Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units.

OBJECTIVES: To evaluate the frequency and the factors associated with performance of echocardiography in acute coronary syndrome (ACS) patients during their stay in intensive care units or coronary care units (ICU/CCU). METHODS: Retrospective cohort study including all patients diagnosed with acute coronary syndrome-unstable angina (UA), acute myocardial infarction (AMI)-included in the 'ARIAM' Spanish multi-centre register. The study period was from June 1996 to December 2005. The follow-up period is limited to the time of stay in the Intensive Care Units or Coronary Care Units (ICUs/CCUs). A univariate analysis was carried out on the patients with UA and AMI according to whether or not echocardiograms were performed during their stay in ICU/CCU. In addition the data was evaluated for any temporal variation in the performance of echocardiography, and two multivariate analyses were carried out to evaluate the factors associated with performance of echocardiography in UA and AMI patients. RESULTS: The study period included 45,688 AMI patients and 17,277 UA patients. Echocardiograms were performed in 26.87% AMI patients and 16.75% UA patients. In total, 15,172 echocardiograms were performed in ACS patients (23.6%). The multivariate analysis demonstrated that the variables associated with the performance of echocardiography in UA were: Killip and Kimball class, cigarette smoking, family history of cardiovascular events, cardiogenic shock, uncontrolled angina, mechanical ventilation and treatment with ACE inhibitors, while the presence of previous AMI was associated with fewer echocardiograms being performed. In AMI, the multivariate analysis showed the following variables to be associated with the performance of echocardiography: Killip and Kimball class, Q-AMI, right heart failure, the need for insertion of Swan-Ganz catheter, cardiogenic shock, high-degree AV block and the administration of ACE inhibitors, while age was associated with fewer being performed. Over the 10 years of the study period, there was a discrete but significant increase in the use of echocardiography in patients in ICU/CCU. CONCLUSIONS: Echocardiography is not commonly used in ACS patients while in ICU/CCU. UA and AMI patients who did have echocardiograms during their stay in ICU/CCU were chiefly those presenting heart failure and major complications, and represent a subpopulation with poor prognosis. The performance of echocardiography in ACS patients increased slightly over the length of their stay in ICU/CCU.

Estrategias adecuadas en la enfermedad cardiovascular. Los pacientes de alto riesgo / Appropriate strategies for the cardiovascular ‘‘disease’’. High-risk patients

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Miocardiopatía severa reversible en el síndrome de Sjögren primario / Severe reversible cardiomyopathy in primary Sjogren's syndrome

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Introducción: el clínico cardiovascular en el siglo XXI / No disponible

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La calidad en cardiología. Desde la teoría a la aplicación práctica / Quality of care in cardiology. From theory to practice

La calidad asistencial es el elemento estratégico en el que debemos basar nuestro trabajo como cardiólogos, lo cual nos permitirá avanzar hacia una mejor atención a los pacientes. Consideramos que los esfuerzos para alcanzar estos objetivos deben encaminarse a unificar dos aspectos fundamentales: a) por parte del cardiólogo, resolver con efectividad las enfermedades cardiovasculares mediante la aplicación de los conocimientos basados en las pruebas científicas, y b) por parte del paciente, un alto grado de satisfacción del servicio recibido y de sus necesidades. En la primera parte analizamos los diferentes criterios y posibles medidas de indicadores de calidad aplicados a las enfermedades cardiovasculares, mientras que en la segunda parte profundizamos en algunas de las experiencias que se han puesto en marcha (AU)

Quality of care is the key factor on which we must base our work as cardiologists as it enables us to provide better patient care. In our view, efforts to achieve quality-of-care objectives involve the combination of two fundamental factors: a) cardiologists must identify an effective treatment for the cardiovascular condition by applying knowledge based on scientific evidence; and b) patients must have a high level of satisfaction with the treatment received and their needs must be satisfied. In the first part of this article, we assess different quality criteria and possible quality indicators that can be applied to cardiovascular diseases, while, in the second part, we give a more in-depth account of some experience with practical applications (AU)

Actividad asistencial en una unidad de insuficiencia cardíaca. Evaluación de sus indicadores / Activity in a heart failure unit. Evaluation of its indicators and quality standards

