% of patients being admitted for medical problems. These data reveal that DVT is a serious health problem in Spain, with high morbidity and mortality. The incidence of this disease seems to be increasing and is particularly associated with medical problems, despite improved diagnosis and the accumulated evidence on thromboprophylaxis. Therefore, greater efforts should be made both to improve identification of at-risk patients and the application of prevention protocols.

Epidemiología hospitalaria de la enfermedad tromboembólica venosa en España / Epidemiology of Venous thromboembolie disease in Spain

Hay gran variabilidad en los resultados de los estudios epidemiológicos sobre enfermedad tromboembólica venosa (ETV) dependiendo tanto del área geográfica como del tipo de estudio. En España no hay datos sobre su incidencia y su distribución. Para conocerlos, realizamos un análisis de las altas hospitalarias codificadas por el Sistema Nacional de Salud. Según este estudio, en España, entre 1999 y 2005, la ETV representó el 0,82% (0,69%-0,92%) del total de altas hospitalarias. La tasa calculada de diagnósticos para el total de altas hospitalarias en 2005 fue 103/100.000 habitantes, con una estimación de diagnósticos totales en España (hospitalizados o no) de 154/100.000. El 53% fueron embolias pulmonares (EP), con una tendencia ascendente, y el 47%, trombosis venosa profunda (TVP), con una tendencia descendente. La media de edad fue de 65 años los varones (el 51% de los casos) y 68 años las mujeres, y la incidencia aumenta exponencialmente con la edad. La media de edad en las EP fue 70 años, frente a 64 años en las TVP. La mortalidad por EP fue el 11,6%, frente al 2,3% por TVP. El 4¿ (3¿-4,7¿) de los hospitalizados por cualquier causa sufrieron una ETV durante su ingreso, y el 74% de los pacientes estaban ingresados por problemas médicos. Estos datos ponen de manifiesto que la ETV representa también en España un serio problema de salud ¿con alta morbimortalidad¿ cuya incidencia parece estar aumentando, particularmente en relación con afecciones médicas a pesar del mejor diagnóstico y las evidencias acumuladas en tromboprofilaxis. Por lo tanto, parece necesario intensificar el esfuerzo en mejorar tanto la identificación de los pacientes en riesgo como la aplicación de protocolos de prevención

The results of epidemiological studies of venous thromboembolic disease (VTD) vary widely, depending both on the geographical area and study type. In Spain, there are no data on the incidence and distribution of VTD. To determine the incidence and distribution of this disease,we analyzed the hospital discharges codified by the Spanish national health system.The results of the analysis showed that VTD represented 0.82% (0.69%-0.92%) of all hospital discharges in Spain between 1999 and 2005. The rate of diagnoses for all hospital discharges in 2005 was 103/100,000 inhabitants, with an estimated number of total diagnoses in Spain (hospitalized or not) of 154/100,000. Fifty-threepercent were pulmonary embolisms (PE), which showed a tendency to increase, and 47% were deep venous thrombosis (DVT), which showed a tendency to decrease. The mean age was 65 years in men (51% of cases) and 68 years in women, with the incidence increasingexponentially with age. The mean age in patients with PE was 70 years vs 64 years in DVT. Mortality associated with PE was 11.6% vs 2.3% with DVT. DVT occurred during admission in 4% (3-4.7) of persons hospitalized for any cause, 74% of patients being admitted for medicalproblems.These data reveal that DVT is a serious health problem in Spain, with high morbidity and mortality. The incidence of this disease seems to be increasing and is particularly associated with medical problems, despite improved diagnosis and the accumulated evidence on thromboprophylaxis. Therefore, greater efforts should be made both to improve identification of at-risk patients and the application of prevention protocols

[Current diagnosis of pulmonary embolism in Spain: ventilation-perfusion lung scan versus helical CT. Findings from the National Health Service and RIETE Registry]. / Gammagrafía pulmonar y tomografía computarizada helicoidal en el diagnóstico de embolia pulmonar en España. Datos del Sistema Nacional de Salud y el Registro RIETE.

