ABSTRACT
INTRODUCTION AND OBJECTIVES: The development of specific heart failure (HF) units has improved the management of patients with this disease due to improved organization and resource management. The Spanish Society of Cardiology (SEC) has defined 3 types of HF units (community, specialized, and advanced) based on their complexity and service portfolio. Our aim was to compare the characteristics, treatment, and outcomes of patients with HF according to the type of unit. METHODS: We analyzed data from the SEC-Excelente-IC quality accreditation program registry, with 1716 patients consecutively included in two 1-month cutoffs (March and October) from 2019 to 2021 by 45 SEC-accredited HF units. We compared the characteristics, treatment and 1-year outcomes between the 3 types of units. RESULTS: Of the 1716 patients, 13.2% were treated in community units, 65.9% in specialized units, and 20.9% in advanced units. The rates of mortality (27.5 vs 15.5/100 patients-year; P < .001), admissions for HF (39.7 vs 29.2/100 patients-year; P = .019), total decompensations (56.1 vs 40.5/100 patients-year; P = .003), and combined death/admission for HF (45.2 vs 31.4/100 patients-year; P = .005) were higher in community units than in specialized/advanced units. Follow-up in a community unit was an independent predictor of higher mortality and admissions at 1 year. CONCLUSIONS: Compared with follow-up by more specialized units, follow-up in a community unit was associated with a higher decompensation rate and increased 1-year mortality.
ABSTRACT
During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of -6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.
ABSTRACT
AIM: To apply, analyze, and evaluate the four syncope risk scores recommended by the 2009 European guidelines and the different parameters that they use to predict death, syncope recurrence, and hospital readmission in the population seen in the emergency room department (ERD) for syncope. METHODS AND RESULTS: A total of 323 patients aged older than 14 years [mean age 59 (32-75) years] and seen in ERD for syncope over a 2-month period were included in the study; 50.7% were women. Patients were evaluated using the four risk scores and were followed up for at least 2 years. In all, 275 patients (85.2%) were discharged directly from ERD after evaluation. During 28±5 months of follow-up, 8% died, 18.3% presented a further syncopal episode, and 18.6% were readmitted to hospital. Only two of the four risk scores were useful in risk discrimination, but no statistically significant differences were detected between predicted risk and observed risk. Multivariate analysis indicated relationships between age and death, a history of cardiovascular disease and syncope recurrence, and between presyncopal palpitations and hospital readmission. CONCLUSION: Although a large number of events occur after syncope, the risk scores recommended by guidelines overestimate risk, but there were no statistically significant differences between observed and predicted risk.
Subject(s)
Electrocardiography/methods , Emergency Service, Hospital , Hospital Mortality , Practice Guidelines as Topic , Syncope/therapy , Adult , Aged , Cardiology/standards , Cohort Studies , Humans , Male , Middle Aged , Multivariate Analysis , Prognosis , Prospective Studies , Recurrence , Risk Assessment , Severity of Illness Index , Societies, Medical , Spain , Survival Analysis , Syncope/diagnosis , Syncope/mortalityABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Porphyria, Variegate/complications , Porphyria, Variegate/diagnosis , Atrial Fibrillation/chemically induced , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Propafenone/administration & dosage , Propafenone/adverse effects , Biopsy , Anti-Arrhythmia Agents/therapeutic use , Porphyria, Variegate/physiopathology , Porphyria, Variegate , Atrial Fibrillation/physiopathology , Atrial Fibrillation , Metabolic Diseases/chemically induced , Metabolic Diseases/complicationsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Fistula/chemically induced , Fistula/diagnosis , Angina, Unstable/complications , Angina, Unstable/diagnosis , Echocardiography , Echocardiography, Stress , Ergometry/methods , Obesity/complications , Smoking/adverse effects , Angina, Unstable/physiopathology , Angina, Unstable/surgery , Angina, Unstable , /trendsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , /complications , /diagnosis , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/diagnosis , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Revascularization/trends , Myocardial RevascularizationSubject(s)
Cardiac Catheterization , Laboratories , Myocardial Infarction/diagnosis , Female , Humans , MaleABSTRACT
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection.
Subject(s)
Coronary Artery Disease , Acute Coronary Syndrome/etiology , Adult , Aged , Coronary Artery Disease/complications , Female , Humans , Male , Middle Aged , Prognosis , Time FactorsABSTRACT
La disección coronaria espontánea es una causa infrecuente de síndrome coronario agudo que afecta predominantemente a mujeres sin apenas factores de riesgo cardiovascular y cuya presentación varía desde la angina inestable hasta la muerte súbita. Los conocimientos de esta entidad se reducen a casos clínicos aislados, y la ausencia de grandes series hace que su tratamiento y sus implicaciones pronósticas no estén plenamente establecidos. Presentamos los datos de 19 casos en 18 pacientes atendidos en nuestro centro desde mayo de 1998 hasta enero de 2009, con una mediana [intervalo intercuartílico] de 3,8 [1,3-4,6] años de seguimiento. Una vez superada la fase aguda, el pronóstico fue favorable sin implicaciones funcionales. Una paciente presentó una recidiva en una coronaria diferente y otra paciente dio a luz sin complicaciones a los 3 años de la disección (AU)
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Dissection/methods , Dissection , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Angiography/methods , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Cohort Studies , Prognosis , Aortic Rupture/complications , Aortic Rupture/etiology , Heart Rupture/complications , Heart Rupture/diagnosisABSTRACT
No disponible
No disponible
Subject(s)
Humans , Female , Adult , Middle Aged , Tachycardia, Sinus/drug therapy , Heart Rate , Tachycardia, Sinus/diagnosisSubject(s)
Benzazepines/therapeutic use , Tachycardia, Sinus/drug therapy , Adult , Female , Humans , Ivabradine , Middle AgedABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Aged , Myocardial Infarction/physiopathology , Electrocardiography , Thorax , Heart VentriclesSubject(s)
Angina, Unstable/etiology , Coronary Vasospasm/etiology , Thyrotoxicosis/complications , Aged , Humans , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Aged , Thyrotoxicosis/complications , Angina Pectoris, Variant/etiology , Hyperthyroidism/complicationsSubject(s)
Cardiomyopathies/pathology , Cardiomyopathies/diagnostic imaging , Humans , Male , Middle Aged , RadiographyABSTRACT
We describe the case of a patient who developed a thrombus on the transseptal sheath in the right atrium before transseptal puncture for circumferential pulmonary vein isolation for paroxysmal atrial fibrillation treatment. The use of intracardiac echocardiography allowed to its identification and probably prevented the patient from suffering a serious thromboembolic complication.