The RICA-2 registry: design and baseline characteristics of the first 1,000 patients.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry. METHODS: Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with de novo HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities. RESULTS: RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition. CONCLUSION: The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine.

Benefits of a comprehensive care model in patients with heart failure and preserved ejection fraction: The UMIPIC program.

BACKGROUND: Patients with heart failure (HF) and preserved ejection fraction (HFpEF), in contrast to those with reduced ejection fraction, are older, have more comorbidities, and are not candidates for effective therapeutic measures. Therefore, they are at high risk for hospital admission and mortality. This study evaluated the benefit of a comprehensive continuous care program (UMIPIC program) in patients with HFpEF. METHODS: We prospectively analyzed data on 2401 patients with HFpEF attended to in internal medicine departments who form part of the RICA registry. They were divided into 2 groups: one was followed-up on in the UMIPIC program (UMIPIC group, n: 1011) and another received conventional care (RICA group, n: 1390). A total of 753 patients in each group were selected by propensity score matching and admissions and mortality were assessed during 12 months of follow-up after an episode of hospitalization due to HF. RESULTS: Compared to the RICA group, the UMIPIC group had a lower rate of HF admissions (19.2% versus 36.5%, respectively; hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.45-0.68; p < 0.001) and mortality (12.6% versus 28%, respectively; HR = 0.40; 95% CI: 0.31-0.51; p < 0.001). There were no differences in hospitalizations for non-HF causes. CONCLUSIONS: Implementation of the UMIPIC program, which is based on comprehensive continuous care, for patients with HFpEF and a high degree of comorbidity reduces both admissions and mortality in the first year of follow-up.

Muscle Assessment by Ultrasonography: Agreement with Dual-Energy X-Ray Absorptiometry (DXA) and Relationship with Physical Performance.

BACKGROUND: Different methods have been proposed to study skeletal muscle mass in sarcopenia diagnosis, although all have inherent drawbacks. The aim of this study was to evaluate the utility of muscle ultrasound in muscle assessment by studying its correlation with dual-energy x-ray absorptiometry (DXA) and calf circumference (CC), cut-off values for ultrasound-based detection of low muscle mass, and the correlation with muscle performance. METHODS: Fifty-seven participants older than 70 years, underwent a muscle ultrasound study, DXA, calf circumference (CC) and functional assessment. Ultrasound measurements were taken in the femoral quadriceps (transverse plane) and in the medial gastrocnemius (transverse and longitudinal planes). Muscle function was assessed by gait speed, Short Physical Performance Battery (SPPB) and grip strength. RESULTS: Median age was 78.9 years (IQR 74.9 - 81.9), and 33 were women (57.9%). We found good correlation between muscle thickness of gastrocnemius muscle in transverse and longitudinal plane and appendicular lean mass measured by DXA (r=0.546 and r=0.689 respectively) and good correlations between muscle thickness of gastrocnemius in transverse and longitudinal plane with CC (r=0.651 and r=0.447 respectively). The thickness of gastrocnemius medialis optimal cut-off points for low muscle mass were 18,5mm in the transverse plane (Sensitivity: 77,8%, Specificity: 77,1%), and 17.3mm in the longitudinal plane (Sensitivity: 100%,Specificity: 68.8%). Muscle thickness was also significantly correlated with gait speed, SPPB and grip strength. CONCLUSIONS: Measures of gastrocnemius medialis thickness obtained by ultrasound are reliable and correlate well with DXA and CC values and muscle performance.

[Analysis of population attended in a tuberculosis unit in Madrid. Evolution and impact of immigration from 1997 to 2006]. / Análisis de la población atendida en una unidad de tuberculosis en Madrid. Evolución e impacto de la inmigración desde 1997 a 2006.

BACKGROUND: In Spain there is a high prevalence of tuberculosis (TB). The aim of this study is to describe population attended in an Isolation Unit, analysing the changes that have occurred in 10 years, the impact of immigration and factors that may condition the loss of following. PATIENTS AND METHODS: Descriptive study of all patients admitted to the Isolation Unit of Hospital Cantoblanco-La Paz from 1997 to 2006. Univariate analysis and multiple logistic regression analysis were performed. RESULTS: 832 patients were studied, 69.4% men, with a mean age of 40.8 years 37.5% immigrants. In new cases, resistance to isoniazid was documented in 6.7% and multidrug resistance in 3.1%, and in previously treated cases, in 11.2% and 8.4%, respectively. Treatment was completed by 74.1%, 17.5% were lost, which was associated with drugs consumption (OR 3.01; CL 95% 1.18-3.41), being immigrant (OR 2.14; CL 95% 1.42-3.21) and HIV infection (OR 1.96; CL 95% 1.18-3.41). In the 10 years, percentage of immigrants and patients who proceeded from the Emergency Departments increased and results improved, while HIV infection and loss of following reduced. CONCLUSIONS: Profile of patient with TB has changed in last years in association with immigration. In spite of better results, more actions are needed in order to improve the adherence and epidemiologic control of the disease. (c) 2009 Elsevier España, S.L. All rights reserved.