Frailty Scales for Prognosis Assessment of Older Adult Patients after Acute Myocardial Infarction.

We aimed to compare the prognostic value of two different measures, the Fried's Frailty Scale (FFS) and the Clinical Frailty Scale (CFS), following myocardial infarction (MI). We included 150 patients ≥ 70 years admitted from AMI. Frailty was evaluated on the day before discharge. The primary endpoint was number of days alive and out of hospital (DAOH) during the first 800 days. Secondary endpoints were mortality and a composite of mortality and reinfarction. Frailty was diagnosed in 58% and 34% of patients using the FFS and CFS scales, respectively. During the first 800 days 34 deaths and 137 admissions occurred. The number of DAOH decreased significantly with increasing scores of both FFS (p < 0.001) and CFS (p = 0.049). In multivariate analysis, only the highest scores (FFS = 5, CFS ≥ 6) were independently associated with fewer DAOH. At a median follow-up of 946 days, frailty assessed both by FFS and CFS was independently associated with death and MI (HR = 2.70 95%CI = 1.32-5.51 p = 0.001; HR = 2.01 95%CI = 1.1-3.66 p = 0.023, respectively), whereas all-cause mortality was only associated with FFS (HR = 1.51 95%CI = 1.08-2.10 p = 0.015). Frailty by FFS or CFS is independently associated with shorter number DAOH post-MI. Likewise, frailty assessed by either scale is associated with a higher rate of death and reinfarction, whereas FFS outperforms CFS for mortality prediction.

Female Genital Mutilation Consequences and Healthcare Received among Migrant Women: A Phenomenological Qualitative Study.

European healthcare systems are increasingly being challenged to respond to female genital mutilation (FGM). This study explores the FGM experiences of migrant women coming from FGM-practicing countries residing in a European host country. A qualitative phenomenological study was carried out and 23 participants were included. Data were collected through 18 face-to-face open-ended interviews and a focus group and were analysed using Giorgi's four-step phenomenological approach. Three main themes were derived: "FGM consequences", "healthcare received" and "tackling FGM". Participants highlighted obstetric, gynaecological and genitourinary consequences such as haemorrhages, perineal tears, caesarean delivery, risk of infection, dysmenorrhea, urinary tract infections and dysuria; consequences for sexuality, mainly, dyspareunia, loss of sexual interest and decreased quality of sexual intercourse; and psychological consequences such as loss of self-esteem, feelings of humiliation and fear of social and familial rejection. Women perceived a profound lack of knowledge about FGM from health providers and a lack of sensitive and empathetic care. Some women perceived threatening and disproportionate attitudes and reported negative experiences. Participants highlighted the importance of educating, raising awareness and improving prevention and detection strategies. The findings disclose the need to improve training and institutional plans to address structural and attitudinal barriers to health equity across migrant families in their host countries.

Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía / Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the assessment of frailty in elderly patients with heart Disease

La fragilidad es un síndrome clínico que ocurre durante el envejecimiento, que se caracteriza por una disminución de la reserva fisiológica ante una situación de estrés y constituye un estado de vulnerabilidad que conlleva mayor riesgo de un resultado adverso. Su prevalencia en España es alta, especialmente en ancianos con comorbilidad y enfermedades crónicas. En el caso de la enfermedad cardiovascular, la fragilidad determina peores resultados clínicos, con mayor morbimortalidad en todos los escenarios, agudos y crónicos; por lo tanto, puede condicionar el diagnóstico y el tratamiento de los pacientes. A pesar de todo ello, se trata de un problema que con frecuencia no se aborda ni se incluye al planificar la atención al paciente mayor con cardiopatía. En este trabajo se repasa la evidencia científica disponible y se destacan las escalas más adecuadas para la medición y la valoración de la fragilidad, algunas con mayor utilidad y mejor capacidad predictiva según el contexto clínico en que se apliquen, y se resalta también la importancia de evaluarla para identificar su presencia e incluirla en el plan individualizado de tratamiento y cuidados que mejor se adapte a cada paciente

Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient

Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease.

Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.

Knowledge, attitudes and practices of primary healthcare professionals to female genital mutilation in Valencia, Spain: are we ready for this challenge?

