[Predictive factors for readmission in heart failure patients]. / Morbimortalidad de los pacientes ingresados por insuficiencia cardíaca. Factores predictores de reingreso.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a prevalent and increasing disease and represents one of the main causes of hospital admission. It is associated with an important morbi-mortality and a high rate of readmission. The objective of this study was to know the clinical characteristics of admitted patients with HF and to detect any valuable prognosis factors. PATIENTS AND METHOD: Prospective study of admitted HF patients between May'99 and May'00. Readmission rate was evaluated six months later. RESULTS: 204 patients were included with an average age of 78 (9.9) years. 66% were women. Diabetes mellitus (DM) (36.4%) and chronic obstructive pulmonary disease (COPD) (23.4%) were the most outstanding associated pathologies. Ischemic heart disease (IHD) was the most frequent etiology in 33.4% cases. Mean time of admission was 10 days. 34% patients had systolic dysfunction (SD). Men with IHD presented a higher rate of SD (p < 0.001). Mortality was 12.4%, especially in COPD patients (p < 0.011). IECAs were prescribed in 71.2% in the SD group. Readmission rate at 6 months was about 43%. Patients with renal failure (p < 0.04) and those with a more impaired functional class (p < 0.02) displayed a higher readmission rate. CONCLUSIONS: Several clinical factors determine the morbi-mortality and prognosis including an older age, associated comorbility, type of cardiopathy and presence of systolic dysfunction. All these factors are detected at the time of hospital admission.

[Efficacy of a protocol for the diagnosis and management of syncope in an unselected population]. / Eficacia de un protocolo para el diagnóstico y tratamiento del síncope en una población no seleccionada.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of a protocol based on European guidelines for the management and diagnosis of syncope applied by a multidisciplinary team in unselected patients. PATIENTS AND METHODS: 402 unselected patients were followed prospectively in a second-level country hospital, between November 2003 and November 2008 with a protocol based on European Guidelines. RESULT: Syncope was diagnosed in 83.3% of patients and 26.6% required hospitalization. For every 100 cases, the number of tests carried out and their performance (percentage of positive diagnostic tests/number of tests carried out) was calculated. Tilt test: 31 and performance: 62.4%, Doppler-echocardiography. 17-8.3%, Holter 16-13.2%, cranial CT 5.2-0%, ergometry 1.9-0%, chest CT 1.4-16%, EPS 1.2-33%, ILR 0.7-33%. CONCLUSIONS: This study shows a high percentage of diagnoses with low number of tests carried out, emphasizing the performance of tilt test. The study of unselected patients with a protocol based on European Guidelines for the management and diagnosis of syncope applied by a multidisciplinary team was very effective.