Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries.

Hip fracture registries have helped improve quality of care and reduce variability, and several audits exist worldwide. The results of the Spanish National Hip Fracture Registry are presented and compared with 13 other national registries, highlighting similarities and differences to define areas of improvement, particularly surgical delay and early mobilization. INTRODUCTION: Hip fracture audits have been useful for monitoring current practice and defining areas in need of improvement. Most established registries are from Northern Europe. We present the results from the first annual report of the Spanish Hip Fracture Registry (RNFC) and compare them with other publically available audit reports. METHOD: Comparison of the results from Spain with the most recent reports from another ten established hip fracture registries highlights the differences in audit characteristics, casemix, management, and outcomes. RESULTS: Of the patients treated in 54 hospitals, 7.208 were included in the registry between January and October 2017. Compared with other registries, the RNFC included patients ≥ 75 years old; in general, they were older, more likely to be female, had a worse prefracture ambulation status, and were more likely to have extracapsular fractures. A larger proportion was treated with intramedullary nails than in other countries, and spinal anesthesia was most commonly used. With a mean of 75.7 h, Spain had by far the longest surgical delay, and the lowest proportion of patients mobilized on the first postoperative day (58.5%). Consequently, development of pressure ulcers was high, but length of stay, mortality, and discharge to home remained in the range of other audits. CONCLUSIONS: National hip fracture registries have proved effective in changing clinical practice and our understanding of patients with this condition. Such registries tend to be based on an internationally recognized common dataset which would make comparisons between national registries possible, but variations such as age inclusion criteria and follow-up are becoming evident across the world. This variation should be avoided if we are to maximize the comparability of registry results and help different countries learn from each other's practice. The results reported in the Spanish RNFC, compared with those of other countries, highlight the differences between countries and detect areas of improvement, particularly surgical delay and early mobilization.

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation / Registro Nacional Español de Fracturas de Cadera (RNFC): descripción de sus objetivos, metodología e implementación

Objective: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. Design: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. Study scope and subjects: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. Results: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition

Objetivo: Conocer la situación actual y la variabilidad clínica del proceso asistencial a la Fractura de Cadera (FC) en España y los factores relacionados con la misma mediante la utilización de un Registro Nacional (RNFC) con elevada casuística y representación territorial RNFC, así como comparar resultados en el ámbito nacional e internacional y proponer estándares y criterios para mejorar la calidad asistencial. Diseño: Registro continuo durante al menos tres años de una muestra representativa de los pacientes ingresados por FC en los hospitales españoles mediante el Minimum Common Dataset - MCD internacional de la Fragility Fracture Network (FFN) adaptado al castellano. Ámbito y sujetos del estudio: se incluirán todos los pacientes mayores de 74 años hospitalizados con el diagnóstico de FC por fragilidad en los hospitales participantes repartidos por el territorio español. Inicialmente están incluidos 48 hospitales, a los que se espera que se vayan incorporando el mayor número posible de centros. Resultados: Se pretende conocer la situación actual de la atención a este proceso en España Se ofrecerá a cada hospital la información de sus resultados y su situación en relación al resto, se compararán los resultados de los hospitales nacionales entre sí y con los hospitales extranjeros incluidos en registros que usan la misma base de datos. Se estudiará la variabilidad, se establecerán estándares asistenciales y se plantearán objetivos para la mejora continua del proceso en la atención a esta patología

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation.

OBJECTIVE: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. DESIGN: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. STUDY SCOPE AND SUBJECTS: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. RESULTS: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition.

Niveles de potasio sérico y mortalidad a largo plazo en ancianos con hipertensión arterial / Serum potassium levels and long-term mortality in the elderly with hypertension

Existen crecientes evidencias de que pequeñas variaciones dentro del rango normal del potasio, entre 3,5-5mEq/l, se asocian con mortalidad. Objetivo: Conocer si existe asociación entre el nivel de potasio sérico (Ks) basal con la mortalidad en una cohorte de ancianos hipertensos. Pacientes y métodos: Estudio observacional retrospectivo, de pacientes que disponían de Ks en un periodo de estabilidad clínica, durante su reclutamiento entre enero-abril de 2006 y seguidos durante 10 años. Se estudiaron 62 pacientes estables, con edad media de 82,19 ± 6 años (rango 69-97); 74,2% mujeres, 33,9% diabéticos, 20,3% con antecedentes de insuficiencia cardiaca y 19,4% de cardiopatía isquémica; un 44,3% recibían inhibidores de la enzima convertidora de angiotensina (IECA). Se registró la mortalidad acontecida durante 10 años. La estadística se hizo con SPSS15.0. Resultados: Cuarenta y nueve pacientes fueron exitus. El Ks tenía distribución normal. Los niveles medios basales y mediana de Ks fueron de 4,45 ± 0,5 mEq/l (rango de 3,1-5,5 mEq/l). Los niveles basales de Ks eran significativamente mayores en diabéticos y en tomadores de IECA. Los pacientes fallecidos tenían niveles Ks mayores (4,53 ± 0,49 mEq/l versus 4,14 ± 0,40 mEq/l; p = 0,011). La supervivencia por Kaplan Meier demostró que pacientes con Ks superior a la mediana y a P75 presentaron mayor mortalidad. Conclusiones: En nuestro estudio los niveles Ks mayores a 4,45mEq/l se asociaban con mortalidad. En ancianos hipertensos, a la hora de seleccionar tratamiento antihipertensivo, se debería valorar individualmente el uso de IECA, con monitorización estrecha en los niveles de Ks y procurar mantenerlos en el rango medio de la normalidad (< 4,45 mEq/l)

There is increasing evidence that small variations within the normal range (3.5-5 mEq/L) of potassium are associated with mortality. Objective: To determine whether there is an association between serum potassium level (sK) and mortality in a cohort of elderly hypertensive patients. Patients and methods: A retrospective, observational study was conducted on patients who had sK levels available in a period of clinical stability during their recruitment between January and April 2006 and followed-up for 10 years. The study obtained a total of 62 stable patients, with a mean age of 82.19 ± 6 years (range 69-97), with 74.2% women, 33.9% diabetics, 20.3% with a history of heart failure, Ischaemic heart disease was observed in 19.4% and 44.3% received Angiotensin Converting Enzyme (ACE) inhibitors. An analysis was performed on the mortality rate during the 10 year period. The statistics were performed using the SPSS15.0 package. Results: There were 49 deaths. The sK had a normal distribution. Baseline mean sK levels and median were 4.45 ± 0.5 mEq/L (range 3.1-5.5 mEq/L). Baseline sK levels were significantly higher in diabetic patients and patients on ACE inhibitors. The patients that died had higher sK levels (4.53 ± 0.49 mEq/L versus 4.14 ± 0.40 mEq/L, P = .011). Survival estimated using Kaplan Meier showed that patients with sK levels higher than the median and P75 had higher mortality. Conclusions: In our study, sK levels greater than 4.45 mEq/L were associated with mortality. When selecting antihypertensive treatment in hypertensive elderly patients,, the use of ACE inhibitors should be assessed individually, with close monitoring at sK levels and try to keep them in the lower limit of the normal range (< 4.45 mEq/L)

[Serum potassium levels and long-term mortality in the elderly with hypertension]. / Niveles de potasio sérico y mortalidad a largo plazo en ancianos con hipertensión arterial.

There is increasing evidence that small variations within the normal range (3.5-5mEq/L) of potassium are associated with mortality. OBJECTIVE: To determine whether there is an association between serum potassium level (sK) and mortality in a cohort of elderly hypertensive patients. PATIENTS AND METHODS: A retrospective, observational study was conducted on patients who had sK levels available in a period of clinical stability during their recruitment between January and April 2006 and followed-up for 10 years. The study obtained a total of 62 stable patients, with a mean age of 82.19±6 years (range 69-97), with 74.2% women, 33.9% diabetics, 20.3% with a history of heart failure, Ischaemic heart disease was observed in 19.4% and 44.3% received Angiotensin Converting Enzyme (ACE) inhibitors. An analysis was performed on the mortality rate during the 10 year period. The statistics were performed using the SPSS15.0 package. RESULTS: There were 49 deaths. The sK had a normal distribution. Baseline mean sK levels and median were 4.45±0.5mEq/L (range 3.1-5.5 mEq/L). Baseline sK levels were significantly higher in diabetic patients and patients on ACE inhibitors. The patients that died had higher sK levels (4.53±0.49mEq/L versus 4.14±0.40mEq/L, P=.011). Survival estimated using Kaplan Meier showed that patients with sK levels higher than the median and P75 had higher mortality. CONCLUSIONS: In our study, sK levels greater than 4.45mEq/L were associated with mortality. When selecting antihypertensive treatment in hypertensive elderly patients,, the use of ACE inhibitors should be assessed individually, with close monitoring at sK levels and try to keep them in the lower limit of the normal range (<4.45 mEq/L).

[Elderly patients with Chronic Kidney Disease: what is their course at one year?]. / Ancianos con enfermedad renal crónica: ¿Cuál es su evolución al cabo de un año?

