Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis.

Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.

Prevalence and incidence of Q-wave unrecognized myocardial infarction in general population: Diagnostic value of the electrocardiogram. The REGICOR study.

BACKGROUND: Diagnosis of unrecognized myocardial infarction (UMI) remains an open question in epidemiological and clinical studies, inhibiting effective secondary prevention of myocardial infarction. We aimed to determine the prevalence and incidence of Q-wave UMI in asymptomatic individuals aged 35 to 74years, and to ascertain the positive predictive value (PPV) of asymptomatic Q-wave to diagnose UMI. METHODS: Two population-based cross-sectional studies were conducted, in 2000 (with 10-year follow-up) and in 2005. A baseline electrocardiogram was obtained for each participant. Imaging techniques (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computerized tomography) were used to confirm UMI in patients with asymptomatic Q-wave. RESULTS: The prevalence of confirmed Q-wave UMI in the 5580 participants was 0.18% (95% confidence interval [CI]: 0.10-0.33) and the incidence rate was 27.1 Q-wave UMI per 100,000person-years. The proportion of confirmed Q-wave UMI with respect to all prevalent MI was 8.1% (95% CI: 4.4-14.2). The PPV of asymptomatic Q-wave to diagnose Q-wave UMI was 29.2% (95% CI: 18.2-43.2%) overall, but much higher (75%, 95% CI: 40.9-92.9%) in participants with 10-year CHD risk ≥10%, compared to lower-risk participants. CONCLUSION: Opportunistic identification of asymptomatic Q-waves by routine electrocardiogram overestimates actual Q-wave UMI, which represents 8% to 13% of all myocardial infarction in the population aged 35 to 74years. This overestimation is particularly high in the population at low cardiovascular risk. In epidemiological studies and in clinical practice, diagnosis of a pathologic Q-wave in asymptomatic patients requires detailed analysis of imaging tests to confirm or rule out myocardial necrosis.

[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001]. / Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001.

BACKGROUND: Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain. METHODS: An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province. RESULTS: Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40). CONCLUSIONS: Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.

Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001 / Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001

Fundamento: Muchos estudios proponen la mortalidad evitable(ME) como indicador para monitorizar los servicios de salud aunquesu generalización está limitada por el gran número de listas de causasutilizadas. El objetivo es analizar la evolución temporal del período1986-2001 y la distribución geográfica de la mortalidad evitable utilizandouna lista de causas consensuada.Métodos: Se analiza la mortalidad evitable global (ME) y agrupadaen causas ISAS (intervenciones de los servicios sanitarios) ycausas IPSI (políticas intersectoriales). Se analiza la evolución temporalajustando una recta de regresión de Poisson o un modelo deregresión de Joinpoint, según el caso, y se estima el porcentaje decambio anual (PCA). Para la distribución geográfica se calculan losíndices de mortalidad estandarizada (IME) por provincia y la razónde mortalidad comparativa (RMC) de cada provincia entre la primeray la segunda parte del periodo temporal.Resultados: Entre 1986-2001 la mortalidad evitable se redujo(PCA -1,68; IC:-1,99 a -1,38) algo más que la no-evitable (PCA -1,28; IC:-1,40 a -1,17). La mayor disminución se observó en la mortalidadpor causas ISAS (PCA del -2,77; IC: -2,89, -2,65) mientrasque la mortalidad por causas IPSI aumentó entre 1986-1990 (PCAdel 4,86; IC: 3,32 y 6,41), se mantiene constante de 1990-1995 (PCAdel -0,03; IC: -2,32 y 2,31) y disminuyó de 1995-2001 (PCA del -3,57; IC: -4,72 y -2,40). Conclusiones: Durante el período estudiado la mortalidad evitableha tenido una reducción mayor que la no evitable y se observandiferencias importantes entre provincias que sería necesario monitorizarpara tratar de identificar posibles disfunciones en los serviciossanitarios. La mortalidad es superior por causas ISAS en la zona surde España y por causas IPSI en algunas provincias costeras y estepatrón no varió mucho en el período analizado

Background: Many studies have proposed Avoidable Mortality(ME) to monitor the performance of health services although itsusefulness is limited by the multiplicity of the avoidable mortalitylists being used. Time trends from 1986-2001 and the geographicaldistribution of avoidable mortality by provinces, are presented forSpain.Methods: An Avoidable Mortality consensus list is being used.It includes avoidable mortality through the intervention of healthservices (ISAS in Spanish) and through health policy interventions(IPSI in Spanish). Time trends are analyzed adjusting Poisson orJoinpoint regression models and the annual percentages of change(APC) are estimated. Changes in geographical distribution betweenthe first half of the analysed period and the second are tested bymeans of standard mortality ratios (SMR) and comparative mortalityrates (CMR) for each province.Results: Between 1986 and 2001 avoidable mortality decreased(APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidablemortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction wasobserved for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) andan irregular trend for IPSI (between 1986-1990 increase APC: 4.86;CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72and -2.40). Conclusions: Avoidable mortality decreased more than nonavoidable mortality and important geographical variability can beobserved among provinces which should be monitored in order toidentify the health services weaknesses. The higher ISAS mortalitywas observed in southern provinces and the higher IPSI mortality insome areas on the coast. The pattern is somewhat similar for bothanalyzed periods

Acute myocardial infarction population incidence and in-hospital management factors associated to 28-day case-fatality in the 65 year and older.

BACKGROUND AND OBJECTIVES: The myocardial infarction (MI) incidence rate, prognosis and hospitalisation rate in the population 65 and over are rarely studied. We sought to determine MI hospitalisation and incidence rates, and 28-day case-fatality, in the 65 year and older population, and to analyse whether their management and prognosis differed from that of younger patients. METHODS: All residents in Gerona (Spain) older than 24 years with suspected fatal or non-fatal MI were investigated and included in a population registry. RESULTS: MI mortality, incidence, and case-fatality dramatically increased with age after 64. Smoking, thrombolysis, antiplatelet and betablocker drug use, coronary angiograms, and coronary revascularisation decreased with age. The risk of death of patients between 75 and 84 years (OR: 4.15, 95% confidence interval, CI: 1.70-10.15) and between 85 and 94 years (OR: 4.68, 95% CI: 1.62-13.52) was higher than in the 34-64 years age group, independently of any patient characteristic. CONCLUSIONS: The magnitude of the impact of MI in the elderly at population and hospital levels is substantially higher than in those younger than 65 years of age. After this age patients receive less treatments and procedures than their younger counterparts.