Fundamento: Para valorar la calidad asistencial (CA) que se da a los pacientes con insuficiencia cardíaca (IC), se cuenta con herramientas que permiten medir y comparar si el nivel de nuestra asistencia alcanza la calidad recomendada por la evidencia científica de las guías clínicas, tales como indicadores, criterios y estándares de calidad. Métodos: Se pretende valorar los niveles que alcanzan los criterios de CA establecidos en las guías clínicas de IC en pacientes seguidos de forma ambulatoria en la unidad de insuficiencia cardíaca (UIC) de nuestro hospital. Para lo cual, entre junio de 2003 y diciembre de 2004, se incluyeron en la base de datos de pacientes con IC (BADAPIC) 124 pacientes para su control, tratamiento y seguimiento. Resultados: La edad media fue de 70,9 años (el 85% eran mayores de 60 años y el 70%, varones). La etiología de la IC fue en el 50% hipertensión arterial, en el 49%, cardiopatía isquémica (CI), en el 18,5%, miocardiopatía dilatada, en el 25%, valvulopatías significativas. Se encontraban en fibrilación auricular (FA) el 25,8% y la distribución de la clase funcional de la NYHA era I en el 1,6%, II en el 34,6%, III en el 60,4% y IV en el 2,4%. Se evaluó la fracción de eyección ventricular izquierda mediante ecocardiografía en el 100% de los pacientes y la función diastólica en el 74%. Durante el seguimiento no se produjo ninguna muerte y sólo reingresó el 2,4%. Recibieron tratamiento con bloqueadores beta el 93%, con inhibidores de la enzima de conversión de la angiotensina el 65%, antagonistas de los receptores de la angiotensina el 40%, diuréticos el 94%, espironolactona el 78% y el 100% de los pacientes con FA fueron anticoagulados. Conclusiones: Aunque el volumen de paciente y el período analizado es corto, su seguimiento nos ha permitido establecer que los criterios de CA evaluados en los pacientes de nuestra UIC alcanzan niveles muy altos, y se pueden resumir en: bajo índice de reingresos; nula mortalidad, y alta utilización de los fármacos que mayor influencia tienen en el pronóstico de la IC

Background: Tools are available to evaluate the quality of the care provided to patients with heart failure (HF). These tools allow us to determine whether the quality of our healthcare reaches that recommended by the scientific evidence in clinical guidelines, such as indicators, criteria, and quality standards. Methods: We aimed to evaluate whether the quality of care received by outpatients attending the Heart Failure Unit in our hospital matched the quality criteria established in clinical guidelines for patients with HF. Between June 2003 and December 2004, 124 patients were included in the HF patient database for monitoring, treatment, and follow-up. Results: The mean age was 70.9 years (85% were aged more than 60 years old and 70% were men). HF was caused by hypertension in 50%, ischemic heart disease in 49%, idiopathic dilated cardiomyopathy in 18.5%, and significant valvular disease in 25%. A total of 25.8% were in atrial fibrillation. The distribution of NYHA functional class was class I in 1.6%, class II in 34.6%, class III in 60.4%, and class IV in 2.4%. Left ventricular ejection fraction was evaluated by echocardiography in all patients and diastolic function was evaluated in 74%. No deaths occurred during follow-up and only 2.4% of the patients were readmitted. Treatment consisted of beta-blockers in 93%, angiotensin-converting enzyme inhibitors in 65%, angiotensin II receptor antagonists in 40%, diuretics in 94%, and spironolactone in 78%. All patients with atrial fibrillation were anticoagulated. Conclusions: Although the volume of patients was small and the time period analyzed was short, follow-up of these patients has allowed us to establish that the quality criteria evaluated in patients attending our Heart Failure Unit achieved very high levels. This was reflected in: the low readmission rate, null mortality, and high use of drugs with the greatest influence on the prognosis of HF

[Apical hypertrophic cardiomyopathy without aneurysm. Diagnosis trough myocardial gammagraphy and magnetic resonance]. / Miocardiopatía hipertrófica apical sin aneurisma apical: diagnóstico por gammagrafía miocárdica y resonancia magnética.

We present three patients with apical hypertrophic cardiomyopathy, their diagnosis was performed by means of imaging techniques to determine morphology, severity, configuration, complications, and distribution of the ventricular hypertrophy. Through color-flow and pulsed Doppler, the protosystolic flow in the midventricular region was detected, which we believe corresponds to the obstruction due to coarctation of the walls during early ventricular systole and that this gradient is independent from the one identified as paradoxical in patients with apical aneurysm. Explorations by means of magnetic resonance and Gated-Spect myocardial gammagraphy revealed the apical location of the hypertrophy confirming the "spadelike" configuration of the left ventricle and the absence of apical aneurysm.