Prevalence and incidence of heart failure in type 2 diabetes patients: results from a nationwide prospective cohort-the DIABET-IC study.

BACKGROUND: Type 2 diabetes (T2D) patients have an increased risk of heart failure (HF). There are limited data on the association between HF and T2D in specific healthcare settings. This study sought to analyse the prevalence and incidence of HF in a contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics. METHODS: We conducted an observational multicentre prospective study (DIABET-IC) that enrolled patients with a T2D diagnosis attending cardiology and endocrinology outpatient clinics in 30 centres in Spain between 2018 and 2019. The prevalence at the start of the study and the incidence of HF after a 3 year follow-up were calculated. HF was defined as the presence of typical symptoms and either: a) LVEF < 40%; or b) LVEF ≥ 40% with elevated natriuretic peptides and echocardiographic abnormalities. RESULTS: A total of 1249 T2D patients were included in the present analysis (67.6 ± 10.1 years, 31.7% female). HF was present in 490 participants at baseline (prevalence 39.2%), 150 (30.6%) of whom had a preserved ejection fraction. The presence of adverse social determinants and chronic conditions such as chronic kidney disease and atherosclerotic cardiovascular disease were more frequent in HF patients. During the study period, there were 58 new diagnoses of HF (incidence 7.6%) among those without baseline HF. The incidence rate was 3.0 per 100 person-years. Independent predictors of incident HF were smoking, left ventricular ejection fraction, NT-ProBNP, history of tachyarrhythmia and treatment with pioglitazone, oral anticoagulants, or diuretics. Despite an average suboptimal glycaemic control, the use of antidiabetic drugs with cardiovascular benefits was low (30.4% for sodium-glucose cotransporter-2 inhibitors and 12.5% for glucagon-like peptide-1 receptor agonists). CONCLUSIONS: In this contemporary cohort of T2D patients attending cardiology and endocrinology outpatient clinics, the prevalence and incidence of HF were high, comorbidities were frequent, and the use of antidiabetic agents with cardiovascular benefit was low. Outpatient care seems to be a unique opportunity for a comprehensive T2D approach that encompasses HF prevention, diagnosis, and treatment.

Clinical characteristics and outcomes of aortic prosthetic valve endocarditis: comparison between transcatheter and surgical bioprostheses.

PURPOSE: Most data regarding infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) comes from TAVI registries, rather than IE dedicated cohorts. The objective of our study was to compare the clinical and microbiological profile, imaging features and outcomes of patients with IE after SAVR with a biological prosthetic valve (IE-SAVR) and IE after TAVI (IE-TAVI) from 6 centres with an Endocarditis Team (ET) and broad experience in IE. METHODS: Retrospective analysis of prospectively collected data. From the time of first TAVI implantation in each centre to March 2021, all consecutive patients admitted for IE-SAVR or IE-TAVI were prospectively enrolled. Follow-up was monitored during admission and at 12 months after discharge. RESULTS: 169 patients with IE-SAVR and 41 with IE-TAVI were analysed. Early episodes were more frequent among IE-TAVI. Clinical course during hospitalization was similar in both groups, except for a higher incidence of atrioventricular block in IE-SAVR. The most frequently causative microorganisms were S. epidermidis, Enterococcus spp. and S. aureus in both groups. Periannular complications were more frequent in IE-SAVR. Cardiac surgery was performed in 53.6% of IE-SAVR and 7.3% of IE-TAVI (p=0.001), despite up to 54.8% of IE-TAVI patients had an indication. No differences were observed about death during hospitalization (32.7% vs 35.0%), and at 1-year follow-up (41.8% vs 37.5%), regardless of whether the patient underwent surgery or not. CONCLUSION: Patients with IE-TAVI had a higher incidence of early prosthetic valve IE. Compared to IE-SAVR, IE-TAVI patients underwent cardiac surgery much less frequently, despite having surgical indications. However, in-hospital and 1-year mortality rate was similar between both groups.

Lp(a) Levels in Relatives of Patients with Acute Coronary Syndrome and Elevated Lp(a): HER(a) Study.

Background: Lipoprotein(a) [Lp(a)] is a proatherogenic particle associated with increased cardiovascular risk. It is mainly genetically determined; so, the aim of our study is to evaluate the levels of Lp(a) in the relatives of a prospective cohort of patients who have suffered from an acute coronary syndrome (ACS) with Lp(a) ≥ 50 mg/dL. Methods: We conducted a multicenter prospective study, in which consecutive patients who had suffered from an ACS and presented Lp(a) ≥ 50 mg/dL and their first-degree relatives were included. Results: We included 413 subjects, of which 56.4% were relatives of the patients. Family history of early ischemic heart disease was present in 57.5%, and only 20.6% were receiving statin treatment. The family cohort was younger (37.5 vs. 59.1 years; p < 0.001), and 4% had ischemic heart disease and fewer cardiovascular risk factors. Mean Lp(a) levels were 64.9 mg/dL, 59.4% had levels ≥ 50 mg/dL, and 16.1% had levels ≥ 100 mg/dL. When comparing the patients with respect to their relatives, the mean level of Lp(a) was lower but without significant differences regarding the levels of LDLc, ApoB, and non-HDL. However, relatives with Lp(a) ≥ 50 mg/dL, had values similar to the group of patients with ACS (96.8 vs. 103.8 mg/dL; p = 0.18). No differences were found in Lp(a) levels in relatives based on the other lipid parameters. Conclusions: Overall, 59.4% of the first-degree relatives of patients who suffered from an ACS with Lp(a) ≥ 50 mg/dL also had elevated levels. Relatives with elevated Lp(a) had similar levels as patients.

Incidence and clinical impact of inappropriate periprocedural and perioperative management of antiplatelet therapy.

BACKGROUND AND AIMS: There is little evidence on the impact of current recommendations on the use of antiplatelet therapy during the perioperative and periprocedural period in our setting. The aim of this study was to analyze the incidence and clinical impact of inappropriate use of antiplatelet therapy in a population of patients undergoing surgery or a diagnostic or therapeutic procedure in "real life" in Spain. METHODS: A prospective multicenter observational study of patients treated with antiplatelet agents requiring intervention was conducted. The incidence of thrombotic and hemorrhagic events at 30 days was analyzed according to peri-intervention management of antiplatelet therapy. RESULTS: We included 643 patients (31.9% women, 39.0% over 75 years of age), most of them (87.7%) receiving aspirin as antiplatelet therapy at a dose of 100mg/day. Indications for antiplatelet therapy were ischemic heart disease (44.9%), cerebrovascular disease (21.7%), and peripheral vascular disease (23.0%). Ischemic risk was low in 74.3%, while 51.6% had a low bleeding risk of the intervention. Periprocedural management was considered appropriate in 61.7% of cases. 30-day incidence of the combined primary endpoint of thrombotic events and major bleeding (12.1% versus 5.0%; p=0.002) and 30-day mortality (5.2% versus 1.5%; p=0.008) were significantly higher in patients with inappropriate periprocedural management of antiplatelet agents. CONCLUSIONS: Despite current recommendations for the use of antiplatelet drugs in the perioperative/periprocedural period, their implementation in the "real world" remains low. Inappropriate use is associated with an increased incidence of adverse events, both thrombotic and hemorrhagic.

Factores de riesgo de mortalidad en pacientes mayores de 65 años hospitalizados por COVID-19 / Risk factors for mortality in patients over 65 years old hospitalized by COVID-19