BACKGROUND: The practice of Female Genital Mutilation (FGM) is a deeply-rooted tradition in 30 Sub-Saharan and Middle-East countries which affects approximately 200 million women and girls worldwide. The practice leads to devastating consequences on the health and quality of life of women and girls in both the short and long term. Globalizing processes and migration flows have recorded cases of this practice worldwide representing for healthcare professionals an emerging challenge on how to approach their healthcare in a transcultural, ethical and respectful way. No survey to assess knowledge, attitudes and practices on FGM among primary healthcare professionals has been conducted in the Valencian region of Spain to date. METHODS: The main purpose of this study is to assess the perceptions, knowledge, practices and attitudes of the primary healthcare professionals in relation to FGM in the Clínic-Malvarrosa healthcare area of Valencia. A cross-sectional descriptive study was conducted based on a self-administered questionnaire to general practitioners, paediatricians, nurses, midwives, gynaecologists, social workers and others. RESULTS: A total of 321 professionals answered the questionnaire. Less than 5% of professionals answered that they had ever found a case of FGM during their professional practice and 21.8% answered that they had ever worked with population at risk of FGM. Almost 15% of professionals answered that they had received training on FGM but of those who had received training, only 22.7% correctly identified the typology of FGM and less than 5% correctly identified the geographical area. Only 6.9% of the respondents admitted to know some protocol of action, being midwives, paediatricians and social workers the most aware professionals of such protocols. CONCLUSION: This study demonstrates that FGM is a problem present in the population attending primary healthcare services in Valencia. However, the professionals showed a profound lack of knowledge around concept, typology, countries of prevalence of FGM and existent protocols of action. It is healthcare professional duty to recognize this situation and to follow the right protocols of action, refer these women and their families to the most appropriate services and professionals that fit their needs, ensuring a multidisciplinary, positive and transcultural care for these families.

Frailty and leucocyte count are predictors of all-cause mortality and hospitalization length in non-demented institutionalized older women.

Alteration in the immune system such as the number of white blood cells count (WBC) has been associated with frailty syndrome but their role in institutionalized older individuals have been rarely investigated. We evaluated the relationships between white blood cell subtypes, geriatric assessment, depression and frailty syndrome based on the criteria of physical phenotype. In particular, we aimed to analyze by a two-year follow-up and prospective study the predictive value of alterations in WBC, frailty and functional impairment in terms of hospitalizations and all-cause mortality in institutionalized older women. There was a significant and inverse correlation between the frailty score and lymphocyte count at baseline but it did not display any predictive effect for the outcomes (hospitalizations and mortality). In contrast, monocytes count was significantly correlated with number of hospital stays and predicted hospitalizations in the follow-up. High frailty score directly and better functional status (Barthel score) inversely predicted mortality in the follow-up with an HR of 1.87 (95%CI: 1.04-3.35), and 0.97 (95% CI: 0.96-0.99) (p < .05 in both cases). Further investigation into the role of white blood cell subtypes in aging and its associated adverse outcomes in older adults is warranted. Physical phenotype of frailty besides general population, also predicted mortality in older institutionalized women and deserves specific intervention in this subgroup of older individuals.

The relationship between depression and frailty syndrome: a systematic review.

OBJECTIVES: Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals. METHOD: We performed searches in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older published and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients. RESULTS: Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described. CONCLUSION: Studies on the causal relationship between the two syndromes are clearly necessary in the future.

Clinical features of prefrail older individuals and emerging peripheral biomarkers: a systematic review.

Frailty is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Individuals with one or two of these alterations are defined as prefrail. The clinical features of prefrail older individuals have been investigated to a lesser extent compared to the frail population, even though this intermediate stage may provide insights into the mechanisms involved in the physical decline associated with aging and it is considered to be potentially reversible. We performed searches in the Medline, Embase, Scopus, Cinahl, and Cochrane databases from January 1995 to July 2013 for papers about the identification of prefrail people aged 65 and older published either in English or Spanish, and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on frailty criteria and outcomes from the selected papers: of the 277 articles retrieved from the searches and 25 articles retrieved from pearling, 84 met the study inclusion criteria. The prevalence of prefrailty ranges between 35% and 50% in individuals aged over 60, is more common in women, and the age and the number of comorbidities in these individuals is similar to their frail counterparts. Weakness is the most prevalent symptom in prefrail individuals although there are some sex differences. Some serum biomarkers seem to discriminate prefrail from non-frail individuals but further research would be required to confirm this.

The value of neutrophil and lymphocyte count in frail older women.

Increasing evidence suggests that systemic inflammation is associated with many pathophysiological processes including frailty in older adults. We evaluated the relationships between white blood cell subtypes, geriatric assessment, and frailty syndrome and in particular, how they correlate with individual frailty criteria (involuntary loss of weight, low energy or exhaustion, slow mobility, muscle weakness, and low physical activity) in frail older women. There was a significant and positive correlation between the frailty score and neutrophil count, but a significantly negative correlation was found when this score was compared to the lymphocyte count. These associations were significant only for two frailty criteria: poor muscular strength and low physical activity. Further investigation into the role of white blood cell subtypes in ageing and its associated adverse outcomes in older adults is warranted, in particular in the loss of muscular strength and for poor physical activity.

Medium-term results of cryoballoon ablation of the pulmonary veins in patients with paroxysmal and persistent atrial fibrillation. First experience of a Spanish center.

PURPOSE: Cryoballoon ablation of the pulmonary veins (CAPV) is a new technique that could have similar results to radiofrequency procedures, but with fewer complications. We analyzed the outcomes and safety of this technique in a consecutive cohort of patients with atrial fibrillation (AF). METHODS: A total of 63 patients with paroxysmal (n = 40) or persistent (n = 23) AF were studied. Patient follow-up was performed at 3 months and then every 6 months with 72-h continuous electrocardiographic recordings. RESULTS: A total of 262 pulmonary veins were treated; 60.3 % of the cases presented normal pulmonary vein drainage with 4 pulmonary veins, and 23.8 % of the cases presented a common left-sided antrum. Complete isolation of all veins was achieved in 95.2 % of cases with 10.3 ± 2.8 (mean ± standard deviation) applications per patient. Transient right phrenic nerve injury was the most common complication (4.7 %). Median follow-up was 5.5 months. The probability of being free of recurrence at 1 and 2 years was, respectively, 86.2 and 72.2 % for paroxysmal AF and 49 and 36.4 % for persistent AF (P = 0.012). Patients with structural heart disease experienced recurrence more often than patients with a normal heart (62.5 versus 24.5 %; P = 0.03). CONCLUSIONS: CAPV appears to be a safe and effective procedure for the treatment of patients with AF, particularly those with paroxysmal AF and no structural heart disease.

[Predictive value of chest pain score for the diagnosis of acute coronary syndromes]. / Valor predictivo de la presentación clínica del dolor torácico en el diagnóstico de los síndromes coronarios agudos.

BACKGROUND AND OBJECTIVE: We analyzed the diagnostic utility of a chest pain score in patients evaluated for chest pain of possible coronary origin. PATIENTS AND METHOD: We studied 1,068 consecutive patients coming to the emergency room with acute chest pain of possible coronary origin without ST-segment elevation, using a chest pain unit protocol. Chest pain was quantified by validated score (0-20 points). The diagnostic value of the chest pain score was analyzed for the diagnosis of acute myocardial infarction (AMI), unstable angina (UA) and acute coronary syndrome (ACS; AMI or UA). RESULTS: The diagnosis of ACS was established in 651 patients (61%), AMI in 439 (41%) and UA in 212 (20%). In the multivariate analysis a chest pain score > or = 10 was an independent predictor of ACS (odds ratio [OR] = 2.9; 95% confidence interval [CI] 2.1-4; p = 0.0001), along with an age older than 70 years (OR = 2.6; 95% CI,1.8-3.7; p = 0.0001), male gender (OR = 2; 95% CI, 1.4-2.8; p = 0.0001); insulin-dependent diabetes (OR = 2.3; 95% CI, 1.2-4.6; p = 0.016); previous myocardial infarction (OR = 1.6; 95% CI, 1.1-2.4; p = 0.022), ST depression (OR = 9.3; 95% CI, 5.2-16.7; p = 0.0001) and T wave inversion (OR = 2.5; 95% CI, 1.4-4.3; p = 0.0001). The chest pain score was associated with the diagnosis of both AMI (OR = 1.4; 95% CI, 1.1-1.9; p < 0.02) and UA (OR = 2.8; 95% CI, 1.8-4.2; p < 0.0001). CONCLUSIONS: The chest pain score allows independent information for the early diagnosis of patients coming to the emergency department with acute chest pain of possible coronary origin.

Valor predictivo de la presentación clínica del dolor torácico en el diagnóstico de los síndromes coronarios agudos / Predictive value of chest pain score for the diagnosis of acute coronary syndromes

Fundamento y objetivo: Presentamos la utilidad diagnóstica de la cuantificación del dolor torácico en pacientes con dolor torácico de posible origen coronario. Pacientes y método: Se estudió a 1.068 pacientes consecutivos que acudieron a un servicio de urgencias por dolor torácico de posible origen coronario sin elevación del segmento ST, siguiendo un protocolo de unidad de dolor torácico. El dolor torácico se cuantificó mediante un sistema de puntuación (0 a 20 puntos). Se determinó el valor diagnóstico de la puntuación de dolor torácico para predecir el diagnóstico final de infarto agudo de miocardio (IAM), angina inestable (AI) y síndrome coronario agudo (SCA; IAM o AI). Resultados: Se diagnosticó de SCA a 651 pacientes (61%), de los que 439 (41%) presentaron IAM y 212 (20%) AI. En el análisis multivariado la puntuación del dolor mayor o igual a 10 fue un predictor independiente de SCA, (odds ratio [OR] = 2,9; intervalo de confianza [IC] del 95%, 2,1-4; p = 0,0001), junto a la edad mayor o igual a 70 años (OR = 2,6; IC del 95%, 1,8-3,7; p = 0,0001), el sexo masculino (OR = 2; IC del 95%, 1,4-2,8; p = 0,0001), la diabetes insulinodependiente (OR = 2,3; IC del 95%, 1,2-4,6; p = 0,016), el infarto de miocardio previo (OR = 1,6; IC del 95%, 1,1-2,4; p = 0,022), el descenso del segmento ST (OR = 9,3; IC del 95%, 5,2-16,7; p = 0,0001) y la inversión de la onda T (OR = 2,5; IC del 95%, 1,4-4,3; p = 0,0001). La puntuación del dolor se asoció tanto al diagnóstico de IAM (OR = 1,4; IC del 95%, 1,1-1,9; p < 0,02) como de AI (OR = 2,8; IC del 95%, 1,8-4,2; p < 0,0001). Conclusiones: La cuantificación clínica del dolor torácico aporta información independiente para el diagnóstico de los pacientes que acuden al servicio de urgencias con dolor torácico de posible origen coronario

