Trends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data.

BACKGROUND: Reliable data are necessary if the burden of early readmissions following hospitalization for heart failure (HF) is to be addressed. We studied unplanned 30-day readmissions, their causes and timing over an 11-year period, using population-based linked data. METHODS: All hospitalizations from 2003 to 2013 were analyzed by using administrative linked data based on the Minimum Basic Set discharge registry of the Department of Health (Region of Murcia, Spain). Index hospitalizations with HF as principal diagnosis (n=27,581) were identified. Transfers between centers were merged into one discharge. Readmissions were defined as unplanned admissions to any hospital within 30-days after discharge. RESULTS: In the 2003-2013 period, 30-day readmission rates had a relative mean annual growth of +1.36%, increasing from 17.6% to 22.1%, with similar trends for cardiovascular and non-cardiovascular causes. The figure of 22.1% decreased to 19.8% when only same-hospital readmissions were considered. Most readmissions were due to cardiovascular causes (60%), HF being the most common single cause (34%). The timing of readmission shows an early peak on the fourth day post discharge (+13.29%) due to causes other than HF, followed by a gradual decline (-3.32%); readmission for HF decreased steadily from the first day (-2.22%). Readmission for HF (12.7%) or non-cardiovascular causes (13.3%) had higher in-hospital mortality rates than the index hospitalization (9.2%, p<0.001). Age and comorbidity burden were the main predictors of any readmission, but the performance of a predictive model was poor. CONCLUSION: These findings support the need for population-based strategies to reduce the burden of early-unplanned readmissions.

[Multicenter comparative study of synthetic salmon calcitonin administered nasally in the treatment of established postmenopausal osteoporosis]. / Estudio comparativo multicéntrico de la calcitonina sintética de salmón, administrada por vía nasal en el tratamiento de la osteoporosis postmenopáusica establecida.

We study the effectivity and tolerance of synthetic salmon calcitonin nasally administered (Miacalcic) in the treatment of established postmenopausic osteoporosis. During one year, two randomized groups of postmenopausic women diagnosed of osteoporosis were treated in an outpatient service either with 1 gr of calcium element per day during the whole study or with 100 daily I.U. of salmon synthetic calcitonin nasally administered in patterns of 14 days and the same period of rest, plus a supplement of 500 mgr of calcium element per day. Globally, 43 patients were assessed at the end of the study in the calcitonin plus calcium group and 45 in the group receiving only calcium. The main evaluation parameters were pain and presence of new fractures. At the beginning and at the end of the study, complementary tests of blood biochemistry were conducted, including alkalin phosphatase, calcium, phosphorus and uric acid, as well as calcium, hydroxiprolin and creatinini in the urine. The results showed a significant improvement of pain (p < 0.001) in the group treated with calcitonin, supported by a lower consumption of analgesics. The rate of vertebral fractures determined according to the Meunier's index, was also significantly lower (p < 0.001) in the group treated with calcitonin at the end of the study period. These results suggest that, compared to only calcium, nasally administered calcitonin precludes the formation of new vertebral fractures during one year of treatment and it is effective in terms of pain reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

[The study of zinc in osteonecrosis]. / Estudio del zinc en la osteonecrosis.

Plasmatic, urinary and intra-erythrocytic zinc levels did not modify in patients with head of femur aseptic osteonecrosis (HFAO), except for those patients with raised alkaline phosphatase who showed a diminution in zinc plasmatic levels, being found a negative correlation between plasmatic zinc levels and a raise in serum alkaline phosphatase. A raise on the latter would mean a raise on the osteoblastic activity in a repair intent from the bone of the small trabecular fractures and/or of the necrotic zone which is produced in HFAO. These results show the relationship of zinc with the increase on bone metabolic activity in patients with HFAO, but the scarce previous references force to study them in depth.

[Zinc and osteoporosis]. / Zinc y osteoporosis.

The relevant role of zinc in osteoporosis, its correlation with nutrient intake and the modifications of its urinary and serum levels, have been demonstrated. In this paper, we have studied the plasmatic, urinary and intraerythrocitary levels of zinc in a group of patients with extended primary osteoporosis, most of them women with postmenopausic osteoporosis. No significant differences were observed in zinc levels between osteoporotic patients and controls. We think that certain aspects regarding the correlation between zinc and bone mineral content still have to be defined, as well as zinc intake and osteoporosis.

