Ictus isquémico y enfermedad tromboembólica venosa sintomática en España: Análisis de las hospitalizaciones, costes asociados y diferencia con los ensayos clínicos

Aim. To analyze the characteristics and economic burden of the patients with ischaemic stroke and symptomatic venous thromboembolism (sVTE+) at the National Health System (NHS). We also compared NHS patients with those included in PREVAIL study. Subjects and methods. Patients 18 years older with ischemic stroke/sVTE + and sVTE - were compared. These patients are included in the Diagnostic Related Group (GDR)14 (Specific Cerebrovascular Disorder excluding transient ischemic attack) with a secondary diagnosis of sVTE [Diagnostic Category 415.x (Pulmonary Embolism) or 451.x and 453.x (Deep Vein Thrombosis)]. It was determined the hospital stays in excess and costs in patients with stroke/sVTE+ (2003 NHS standards). Results. There were 171 patients with stroke/sVTE+ and 33953 with stroke/sVTE-. Patients with stroke/ sVTE+ were older, women in higher proportion, with an increment of 6.8 days in mean stay [stroke/sVTE+: 17,5(CI95%:15,2-19,8); stroke/sVTE-: 10,7(CI95%: 10,6-10,8)]. Mortality was similar. There were 1433 stays in excess for stroke/sVTE+ with associat ed costs of 443799 � (0.4% additional costs to the GDR14 overall budget). The SNS population was older and with greater mortality than patients of PREVAIL study. Conclusions. Patients with stroke/sVTE+ have greater morbidity with longer stays and additional costs (nearly to 0,5 million euros/year). They are older and have increased mortality in comparison with clinical trials. Effective measures of thromboprophylaxis could minimize such complications.Objetivo. Analizar las características y costes económicos de pacientes hospitalizados en el Sistema Nacional de Salud (SNS) con ictus isquémico que presentaron una Enfermedad Tromboembólica Venosa sintomática (ETVs). Se comparó también dicha población con la incluida en el estudio PREVAIL.Sujetos y Método. Comparamos las características de los pacientes del SNS con ictus isquémico/ETVs+ con la de aquellos ictus/ETVs-. Para ello se estudiaron los pacientes >18 años incluidos en el Grupo Relacionado de Diagnóstico (GDR)14 (Trastorno Cerebrovascular Específico excluyendo AccidenteIsquémico Transitorio) con un diagnóstico secundario de ETVs [Categoría diagnóstica 415.x (Embolismo pulmonar) o 451.x o 453.x (Trombosis venosa profunda)]. Se determinaron el exceso de estancias en los ictus/ETVs+ y sus costes según los estándares del SNS (2003). Resultados. Se obtuvieron 171 pacientes con ictus/ETVs+ y 33953 con ictus/ETVs-. Los ictus/ETVs+ eran de mayor edad, en mayor proporción mujeres y con una prolongación de estancia media de 6,8 días [ictus/ETVs+: 17,5 (IC95%:5,2-19,8); ictus/ETVs-: 10,7(IC95%: 10,6-10,8)]. No existieron diferencias en mortalidad. Hubo 1433 estancias en exceso en ictus/ETVs+ con unos costes mínimos asociados de 443799 � (0,4% adicional al coste global del GDR14). La población del SNS presentó mayor edad y mortalidad que la del estudio PREVAIL. Conclusiones. Los pacientes con ictus/ETVs+ muestran mayor morbilidad traducida en alargamiento de las estancias y coste adicional anual cercano a 0,5 millones de euros. Presentan mayor edad y mortalidad que los ensayos clínicos que reclutan poblaciones similares. Es posible que medidas eficaces de tromboprofilaxis puedan minimizar tales complicaciones

Trends in Diabetes-Related Potentially Preventable Hospitalizations in Adult Population in Spain, 1997–2015: A Nation-Wide Population-Based Study

We aimed to assess national trends in the rates of diabetes-related potentially preventable hospitalizations (overall and by preventable condition) in the total adult population of Spain. We performed a population-based study of all adult patients with diabetes who were hospitalized from 1997 to 2015. Overall potentially preventable hospitalizations and hospitalizations by diabetes-related preventable conditions (short-term complications, long-term complications, uncontrolled diabetes, and lower-extremity amputations) were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. Over 19-years-period, 424,874 diabetes-related potentially preventable hospitalizations were recorded. Overall diabetes-related potentially preventable hospitalizations decreased significantly, with an average annual percentage change of 5.1 (95%CI: −5.6–(−4.7%); ptrend < 0.001). Among preventable conditions, the greatest decrease was observed in uncontrolled diabetes (−5.6%; 95%CI: −6.7–(−4.7%); ptrend < 0.001), followed by short-term complications (−5.4%; 95%CI: −6.1–(−4.9%); ptrend < 0.001), long-term complications (−4.6%; 95%CI: −5.1–(−3.9%); ptrend < 0.001), and lower-extremity amputations (−1.9%; 95%CI: −3.0–(−1.3%); ptrend < 0.001). These reductions were observed in all age strata for overall DM-related PPH and by preventable condition but lower-extremity amputations for those <65 years old. There was a greater reduction in overall DM-related PPH, uncontrolled DM, long-term-complications, and lower extremity amputations in females than in males (all p < 0.01). No significant difference was shown for short-term complications (p = 0.101). Our study shows a significant reduction in national trends for diabetes-related potentially preventable hospitalizations in Spain. These findings could suggest a sustained improvement in diabetes care in Spain, despite the burden of these diabetes-related complications and the increase in the diabetes mellitus prevalence

Use of Linagliptin for the Management of Medicine Department Inpatients with Type 2 Diabetes in Real-World Clinical Practice (Lina-Real-World Study)

The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100–140 mg/dL (standardized difference = 0.017) and >200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies