Temporal trends on the prevalence of renal disease and outcomes among patients with diabetes mellitus hospitalized by heart failure: findings from INCAex.

BACKGROUND: To assess 20-year time trends in the prevalence of diabetes mellitus (DM) among inpatients with heart failure (HF) and the influence of coexisting DM and kidney disease (KD) on outcomes. RESEARCH DESIGN AND METHODS: A retrospective study of patients was admitted due to HF, during the period 2000/2019. The period of follow-up was divided into three intervals according to the European Medical Agency approval of newer hypoglycemic drugs. We analyzed in-hospital mortality and outcomes during the follow-up period. RESULTS: A total of 4959 patients were included. Over time, prevalence of DM was significantly raising among women with HF (50 to 53.2%) and descending among men (50% to 46.8%, p = 0.02). Total mortality and readmissions were higher in patients with DM during the and second periods. However, no significant differences were found in the third-one (HR 1.14, 95% CI 0.94-1.39, p = 0.181). A protector role of oral hypoglycemic medications was observed in this last period. According to the presence of KD, the patients with both DM and KD were who presented most of the events. CONCLUSIONS: Over the time analyzed, the prevalence of DM raised among women and decreased among men. DM influenced the prognosis of HF except in the third period when more protective hypoglycemic drugs started to be used.

Analysis and prediction of readmissions for heart failure in the first year after discharge with INCA score.

To determine the readmissions trends and the comorbidities of patients with heart failure that most influence hospital readmission rates. Heart failure (HF) is one of the most prevalent health problems as it causes loss of quality of life and increased health-care costs. Its prevalence increases with age and is a major cause of re-hospitalisation within 30 days after discharge. INCA study had observational and ambispective design, including 4,959 patients from 2000 to 2019, with main diagnosis of HF in Extremadura (Spain). The variables examined were collected from discharge reports. To develop the readmission index, capable of discriminating the population with higher probability of re-hospitalisation, a Competing-risk model was generated. Readmission rate have increased over the period under investigation. The main predictors of readmission were: age, diabetes mellitus, presence of neoplasia, HF without previous hospitalisation, atrial fibrillation, anaemia, previous myocardial infarction, obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). These variables were assigned values with balanced weights, our INCA index showed that the population with values greater than 2 for men and women were more likely to be re-admitted. Previous HF without hospital admission, CKD, and COPD appear to have the greatest effect on readmission. Our index allowed us to identify patients with different risks of readmission.

La investigación en los servicios públicos de salud y su reconocimiento en las carreras profesionales de las comunidades autónomas en España / Research in public health services and its recognition in the professional careers in the regions of Spain

Objetivo: La investigación es una actividad accesoria para la mayoría de los profesionales sanitarios del Sistema Nacional de Salud. Una forma de reconocimiento de su valor es mediante las carreras profesionales. Fue nuestro objetivo comparar la valoración de la actividad investigadora entre las carreras profesionales de los servicios de salud de las distintas comunidades autónomas. Diseño: Revisión de los acuerdos, resoluciones y decretos que definen las carreras profesionales de cada comunidad recogidas de las webs corporativas de los servicios de salud y consejerías de sanidad. Sitio: Comisión de investigación e innovación en salud del Servicio Extremeño de Salud. Participantes: Miembros de la citada comisión. Métodos: Se realizó una comparación atendiendo si la actividad investigadora se valora de forma aislada de otros conceptos, si se considera para avanzar en distintos niveles, si para alguno es requisito y el porcentaje de puntuación asignada al bloque al que pertenece. Resultados: Casi todas las comunidades autónomas consideran la investigación como mérito en todos los niveles de carrera. La puntuación asignada al bloque que incorpora la investigación se sitúa entre 4 y 50%. Solo se considera de forma independiente en Canarias, Castilla-La Mancha, Castilla-León, Cataluña, Madrid y Murcia. Son requisito para subir de determinado nivel en Canarias y Castilla-León. Conclusiones: Existe una alta variabilidad en el reconocimiento de la actividad investigadora entre comunidades. Las carreras que mejor valoran la investigación serían las de Canarias y Castilla-León, que la consideran como actividad independiente y llega a ser un requisito. Con enfoques más negativos están aquellas en las que se pueden ascender, hasta el nivel más alto, sin realizar ninguna aportación en investigación.(AU)