Antecedentes y objetivoCOVID-19 es una enfermedad causada por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), que ha provocado una pandemia que sufrimos en la actualidad.Objetivo:identificar factores asociados con la mortalidad en pacientes de 65 años o más hospitalizados por COVID-19.Materiales y métodos: Estudio observacional retrospectivo. Incluimos pacientes de edad ≥65 años ingresados por COVID-19 entre el 5 y el 25 de marzo del 2020. Utilizamos el análisis bivariante y la regresión logística multivariante para determinar los factores de riesgo asociados a la mortalidad hospitalaria.Resultados: Se incluyeron 277 pacientes en el presente estudio. El análisis bivariante mostró diferencias significativas (p<0,05) entre fallecidos y supervivientes: edad, mayor dependencia y comorbilidad, antecedentes de cardiopatía isquémica, insuficiencia renal y neoplasias no hematológicas, insuficiencia cardiaca durante el ingreso, leucocitosis, valores elevados de creatinina, PCR, GOT y troponina Ic, linfopenia, y disminución de SatO2 y pH sanguíneo. La regresión logística multivariante reveló que la edad ≥65 años [OR: 4,23 (IC 95%: 1,43-12,52); p=0,009], linfopenia <1.000/μl [OR: 2,36 (IC 95%: 1,07-5,20); p=0,033], creatinina>1,2mg/dl [OR: 3,08 (IC 95%: 1,37-6,92); p=0,006], SatO2 <90% [OR: 2,29 (IC 95%: 1,01-5,21); p=0,049] y la troponina Ic>11ng/ml [OR: 2,32 (IC 95%: 1,04-5,16); p=0,040] se asociaron independientemente con mayor mortalidad hospitalaria.Conclusiones: La edad avanzada, linfopenia, SatO2 <90%, valores elevados de creatinina y troponina Ic se asociaron independientemente con mayor mortalidad en pacientes hospitalizados con COVID-19, lo que podría ayudar a los médicos a identificar a los pacientes con mal pronóstico para su manejo y tratamiento. (AU)

Background and objectiveCOVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has caused a global pandemic that we are currently suffering from.Objective: to identify factors associated with the death of patients aged 65 years or older hospitalized for COVID-19.Materials and methods: Retrospective cohort study. We included patients aged 65 years or older who were hospitalized for COVID-19 and dead o discharged between March 5 and 25, 2020. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Results: 277 patients were included in this study. The bivariate analysis showed significant differences (p<0.05) between survivors and non survivors: age, increased dependence and comorbidity, history of ischemic heart disease, renal failure and non-hematological neoplasms, heart failure during admission, leukocytosis, elevated creatinine, PCR, GOT and troponin Ic values, lymphopenia, and decreased blood pH and SatO2. Multivariate logistic regression revealed that age ≥65 years (OR: 4.23 (95% CI: 1.43-12.52; p=0.009), lymphopenia <1000/μL (OR: 2.36 (95% CI: 1.07-5.20; p=0.033), creatinine>1.2mg/dL (OR: 3.08 (95% CI: 1.37-6.92; p=0.006), SatO2 <90% (OR: 2.29 (95% CI: 1.01-5.21; p=0.049) and troponin Ic>11ng/mL (OR: 2.32 (95% CI: 1.04-5.16; p=0.040) were independently associated with higher hospital mortality. Conclusions: Older age, lymphopenia, SatO2 <90%, elevated creatinine and troponin Ic values were independently associated with higher mortality in hospitalized patients with COVID-19, these factors could help clinicians to identify patients with poor prognosis. (AU)

Síndrome del carrete: una causa poco común de asistencia en laurgencia hospitalaria / Reel's syndrome: a rare cause of emergency hospital care

Poor positioning of the electrodes implantable cardiac electronic device(IEHD) is a very rare event, but can occasionally lead to serious clinical complications, such as syncope, heart failure or death due to asystole in patientsdependent on stimulation1.Recently, a new terminology management for ICED lead macro-dislodgementhas been proposed2. This new classification may be useful for clinicians. Wereport a clinical case of Reel´s Syndrome. (AU)

El mal posicionamiento de electrodos de dispositivos cardiacos electrónicosimplantables (DCEI) es un hecho infrecuente pero asociado a complicacionesclínicas graves como síncopes, insuficiencia cardiaca e incluso muerte porasistolia en pacientes dependientes de estimulación1.Recientemente se ha propuesto una actualización de la ordenación terminológica sobre macrodislocación de electrodos de DCEI que resulta de granutilidad para la práctica clínica habitual2. Siguiendo esta terminología presentamos el caso clínico de un síndrome del carrete. (AU)

Diferencias en mortalidad intrahospitalaria tras IAMCEST frente a IAMSEST por sexo. Tendencia durante once años en el Sistema Nacional de Salud / Differences in in-hospital mortality after STEMI versus NSTEMI by sex. Eleven-year trend in the Spanish National Health Service

Introducción y objetivos: Hay resultados contradictorios sobre si existen diferencias de sexo en la mortalidad tras el infarto agufo de miocardio (IAM). Además, hay escasez de datos sobre el impacto del sexo en los resultados tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) o sin elevación del segmento ST (IAMSET). El objetivo de este estudio es analizar las tendencias de diferencias de sexo en las diferencias de mortalidad relacionadas con el sexo para IAMCEST e IAMSEST. Métodos: Se ha realizado un análisis retrospectivo de 445.145 episodios de IAM (2005-2015) utilizando información del Sistema Nacional de Salud español. Las tasas de incidencia se expresan como eventos por 10.000 personas-año. Los denominadores (grupos específicos por edad) se han obtenido del censo nacional. Se ha calculado la mortalidad bruta y ajustada (regresión logística multinivel) y se ha utilizado análisis de regresión de Poisson para estudiar las tendencias temporales de la mortalidad hospitalaria. Resultados: El 69,8% eran varones, con una edad media de 66,1 (13,3) años, significativamente más joven que las mujeres 74,9 (12,1) (p <0,001). Un total de 272.407 (61,2%) episodios son IAMCEST y 172.738 (38,8%) IAMSEST. Las mujeres son el 28,8% de IAMCEST y el 33,9% de los IAMSEST (p <0,001). En los modelos de ajuste de riesgo de mortalidad hospitalaria el efecto del sexo femenino es opuesto en IAMCEST (OR para mujeres=1,18; IC95%, 1,14-1,22; p <0,001) y IAMSEST (OR para mujeres:=0,85; IC95%, 0,81-0,89; p <0,001). Las tasas de hospitalización por IAM son más altas en varones que en mujeres para todos los grupos de edad [20 frente a 7,7 por cada 10.000 35-94 años (p <0,001)], con una tendencia a disminuir para ambos sexos... (AU)

Introduction and objectives: Conflicting results have been reported on the possible existence of sex differences in mortality after myocardial infarction (MI). There is also a scarcity of data on the impact of sex on outcomes after ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). The aim of this study was to analyze sex difference trends in sex-related differences in mortality for STEMI and NSTEMI. Methods: A retrospective analysis of 445 145 episodes of MI (2005-2015) was carried out using information from the Spanish National Health System. The incidence rates were expressed as events per 10 000 person-years. The denominators (age-specific groups) were obtained from the nationwide census. We calculated crude and adjusted (multilevel logistic regression) mortality. Poisson regression analysis was used to study temporal trends for in-hospital mortality. Results: A total of 69.8% episodes occurred in men. The mean age in men was 66.1±13.3 years, which was significantly younger than in women, 74.9±12.1 (P<.001). A total of 272 407 (61.2%) episodes were STEMI, and 172 738 (38.8%) were NSTEMI. Women accounted for 28.8% of STEMI and 33.9% of NSTEMI episodes (P <.001). The effect of female sex on risk-adjusted models for in-hospital mortality was the opposite in STEMI (OR for women, 1.18; 95%CI, 1.14-1.22; P <.001) and NSTEMI (OR for women, 0.85; 95%CI, 0.81-0.89; P <.001). MI hospitalization rates were higher in men than in women for all age groups [20 vs 7.7 per 10 000 individuals aged 35-94 years (P <.001)], with a trend to diminish in both sexes. Conclusions: Women had a slight but significantly increased risk of in-hospital mortality after MI, but the effect of sex depended on MI type, with women exhibiting higher mortality for STEMI and lower mortality for NSTEMI. (AU)

Recomendaciones para mejorar el control lipídico. Documento de consenso de la Sociedad Española de Cardiología / Recommendations to improve lipid control. Consensus document of the Spanish Society of Cardiology

El control actual de la concentración de colesterol unido a lipoproteínas de baja densidad en el paciente con enfermedad cardiovascular ateroesclerótica es muy escaso y esto se asocia con un aumento del riesgo de que se presenten complicaciones cardiovasculares. Además, cuanto más tarde se logren dichos objetivos, el riesgo será mayor. Esto se debe principalmente a un uso insuficiente de las terapias hipolipemiantes actualmente disponibles. De hecho, con los tratamientos actuales (estatinas, ezetimiba e inhibidores de la proteína PCSK9), la mayoría de los pacientes en prevención secundaria debería lograr los objetivos de control del colesterol unido a lipoproteínas de baja densidad. Por estos motivos, en el presente documento promovido por la Sociedad Española de Cardiología se proponen 3 algoritmos de abordaje sencillos y fácilmente aplicables, que abarcan la mayoría de las situaciones clínicas que nos podemos encontrar en los pacientes con cardiopatía isquémica, con el doble objetivo de lograr controlar a la mayoría de los pacientes y hacerlo lo antes posible, ya que el beneficio en prevención secundaria depende del riesgo y del tiempo