BACKGROUND AND OBJECTIVE: To analyze the trends in the utilization of ventilation/perfusion pulmonary scintigraphy (V/QSc), spiral CT (sCT) and pulmonary angiography for diagnosis of pulmonary embolism (PE) in Spain, taking in account the information from the National System of Health (NSH) and RIETE Registry. To examine the diagnostic conformities of V/QSc and sCT in RIETE, with special reference to V/QSc of intermediate/indeterminate probability (V/QScIP). MATERIAL AND METHOD: We examined annual trends of diagnostic imaging for PE in 5,678 Spanish patients included in RIETE (period 2001-2005) and in those of the NHS Databases (1999-2003 period). In RIETE the agreement between diagnostics was compared in cases with both V/QSc and sCT and angiography and V/QSc or sCT. RESULTS: We observed an increasing trend in sTC use, which overcame to V/QSc in 2002 (RIETE) and 2003 (NHS). In 732 cases with both techniques there was a diagnostic conformity of 53%. In 116 cases with V/QScIP a concomitant sTC was + for PE in 87%. If clinical signs of PE were present, then sTC was + in 95% of cases. In 29 cases with sCT and angiography agreement was 83% and in 31 cases with angiography and V/QSc was 77%. CONCLUSIONS: Nowadays in Spain the sTC is the most utilized method to diagnose EP. However, V/QSc studies are also broadly used. In studies V/QScIP it is advisable to look for deep venous thrombosis and, if present, the results of RIETE allow to assure EP coexistence in 87-95% of cases.

Gammagrafía pulmonar y tomografía computarizada helicoidal en el diagnóstico de embolia pulmonar en España. Datos del Sistema Nacional de Salud y el Registro RIETE / Current diagnosis of pulmonary embolism in Spain: ventilation-perfusion lung scan versus helical CT. Findings from the National Health Service and RIETE Registry

Fundamento y objetivo: Analizar las tendencias de utilización de gammagrafía de ventilación-perfusión (gammaV/Q), tomografía computarizada helicoidal (TCH) y arteriografía pulmonar para el diagnóstico de embolia pulmonar (EP) en España, considerando los datos del Sistema Nacional de Salud (SNS) y el Registro RIETE y examinar las analogías diagnósticas de la gammaV/Q y la TCH en RIETE, con especial referencia a la gammaV/Q de probabilidad intermedia/indeterminada (GV/QPI). Material y método: Se examinaron las tendencias anuales en pruebas de imagen para diagnosticar EP en 5.678 pacientes españoles incluidos en el Registro RIETE (2001 a 2005) y se compararon con los pertenecientes al SNS (período 1999-2003). En el RIETE se compararon los resultados análogos entre los casos con gammaV/Q y TCH concomitantes y arteriografía y gammaV/Q o TCH. Resultados: Hubo una tendencia creciente en la utilización de TCH, que superó en 2002 (RIETE) y en 2003 (SNS) a la gammaV/Q. En 732 casos con ambas pruebas, se obtuvieron resultados análogos en el 53%. En 116 casos con gammaV/QPI, la TCH disponible fue positiva a EP en un 87%. Cuando además había signos clínicos de EP, la TCH fue positiva en un 95%. En 29 casos con angiografía pulmonar (AP) y TCH, los resultados fueron análogos en un 83% y en 31 casos con arteriografía y gammaV/Q, en un 77%. Conclusiones: Actualmente, en España, la TCH es el método más utilizado para el diagnóstico de EP, aunque siguen realizándose numerosos estudios con gammaV/Q. En los resultados de gammaV/QPI es aconsejable estudiar la posible trombosis venosa profunda y, si la hay, los resultados del RIETE permiten asegurar la coexistencia de EP en un 87-95% de casos

Background and objective: To analyze the trends in the utilization of ventilation/perfusion pulmonary scintigraphy (V/QSc), spiral CT (sCT) and pulmonary angiography for diagnosis of pulmonary embolism (PE) in Spain, taking in account the information from the National System of Health (NSH) and RIETE Registry. To examine the diagnostic conformities of V/QSc and sCT in RIETE, with special reference to V/QSc of intermediate/indeterminate probability (V/QScIP). Material and method: We examined annual trends of diagnostic imaging for PE in 5,678 Spanish patients included in RIETE (period 2001-2005) and in those of the NHS Databases (1999-2003 period). In RIETE the agreement between diagnostics was compared in cases with both V/QSc and sCT and angiography and V/QSc or sCT. Results: We observed an increasing trend in sTC use, which overcame to V/QSc in 2002 (RIETE) and 2003 (NHS). In 732 cases with both techniques there was a diagnostic conformity of 53%. In 116 cases with V/QScIP a concomitant sTC was + for PE in 87%. If clinical signs of PE were present, then sTC was + in 95% of cases. In 29 cases with sCT and angiography agreement was 83% and in 31 cases with angiography and V/QSc was 77%. Conclusions: Nowadays in Spain the sTC is the most utilized method to diagnose EP. However, V/QSc studies are also broadly used. In studies V/QScIP it is advisable to look for deep venous thombosis and, if present, the results of RIETE allow to assure EP coexistence in 87-95% of cases

Variación estacional de los ingresos por infarto agudo de miocardio / Seasonal variations in admissions for acute myocardial infarction

No disponible