Objective: Health research is an accessory activity for most health professionals in the national health service of Spain. One way to recognize your worth is through professional careers. The objective of this paper has been to compare how research activity is valued in the professional careers of the health services of the different regions of Spain. Design: Review of agreements, resolutions and decrees that define the professional careers of each community collected from the corporate websites of health services and health ministries. Site: Health Research and Innovation Commission of the Extremadura Health Service. Participants: Members of said commission. Methods: The following was considered for comparison: if the research activity is valued in isolation from other concepts, if it is considered to advance in different levels, if it is a requirement for any of them, and the percentage of score assigned to the block to which it belongs. Results: Almost all the regions consider research as merit at all career levels. The score of the research block is between 4 and 50% of overall. They are only considered independently, of others activities, in the Canary Islands, Castilla-La Mancha, Castilla-León, Cataluña, Madrid and Murcia. They are required to climb a certain level in the Canary Islands and Castilla-León. Conclusions: There is a high variability in the recognition of research activity between regions. The careers that best value research would be those of the Canary Islands and Castilla-León, which consider it an independent activity and it becomes a requirement. The regions that have a more negative approach are those that can be promoted to the highest level, without making any contribution to research.(AU)

Functionalization of Poly(styrene-co-methyl methacrylate) Particles for Selective Removal of Bilirubin.

Hyperbilirubinemia is one of the main causes of death in patients with severe hepatic problems, which justifies the research for bilirubin removal solutions. In this study, St-MMA particles with PEGMA and/or GMA brushes were synthesized. First, the recipe for St-MMA was optimized and then adapted for PEGMA and GMA incorporation. Different solvents were then assayed to improve the BSA immobilization capacity of the particles. Ethyl lactate proved to be the best solvent, reaching a BSA immobilization capacity improvement of up to 60% for St-MMA-GMA-PEGMA particles. These particles also presented the best results for BR removal from PBS. No significant differences in the final capacity for BR removal from PBS media were observed when BSA was attached to the particles; however, the kinetics were greatly improved, requiring half the time. Finally, St-MMA-GMA-PEGMA particles that were wetted in EL with BSA reduced the bilirubin concentration in plasma from levels that threaten the survival of critical patients to levels close to those of healthy individuals in less than 30 min. On the contrary, particles without BSA were unable to remove bilirubin from plasma. Thus, the attachment of albumin to the particles plays a key role in selectively reducing bilirubin levels.

[Research in public health services and its recognition in the professional careers in the regions of Spain]. / La investigación en los servicios públicos de salud y su reconocimiento en las carreras profesionales de las comunidades autónomas en España.

OBJECTIVE: Health research is an accessory activity for most health professionals in the national health service of Spain. One way to recognize your worth is through professional careers. The objective of this paper has been to compare how research activity is valued in the professional careers of the health services of the different regions of Spain. DESIGN: Review of agreements, resolutions and decrees that define the professional careers of each community collected from the corporate websites of health services and health ministries. SITE: Health Research and Innovation Commission of the Extremadura Health Service. PARTICIPANTS: Members of said commission. METHODS: The following was considered for comparison: if the research activity is valued in isolation from other concepts, if it is considered to advance in different levels, if it is a requirement for any of them, and the percentage of score assigned to the block to which it belongs. RESULTS: Almost all the regions consider research as merit at all career levels. The score of the research block is between 4 and 50% of overall. They are only considered independently, of others activities, in the Canary Islands, Castilla-La Mancha, Castilla-León, Cataluña, Madrid and Murcia. They are required to climb a certain level in the Canary Islands and Castilla-León. CONCLUSIONS: There is a high variability in the recognition of research activity between regions. The careers that best value research would be those of the Canary Islands and Castilla-León, which consider it an independent activity and it becomes a requirement. The regions that have a more negative approach are those that can be promoted to the highest level, without making any contribution to research.

Evolución del perfil clínico y pronóstico de pacientes con alta hospitalaria por insuficiencia cardíaca en las dos primeras décadas del sigloxxi. El Registro INCA-Ex / Clinical and prognostic profile evolution of patients discharged from hospital due to heart failure in the first two decades of the 21st century. The INCA-Ex Registry

