Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Validity and reliability of the measurement instrument of the nursing outcome health-related Physical Fitness (2004), proposed and transculturally adapted to the Spanish context

Abstract Background Presently, physical inactivity is the main public health problem in many countries worldwide. Physical activity promotes the maintenance or improvement of one’s physical condition. Physical fitness has been established as the main biological marker of the state of health of an individual, and therefore, there is a clear need to measure health-related physical fitness through the use of a reliable and valid instrument. This study is a continuation of the transcultural adaptation process and a new proposal of the nursing outcome Physical Fitness (2004), found in the 5th Edition of the Nursing Outcomes Classification. The objective of this study was to examine the validity and reliability of the nursing outcome Health-Related Physical Fitness survey, proposed and transculturally adapted to the Spanish context. Methods An instrumental study to validate the nursing outcome Physical Fitness (2004), from the 5th Edition of the Nursing Outcome Classification was carried out. It took place between the months of May, 2016 to May, 2017. On the first stage, the instrument proposed Health-Related Physical Fitness survey was administered to 160 adults who used the Health Services of Murcia, Spain by three independent evaluators. After 4 weeks, it was administered again to 33 participants to calculate the intra-rater reliability. Lastly, the SF-12v2 Health Survey was administered to obtain external evidence of validity. Results The inter-rater reliability of the nursing outcome proposed obtained high values (between 0.91–0.99) in the evaluations performed by the three evaluators. As for the intra-rater reliability, high values were obtained (0.94–1), except for the item “balance”, which was moderate (0.56). Lastly, a positive and statistically significant correlation (p < 0.05) was obtained between the Physical Component Summary, and the dimensions Physical Functioning and General Health from the SF-12v2 Health Survey, and the global score of the Health-Related Physical Fitness proposed instrument. Conclusions The validity and reliability results of the nursing outcome Health-Related Physical Fitness survey, proposed and transculturally adapted to the Spanish context, were adequate for its use by nurses with adults who use the Health Services of Murcia. However, this instrument must be analyzed with more diverse samples of health services users

Rotura de balón y extravasación de alcohol hacia la arteria descendente anterior durante la ablación septal en paciente con miocardiopatía hipertrófica obstructiva

Presentamos un caso de rotura del balón de oclusión septal durante el procedimiento de ablación con alcohol en un paciente con miocardiopatía hipertrófica obstructiva. La rotura causó reflujo de alcohol a la arteria descendente anterior y originó angina, leve hipocinesia global, transitoria de ventrículo izquierdo y bloqueo auriculoventricular avanzado. La función contráctil se recuperó en pocos minutos y el pico de creatincinasa fue de 526 U. A pesar de restaurarse el ritmo sinusal, hubo episodios de bloqueo auriculoventricular que obligaron al implante de marcapasos definitiv

Concordancia intercentros en la interpretación de la ecocardiografía de ejercicio

Introducción y objetivos. Se ha demostrado un acuerdo bajo-moderado en la interpretación de la ecocardiografía con dobutamina, pero no se ha realizado un estudio similar con ejercicio. El objetivo fue evaluar la concordancia intercentros de la ecocardiografía de ejercicio y la precisión de la técnica realizada de forma «ciega». Pacientes y método. Cada uno de los 6 centros remitió 25 casos a los demás centros: 15 eran pacientes consecutivos en los que se había realizado una coronariografía y 10 eran no diabéticos, asintomáticos o con dolor precordial atípico y con una probabilidad pretest 1,50 (88%; rango, 85-90%). La sensibilidad, la especificidad y la precisión diagnóstica media de la técnica «a ciegas» para estenosis coronaria = 50% en = 1 vaso fue del 68, el 66 y el 67%, respectivamente, pero con una amplia variabilidad intercentros. Conclusiones. La concordancia intercentros de la ecocardiografía de ejercicio es moderada. La precisión diagnóstica «a ciegas» es inferior a la comunicada cuando se conocen los datos clínicos