The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe Part 1: patient characteristics and diagnosis

The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. Methods The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. Results A total of 46,788 deaths and discharges were screened from which 11,327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been measured in 57% of men and 41% of women, usually by echocardiography (84%) and was <40% in 51% of men but only in 28% of women. Forty-five percent of women and 22% of men were reported to have normal left ventricular systolic function by qualitative echocardiographic assessment. A substantial proportion of patients had alternative explanations for heart failure other than left ventricular systolic or diastolic dysfunction, including valve disease. Within 12 weeks of discharge, 24% of patients had been readmitted. A total of 1408 of 10,434 (13.5%) patients died between admission and 12 weeks follow-up. Conclusions Known or suspected heart failure comprises a large proportion of admissions to medical wards and such patients are at high risk of early readmission and death. Many of the basic investigations recommended by the ESC were usually carried out, although it is not clear whether this was by design or part of a general routine for all patients being admitted regardless of diagnosis. The investigation most specific for patients with suspected heart failure (echocardiography) was performed less frequently, suggesting that the diagnosis of heart failure is still relatively neglected. Most men but a minority of women who underwent investigation of cardiac function had evidence of moderate or severe left ventricular dysfunction, the main target of current advances in the treatment of heart failure. Considerable diagnostic uncertainty remains for many patients with suspected heart failure, even after echocardiography, which must be resolved in order to target existing and new therapies and services effectively. (C) 2003 Published by Elsevier Science Ltd on behalf of The European Society of Cardiology

The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe Part 2: treatment

National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro, Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition. Methods The survey screened discharge summaries of 11 304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment. Results Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium. channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age 70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in mate subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, mate subjects but was decreased in patients over 70. Conclusion Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains tow, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge

Double excitation transitions in Mn2+ -doped alkali halides

4 págs.; 4 figs.It is shown in this work that the room-temperature excitation spectra of as-grown crystals of LiF, NaF, NaCl, KCl, and KBr doped with Mn2+ reveal the existence of double excitation peaks. These peaks are related to the formation of precipitated phases containing Mn2+ in the alkali halide lattice. In the case of LiF:Mn2+ the position of the [A14(G), E4(G)] and T14(G) peaks suggests an anomalously small Mn2+- F- distance for the precipitated phase. © 1983 The American Physical Society.Financial support by the Comision Asesora para la Investigacion Cientifica y Tecnica, is gratefully acknowledged.Peer Reviewe

What can genetics tell us about the history of a human-mediated introduction of the golden-striped salamander south of its native range?

The golden-striped salamander is a streamside species endemic to the northwestern corner of the Iberian Peninsula. In the first half of the twentieth century, an undisclosed number of individuals of this species were reportedly captured in Buçaco, Central Portugal, and deliberately introduced in Sintra Mountains, 170 km south of its native distribution range. The discovery of a breeding population of this salamander in Sintra during 2015 prompted this work: we used neutral genetic markers, the mitochondrial DNA cytochrome b (cytb), and seven microsatellite loci to elucidate on the relict/human-introduced nature of Sintra population, identify the potential source population, and infer the severity of founder effect. Our results support a human-mediated introduction. First, sequencing analysis of cytb showed the presence of a unique haplotype (h31) in Sintra, which was detected only in Buçaco and in two additional populations located close to Mondego river. Second, microsatellite analysis showed that Sintra is more closely related to populations in between Douro and Mondego rivers (Central Portugal), instead of its geographically closest populations (southernmost), as would be expected if Sintra was a relict population isolated in an interglacial refuge. Third, Sintra presents both reduced levels of genetic variability and effective population size when compared to native populations, particularly to those of Central Portugal. Consistent with an isolated population funded by a small number of individuals (inferred herein to be ca. 10–11 salamanders), Sintra forms a geographically coherent genetic unit that is significantly differentiated from the extant native C. lusitanica populations. Although our data provide supporting evidence for Buçaco as a likely source population, as documented in the literature, overall, we cannot unequivocally exclude other populations close to Mondego river as a potential source of the introduced individuals in Sintra.info:eu-repo/semantics/acceptedVersio