The current control of low-density lipoprotein cholesterol among patients with atherosclerotic cardiovascular disease is very low and this is associated with an increase of cardiovascular outcomes. In addition, the latter this happens, the risk will be greater. This is mainly due to an insufficient use of the lipid-lowering therapy currently available. In fact, with current treatments (statins, ezetimibe and PCSK9 inhibitors), the majority of patients in secondary prevention should achieve low-density lipoprotein cholesterol goals. For these reasons, in this manuscript promoted by the Spanish Society of Cardiology we propose three simple and feasible decision-making algorithms that include the majority of clinical scenarios among patients with ischemic heart disease, with the double aim of attaining therapeutic goals in the majority of patients as soon as possible; in secondary prevention the magnitude of the benefit is risk- and time-dependent

Recomendaciones sobre el tratamiento antitrombótico durante la pandemia COVID-19. Posicionamiento del Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología / Recommendations on antithrombotic treatment during the COVID-19 pandemic. Position statement of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology

La pandemia producida por la infección del nuevo coronavirus SARS-CoV-2, que da lugar a una enfermedad altamente contagiosa (COVID-19), ha producido un colapso de los sistemas sanitarios de todo el mundo. Se ha descrito que estos pacientes sufren un estado inflamatorio que condiciona un alto riesgo trombótico. Sin embargo, apenas hay información sobre cómo abordar el riesgo trombótico, la coagulopatía y el tratamiento anticoagulante de estos pacientes. Por otra parte, incluso los pacientes no infectados por COVID-19 sufren una tremenda influencia en su abordaje habitual por la situación sanitaria actual. El objetivo del presente documento, elaborado por el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología, es presentar la información disponible y dar unas pautas sencillas de tratamiento con fármacos antitrombóticos

The new coronavirus SARS-CoV-2, which gives rise to the highly contagious COVID-19 disease, has caused a pandemic that is overwhelming health care systems worldwide. Affected patients have been reported to have a heightened inflammatory state that increases their thrombotic risk. However, there is very scarce information on the management of thrombotic risk, coagulation disorders, and anticoagulant therapy. In addition, the situation has also greatly influenced usual care in patients not infected with COVID-19. This article by the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology aims to summarize the available information and to provide a practical approach to the management of antithrombotic therapy

Consenso de expertos sobre la insuficiencia cardiaca con fracción de eyección reducida: más allá de las guías / Expert consensus statement on heart failure with reduced ejection fraction: beyond the guidelines

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¿Existe brecha de género en la cardiología española? / Is there a gender gap in Spanish cardiology?

No disponible

Análisis de la situación de la profilaxis de la endocarditis infecciosa en odontología tras casi una década de guías de práctica clínica. Respuesta / Prophylaxis of infective endocarditis in dentistry: analysis of the situation after almost a decade of clinical practice guidelines. Response

No disponible

¿Los odontólogos de nuestro medio siguen correctamente las pautas de profilaxis de endocarditis infecciosa recomendadas? / Prophylaxis of infective endocarditis in dentistry: analysis of the Situation after almost a decade of clinical practice guidelines

No disponible

Diferencias de género en la carrera profesional de los cardiólogos en 70 hospitales españoles / Gender differences in the professional lives of cardiologists in 70 Spanish hospitals

No disponible

¿El uso de edoxabán sería coste-efectivo para la prevención del ictus y la embolia sistémica en pacientes con fibrilación auricular no valvular en España? / Would the use of edoxaban be cost-effective for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation in Spain?

