Association of Chronic Renal Insufficiency with Inhospital Outcomes in Primary Heart Failure Hospitalizations (Insights from the National Inpatient Sample 2004 to 2018).

Chronic kidney disease (CKD) is a major co-morbidity in patients with heart failure (HF). There are limited contemporary data characterizing the clinical profile, inhospital outcomes, and resource use in patients hospitalized for HF with co-morbid CKD. We utilized a nationally representative population to address the knowledge gap. We examined the National Inpatient Sample 2004 to 2018 database to study the co-morbid profile, in-hospital mortality, clinical resource utilization, healthcare cost, and length of stay (LOS) in primary adult HF hospitalizations stratified by presence versus absence of a diagnosis codes of CKD. There were a total of 16,050,301 adult hospitalizations with a primary HF diagnosis from January 1, 2004, to December 31, 2018. Of these, 428,175 (33.81%) had CKD; 1,110,778 (6.92%) had end-stage kidney disease (ESKD); and 9,511,348 (59.25%) had no diagnosis of CKD. Patients with hospitalizations for HF with ESKD were younger (mean age 65.4 years) compared with those without ESKD. In multivariable analysis, those with CKD had higher odds of inhospital mortality (2.82% vs 3.57%, adjusted odds ratio [aOR] 1.30, confidence interval [CI] 1.28 to 1.26, p <0.001), cardiogenic shock (1.01% vs 1.79% aOR 2.00, CI 1.95 to 2.05, p <0.001), and the need for mechanical circulatory support (0.4% vs 0.5%, aOR 1.51, 1.44 to 1.57, p <0.001) compared with those without CKD. In multivariable analysis, those with ESKD had higher odds of inhospital mortality (2.82% vs 3.84%, aOR 2.07, CI 2.01 to 2.12, p <0.001), need for invasive mechanical ventilation use (2.04% vs 3.94%, aOR 1.79, CI 1.75 to 1.84, p <0.001), cardiac arrest (0.72% vs 1.54%, aOR 2.09, CI 2.00 to 2.17, p <0.001), longer LOS (Adjusted mean difference 1.48, 1.44 to 1.53, p <0.001) and higher inflation-adjusted cost (Adjusted mean difference 3,411.63, CI 3,238.35 to 3,584.91, p <0.001) compared with those without CKD. CKD and ESKD affected about 40.7% of all primary HF hospitalizations from 2004 to 2018. The inhospital mortality, clinical complications, LOS, and inflation-adjusted cost were higher in hospitalized patients with ESKD compared with patients with and without CKD. In addition, compared with those without CKD, hospitalized patients with CKD had higher inhospital mortality, clinical complications, LOS, and inflation-adjusted cost compared with patients with no diagnosis of CKD.

Validación de la versión en español para Colombia de la escala ASES / Validation of the Spanish version for Colombia of the ASES (American Shoulder and Elbow Surgeons) score

Introducción: La escala de ASES (American Shoulder and Elbow Surgeons) es una herramienta de medición funcional para evaluar problemas alrededor del hombro. Desarrollada en inglés, se utiliza desde 1993 en su idioma original. Está conformada por datos demográficos, una sección de evaluación médica y otra sección autodiligenciada por el paciente. El objetivo de este estudio es la traducción al español de Colombia de la escala ASES y su validación. Materiales y métodos: Estudio de traducción al español y validación de la escala de ASES. Se incluyeron pacientes con patología en el hombro entre diciembre de 2015 y marzo de 2016. Los pacientes respondieron la escala en dos ocasiones, con diferencia de 7-14 días entre una y otra. Se calculó el alfa de Cronbach (AC) y el coeficiente de correlación intraclase (CCI) para determinar la consistencia interna y la confiabilidad test-retest. Se utilizó el gráfico de Bland-Altman para determinar el error de medición. Resultados: Sesenta y cinco pacientes con patología de hombro fueron incluidos en el estudio, la lesión del manguito rotador (27%) fue la patología más frecuente. El alfa de Cronbach fue de 0.76 y el coeficiente de correlación intraclase fue de 0.74. El gráfico de Bland-Altman determinó la ausencia de error sistemático. Conclusiones: La versión en español para Colombia de la escala de ASES es una herramienta válida y confiable para evaluar calidad de vida en pacientes con patología en el hombro y puede ser aplicada en pacientes de habla hispana en Colombia.

Introduction: The ASES (American Shoulder and Elbow Surgeons) score, is a measurement tool developed in English for evaluating function around the shoulder. It has been used since 1993 in its original language. It is made up of demographic data, a medical evaluation section and another section self-completed by the patient. The aim if the study was to translate the ASES score to Colombian Spanish and validate it. Materials and methods: This is a translation and validation study of Spanish of the ASES score. Patients with shoulder problems were included between December 2015 and March 2016. Patients answered the score twice, during the first consultation and again 7-14 days after. Statistical analysis was performed with Stata 13.0. Cronbach's alpha (AC) and intraclass correlation coefficient (ICC) were calculated to determine internal consistency and test-retest reliability. The Bland-Altman plot was used to determine the measurement error. Results: Sixty-five patients were included in the study. The first cause of consultation was rotator cuff tear (27%). Cronbach's alpha was 0.76 and the intraclass correlation coefficient was 0.74. The Bland-Altman showed absence of systematic error. Conclusion: The Colombian Spanish version of the ASES score is a valid and reliable tool to assess the quality of life in patients with shoulder pathology and can be used in Colombia on Spanish speaking patients.