INTRODUCTION: Aging is associated to several structural and functional kidney changes. Recently, there is a great interest in the detection of Chronic Kidney Disease (CKD) in the general population. A classification of CKD, based on several stages of the estimated glomerular filtration rate (eGFR), has been established. In this study we followed up, clinically and biochemically, during one year eighty patients older than 65 years so as to ascertain the applicability and utility of such classification to those patients. PATIENTS AND METHODS: 80 clinically stable patients, with a median age of 83 years, recruited within January and April 2006, were followed up during one year. We separated them in two groups: Group 1: 38 patients with serum creatinine pound sterling 1,1 mg/dl (range 0,7-1,1) and with no proteinuria; and Group 2: 42 patients with serum creatinine > or =1.1 mg/dl (range 1,2-3) and with proteinuria <3 grs/24 hours. Clinically we registered morbimortality and treatments received, and biochemically we measured serum creatinine and eGFR at the time of recruitment and after one year of follow up using two equations: Cockroft and abbreviated MDRD. Statistical comparisons were made using the general lineal model for repeated measures of the SPSS 11.0 program. RESULTS: 10% of the patients died during the follow up. Cardiac problems were the kind of morbidity more frequently found. Only a small proportion (23%) of group 2 patients were receiving erythropoietin (EPO) treatment. Estimated GFR and proteinuria remained stable at the end of one year independently of basal GFR; we found no significant differences between groups in the rest of analytical parameters. CONCLUSION: in old patients with no significant proteinuria, the similarity of their clinical evolution and the stability of their eGFR (independently of its basal value), as well as the lack of differences in other analytical parameters, appears not to confer any advantages to the use of mathematical formulae to classified them according to their eGFR.

Ancianos con enfermedad renal crónica: ¿cuál es su evolución al cabo de un año? / Elderly patients with chronic kidney disease: what is their course at one year?

Introducción: El envejecimiento conlleva diversos cambios estructurales y funcionales en el riñón. Recientemente se está prestando un gran interés a la detección precoz de la Enfermedad Renal Crónica (ERC) en la población general, a partir de la estimación mediante fórmulas matemáticas del filtrado glomerular (FG); por otra parte, se ha establecido una clasificación de la ERC en diversos estadios según el FG estimado (FGe). En este estudio se analizó la evolución clínica y del FGeen un grupo de pacientes ancianos con FGe basal disminuido, con el objetivo de valorar si la aplicación de dicha clasificación tiene utilidad práctica en este tipo de pacientes. Pacientes y métodos: 80 pacientes clínicamente estables con una media de edad de 82,4 ± 6,5 años, reclutados entre enero y abril de 2006 fueron seguidos durante un año (grupo 1: 38pacientes con creatinina sérica (Crs) < = 1,1 mg/dl (rango 0,7-1,1) y sin proteinuria; y grupo 2: 42 pacientes, con Cr s > 1,1mg/dl (rango 1,2-3) y con proteinuria < 3 g/día). El 70% del total de pacientes tenía un estadio 3 ó 4 de ERC, de acuerdo con el FGe (MDRD abreviado). Clínicamente se estudiaron la morbi-mortalidad y los fármacos empleados. Analíticamente se determinó la Crs y se estimó el FG basal y un año después según fórmulas de Cockroft y MDRD abreviado. La estadística se realizó con el programa SPSS 11.0 usando un modelo lineal general para medidas repetidas. Resultados: Un 10% de los pacientes falleció antes del año. La patología cardíaca fue la comorbilidad más frecuente. Sólo (..) (AU)

Introduction: Aging is associated to several structural and functional kidney changes. Recently, there is a great interest in the detection of Chronic Kidney Disease (CKD) in the general population. A classification of CKD, based on several stages of the estimated glomerular filtration rate (eGFR), has been established. In this study we followed up, clinically and biochemically, during one year eighthy patients older than 65years so as to ascertain the applicability and utility of such classification to those patients. Patients and methods: 80 clinically stable patients, with a median age of 83 years, recruited within january and april 2006,were followed up during one year. We separated them in two groups: Group 1: 38 patients with serum creatinine £ 1,1mg/dl (range 0,7-1,1) and with no proteinuria; and Group 2:42 patients with serum creatinine > = 1.1 mg/dl (range 1,2 –3) and with proteinuria < 3 g/24 hours. Clinically we registered morbimortality and treatments received, and biochemically we measured serum creatinine and eGFR at the time of recruitment and after one year of follow up using two equations: Cockroft and abreviated MDRD. Statistical comparisons were made using the general lineal model for repeated measures of the SPSS 11.0 program. Results: 10% of the patients died during the follow up. Cardiac problems were the kind of morbidity more frequently (..) (AU)