Objetivo: Estudiar la evolución del perfil clínico de una población dada de alta con diagnóstico principal de insuficiencia cardíaca (IC) en las dos primeras décadas del siglo y las variables predictoras de mortalidad y reingreso en el primer año de alta. Diseño: Estudio observacional, retrospectivo, longitudinal. Emplazamiento: Área de salud Don Benito-Villanueva de la Serena, Badajoz, España. Participantes: Todos los pacientes dados de alta con diagnóstico principal de IC entre 2000 y 2019 en un complejo hospitalario general.Mediciones principalesSe recogieron variables sociodemográficas y clínicas, y se realizó un seguimiento de un año; la variable resultado fue un compuesto de mortalidad y/o reingreso. Resultados: Se incluyeron 4.107 altas, edad media 77,1 (DE 10,5) años, 53,1% de mujeres. El número de ingresos, la edad, los antecedentes de neoplasias, los ictus, la insuficiencia renal y la anemia fueron en aumento, así como los reingresos (p de tendencias <0,001), mientras permaneció constante la mortalidad. Fueron variables predictoras de reingreso y/o muerte HR (IC95%): edad (por año) 1,04 (1,03-1,04), diabetes: 1,11 (1,01-1,24), IC previa 1,41 (1,28-1,57), variable compuesta infarto, ictus y/o arteriopatía periférica 1,24 (1,11-1,38), enfermedad pulmonar obstructiva crónica (EPOC) 1,29 (1,15-1,44), neoplasia 1,33 (1,16-1,53), anemia 1,63 (1,41-1,86), insuficiencia renal 1,42 (1,26-1,60). Conclusiones: En los últimos 20años se han incrementado los ingresos de pacientes por IC, su edad y la comorbilidad. Fueron variables predictoras de mortalidad y/o reingreso la edad, la diabetes, la enfermedad cardiovascular previa, las neoplasias, la EPOC, la insuficiencia renal y la anemia; sin embargo, la mortalidad al año se mantuvo constante.(AU)

Aim: To study the evolution of the clinical profile of a population discharged with a main diagnosis of heart failure (HF) in the first two decades of the century and the predictive variables of mortality and readmission in the first year of discharge. Design: Observational, retrospective, longitudinal study. Site: Don Benito Villanueva de la Serena Badajoz health area. Participants: All patients discharged with a main diagnosis of HF between 2000 and 2019 in a general hospital complex were included. Main measurements: Sociodemographic and clinical variables were collected, and a one-year follow-up; the result variable was a composite of mortality and/or readmission. Results: A total of 4107 discharges were included, mean age 77.1 (SD±10.5) years, 53.1% women. The number of admissions, age, history of neoplasms, stroke, kidney failure, and anemia increased, as did readmissions (P for trends <.001), while mortality remained constant. Predictive variables for readmission and/or death were HR (95%CI): age (per year) 1.04 (1.03-1.04), diabetes: 1.11 (1.01-1.24), previous HF 1.41 (1.28-1.57), composite variable myocardial infarction, stroke and/or peripheral artery disease 1.24 (1.11-1.38), chronic obstructive pulmonary disease (COPD) 1.29 (1.15-1.44), neoplasia 1.33 (1.16-1.53), anemia 1.63 (1.41-1.86), chronic kidney failure 1.42 (1.26-1.60). Conclusions: In the last 20 years, admissions for heart failure, patient age, and comorbidity have increased. Predictive variables for mortality and/or readmission were age, diabetes, previous cardiovascular disease, neoplasms, COPD, kidney failure, and anemia; however, mortality at one year remained constant.(AU)

[Clinical and prognostic profile evolution of patients discharged from hospital due to heart failure in the first two decades of the 21st century. The INCA-Ex Registry]. / Evolución del perfil clínico y pronóstico de pacientes con alta hospitalaria por insuficiencia cardíaca en las dos primeras décadas del sigloxxi. El Registro INCA-Ex.

AIM: To study the evolution of the clinical profile of a population discharged with a main diagnosis of heart failure (HF) in the first two decades of the century and the predictive variables of mortality and readmission in the first year of discharge. DESIGN: Observational, retrospective, longitudinal study. SITE: Don Benito Villanueva de la Serena Badajoz health area. PARTICIPANTS: All patients discharged with a main diagnosis of HF between 2000 and 2019 in a general hospital complex were included. MAIN MEASUREMENTS: Sociodemographic and clinical variables were collected, and a one-year follow-up; the result variable was a composite of mortality and/or readmission. RESULTS: A total of 4107 discharges were included, mean age 77.1 (SD±10.5) years, 53.1% women. The number of admissions, age, history of neoplasms, stroke, kidney failure, and anemia increased, as did readmissions (P for trends <.001), while mortality remained constant. Predictive variables for readmission and/or death were HR (95%CI): age (per year) 1.04 (1.03-1.04), diabetes: 1.11 (1.01-1.24), previous HF 1.41 (1.28-1.57), composite variable myocardial infarction, stroke and/or peripheral artery disease 1.24 (1.11-1.38), chronic obstructive pulmonary disease (COPD) 1.29 (1.15-1.44), neoplasia 1.33 (1.16-1.53), anemia 1.63 (1.41-1.86), chronic kidney failure 1.42 (1.26-1.60). CONCLUSIONS: In the last 20 years, admissions for heart failure, patient age, and comorbidity have increased. Predictive variables for mortality and/or readmission were age, diabetes, previous cardiovascular disease, neoplasms, COPD, kidney failure, and anemia; however, mortality at one year remained constant.

Assessment of the Cost of the Mediterranean Diet in a Low-Income Region: Adherence and Relationship with Available Incomes.

