Mortalidad intrahospitalaria por infarto agudo de miocardio. Relevancia del tipo de hospital y la atención dispensada: estudio RECALCAR

[Abstract] Introduction and objectives. To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided. Methods. Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States). Results. Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed. Conclusions. The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction.[Resumen] Introducción y objetivos. Investigar la relación entre mortalidad intrahospitalaria por infarto agudo de miocardio y tipología del hospital, servicio de alta y tratamiento dispensado. Métodos. Análisis retrospectivo de 100.993 altas por infarto en los hospitales del Sistema Nacional de Salud. La mortalidad se ajustó por riesgo utilizando los modelos del Institute of Clinical Evaluative Sciences (Canadá) y de los Centers for Medicare & Medicaid Services (Estados Unidos). Resultados. Las características de los hospitales son relevantes para explicar la variación de la probabilidad individual de morir por infarto (odds ratio mediana = 1,3561). La mortalidad intrahospitalaria ajustada por riesgo fue significativamente menor en los hospitales de los clusters 3 y 4 (500 a 1.000 camas y complejidad mediana-alta) que en hospitales de menos de 200 camas. El cluster 5 (más de 1.000 camas), que es muy heterogéneo, tenía mayor mortalidad que los clusters 3 y 4. Las diferencias de la mortalidad ajustada entre el grupo con mejores y peores resultados fueron del 6,74% (cluster 4) y el 8,49% (cluster 1) (p < 0,001). La mortalidad también fue menor cuando el servicio de cardiología se encargó del alta, así como cuando se practicó angioplastia. Conclusiones. Las características del hospital, ser atendido por un servicio de cardiología y el intervencionismo coronario se asocian con la supervivencia intrahospitalaria del paciente con infarto. Se recomienda la creación de redes asistenciales en el Sistema Nacional de Salud que favorezcan el intervencionismo coronario y la participación de los servicios de cardiología en el manejo de pacientes con infarto agudo de miocardio

Cardiologists and the Cardiology of the Future. Vision and proposals of the Spanish Society of Cardiology for the Cardiology of the 21st Century.

The Cardiology of the Future is a project of the Spanish Society of Cardiology (SEC) whose objectives are as follows: to define the action policies of the SEC; to analyze the trends and changes in the environment that will influence the practice of cardiology in Spain; to define the profile of the cardiologists needed in the future; to propose policies to achieve the objectives resulting from the identified needs; and to identify the role of the SEC in the development and implementation of these policies. This article describes the methodology and the most relevant findings of the final report of this project and the strategic lines to be developed by the SEC in the immediate future, resulting from the analysis performed.The project Cardiologists and the Cardiology of the Future and the creation of this article have been financed through the resources of the SEC.S

Aspirin Therapy on Prophylactic Anticoagulation for Patients Hospitalized With COVID-19: A Propensity Score-Matched Cohort Analysis of the HOPE-COVID-19 Registry

Background COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for patients hospitalized with COVID-19. The aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in patients hospitalized with COVID-19 and its impact on survival. Methods and Results A total of 8168 patients hospitalized for COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC versus PAC and aspirin was performed using an adjusted analysis with propensity score matching. Of 7824 patients with complete data, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin versus PAC (15% versus 21%, Log Rank P=0.01). At multivariable analysis in propensity matched population of patients with COVID-19, including age, sex, hypertension, diabetes, kidney failure, and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (hazard ratio [HR], 0.62; [95% CI 0.42-0.92], P=0.018). Conclusions Combination PAC and aspirin was associated with lower mortality risk among patients hospitalized with COVID-19 in a propensity score matched population compared to PAC alone

Renin-angiotensin system inhibitors effect before and during hospitalization in COVID-19 outcomes: Final analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry.

The use of Renin-Angiotensin system inhibitors (RASi) in patients with coronavirus disease 2019 (COVID-19) has been questioned because both share a target receptor site. HOPE-COVID-19 (NCT04334291) is an international investigator-initiated registry. Patients are eligible when discharged after an in-hospital stay with COVID-19, dead or alive. Here, we analyze the impact of previous and continued in-hospital treatment with RASi in all-cause mortality and the development of in-stay complications. We included 6503 patients, over 18 years, from Spain and Italy with data on their RASi status. Of those, 36.8% were receiving any RASi before admission. RASi patients were older, more frequently male, with more comorbidities and frailer. Their probability of death and ICU admission was higher. However, after adjustment, these differences disappeared. Regarding RASi in-hospital use, those who continued the treatment were younger, with balanced comorbidities but with less severe COVID19. Raw mortality and secondary events were less frequent in RASi. After adjustment, patients receiving RASi still presented significantly better outcomes, with less mortality, ICU admissions, respiratory insufficiency, need for mechanical ventilation or prone, sepsis, SIRS and renal failure (p RASi historic use, at admission, is not related to an adjusted worse prognosis in hospitalized COVID-19 patients, although it points out a high-risk population. In this setting, the in-hospital prescription of RASi is associated with improved survival and fewer short-term complications

Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry.

Recently the coronavirus disease (COVID-19) outbreak has been declared a pandemic. Despite its aggressive extension and significant morbidity and mortality, risk factors are poorly characterized outside China. We designed a registry, HOPE COVID-19 (NCT04334291), assessing data of 1021 patients discharged (dead or alive) after COVID-19, from 23 hospitals in 4 countries, between 8 February and 1 April. The primary end-point was all-cause mortality aiming to produce a mortality risk score calculator. The median age was 68 years (IQR 52-79), and 59.5% were male. Most frequent comorbidities were hypertension (46.8%) and dyslipidemia (35.8%). A relevant heart or lung disease were depicted in 20%. And renal, neurological, or oncological disease, respectively, were detected in nearly 10%. Most common symptoms were fever, cough, and dyspnea at admission. 311 patients died and 710 were discharged alive. In the death-multivariate analysis, raised as most relevant: age, hypertension, obesity, renal insufficiency, any immunosuppressive disease, 02 saturation  0.999; bootstrap-optimist: 0.0018). We provide a simple clinical score to estimate probability of death, dividing patients in four grades (I-IV) of increasing probability. Hydroxychloroquine (79.2%) and antivirals (67.6%) were the specific drugs most commonly used. After a propensity score adjustment, the results suggested a slight improvement in mortality rates (adjusted-ORhydroxychloroquine 0.88; 95% CI 0.81-0.91, p = 0.005; adjusted-ORantiviral 0.94; 95% CI 0.87-1.01; p = 0.115). COVID-19 produces important mortality, mostly in patients with comorbidities with respiratory symptoms. Hydroxychloroquine could be associated with survival benefit, but this data need to be confirmed with further trials. Trial Registration: NCT04334291/EUPAS34399

Otro título: Elementos folklóricos y creación estética del Lazarillo de Tormes

Gregorio Marañón Moya, Dir. ICH. Dámaso Alonso, escritor. Elsa Mercado, Embajadora de Panamá en España.Cinta 1: Presentación por parte de Marañón -- Min. 0.24: El secretario general entrega las condecoraciones: Miembros de honor: Yolanda de Arzate Avendeyo. José Solís Ruiz, Mº Scret. Gral. del Movimiento. Antonio Garrigues, Embajador de España en Washington. José Antonio Giménez-Arnau, Embajador de España en Guatemala. James A. Farley, Ex-presidente del partido demócrata de EE.UU. Edmundo Correa, Ex-rector de la Universidad de Cuya. Francisco Javier Sánchez Cantón, Miembro de la Real Academia de la Historia. Federico García Sanchís, Miembro de la RAE. Juán José López Ibor, Catedrático Facultad de Medicina Madrid. Hermenegildo Arruga, Conde de Arruga. José de la Peña, Dir. Archivo de Indias. José Antonio Elola-Olaso, Delegado Nal. de Educación Física y Deportes. Alfonso de la Peña, Catedrático Facultad de Medicina de Madrid. Miembros titulares del ICH: Elvira Pérez Peña, Inst. Cuyano de Cultura Hispánica. Alberico Praga, Rector de la Unv. de Bahía. Francisco Monterde, de la Academia Mexicana de la Lengua. José Barroso, Presidente del Inst. Hispano-Mexicano. Jorge Montoya, Dir. Inst. Antioqueño de Cultura Hispánica. Paul Bouchard, Prof. Hª Precolombina Unv. Laval Canadá. George Age Ornstein, Dir. United Airlines. Luis Alfonso D'Escargnolle, Arquitecto Brasileño de la Casa de Brasil. Juán José Espinosa, Dir. Gral. PSOE. Marcos Peña Royo, Gobernador Civil de Asturias. Plácido Careaga, Pdte. Diputación Vizcaya. José Burgos y Rosado, Marqués de la Liseda. Gabriel Cañadas, Scre. Gral. Mº Infomación y Turismo. Jose María Mor, Dir. Personal Mº Asuntos Exteriores. Fernando Luis Ybarra y López de Dóriga, Marqués de de Agridulce y Pte. Del Ins. Cultura Vascongadas. Antonio Fondán, Dir. Escuela Periodismo Vascongadas. Jose Ignacio Ramos, Delegado de Prensa Embajada de España en Buenos Aires. Salvador Bermúdez, Delegado de Prensa Embajada de España en Lima. Jaime de Abrisqueta, Scre. Embajada de España en Quito. Tomás Lozano, Embajador de España en Honduras. Francisco Javier Chapa, Embajador de España en México. Amaro González de Mesa, Embajador de España en la Santa Sede. Jose Luís Aparicio, Cónsul España en Nueva Orleans. Joaquín Tomás, Cónsul de España en Mendoza. Enrique de la Hoz Díaz, Scret. Gral. Mº de Información -- MIn. 11.35: Conferencia de Dámaso Alonso "Elementos folklóricos y creación estética del Lazarillo de Tormes" -- Cinta 2: Continuación de la conferencia de Dámaso Alonso -- Min. 27.56: Discurso de Elsa Mercado, Embajadora de Panamá en España -- Min. 33.14: Palabras de clausura de Gregorion Marañó