Introducción y objetivos: Analizar el coste-efectividad del edoxabán frente al acenocumarol en la prevención del ictus y la embolia sistémica en pacientes con fibrilación auricular no valvular (FANV) en España. Métodos: Modelo de Markov, adaptado a España desde la perspectiva del Sistema Nacional de Salud, que simula la evolución de una cohorte hipotética de pacientes con FANV a lo largo de toda su vida a partir de diferentes estados de salud: ictus, hemorragias y otras complicaciones cardiovasculares. Los datos de eficacia y seguridad se obtuvieron a partir de la evidencia clínica disponible (principalmente del estudio en fase III ENGAGE AF-TIMI 48). Los costes del tratamiento de la FANV y sus complicaciones se obtuvieron de fuentes españolas. Resultados: El edoxabán resultó en 0,34 años de vida ajustados por calidad (AVAC) adicionales en comparación con el acenocumarol. El coste incremental con el edoxabán fue de 3.916 euros, derivado principalmente de un mayor coste farmacológico, que se compensa parcialmente por los menores costes de la monitorización del tratamiento y del tratamiento de eventos y complicaciones de la FANV. Se obtuvo un coste por AVAC de 11.518 euros, dentro de los umbrales comúnmente considerados coste-efectivos en España (25.000-30.000 euros/AVAC). Los diferentes análisis de sensibilidad realizados confirmaron la robustez de los resultados. Conclusiones: El edoxabán es una alternativa coste-efectiva frente al acenocumarol en la prevención del ictus y la embolia sistémica en pacientes con FANV en España

Introduction and objectives: To assess the cost-effectiveness of edoxaban versus acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain. Methods: Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, hemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources. Results: Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was €3916, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was €11 518, within the thresholds commonly considered cost-effective in Spain (€25 000-€30 000/QALY). The robustness of the results was confirmed by various sensitivity analyses. Conclusions: Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain

Intervencionismo percutáneo cardiológico y cirugía cardiaca: el paciente en el centro de los procesos. Documento de posicionamiento de la Sociedad Española de Cardiología / Percutaneous cardiological intervention and cardiac surgery: patient-centered care. Position statement of the Spanish Society of Cardiology

El tratamiento percutáneo de la enfermedad coronaria y determinadas enfermedades cardiovasculares estructurales ha experimentado un desarrollo espectacular. Cada vez se trata a un mayor número de pacientes con diferentes tipos de cardiopatías mediante intervenciones percutáneas o transcatéter, mientras que este incremento no se observa en los pacientes sometidos a cirugía cardiaca. Esta situación ha motivado diferentes posicionamientos que requieren un análisis objetivo que considere todos los aspectos que pueden influir en esta evolución. En este documento se evalúan las 2 situaciones en que el problema es más manifiesto: la revascularización coronaria y el tratamiento de la estenosis aórtica. El artículo analiza la situación de la revascularización coronaria en España y las causas que pueden explicar las diferencias existentes entre el número de pacientes que actualmente se someten a revascularización percutánea respecto a los que se someten a cirugía coronaria. Por otra parte, el implante percutáneo de válvula aórtica mediante catéter en el tratamiento de la estenosis aórtica condicionará una previsible reducción del número de pacientes candidatos a tratamiento mediante recambio quirúrgico. Diferentes sociedades científicas internacionales han publicado los requisitos de formación y experiencia y los volúmenes exigidos a los operadores y centros para desarrollar un programa de implante percutáneo de válvula aórtica, condiciones que la Sociedad Española de Cardiología, situando al paciente en el centro del proceso asistencial, considera como absolutamente imprescindibles. Teniendo en cuenta que ambas formas de intervención (percutánea y quirúrgica) son procedimientos complementarios, la valoración multidisciplinaria de los pacientes (Heart Team) sigue siendo de extrema necesidad para poder ofrecerles la mejor opción de tratamiento. En este escenario de aproximaciones diversas, la figura del cardiólogo clínico adquiere una relevancia clave. Por último, la evolución que está experimentando el tratamiento de la enfermedad estructural obligará en el futuro a realizar procedimientos en los que se requiera la actuación conjunta de profesionales de ambas especialidades. Este acercamiento exigirá un rediseño de los programas de formación actualmente existentes

The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs

Evidence of the association between increased use of direct oral anticoagulants and a reduction in the rate of atrial fibrillation-related stroke and major bleeding at the population level (2012–2019) / Evidencia a nivel poblacional de la asociación entre el aumento del uso de anticoagulantes orales directos y una reducción de la incidencia de ictus y hemorragias mayores relacionados con fibrilación auricular (2012-2019)

Background: The introduction of direct-acting oral anticoagulants (DOACs) has shown to decrease atrial fibrillation (AF)-related stroke and bleeding rates in clinical studies, but there is no certain evidence about their effects at the population level. Our aim was to assess changes in AF-related stroke and major bleeding rates between 2012 and 2019 in Andalusia (Spain), and the association between DOACs use and events rates at the population level. Methods: All patients with an AF diagnosis from 2012 to 2019 were identified using the Andalusian Health Population Base, that provides clinical information on all Andalusian people. Annual ischemic and hemorrhagic stroke, major bleeding rates, and used antithrombotic treatments were determined. Marginal hazard ratios (HR) were calculated for each treatment. Results: A total of 95,085 patients with an AF diagnosis were identified. Mean age was 76.1±10.2 years (49.7% women). An increase in the use of DOACs was observed throughout the study period in both males and females (p<0.001). The annual rate of ischemic stroke decreased by one third, while that of hemorrhagic stroke and major bleeding decreased 2–3-fold from 2012 to 2019. Marginal HR was lower than 0.50 for DOACs compared to VKA for all ischemic or hemorrhagic events. Conclusions: In this contemporary population-based study using clinical and administrative databases in Andalusia, a significant reduction in the incidence of AF-related ischemic and hemorrhagic stroke and major bleeding was observed between 2012 and 2019. The increased use of DOACs seems to be associated with this reduction.(AU)

Introducción: La introducción de los anticoagulantes orales de acción directa (ACOD) ha demostrado disminuir las tasas de accidentes cerebrovasculares y hemorragias relacionados con fibrilación auricular (FA) en estudios clínicos, pero no hay tanta evidencia sobre sus efectos a nivel poblacional. Nuestro objetivo fue evaluar los cambios en la incidencia de ictus y hemorragias mayores relacionados con FA entre 2012 y 2019 en Andalucía (España), y estudiar la asociación entre el uso de ACOD y estos eventos a nivel poblacional. Métodos: Se incluyeron pacientes con diagnóstico de FA entre los años 2012 y 2019 en la Base de Población Sanitaria de Andalucía, que proporciona información clínica de todos los andaluces. Se determinaron los accidentes cerebrovasculares isquémicos y hemorrágicos anuales, las tasas de sangrado mayor y los tratamientos antitrombóticos utilizados. Se estimaron los hazard ratio para cada tratamiento. Resultados: Se identificaron un total de 95.085 pacientes con diagnóstico de FA. La edad media fue de 76,1±10,2 años (49,7% mujeres). Se observó un aumento en el uso de ACOD a lo largo del período de estudio, tanto en varones como en mujeres (p<0,001). La tasa anual de ictus isquémico disminuyó en un tercio, mientras que la de ictus hemorrágico y hemorragia mayor se redujo de 2 a 3 veces entre 2012 y 2019. Los hazard ratio fueron inferiores a 0,50 para los ACOD en comparación con los antivitamina K para todos los eventos isquémicos o hemorrágicos. Conclusiones: En este estudio poblacional contemporáneo, se observó, utilizando bases de datos clínicas y administrativas de Andalucía, una reducción significativa en la incidencia de ictus isquémico y hemorrágico, y hemorragia mayor relacionados con FA entre los años 2012 y 2019. El mayor uso de ACOD parece estar asociado con esta reducción.(AU)

Perspectiva de género en el estudio OFRECE: diferencias en la atención entre pacientes que consultan por dolor torácico o por palpitaciones / The gender perspective within the OFRECE study: differences in health care among patients consulting for chest pain and/or palpitations

