Consensus for improving the comprehensive care of patients with acute heart failure: summarised version.

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System.

[Preventing dependency in the elderly]. / Prevención de la dependencia en las personas mayores.

INTRODUCTION: Dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs. OBJECTIVE: To create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities). METHODS: a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement. RESULTS: The document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life. CONCLUSION: These recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the xxi century.

[Pregnancy and systemic lupus erythematosus]. / Embarazo y lupus eritematoso sistémico.

BACKGROUND: The interrelations between systemic lupus erythematosus (SLE) and pregnancy are reason for debate. Patients with SLE may present antiphospholipid antibodies (APL), anti-Ro (a-Ro) or anti-La (a-La) with their influence in pregnancy not being well defined. METHODS: The pregnancies in a series of 96 fertile age women with SLE, followed during the period of 1975-1991 with a mean follow up of 6.2 years were studied. The spontaneous or provoked abortions, prematurity and the number of flares of the disease during pregnancy and during the year after birth were analyzed. The number of flares was compared with that presented by a control group of women with SLE of similar clinical features followed over the same time period. RESULTS: Twenty-seven patients had 35 pregnancies with 23 full term pregnancies, 5 spontaneous abortions and 7 provoked abortions. Twenty-six percent of the deliveries were premature. One or two flares related with 43% of the pregnancies with viable fetus (11 flares in total) were registered. The number of flares in the control group was 6%. The difference was not statistically significant (p = 0.55) but the relative risk was of 1.6. No relation was found between the presence of APL, a-Ro and a-La and the course of the pregnancy. No case of lupus neonatorum was observed. CONCLUSIONS: Pregnancy is not advised in patients with systemic lupus erythematosus in remission. Patients should be more frequently controlled during pregnancy and post partum. The presence of antiphospholipid antibodies or anti-Ro does not modifies the prognosis.

[Infection and systemic lupus erythematosus: analysis of a series of 145 patients]. / Infección y lupus eritematoso sistémico: análisis de una serie de 145 pacientes.

Systemic lupus erythematosus (SEL) is a chronic inflammatory disease, which often requires corticosteroid treatment, being infection a common cause of both morbidity and mortality. We report the infectious episodes from 145 SLE patients revisited through 1975-1991, with a 6.8 years mean follow-up period. The relationship between each episode and several variables, especially corticosteroid treatment a month before the infectious episode, was analyzed. Forty two infections were diagnosed in 32 patients (22.06%). A significant increase in the number of infections among SLE patients with daily corticosteroids treatment was observed with respect to that of SLE patients with alternate day treatment (p < 0.001). The administration corticosteroids in alternate day form, if possible, can decrease the infection incidence in SLE patients.