BACKGROUND: The Mediterranean Diet (MD) is recognized as heart-healthy, but the economic cost associated with this type of diet has scarcely been studied. The objective of the present study is to explore the cost and adherence of a low-income region population to the MD and its relationship with income. METHODS: A population-based study was carried out on 2,833 subjects between 25 and 79 years of age, 54% women, selected at random from the municipalities of Vegas Altas, La Siberia and La Serena in the province of Badajoz, Extremadura (Spain). Average monthly cost of each product included in the MD was computed and related to adherence to the MD using the Panagiotakos Index and average disposable income. RESULTS: The monthly median cost was 203.6€ (IQR: 154.04-265.37). Food-related expenditure was higher for men (p<0.001), age cohort between 45 and 54 years (p<0.013) and those living in urban areas (p<0.001). A positive correlation between food-related expenditure and the MD adherence was found. Monthly median cost represents 15% of average disposable income, ranging between 11% for the group with low MD adherence and 17% for the group with high MD adherence. CONCLUSIONS: The monthly cost of the MD was positively correlated with the degree of adherence to this dietary pattern. Given that the estimated monthly cost is similar to that of other Spanish regions with a higher income level, the economic effort required to be able to afford the Mediterranean diet is higher. This may represent a barrier to access, which should be analyzed in detail by public decision-makers.

Efecto de la enfermedad renal crónica sobre la incidencia de episodios cardiovasculares en población española / Study of the effect of chronic kidney disease on the incidence of cardiovascular events in a native Spanish population

Objetivos: Evaluar prospectivamente la correlación entre enfermedad renal crónica y el riesgo cardiovascular medido por la aparición de episodios cardiovasculares en la población española.Diseño y métodosLa muestra incluyó 2.668 personas con una edad media de 50,6±14,5 años, siendo el 54,6% mujeres. En total, el 3,5% de los sujetos tenían una tasa de filtrado glomerular (TFG)<60ml/min y el 4,3% una albuminuria>30mg/g. La TFG fue estimada a partir de la creatinina usando la ecuación CKD-EPI. La excreción urinaria de albúmina fue medida como mg/g de creatinina en una muestra de orina de primera hora de la mañana. Se estudió mediante análisis de regresión de Cox la asociación entre TFG y excreción urinaria de albúmina con la morbimortalidad cardiovascular. La mediana de seguimiento fue de 81 (75-89) meses.ResultadosLa hazard ratio (HR) para episodios cardiovasculares fue de 1,36 (IC 95% 0,97-1,91) (p=0,079) para pacientes con TFG disminuida y la HR para mortalidad cardiovascular fue de 1,62 (IC 95% 0,53-4,91) (p=0,396). Por otra parte, una excreción urinaria de albúmina elevada se asociaba a un mayor riesgo cardiovascular (HR 2,38; IC 95% 1,51-3,74; p<0,001), así como a una mortalidad cardiovascular incrementada (HR 4,78; IC 95% 2,50-9,11; p<0,001). Para los pacientes con excreción urinaria de albúmina entre 30 y 300mg/g, la HR para episodios cardiovasculares fue de 2,09 (IC 95% 1,34-3,50; p=0,005) y de 3,80 (IC 95% 1,81-7,96; p<0,001) para mortalidad cardiovascular.ConclusionesSe observó una asociación independiente entre TFG disminuida y la incidencia de episodios cardiovasculares y la mortalidad, en la población estudiada. La excreción urinaria de albúmina mostró un valor pronóstico mayor que el descenso de la TFG sobre ambos parámetros. Nuestros resultados subrayan la importancia de la medición sistemática de la excreción urinaria de albúmina. (AU)

Aims: To evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population.Design and methodsThe sample consisted of 2,668 subjects. Mean age was 50.6±14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60ml/min and 4.3% a urinary albumin excretion (UAE) above 30mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75-89) months.ResultsIn CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97-1.91) (P=.079) for cardiovascular events and 1.62 (95% CI 0.53-4.91) (P=.396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51-3.74; P<.001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50-9.11; P<.001). For patients with UAE between 30 and 300mg/g HR for cardiovascular events was 2.09 (95% CI 1.34-3.50; P=.005) and 3.80 (95% CI 1.81-7.96; P<.001) for cardiovascular mortality.ConclusionsAn independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE. (AU)

[Study of the effect of chronic kidney disease on the incidence of cardiovascular events in a native Spanish population]. / Efecto de la enfermedad renal crónica sobre la incidencia de episodios cardiovasculares en población española.

AIMS: To evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population. DESIGN AND METHODS: The sample consisted of 2,668 subjects. Mean age was 50.6±14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60ml/min and 4.3% a urinary albumin excretion (UAE) above 30mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75-89) months. RESULTS: In CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97-1.91) (P=.079) for cardiovascular events and 1.62 (95% CI 0.53-4.91) (P=.396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51-3.74; P<.001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50-9.11; P<.001). For patients with UAE between 30 and 300mg/g HR for cardiovascular events was 2.09 (95% CI 1.34-3.50; P=.005) and 3.80 (95% CI 1.81-7.96; P<.001) for cardiovascular mortality. CONCLUSIONS: An independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE.

Desarrollo de modelo experimental animal de peritonitis bacteriana / Development of animal experimental model for bacterial peritonitis

OBJETIVO: Desarrollar un modelo de sepsis abdominal en animal de experimentación. MATERIAL Y MÉTODOS: Se utilizan ratas Sprague-Dawley(R), machos de 5 semanas con pesos entre 270-280 g en el momento de la inoculación (N=39). Inicialmente se realiza un estudio piloto (N=9), distribuyéndolas en 3 grupos (3/3/3) con inóculo de 1cc de Escherichia coli ATCC 25922 intraperitoneal en concentraciones de 10E8, 10E9 y 10E10 UFC. En un segundo estudio (N=6) con distribución en dos grupos (3/3) se utilizan 1cc una concentración de E. coli 10E10 UFC que se diluyen en 10 y 15 ml de agua destilada para su inoculación. Por último se inicia un ensayo experimental con aleatorización de 24 ratas en tres grupos de tratamiento tras la infección intraperitoneal: Grupo I con suero fisiológico (N=6), Grupo II con antibiótico (ceftriaxona) (N=9), Grupo III con antibiótico más adyuvante (ceftriaxona más alicina) (N=9). Se realizan muestras microbiológicas de sangre y líquido peritoneal, así como estudio histopatológico de órganos intraperitoneales (hígado, diafragma y peritoneo). RESULTADOS: Se observa muerte en el 100% de las ratas infectadas con la concentración de E. coli 10E10 UFC con la dilución de 15 ml de agua destilada y sin antibiótico. El hemocultivo y cultivo de líquido peritoneal es positivo a la misma cepa en todas ellas. Se observa la formación de abscesos en la superficie del hígado e infiltración por polimorfonucleares en los tejidos. CONCLUSIÓN: Se establece que la dosis letal de E. coli es 10E10 UFC diluida en 15 ml agua destilada en inyección intraperitoneal

OBJECTIVE: The aim of the study was to develop a model of abdominal sepsis in the experimental animal. MATERIAL AND METHODS: Sprague-Dawley male rats of 5 weeks (N=39) were used. Initially, a pilot study (N = 9) was performed and distributed in 3 groups with 1cc inoculum of Escherichia coli ATCC 25922 intraperitoneally at concentrations of 10E8, 10E9 and 10E10 CFU. Subsequently, concentrations of 10E10 CFU are used in two groups of 3 rats with dilutions of 10 cc and 15 cc of distilled water respectively. Finally, a randomized trial of 24 rats was started in three treatment groups after intraperitoneal infection: Group I with physiological serum (N = 6), Group II with ceftriaxone (N = 9), Group III with ceftriaxone plus allicin (N = 9). Microbiological samples of blood and peritoneal fluid were made, as well as histopathological study of intraperitoneal organs (liver, diaphragm and peritoneum). RESULTS: Death of 100% of the rats infected with 10E10 E. coli UFC concentration with the dilution of 15 ml of distilled water and without antibiotic was oberved. The blood culture and peritoneal fluid culture was positive for the same strain in all of them. The formation of abscesses on the liver surface and polymorphonuclear infiltration in tissues were observed. CONCLUSION: The lethal dose of E. coli is 10E10 CFU diluted in 15 cc distilled water by intraperitoneal injection

Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva / Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy

OBJETIVO: Determinar la fracción atribuible poblacional (FAP) de los factores de riesgo (FR) clásicos para la aparición de la enfermedad cardiovascular en una cohorte poblacional de Extremadura, a fin de recomendar intervenciones preventivas prioritarias. MÉTODOS: DISEÑO: estudio de cohortes. Emplazamiento: Muestra poblacional representativa de un área de salud de Extremadura (España). PARTICIPANTES: Dos mil ochocientos treinta y tres individuos, de 25 a 79 años, seleccionados aleatoriamente e incluidos entre 2007 y 2009. Se registraron antecedentes y se midieron parámetros clínicos, siendo seguidos hasta el 31 de diciembre de 2015. Mediciones: Variables explicativas: edad, sexo, obesidad, tabaquismo, hipertensión arterial (HTA), diabetes mellitus (DM) e hipercolesterolemia. Variable resultado: Primer evento de la variable combinada de infarto de miocardio, angina de pecho, ictus, isquemia de miembros inferiores y muerte cardiovascular. Se calcularon las hazard ratio mediante regresión de Cox, totalmente ajustadas y las FAP mediante la fórmula de Levin. RESULTADOS: Se analizaron 2.669 sujetos de la cohorte inicial, al ser excluidos 103 por antecedentes de enfermedad cardiovascular y 61 por pérdidas. El seguimiento fue de 6,9 años (RI: 6,5-7,5). Se documentaron 134 eventos. Tasa de incidencia 7,42/1.000 personas-año. Las hazard ratio ajustadas (IC 95%) fueron: HTA 2,26 (1,40-3,67), hipercolesterolemia 2,23 (1,56-3,18), DM 1,79 (1,24-2,58), tabaquismo 1,72 (1,11-2,69). Las FAP (IC 95%) fueron HTA 31,1 (12,4-48,8), hipercolesterolemia 27,0% (14,8-40,6), tabaquismo 18,8% (3,3-35,0), DM 7,9% (2,6-15,2). CONCLUSIONES: La HTA es el FR con mayor impacto en la salud cardiovascular de la población extremeña, seguido de hipercolesterolemia y tabaquismo, constituyendo objetivos prioritarios para una estrategia preventiva poblacional

OBJECTIVE: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS: Design, Cohort study. LOCATION: Representative population sample of a health area of Extremadura (Spain). PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. Measurements: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. Outcome variable: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy

[Impact of cardiovascular risk factors in the Extremadura population: HERMEX cohort contributions for a preventive strategy]. / Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva.

OBJECTIVE: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. METHODS: Design, Cohort study. LOCATION: Representative population sample of a health area of Extremadura (Spain) PARTICIPANTS: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. MEASUREMENTS: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. OUTCOME VARIABLE: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. RESULTS: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). CONCLUSIONS: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy.

Mortalidad y fibrilación auricular en el estudio FIACA: evidencia de un efecto diferencial según el diagnóstico al ingreso hospitalario / Mortality and atrial fibrillation in the FIACA study: evidence of a differential effect according to admission diagnosis

Introducción y objetivos: La fibrilación auricular (FA) es un conocido factor de riesgo de mortalidad en diferentes patologías. Sin embargo, los datos publicados en insuficiencia cardiaca descompensada (ICD) son contradictorios. El objetivo es investigar el impacto en la mortalidad de la FA en pacientes ingresados por ICD, comparativamente con otras causas. Métodos: Estudio retrospectivo de cohortes, en el que durante 10 años se reclutó a todos los pacientes que ingresaron por ICD, infarto agudo de miocardio (IAM) y accidente cerebrovascular (ACV), con una mediana de seguimiento de 6,2 años. Resultados: Se reclutó a 6.613 pacientes (74 ± 11 años; 54,6% varones); 2.177 con IAM, 2.208 con ICD y 2.228 con ACV. La mortalidad cruda tras el alta de los pacientes con FA e IAM (razón de tasas de incidencia, 2,48; p < 0,001) y ACV (razón de tasas de incidencia, 1,84; p < 0,001) fue superior a aquellos sin FA. En los pacientes con ICD no hubo diferencias (razón de tasas de incidencia, 0,90; p = 0,12). En modelos ajustados, la FA no fue un predictor de mortalidad hospitalaria en función del diagnóstico; sin embargo, sí fue un predictor independiente de mortalidad tras el alta en pacientes con IAM (HR = 1,494; p = 0,001) y ACV (HR = 1,426; p < 0,001) no siendo así en pacientes con ICD (HR = 0,964; p = 0,603). Conclusiones: La FA se comporta como factor de riesgo independiente de mortalidad tras el alta en pacientes con un ingreso previo por IAM y ACV, no así para aquellos con ICD (AU)

Introduction and objectives: Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons. Methods: This retrospective cohort study included all patients admitted to hospital within a 10-year period due to DHF, acute myocardial infarction (AMI), or ischemic stroke (IS), with a median follow-up of 6.2 years. Results: We included 6613 patients (74 ± 11 years; 54.6% male); 2177 with AMI, 2208 with DHF, and 2228 with IS. Crude postdischarge mortality was higher in patients with AF hospitalized for AMI (incident rate ratio, 2.48; P < .001) and IS (incident rate ratio, 1.84; P < .001) than in those without AF. No differences were found in patients with DHF (incident rate ratio, 0.90; P = .12). In adjusted models, AF was not an independent predictor of in-hospital mortality by clinical diagnosis. However, AF emerged as an independent predictor of postdischarge mortality in patients with AMI (HR, 1.494; P = .001) and IS (HR, 1.426; P < .001), but not in patients admitted for DHF (HR, 0.964; P = .603). Conclusions: AF was as an independent risk factor for postdischarge mortality in patients admitted to hospital for AMI and IS but not in those admitted for DHF (AU)

The Global End-Diastolic Volume (GEDV) Could Be More Appropiate to Fluid Management Than Central Venous Pressure (CVP) During Closed Hyperthermic Intrabdominal Chemotherapy with CO2 Circulation.