Background and objective: We analyzed the diagnostic utility of a chest pain score in patients evaluated for chest pain of possible coronary origin. Patients and method: We studied 1,068 consecutive patients coming to the emergency room with acute chest pain of possible coronary origin without ST-segment elevation, using a chest pain unit protocol. Chest pain was quantified by validated score (0-20 points). The diagnostic value of the chest pain score was analyzed for the diagnosis of acute myocardial infarction (AMI), unstable angina (UA) and acute coronary syndrome (ACS; AMI or UA). Results: The diagnosis of ACS was established in 651 patients (61%), AMI in 439 (41%) and UA in 212 (20%). In the multivariate analysis a chest pain score >= 10 was an independent predictor of ACS (odds ratio [OR] = 2.9; 95% confidence interval [CI] 2.1-4; p = 0.0001), along with an age older than 70 years (OR = 2.6; 95% CI,1.8-3.7; p = 0.0001), male gender (OR = 2; 95% CI, 1.4-2.8; p = 0.0001); insulin-dependent diabetes (OR = 2.3; 95% CI, 1.2-4.6; p = 0.016); previous myocardial infarction (OR = 1.6; 95% CI, 1.1-2.4; p = 0.022), ST depression (OR = 9.3; 95% CI, 5.2-16.7; p = 0.0001) and T wave inversion (OR = 2.5; 95% CI, 1.4-4.3; p = 0.0001). The chest pain score was associated with the diagnosis of both AMI (OR = 1.4; 95% CI, 1.1-1.9; p < 0.02) and UA (OR = 2.8; 95% CI, 1.8-4.2; p < 0.0001). Conclusions: The chest pain score allows independent information for the early diagnosis of patients coming to the emergency department with acute chest pain of possible coronary origin

Rendimiento diagnóstico de un protocolo de estudio del síncope de causa no aparente / Diagnostic Accuracy of a Protocol in the Evaluation of Unexplained Syncope

Introducción y objetivos. Valorar la capacidad diagnóstica de un protocolo de estudio del síncope de causa indeterminada que utiliza, selectivamente, los estudios electrofisiológicos y las pruebas de tabla basculante. Pacientes y método. El estudio se realizó en 137 pacientes consecutivos (94 varones y 43 mujeres, con una edad media de 57,6 ñ 18,3 años), con síncope de causa indeterminada tras la evaluación clínica inicial, que fueron divididos en dos grupos. El grupo A estaba compuesto por 77 pacientes que cumplían alguno de los siguientes criterios: a) presencia de cardiopatía estructural; b) ECG anormal; c) presencia de arritmias significativas no sintomáticas en el Holter, y d) presencia de palpitaciones paroxísticas. Estos pacientes fueron sometidos inicialmente a estudio electrofisiológico. El grupo B estaba compuesto por 60 pacientes que no cumplían ninguno de los criterios anteriores y fueron sometidos en un principio a pruebas de tabla basculante. Resultados. En el grupo A el estudio electrofisiológico fue positivo en 43 pacientes (55 por ciento). En el grupo B el test de basculación fue positivo en 41 pacientes (68 por ciento). De los pacientes del grupo A con estudio negativo, 20 (59 por ciento) fueron sometidos a test de tabla basculante, con 7 positividades (35 por ciento). Cinco pacientes del grupo B con test de basculación negativo fueron sometidos a estudio electrofisiológico, que fue negativo en todos ellos. Globalmente se consiguió un diagnóstico positivo en 91 de 137 pacientes (66 por ciento). Conclusiones. En pacientes con síncope de causa inaparente en la evaluación inicial, la utilización dirigida de manera selectiva por criterios clínicos, bien de estudios electrofisiológicos bien de pruebas de tabla basculante, permite establecer un diagnóstico positivo en más del 60 por ciento de los casos. Nuestros resultados sugieren que el test de tabla basculante debería ser realizado en aquellos casos del grupo A con estudio electrofisiológico negativo (AU)