Impact of clinical ultrasound in patients with heart failure treated in home. / Impacto de la ecografía clínica en pacientes con insuficiencia cardíaca atendidos en hospitalización a domicilio.

BACKGROUND AND OBJECTIVE: In Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC). PATIENTS AND METHODS: A randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the UG-ultrasound group (SC and CU performed) and the CG-control group (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF. RESULTS: A total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1-1) and mortality by 30% (RR 0.7; 95% CI: 0.2-2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power. CONCLUSION: Our results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.

Fatality as a Feature of Medical Care.

Taking advantage of an interesting clinical scenario, we want to introduce a discussion about fatality in our daily practice and the need to accept that. An 80 year-old man with non-traumatic spontaneous bleeding tendency came to the clinics. Although being on warfarin as a consequence of primary thrombotic prophylaxis due to an atrial fibrillation, full assessment was performed. Not only the rare entity found on him, but also the severe complication that happened afterwards challenged clinicians and led them to risky treatment options.

Enfermedad tromboembólica venosa en pacientes con Enfermedades Autoinmunes en el Hospital Reina Sofía de Tudela / Venous thromboembolism in patients with autoimmune disorders a small Hospital

Introducción: Los pacientes con Enfermedades Autoinmunes Sistémicas (EAS) tienen alto riesgo de desarrollar Enfermedad Tromboembólica Venosa (ETV). El comportamiento clínico una vez empiezan con el tratamiento anticoagulante acaba de ser descrito por el grupo RIETE durante este año. Material y métodos: Creamos una base de datos en el Hospital Reina Sofía para comparar las tasas de recurrencias, sangrado mayor y muerte durante el tratamiento anticoagulante de acuerdo a la presencia o ausencia de EAS. Resultados: No se detectan diferencias significativas en las características basales de los pacientes salvo en la presencia de ETV idiopática y de anticuerpos antifosfolípidos. Los enfermos con EAS presentan mayores tasas de recurrencia estando bajo tratamiento anticoagulante y similares tasas de hemorragia y mortalidad. Conclusiones: En un escenario local y más homogéneo de partida que el observado en el RIETE, los enfermos con EAS presentan mayor tendencia a recurrir estando en tratamiento anticoagulante que los enfermos sin esta condición. (AU)

Background: Patients with Autoimmune Disorders (AD) are at increased risk for venous thromboembolism (VTE). The natural history of VTE in these patients has been consistently evaluated by RIETE investigators this year. Methods: We used a newly created database in Reina Sofía´s Hospital to compare the rates of VTE recurrences, major bleeding and death during the course of anticoagulation according to the presence or absence of autoimmune disorders. Results: No significant differences were detected in the baseline characteristics of patients except for the presence of idiopathic VTE and antiphospholipid antibodies. Patients with AD presented higher rates of recurrence while being under anticoagulant treatment and similar rates of bleeding and mortality. Conclusions: In a more local and homogeneous starting scenario than what was observed in the RIETE, patients with AD have a greater tendency to recur while being on anticoagulant treatment than patients without this condition. (AU)

Cinturas hipercaptantes / Hyper-uptake waists

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