BACKGROUND: Closed hyperthermic intraperitoneal chemotherapy (HIPEC) may increase abdominal pressure and effects of hemodynamic changes due to maintenance hyperthermia. Our aim was to analyze the safety and effectiveness of our closed technique with CO2 circulation in management fluid status and hemodynamic parameters by means of cardiac preload control measured by Global End Diastolic Values (GEDV) and a gas exchanger. MATERIAL AND METHODS: A Pilot Clinical Study that included 18 advanced ovarian cancer patients undergoing citoreductive surgery and HIPEC. We used a closed-perfusion system (PRS Combat®) that includes CO2 circulation and a gas exchanger. Transpulmonary thermodilutions and hemodynamic measurements (PiCCO2®) were performed after citoreductive surgery (Pre-HIPEC); At half time of the HIPEC (Intra-HIPEC); After HIPEC (Post-HIPEC). RESULTS: No significant hemodynamic measurements changes in the three thermodilutions values of Cardiac Index (CI) (p = 0.227), Global End Diastolic Values (GEVD) (p = 0.966), Stroke Volume Variation (SVV) (p = 0,884) and Systemic Vascular Resistance Index (SVRI) (p = 0.082). No correlation between central venous pressure (CVP) and GEDV (Pre-HIPEC: r = 0.164, p = 0.211; Intra-HIPEC: r = 0.015, p = 0.900; Post-HIPEC: r = 0.018, p = 0.890). There was better correlation between GEDV and CI (Pre-HIPEC: r = 0.432, p = 0.071; Intra-HIPEC: r = 0.418, p = 0.074; Post-HIPEC: r = 0.411, p = 0.080). CONCLUSIONS: Closed intrabdominal chemotherapy with CO2 circulation model may be a safe model for HIPEC by means of a gas exchanger. GEDV and its changes significantly correlated to CI, and not observed for CVP. GEDV values may be more appropriate for monitoring cardiac preload, blood loss limitation and to predict changes in intravascular volume status during intraperitoneal chemotherapy.

Mortality and Atrial Fibrillation in the FIACA Study: Evidence of a Differential Effect According to Admission Diagnosis.

INTRODUCTION AND OBJECTIVES: Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons. METHODS: This retrospective cohort study included all patients admitted to hospital within a 10-year period due to DHF, acute myocardial infarction (AMI), or ischemic stroke (IS), with a median follow-up of 6.2 years. RESULTS: We included 6613 patients (74 ± 11 years; 54.6% male); 2177 with AMI, 2208 with DHF, and 2228 with IS. Crude postdischarge mortality was higher in patients with AF hospitalized for AMI (incident rate ratio, 2.48; P < .001) and IS (incident rate ratio, 1.84; P < .001) than in those without AF. No differences were found in patients with DHF (incident rate ratio, 0.90; P = .12). In adjusted models, AF was not an independent predictor of in-hospital mortality by clinical diagnosis. However, AF emerged as an independent predictor of postdischarge mortality in patients with AMI (HR, 1.494; P = .001) and IS (HR, 1.426; P < .001), but not in patients admitted for DHF (HR, 0.964; P = .603). CONCLUSIONS: AF was as an independent risk factor for postdischarge mortality in patients admitted to hospital for AMI and IS but not in those admitted for DHF.

Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial.

INTRODUCTION: Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO2. The trial presented here aims to compare the efficacy of high versus conventional FIO2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation. METHODS AND ANALYSIS: This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will be randomised into two groups: (1) a high FIO2 group (80% oxygen; FIO2 of 0.80) and (2) a conventional FIO2 group (30% oxygen; FIO2 of 0.30). Each group will be assessed intra- and postoperatively. The primary outcome is the appearance of postoperative SSI complications. Secondary outcomes are the appearance of systemic and pulmonary complications. ETHICS AND DISSEMINATION: The iPROVE-O2 trial has been approved by the Ethics Review Board at the reference centre (the Hospital Clínico Universitario in Valencia). Informed consent will be obtained from all patients before their participation. If the approach using high FIO2 during individualised open-lung ventilation decreases SSIs, use of this method will become standard practice for patients scheduled for future abdominal surgery. Publication of the results is anticipated in early 2019. TRIAL REGISTRATION NUMBER: NCT02776046; Pre-results.

Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection.

BACKGROUND: Central venous pressure often fails to identify the true value of cardiac preload. Our purpose is to investigate whether Global End-Diastolic Volume (GEDV) values can control hemodynamic parameters for the measurement of fluid volume, cardiac preload and blood loss during liver transection. METHODS: This was a prospective clinical study that included patients undergoing liver resection. All patients were monitored by means of PiCCO technology and 222 hemodynamic measurements were performed in 74 patients. Fluid restriction was used. Transpulmonary thermodilutions were performed at different times of surgery, namely: 1. at the beginning of surgery; 2. before hepatectomy and after selective vascular exclusion (Time 1); 3. approximately half way through the liver transection (Time 2); and 4. after liver resection (Time 3). RESULTS: One hundred and twenty-nine of the 222 GEDV values were decreased (prevalence of hypovolemia of 58.1%). However, twenty two of the 222 CVP values were decreased (prevalence of 10.8%). Sensitivity of CVP with regard to volume depletion (GEDV > 650 mL m-2) on the times (1, 2 and 3) were 16.28 (4.08-28.48, 95% CI), 18.18 (5.65-30.75, 95% CI) and 21.43 (7.83-35.03, 95% CI), respectively. There was no correlation between CVP and GEDV. CONCLUSIONS: GEDV values may be more appropriate for monitoring cardiac preload during liver transection.

[Active Smoking and Coronary Risk in a Population of a Spanish Health-Care Centre: An Observational Cohort Study]. / Tabaquismo y riesgo coronario en la población de un centro de salud. Estudio de cohortes retrospectivo.

OBJECTIVE: Smoking is a major risk factor for multiple chronic diseases, such as cardiovascular diseases and cancer, and an established risk factor for premature death .The objective was to analyze the association between smoking and total coronary risk (incidence of lethal and non-lethal coronary events) in a cohort of 35-74 years old patients followed for 10 years. METHODS: Longitudinal, observational study of a retrospective cohort followed for ten years in primary care practices in Badajoz (Spain). 1011 patients (mean 55.7 year-old; 56.0% women) without evidence of cardiovascular disease was studied. Multivariate analysis was performed using a binary logistic regression model, introducing as the dependent variable the presence of total coronary events during the follow-up period. RESULTS: 29.1% of the patients were smokers. Smokers were younger (52.1 vs 57.2 years, p smaller than 0.001), with less prevalence of arterial hypertension (46.9% vs 61.5%, p smaller than 0.01), obesity (25.5% vs 31.8%, p=0,055) and lower HDL-cholesterol (45.7 vs 54.0 mg/dl, p smaller than 0.001). During the follow-up, they presented a higher mortality (11.2% vs 6.7%, p smaller than 0.05) and higher incidence of total coronary events (14.3% vs 9.2%, p smaller than 0.05). The final model of the logistic regression multivariate analysis revealed that only smoking and age are predictor variables of total coronary events, the greater odds ratio (OR) corresponding to smoking [OR: 2.33; 95% confidence interval (CI):1.31-4.16; p smaller than 0.01]. CONCLUSIONS: In patients aged 35-74 years followed during 10 years, smoking doubles the risk of total coronary events.

OBJETIVO: El tabaquismo es un importante factor de riesgo para múltiples enfermedades crónicas, tales como enfermedades cardiovasculares y cáncer, y también de muerte prematura. El objetivo fue valorar la relación entre tabaquismo y riesgo coronario total en una cohorte de pacientes de 35 a 74 años de edad. METODOS: Estudio observacional de una cohorte retrospectiva de 1.011 personas (edad media 55,7 años, 56,0% mujeres) sin antecedentes de enfermedades cardiovasculares, seguidas durante 10 años en un centro de salud de Badajoz (Extremadura, España). Se realizó un análisis multivariante mediante regresión logística binaria, incluyéndose como variable dependiente la incidencia de eventos coronarios durante el periodo de seguimiento. RESULTADOS: El 29,1% de la población era fumadora, con menor edad (52,1 vs 57,2 años, p menor que 0,001), menores cifras de colesterol-HDL (45,7 vs 54,0 mg/dl, p menor que 0,001), menor prevalencia de hipertensión arterial (46,9% vs 61,5%, p menor que 0,01) y obesidad (25,5% vs 31,8%, p=0,055) que los pacientes no fumadores. Sin embargo, durante el seguimiento presentaron mayores tasas de mortalidad (11,2% vs 6,7%, p menor que 0,05) e incidencia de eventos coronarios totales (14,3% vs 9,2%, p menor que 0,05). En el análisis multivariante solamente la edad y el tabaquismo se comportaron como variables predictoras de eventos coronarios totales, correspondiendo al tabaquismo las mayores odds ratio (OR: 2,33; IC95%:1,31-4,16; p menor que 0,01). CONCLUSIONES: En personas de 35 a 74 años seguidos durante 10 años el consumo de tabaco duplica el riesgo de eventos coronarios.