Introducción y objetivos: En un estudio de base poblacional, se analizaron las posibles diferencias en función del sexo en la atención al dolor torácico o las palpitaciones como motivo de consulta. Métodos: El estudio OFRECE incluyó una muestra aleatoria de la población española de 8.400 participantes de edad ≥ 40 años, de los que 1.132 (13,5%) tenían antecedentes de consulta por dolor en el pecho y 1.267 (15,1%), por palpitaciones y se incluyen en este estudio. Se calculó la odds ratio (OR) de que se practicaran determinadas pruebas y se comunicaran los resultados de las consultas en relación con el hecho de ser mujer, tanto brutas como ajustadas por los factores de riesgo cardiovascular clásicos, antecedentes de enfermedad cardiovascular y diagnóstico de angina estable o fibrilación auricular confirmado en este estudio en cada caso. Resultados: No se observaron diferencias en los antecedentes de consulta por dolor torácico entre mujeres y varones (el 13 y el 14,1%; p=0,159) y sí en las consultas por palpitaciones (el 19,0 y el 10,4% respectivamente; p <0,001). A las mujeres con antecedentes de consulta por dolor torácico, en comparación con los varones, se les realizaron menos ecocardiogramas (el 32,5 y el 45,3%; p <0,001), se las remitió con menor frecuencia al cardiólogo (el 49,1 y el 60,1%; p <0,001), ingresaron menos (el 20,1 y el 39,4%; p <0,001) y se alcanzó un diagnóstico en menor proporción de casos (el 60,9 y el 71,9%; p <0,001). Al ajustar, disminuyen las diferencias y dejan de ser significativas en todos los casos: para ecocardiogramas, OR ajustada=0,81 (IC95%, 0,60-1,09); para remisión al cardiólogo, OR ajustada=0,86 (IC95%, 0,63-1,16), y para ingreso, OR ajustada=0,76 (IC95%, 0,54-1,09). En el caso de las palpitaciones, las diferencias no ajustadas son menores y todas desaparecen al ajustar. Conclusiones: Este trabajo no confirma un sesgo en razón del sexo en la atención a estos síntomas, aunque no es descartable completamente un sesgo de género en el diagnóstico confirmado en el estudio que limite su capacidad para identificar diferencias en la atención a las pacientes

Introduction and objectives: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. Methods: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. Results: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. Conclusions: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care

Resultados a largo plazo del tratamiento precoz con ivabradina más bloqueadores beta en pacientes hospitalizados por insuficiencia cardiaca sistólica / Effect of early treatment with ivabradine plus beta-blockers on long-term outcomes in patients hospitalized with systolic heart failure

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Evolución de la asistencia cardiovascular en el Sistema Nacional de Salud de España. Datos del proyecto RECALCAR 2011-2020 / Trends in cardiovascular care in the National Health System in Spain. Data from the RECALCAR project 2011-2020

Introducción y objetivos: El proyecto RECALCAR (Recursos y Calidad en Cardiología), iniciativa de la Sociedad Española de Cardiología, pretende estandarizar la información para generar evidencia sobre los resultados en salud cardiovascular. Su objetivo es analizar la evolución de los recursos y la actividad de las unidades y los servicios de cardiología y conocer los resultados en la asistencia cardiovascular durante la última década en España. Métodos: Este estudio se basa en las dos fuentes anuales de datos del proyecto RECALCAR: una encuesta sobre recursos y actividad de las unidades y servicios de cardiología (2011-2020) y el conjunto mínimo básico de datos del Sistema Nacional de Salud (2011-2019), referido a insuficiencia cardiaca (IC), infarto agudo de miocardio con (IAMCEST) y sin (IAMSEST) elevación del segmento ST. Resultados: La encuesta incluye el 70% de las unidades y servicios de cardiología de España. Se ha observado una disminución en el número de camas de hospitalización y la estancia media y un incremento notable en el número de estudios de imagen cardiaca y procedimientos terapéuticos percutáneos. Los ingresos por IC ajustados por edad y sexo han disminuido, aunque su mortalidad y el porcentaje de reingresos han ido en aumento. La evolución de la mortalidad y los reingresos ha sido muy favorable en el IAMCEST; en el IAMSEST, aunque positiva, ha sido menos relevante. Conclusiones: La información aportada por el proyecto RECALCAR demuestra una evolución favorable en la última década en recursos, actividad y resultados en determinados procesos cardiovasculares y constituye una fuente esencial para mejoras futuras y facilitar la toma de decisiones en política sanitaria. (AU)

Introduction and objectives: The RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. Methods: The study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. Results: The survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. Conclusions: The information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy. (AU)