Estancia media, mortalidad intrahospitalaria y reingresos en pacientes hospitalizados por insuficiencia cardiaca en España

La insuficiencia cardiaca (IC) es uno de los principales problemas sanitarios en España, aunque la falta de estudios con un diseño adecuado impide conocer con exactitud la envergadura real de este problema clínico. La prevalencia de la IC se estima en un 2% en otros países europeos y en Estados Unidos, mientras que los estudios epidemiológicos en nuestro país la sitúan en torno al 5%, probablemente debido a sus limitaciones metodológicas. La IC es una auténtica epidemia cardiovascular de nuestro siglo: es la primera causa de ingreso de mayores de 65 años, supone el 3% del total de las hospitalizaciones, y consume el 2,5% del presupuesto sanitario. La IC presenta dos perfiles clínicos diferenciados: la IC con fracción de eyección preservada (IC-FEP), más relacionado con la hipertensión arterial, y la IC con fracción de eyección reducida (IC-FER), asociada frecuentemente a la cardiopatía isquémica. En los últimos años hemos sido testigos de una reducción progresiva de la mortalidad por IC, en parte consecuencia de una mayor aplicación de las recomendaciones de las Guías Internacionales de práctica clínica..

Satisfacción vital, síntomas depresivos y apoyo social percibido en pacientes con insuficiencia cardiaca

This research examined life satisfaction, depressive symptoms and perceived social support in two groups of adults (N = 120; age 40-89 years). The first was formed by stable heart failure (HF) outpatients and the second was a control group of similar age. Perceived social support was the only significant predictor of life satisfaction in the control group but, in the HF group, life satisfaction was associated with more social support and less depressive symptoms. Gender (men > women) was also an important predictor of life satisfaction in both groups, but more significantly in the HF one. All womenreported more depressive symptoms and less life satisfaction than men. Female HR patients also perceived more social support than male patients did. Finally, a partial mediation of depressive symptoms in the association between social support and life satisfaction was found in the HF group.En esta investigación se analizaron la satisfacción vital, los síntomas depresivos y el apoyo social percibido en dos grupos de adultos (N =120; rango = 40-89 años), uno formado por pacientes no hospitalizados con insuficiencia cardiaca (IC) estable y otro control con personas de similar edad. El apoyo social percibido fue el único predictor significativo de la satisfacción vital en el grupo control, mientras que en el grupo con IC, se asociaba con más apoyo social y menos síntomas depresivos. El género fue también un predictor importante de la satisfacción vital (hombres > mujeres), aunque de forma más significativa en el grupo con IC. Todas las mujeres informaban más síntomas depresivos y menos satisfacción vital que los hombres. En el grupo IC, las mujeres también percibían más apoyo social que los varones. Finalmente, se encontró en este grupo que la asociación entre apoyo social y satisfacción vital estaba parcialmente mediada por los síntomas depresivos

Determinantes de la duración del desempleo : el paro de larga duración y la salida a un empleo fijo

Artículo de revistaEl objetivo de este trabajo es doble: por un lado el estudio de los factores que afectan a las salidas a un empleo, segun sea fijo o temporal, en parados de todas las duraciones, y por otro, el analisis de las salidas del desempleo de larga duracion, bien sea hacia un empleo o hacia otro tipo de salidas que compitan con este (en concreto, se consideran la inactividad y el estudio). Para ello se estiman modelos de duracion discreta con salidas multiples por maxima verosimilitud y se comparan los modelos y metodos de estimacion alternativo

Nuevos resultados sobre la duración del desempleo : el paro de larga duración y la salida a un empleo fijo

Incluye bibliografí

TBC: A simple algorithm to rule out abnormalities in electrocardiograms of patients with pacemakers

Background: The aim of the study was to create a straightforward method to rule out abnormalities in electrocardiograms (ECGs) performed in patients with pacemakers. Methods: The TBC method screens the ECG for any of the following findings: Tachycardia with pacing spikes, Bradycardia without spikes and Chaos with spikes unrelated to QRS-T complexes. T was considered to advise for patient assessment and B and C to require referral for urgent pacemaker evalu­ation. The diagnostic accuracy of the algorithm was validated using a cohort of 151 ECGs with normal and dysfunctional pacemakers. The effect of the algorithm was then evaluated for diagnostic skills and management of patients with pacemakers by non-cardiologists, comparing their diagnostic accuracy before and after teaching the algorithm. Results: The TBC algorithm had a sensitivity of 86% and a specificity of 94% in diagnosing a mal­functioning pacemaker. The diagnostic skills and patient referral were significantly improved (74.8% vs. 89.5%, p < 0.001; and 57.4% vs. 83%, p < 0.001). Conclusions: TBC is an easy to remember and apply method to rule out severe abnormalities in ECGs of patients with pacemakers. TBC algorithm has a very good diagnostic capability and is easily applied by non-expert physicians with good results

Digital Rock Physics in Cuttings Using High-Resolution Thin Section Scan Images

Digital rock physics (DRP) has undergone significant advancements in the use of various imaging techniques to acquire three-dimensional volumes and images of rock samples for the computation of petrophysical properties. This study focuses on developing a DRP workflow using high-resolution thin section scans for computing porosity and permeability in cuttings samples. The workflow was tested on quarry sandstone plug samples and artificially generated pseudo-cuttings before applying it to real cuttings from oil and gas wells. The results show that the porosity and permeability values obtained through the DRP workflow are statistically equivalent to those obtained through conventional routine core analysis (RCAL). The workflow was also able to handle the presence of various lithologies in real cuttings samples. The study demonstrates the feasibility of obtaining porosity and permeability values in cutting samples using the DRP approach, offering a fast and cost-effective methodology that provides additional data and allows linking petrophysical properties to image data from the cuttings

Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction.

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.This research was funded by CIBERCV I and supported by the Instituto de Salud Carlos III. L.V. is funded by the Instituto de Salud Carlos III, Spain (CM20/00104 and ).S

Documento de consenso y recomendaciones sobre cuidados paliativos en insuficiencia cardiaca de las Secciones de Insuficiencia Cardiaca y Cardiología Geriátrica de la Sociedad Española de Cardiología

Review[Abstract] Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.[Resumen] La insuficiencia cardiaca es una entidad compleja, que conlleva elevada morbilidad y mortalidad y cuyo curso y evolución son inciertos y difíciles de predecir. Este trabajo, impulsado por las Secciones de Insuficiencia Cardiaca y Cardiología Geriátrica de la Sociedad Española de Cardiología, aborda los diferentes aspectos relacionados con los cuidados paliativos en el campo de la insuficiencia cardiaca, vía final común de la mayoría de las enfermedades cardiovasculares. También establece un consenso y una serie de recomendaciones con el objetivo de reconocer y comprender la necesidad de implementar y aplicar, de modo progresivo, este tipo de cuidados a lo largo del curso de la enfermedad, y no únicamente en sus estadios avanzados, para mejorar la atención que reciben los pacientes y su calidad de vida. La finalidad es mejorar y adecuar los tratamientos a las necesidades y los deseos de cada paciente, que debe contar con información adecuada y ser partícipe de la toma de decisiones

A 3-biomarker 2-point-based risk stratification strategy in acute heart failure

[Abstract] Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715–0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747–0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.Instituto de Salud Carlos III; RD06-0003-0000Instituto de Salud Carlos III; RD12/0042/000

A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure

Altres ajuts: ISCIII/RD06-0003-0000Altres ajuts: ISCIII/RD12/0042/0002Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality