Clinical Characteristics, Management, and In-Hospital Mortality in Patients with Heart Failure with Reduced Ejection Fraction According to Sex and the Presence of Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a risk factor for the development of heart failure with reduced ejection fraction (HFrEF). AIMS: (1) To describe and compare the clinical characteristics and the use of diagnostic and therapeutic procedures among subjects hospitalized with HFrEF according to the presence of type 2 diabetes mellitus (T2DM) and sex; (2) to assess the effect of T2DM and sex on hospital outcomes among the patients hospitalized with HFrEF using propensity score matching (PSM); and (3) to identify which clinical variables were associated to in-hospital mortality (IHM) among the patients hospitalized with HFrEF and T2DM according to their sex. METHODS: A retrospective cohort study from 2016 to 2019 using the Spanish National Hospital Discharge Database was conducted. The diagnosis and procedures were codified with the International Classification of Disease 10th version (ICD10). Subjects aged ≥ 40 with a primary diagnosis of HFrEF were included. We included those patients with a diagnosis of T2DM in any diagnosis position. The descriptive statistics used were total and relative frequencies (percentages), means with standard deviations, and medians with an interquartile range. To control the effect of confounding variables when T2DM patients and non-T2DM patients were compared, we matched the cohorts using PSM. Multivariable logistic regression models were used to identify which study variables independently affected the IHM among men and women with HF and T2DM. Also, this multivariable method was applied for sensitivity analyses to confirm the results of the PSM. RESULTS: A total of 28,894 patients were included. T2DM was present in 39.59%. Women with T2DM more frequently had atrial fibrillation, valvular heart disease, anemia, dementia, depression, and hyponatremia than men with T2DM. However, men had more coronary heart disease, chronic renal disease, COPD, and obstructive sleep apnea. All the procedures were significantly more commonly used among men than women. Blood transfusion was the only procedure more frequently identified among women with T2DM. For the sensitivity analysis in patients with T2DM hospitalized with HFrEF, we confirmed the results of the PSM, finding that women had a 14% higher risk of dying in the hospital than men (OR 1.14; 95% CI 1.01-1.35). Obesity seemed to have a protective effect (OR 0.85; 95% CI 0.73-0.98) on the in-hospital morality. CONCLUSIONS: Subjects with diabetes are admitted for HFrEF and have a greater number of comorbidities than non-diabetics. Diabetic women have a higher mortality rate than men with diabetes and all the procedures evaluated were significantly more often used among men than women.

Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure.

Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/- 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/- 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508-0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results.

Sex Differences in the Incidence and Outcomes of COPD Patients Hospitalized with Ischemic Stroke in Spain: A Population-Based Observational Study.

Purpose: To compare the incidence, clinical characteristics and outcomes of patients admitted with ischemic stroke (IS) according to the presence of COPD and sex in Spain (2016-2018). Patients and Methods: We selected all admissions with IS (≥35 years) included in the Spanish National Hospital Discharge Database. We matched each patient suffering COPD with a non-COPD patient with identical age, sex, IS type and year of hospitalization. Results: IS was coded in 92,524 men and 79,731 women (8.67% with COPD). The incidence of IS was higher in COPD men than in non-COPD men (IRR 1.04; 95% CI 1.03-1.06), although the differences were not significant among women. COPD men had twice higher incidence of IS than COPD women (IRR 2.00; 95% CI 1.93-2.07). After matching, COPD men had a higher in-hospital mortality (IHM) than non-COPD men (11.48% vs 9.80%; p<0.001), and the same happened among women (14.09% vs 11.96%; p=0.002). COPD men received thrombolytic therapy less frequently than non-COPD men. For men and women, the risk of dying in the hospital increased with age, some comorbidities and mechanical ventilation use. After multivariable adjustment, COPD increased the risk of IHM in men (OR 1.16; 95% CI 1.06-1.28) and women (OR 1.12; 95% CI 1.01-1.27). Finally, among COPD patients, being women increased the risk of dying during the hospitalization with IS by 15% (OR 1.15; 95% CI 1.03-1.28). Conclusion: Incidence of IS was higher in COPD patients, although the difference was only significant for men. COPD was associated with an increased risk of IHM. Among COPD patients, women had higher IHM.