[Clinical activity and serum immunoglobulin concentrations in patients with ankylosing spondylitis]. / Estudio de la actividad clínica y de las concentraciones séricas de inmunoglobulinas en pacientes con espondilitis anquilosante.

Several authors have suggested that immunoglobulin A plays a pathogenic role in ankylosing spondylitis. We have determined the levels of immunoglobulins in 30 patients, observing higher levels than in control patients (248 vs 176 mg/dl); p less than 0.01) and a relation between the increase of immunoglobulin A and the presence of clinical activity in the subgroup of patients B27-negative (163 vs 398 mg/dl, p less than 0.005), but not in B27-positive patients. We think that these e results support the hypothesis that ankylosing spondylitis is an heterogeneous disease, with different pathogenic mechanisms depending on the presence or absence of the serological marker HLA-B27.

[Zinc in arthrosis and microcrystalline arthritis]. / Estudio del zinc en la artrosis y en las artritis microcristalinas.

Plasma, urine, intra-erythrocytes and salivary zinc levels are not modified in Generalized Primary Arthrosis. In patients with microcrystalline arthritis (Gout and Joint Chondrocalcinosis), zinc levels do not vary in the absence of disease activity. In patients suffering gout with clinical activity, the lowest plasma zinc levels are observed. Zinc concentrations in patients presenting Chondrocalcinosis, since they belong to groups C and D ("pseudoarthrosis"), were not modified, similarly to the group of patients with arthrosis. The mechanisms of action of zinc in relation to the pathogenesis of the microcrystals induced inflammation are analyzed.

[Lymphocyte subpopulations in rheumatoid arthritis patients, their relatives and spouses]. / Subpoblaciones linfocitarias en pacientes con artritis reumatoide, sus familiares y cónyuges.

A study of lymphocytic sub-populations of patients with rheumatoid arthritis, their families and partners, is presented. The determination was carried out by means of monoclonal antibodies, analysing: T cells sub-population (CD3, CD4, CD8 and quotient CD4/CD8); B cells sub-population (B1); activated cells (OK1a); monocytes and NK cells (OKM1 and BMA 070). The results showed an increase of CD3 sub-population (T total lymphocytes) in patients with RA and their families. The meaning of these results is difficult to evaluate as lymphocyte sub-population is affected by several variables. The lack of modification of suppressor population, CD4/CD8 quotient and IKM1 cells in RA patients is probably due to the moderate activity of the disease.

[HLA antigens in patients with rheumatoid arthritis, their relatives, and spouses]. / Estudio de los antígenos HLA en pacientes con artritis reumatoide, sus familiares y cónyuges.

The results of the comparison between phenotypic frequency of HLA antigen classes I and II in patients afflicted with rheumatoid arthritis (RA) and their relatives (study carried out in the east of Andalusian), showed a significant increase of HLA A24, B51, B44, CW1 ans CW5 class I antigen in the group of relatives. We found a statistically significant DR4 antigen class II increase in both, patients and relative groups. The marriage parther of patients with RA did not have variations in class I or II HLA antigens compared to the control group. We concluded that RA is probably related to the following antigens: A24, B51, B44, CW1, CW5 and DR4.

[Plasma and intraerythrocytic zinc in rheumatoid arthritis and ankylosing spondylitis]. / Cinc plasmático e intraeritrocitario en la artritis reumatoide y espondilitis anquilosante.

The levels of plasmatic and intraerythrocyte zinc in our control group did not show differences in accordance with age or sex. Patients affected by rheumatoid arthritis showed a decrease of plasmatic levels of zinc and an increase of intraerythrocyte zinc level. The patients with ankylosing spondylitis did not show significant variations of zinc levels, even though the patient with increased SR after the first hour (25 mm) showed lower plasmatic zinc with statistical significance. Finally, patients with rheumatoid arthritis in treatment with NSAID, low dose of steroids, gold salts, D-penicilamin, did not show differences compared to the total group of patients with this disease.