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Increasing awareness and improving the management of heart failure in Europe:the IMPROVEMENT of HF initiative

Background: Previous reports suggest that patients with suspected heart failure are inadequately investigated and that patients who do have heart failure are sub-optimally treated. Guidelines on the diagnosis and treatment of heart failure have been published by the European Society of Cardiology and provide a framework for the management of heart failure against which to judge current medical practice. Both primary care and hospital physicians are responsible for ensuring appropriate management of patients with heart failure. This programme concentrates on management of heart failure in primary care and is complementary to a similar exercise that will be conducted in 50 European regions (EUROHEART-CHF). Aims: The IMPROVEMENT of HF initiative investigates, in Europe, how primary care physicians perceive heart failure should be diagnosed and treated and whether they perceive that they are provided with adequate support to implement best medical practice. Subsequently, their perceptions are compared to their actual practice by reviewing relevant case notes. The results will be used to recommend changes in practice. A future study is planned to analyse the impact of the initiative. Methods: The initiative comprises a research phase and an educational phase. For the research phase, 10 regional centres (to include both urban and rural areas) from each of 14 participating countries have been identified and each region has randomly selected 10 primary healthcare physicians. The primary healthcare physicians are participating in two surveys: a 'perception' survey and an 'actual practice' survey. For the 'actual practice' survey, the physicians are supplying case notes of nine patients who have or are at high risk of having heart failure. The results of these surveys will be used to organise an educational programme. Conclusion: This study is expected to provide valuable data on the perceptions of primary care physicians about heart failure, possible deficiencies in the current provision of care and how any deficiencies may be corrected. (C) 1999 Published by European Society of Cardiology. All rights reserved

Computers and Structures

info:eu-repo/semantics/publishedVersio

Hungarian results of the IMPROVEMENT HF European survey on the everyday diagnostics and treatment of heart failure: Comparison of European and Hungarian data

The Working Group on Heart Failure of the European Society of Cardiology published guidelines on diagnosis and treatment of heart failure in 1995, 1997 and 2001. The IMPROVEMENT HF Study, examining a set of data obtained by 1363 family care physicians and 11.062 patients suffering in (or suspected of) heart failure, was primarily focused on a survey of the perception of the diagnostic signs and symptoms of heart failure and the real treatment of the patients suffering in heart failure. Hungary participated in the study with 98 familiy care physicians in 12 investigation centers. The mean age of the European patients was 70± 12 years, which was 66± 10 years in the cases of the Hungarian participants. The Hungarian patients had hypertension (60%), diabetes mellitus (28%) and previous myocardial infarction (40%), exceeding thus in all aspects the European mean values of the cohort. Both ECG and echocardiographic diagnostic examinations were extensively used in Hungary in diagnosing heart failure, and the recognition of diastolic and systolic left ventricular dysfunction signs is one of the best in Europe. Similarly, the functional classes of heart failure based on the New York Heart Accociation classification is also well known among the family practitioners in Hungary. The modern trends in the treatment of chronic heart failure, with a special regard to the angiotensine convertase enzyme inhibitors and beta receptor blockers were also wide spread during the study period (1999-2001) in Hungary. In spite of that, the mean daily therapeutic dose of angiotensine convertase enzyme blockers did not reach the required dose, only prindopril, bearing a long lasting therapeutic plasma level, approached the daily target dose. It is a special succes, that the Hungarian incidence of the combined angiotensine convertase inhibitor and beta receptor blokker therapy was the highest (44%) among the European countries. The International Study Group on Heart Failure of the Working Group of the European Society of Cardiology considers that the individual differences in perception and also in treatment in the European countries may be the consequence of the differtent structures in medical education and postgraduate teaching, and also of the differences in health care expenses. However, differences in the organization of health care may also be important