Trends and Clinical Impact of Gastrointestinal Endoscopic Procedures on Acute Heart Failure in Spain (2002-2017).

INTRODUCTION: Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions. OBJECTIVES: The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy. METHODS: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy. RESULTS: A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04-1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41-0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55-0.64). CONCLUSION: In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitalized HF population seen over the course of the study could have contributed to this. Both procedures seemed to be associated with lower in-hospital mortality, but in the case of colonoscopy, the risk of in-hospital mortality was higher in elderly patients with heart failure and associated neoplasms. Colonoscopy and EGD seemed not to increase IHM in patients with heart failure.

Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016-2018).

We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016-2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29-1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96-2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75-3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03-1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01-1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men.

The Influence of Sex on Clinical Outcomes after Surgical Mitral Valve Replacement in Spain (2001-2015).

(1) Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries. Mitral valve (MV) disease is a common cause of heart failure and a leading cause of morbidity and mortality in the U.S.A. and Europe. (2) Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients that had surgical mitral valve replacement (SMVR) listed as a procedure in their discharge report. We sought to (i) examine trends in incidence of SMVR among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic). The incidence of SMVR was higher in women (IRR 1.51; 95% CI 1.48-1.54). The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes. Men who underwent mechanical and bioprosthetic SMVR had higher comorbidity than women. IHM was significantly lower in women who underwent SMVR than in men (10% vs. 12% p < 0.001 for mechanical and 14% vs. 16% p = 0.025 for bioprosthetic valve, respectively). Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly lower in women who underwent mechanical and bioprosthetic SMVR. A significant reduction in both in-hospital MACCEs and IHM was observed over the study period regardless of sex. After multivariable logistic regression, male sex was associated with increased IHM only in bioprosthetic SMVR (OR 1.28; 95% CI 1.1-1.5). (4) Conclusions: This nationwide analysis over 15 years of sex-specific outcomes after SMVR showed that incidences are significantly higher in women than men for mechanical and bioprosthetic SMVR. IHM and MACCE have improved over time for SMVR in both sexes. Male sex was independently associated with higher mortality after bioprosthetic SMVR.

National trends and outcomes of hospitalizations for pulmonary hypertension in Spain (2001-2014).

OBJECTIVE: To assess changes in incidence, diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), costs, and in-hospital mortality (IHM) for patients hospitalized with pulmonary hypertension (PH). METHODS: We included patients hospitalized with PH in Spain from 2001 to 2014. The data were collected from the National Hospital Discharge Database. RESULTS: We included 644,436 discharges (43.31% males and 56.09% females) admitted for primary PH (8.34%) or secondary PH (91.66%). The crude incidence rate increased from 58.67 to 148.32 hospitalizations per 100,000 inhabitants between 2001 and 2002 and 2013-2014 (p < 0.001). The percentage of patients with a Charlson comorbidity index ≥2 was 27.87% in 2001-2002, increasing to 47.02% in 2013-2014 (p < 0.001). IHM was 8.77%, with a reduction in the value yielded by the multivariable analysis between 2009 and 2010 and 2013-2014. Median LOHS was 9 ±â€¯9 days in 2001-2002, which decreased to 7 ±â€¯8 days in 2013-2014 (p < 0.001). The mean cost per patient increased from €3352.4 ±â€¯€1495 in the period 2001-2002 to €4198.94 ±â€¯€1287.96 in 2013-2014 (p < 0.001). CONCLUSIONS: Despite the increase over time in hospital admissions for PH, associated comorbidity, and costs, LOHS and IHM decreased, suggesting that the management of PH-related hospitalizations improved in Spain during the study period.

Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015.

BACKGROUND: To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. METHODS: We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. RESULTS: We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p < 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). CONCLUSIONS: The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD.

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014-2015).

BACKGROUND: Type 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures. METHODS: We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS). RESULTS: We identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37-0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR). CONCLUSIONS: T2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.

Hyponatremia in hospitalised patients with heart failure in internal medicine: Analysis of the Spanish national minimum basic data set (MBDS) (2005-2011).

