Hospital-at-Home Expands Hospital Capacity During COVID-19 Pandemic.

A Coronavirus Disease 2019 (COVID-19)-specific Hospital-at-Home was implemented in a 400-bed tertiary hospital in Barcelona, Spain. Senior or immune-compromised physicians oversaw patient care. The alternative to inpatient care more than doubled beds available for hospitalization and decreased the risk of transmission among patients and health care professionals. Mild cases from either the emergency department or after hospital discharge were deemed suitable for admission to the Hospital-at-Home. More than half of all patients had pneumonia. Standardized protocols and management criteria were provided. Only 6% of cases required referral for inpatient hospitalization. These results are promising and may provide valuable insight for centers undertaking Hospital-at-Home initiatives or in the case of new COVID-19 outbreaks.

Clinical characteristics and prognosis in patients with a first acute heart failure hospitalization according to admission hyponatremia.

Objective Admission hyponatremia is related to poor outcomes in patients with heart failure (HF). Few studies have examined the influence of hyponatremia in the prognosis of HF patients without previous admissions. Our aim is to determine whether baseline hyponatremia predicts worse outcomes in a cohort of real-world HF patients admitted because of a first episode of acute HF. Methods We reviewed the medical records of 985 patients >50 years of age admitted within a two-year period for a first episode of decompensation of HF. We divided the sample according to the presence of hyponatremia, defined as serum sodium <135 mEq/L. We compared one-year all-cause mortality rates between groups, using Cox regression analyses. Results The patients' mean serum sodium at admission was 138 ± 4; 150 (15.2%) patients had hyponatremia. Hyponatremic patients had lower hematocrit values compared with the rest. Global mortality rates were higher across all evaluations (one, three, and 12 months) in the hyponatremia group, although statistical significance was not reached. After one year of follow-up no differences in patients' baseline sodium values were found between those who died and survivors (137.9 vs.138.6; p = 0.05). Natremia at admission considered as a continuous variable (HR 0.971; IC 95% 0.945-0.997) was associated with mortality; however, multivariate Cox regression analysis did not confirm this association. Conclusions Admission hyponatremia is not uncommon even in patients admitted for the first time because of acute HF. However, hyponatremia in this cohort of patients does not seem to influence significantly in short- to mid-term mortality.

Association between diabetes and mortality in elderly patients admitted for a first episode of acute heart failure.

AIM: To examine whether the presence of a prior diagnosis of diabetes mellitus (DM) influences mortality risk in elderly patients experiencing a first episode of heart failure (HF) hospitalization. METHODS: A total of 677 consecutive patients aged ≥75 years admitted for a first episode of acute decompensated heart failure were evaluated according to the presence or not of DM, and in-hospital and 1-year mortality rates were evaluated. RESULTS: A total of 240 patients (35.4%) had a diagnosis of DM. Overall, 42 patients (6.2%) died during admission; and 205 patients (30.3%) died after 1 year; however, no differences were observed in mortality rates between both groups. Cox univariate analysis did not identify prior DM diagnosis as a risk factor for 1-year mortality (HR 0.767, P < 0.082). Multivariate analysis identified older age (HR 1.101, P < 0.0001), lower preadmission Barthel Index (HR 0.987, P = 0.002), higher heart rate (HR 1.013, P = 0.02), higher admission serum potassium (HR 1.471, P = 0.016) and non-prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (HR 1.597, P = 0.018) as independent risk factors for 1-year mortality. CONCLUSIONS: More than one-third of elderly patients experiencing a first admission because of acute heart failure decompensation had a prior diagnosis of DM. However, DM did not seem to be associated to a significant 1-year mortality risk. Geriatr Gerontol Int 2018; 18: 554-560.

Jerarquizando y fortaleciendo la investigación en salud en la Red de Atención Primaria Metropolitana de ASSE (RAP metropolitana ASSE) / Hierarchizing and strengthening health research in the ASSE Metropolitan Primary Care Network (Metropolitan RAP ASSE)

La Red de Atención Primaria Metropolitana es una unidad ejecutora de ASSE del primer nivel de atención que brinda cobertura a 340.000 usuarios de Montevideo y zona metropolitana, a través de 14 Centros del Primer Nivel y 112 policlínicas. Se presenta como un espacio donde, no solo se cumplen actividades asistenciales de primer nivel, interdisciplinarias y complejas, sino como un espacio propicio para la adquisición, transferencia y perfeccionamiento de conocimientos, y para la investigación en salud. Esta investigación debe ser aplicada a las necesidades del primer nivel, detectadas conjuntamente por la comunidad y el equipo de salud a través de los Análisis de Situación de Salud (ASIS) correspondientes- Pero además debe ser de alta calidad ya que es la fuente natural para la optimización del proceso de gestión y de prestación de servicios de atención sanitaria. (AU)