Programa de consulta electrónica universal (e-consulta) de un servicio de cardiología. Resultados a largo plazo / Universal electronic consultation (e-consultation) program of a cardiology service. Long-term results

Introducción y objetivos: Muchos sistemas sanitarios han iniciado programas de consulta electrónica, aunque poco se conoce de su impacto en acceso, seguridad y satisfacción. El objetivo de este estudio es evaluar el impacto clínico de la puesta en marcha de un modelo de atención ambulatoria que incluye una consulta electrónica (e-consulta) inicial comparándolo con un modelo presencial de acto único. Métodos: Se seleccionó a pacientes con al menos 1 consulta al servicio de cardiología entre 2010 y 2019. Mediante un modelo de regresión de series temporales interrumpidas, se analizó el impacto de la incorporación de la e-consulta en el modelo asistencial (iniciado en 2013), evaluando: tiempo de espera de la atención, asistencias a urgencias, ingresos hospitalarios y mortalidad. Resultados: Se analizó a 47.377 pacientes: el 61,9% de ellos atendidos incorporando la e-consulta y el 38,1% en el modelo de consulta presencial de acto único. La mediana [intervalo intercuartílico] de la demora a la atención en el modelo de e-consulta, 7 [5-13] días, fue menor que en el modelo presencial: 33 [14-81] días (p<0,001). El modelo de regresión para series temporales interrumpidas mostró que la incorporación de la e-consulta aporta una disminución muy importante en la demora de la atención, que se mantiene en torno a los 9 días, aunque con ligeras oscilaciones. Los pacientes valorados vía e-consulta tuvieron menos ingresos hospitalarios (el 0,9 frente al 1,2%; p=0,0017) y mortalidad (el 2,5 frente al 3,9%; p<0,001). Conclusiones: Un programa de atención ambulatoria que incluye una e-consulta ha mostrado importantes reducciones en los tiempos de espera y es un modelo seguro, con menores tasas de ingresos hospitalarios y mortalidad en el primer año (AU)

Introduction and objectives: Many health systems have initiated electronic consultation (e-consultation) programs, although little is known about their impact on accessibility, safety, and satisfaction. The aim of this study was to assess the clinical impact of the implementation of an outpatient care model that includes an initial e-consultation and to compare it with a one-time face-to-face consultation model. Methods: We selected patients who visited the cardiology service at least once between 2010 and 2019. Using an interrupted time series regression model, we analyzed the impact of incorporating e-consultation into the health care model (started in 2013), and evaluated waiting times, emergency services, hospital admissions, and mortality. Results: We analyzed 47 377 patients: 61.9% were attended in e-consultation and 38.1% in one-time face-to-face consultations. The waiting time for care was shorter in the e-consultation model (median [IQR]: 7 [5-13] days) than in the face-to-face model (median [IQR]: 33 [14-81] days), P<.001. The interrupted time series regression model showed that the introduction of e-consultation substantially decreased waiting times, which held steady at around 9 days, although with slight oscillations. Patients evaluated via e-consultation had fewer hospital admissions (0.9% vs 1.2%, P=.0017) and lower mortality (2.5% vs 3.9%, P<.001). Conclusions: An outpatient care program that includes an e-consultation reduced waiting times significantly and was safe, with a lower rate of hospital admissions and mortality in the first year (AU)

[A paradoxical intraventricular gradient in a patient with atypical hypertrophic myocardiopathy]. / Gradiente intraventricular paradójico en un paciente con miocardiopatía hipertrófica apical.

A paradoxic diastolic intraventricular flow (directed from apex to base), caused by a pressure gradient between a small apical aneurysm and the main left ventricular cavity, connected by a narrow muscular tunnel, was detected by Doppler echocardiography in a 69 year old male with apical hypertrophic cardiomyopathy and effort angina. Coronary arteriography was normal and the clinical, electrocardiographic, echocardiographic and angiocardiographic features of the patient were otherwise typical of apical hypertrophic cardiomyopathy. Paradoxic diastolic gradients have been occasionally described in patients with hypertrophic cardiomyopathy, and indicate the existence of a sequestered apical cavity, which is frequently not detected by echocardiography. Identification of these gradients may have important clinical implications, since they have been related with a higher incidence of embolic events, severe ventricular arrhythmias and myocardial ischaemia and necrosis.