OBJECTIVE: Hyponatremia is the most common electrolyte disorder seen in clinical practice. Numerous studies have reported increased inhospital mortality associated to this condition, which is also an independent predictor of comorbidity in patients admitted with heart failure (HF). The objective of this study is to assess the incidence, average length of stay, associated comorbidities, readmissions and mortality caused by hyponatremia in admissions for acute heart failure from the Spanish national minimum basic data set (MBDS). MATERIALS AND METHODS: Data from the Spanish national minimum basic data set (MBDS) of discharged patients who were initially diagnosed with heart failure (HF) from all internal medicine (IM) departments of Spanish National Health System (SNS) hospitals between 2005 and 2011 were analysed (ICD-9: 428; DRGs 127 and 544). A descriptive data analysis was conducted comparing the diagnosis codes and administrative variables of heart failure patients with and without hyponatremia. The chi-square test was used for qualitative variables and the Student's t test for quantitative variables. A bivariate analysis was used to detect statistical differences in the mortality of both groups, as well as mean age, Charlson index, average length of stay and readmissions. A multivariate logistic regression analysis was performed, taking intrahospital mortality and hospital readmissions as dependent variables, and age, gender, comorbidity according to the Charlson index and hyponatremia as independent variables. RESULTS: A total of 504,860 patients with acute heart failure were identified, of whom 11,095 (2.2%) presented with HNa. A gradual year-on-year increase of hyponatremia codification (both primary and secondary diagnosis) was observed at discharge throughout the study period (from 1.6% in 2005 to 2.8% in 2011; p<0.0001). Overall mortality due to any cause in patients with hyponatremia was 17% (1937 patients) versus 11% in non-hyponatremic patients (53,820 patients). The probability of readmission for patients with hyponatremia was 22% versus 17% in the non-hyponatremic group. Hyponatremia was associated to a higher rate of mortality during hospitalisation for acute heart failure with an odds ratio (OR) of 1.58, 95% CI, 1.50-1.66 (p<0.05). Hyponatremia maintained statistical significance in the regression model after adjusting for gender, OR 0.919 (95% CI 0.902-0.936); age, OR 1.061 (95% CI 1.060-1.062); and Charlson index, OR 1.388 (95% CI 1.361-1.461). CONCLUSIONS: Hyponatremia is associated to an increased rate of mortality and readmission in patients admitted for acute heart failure in SNS hospitals. Our study identified a statistically significant association between hyponatremia and increased intrahospital mortality independent of age, gender and the Charlson comorbidity index. During the defined follow-up period the discharge reports showed an increased codification of hyponatremia.

National trends in incidence and outcomes of acute pancreatitis among type 2 diabetics and non-diabetics in Spain (2001-2011).

BACKGROUND: Diabetes is often observed in patients with acute pancreatitis (AP). Our aim was to compare trends in the clinical epidemiology and outcomes of AP in diabetic and non-diabetic patients in Spain. METHODS: We conducted a retrospective observational study. We identified all patients who had a diagnosis of AP using national hospital discharge data (2001-2011). The incidence of discharges of patients with AP was calculated, stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We applied joinpoint log-linear regression to identify the years in which changes in tendency occurred in the diagnosis of AP. The multivariate analysis was adjusted for age, sex, year and Charlson comorbidity index (CCI). RESULTS: The total number of subjects who had a diagnosis of AP was 282,349. Of them, 42,009 (14.9%) had type 2 diabetes. The annual percentage of change in the incidence of AP for the whole period was 4.90% for those suffering from type 2 diabetes and almost null (0.1%) for those without this disease. Among hospitalized patients with type 2 diabetes and acute pancreatitis, those with a CCI equal to or greater than three had 5.53 times more probability of dying in the hospital than those with a CCI of zero. The corresponding OR for the non-diabetic group was 6.50 (95%CI 6.15-6.87). Suffering from type 2 diabetes was significantly associated with a lower risk of dying in the hospital with a diagnosis of AP (OR 0.82; 95% CI 0.78-0.86). CONCLUSIONS: In Spain, time trend analyses suggest that the incidence of AP is increasing more among those with prevalent type 2 diabetes than among those without this disease. Type 2 diabetes was associated with a lower risk of dying in hospital with AP.