Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow-up.

BACKGROUND: Patient satisfaction with remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) seems to be high, yet knowledge on long-term patient experiences is limited. The European REMOTE-CIED study explored patients' experiences with RPM, examined patient's preferences for ICD follow-up, and identified determinants of patient's preferences in the first 2 years postimplantation. METHODS: European heart failure patients (N = 300; median age = 66 years [interquartile range (IQR) = 59-73], and 22% female) with a first-time ICD received a Boston Scientific LATITUDE RPM system (Marlborough, MA, USA) and had scheduled in-clinic follow-ups once a year. Patients completed questionnaires at 1-2 weeks and also at 3, 6, 12, and 24 months postimplantation and clinical data were obtained from their medical records. Patient evaluation data were analyzed descriptively, and Student's t-tests/Man-Whitney U tests or Chi-square tests/Fisher's exact tests were performed to examine determinants of patient preferences. RESULTS: At 2 years postimplantation, the median patient satisfaction score with the RPM system was 9 out of 10 (IQR = 8-10), despite 53% of the patients experiencing issues (eg, failure to transmit data). Of the 221 patients who reported their follow-up preferences, 43% preferred RPM and 19% preferred in-clinic follow-up. Patients with a preference for RPM were more likely to be higher educated (P = 0.04), employed (P = 0.04), and equipped with a new LATITUDE model (P = 0.04), but less likely to suffer from chronic obstructive pulmonary disease (P = 0.009). CONCLUSION: In general, patients were highly satisfied with RPM, but a subgroup preferred in-clinic follow-up. Therefore, physicians should include patients' concerns and preferences in the decision-making process, to tailor device follow-up to individual patients' needs and preferences.

The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions.

BACKGROUND: Studies have shown that remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) is at least comparable to in-clinic follow-up with regard to clinical outcomes and might be cost-effective, yet RPM is not standard clinical practice within Europe. Better insight into the patient perspective on RPM may aid in its acceptance, implementation, and reimbursement. This narrative review (1) summarizes existing evidence on the impact of RPM on patient-reported outcomes and (2) discusses future directions in examining the patient perspective. METHODS AND RESULTS: Literature review indicated that only five randomized trials on RPM in ICD patients included patient-reported outcomes, with inconclusive results. Observational studies show a trend toward good patient satisfaction and acceptation of RPM. Yet, results should be interpreted with caution due to a number of limitations including a potential selection bias, use of generic/nonvalidated questionnaires, relatively short follow-up durations, and a lack of subgroup identification. CONCLUSION: Although RPM seems to be safe, effective, timely, and efficient, the patient perspective has received little attention so far. The scarce evidence on patient-reported outcomes in RPM studies seems to be positive, but future trials with a follow-up of ≥12 months and validated patient-reported outcome measures are needed. The REMOTE-CIED study from our group is the first prospective randomized controlled trial primarily designed to examine the patient perspective on RPM, and is powered to identify characteristics associated with RPM satisfaction and benefit. Results are expected in 2018 and will add valuable information to the current evidence.

Sex bias in diagnostic delay in bronchiectasis: An analysis of the Spanish Historical Registry of Bronchiectasis.

Diagnostic delay is common in most respiratory diseases, particularly in bronchiectasis. However, sex bias in diagnostic delay has not been studied to date. OBJECTIVE: Assessment of diagnostic delay in bronchiectasis by sex. METHODS: The Spanish Historical Registry of Bronchiectasis recruited adults diagnosed with bronchiectasis from 2002 to 2011 in 36 centres in Spain. From a total of 2113 patients registered we studied 2099, of whom 1125 (53.6%) were women. RESULTS: No differences were found for sex or age (61.0 ± 20.6, p = 0.88) or for localization of bronchiectasis ( p = 0.31). Bronchiectasis of unknown aetiology and secondary to asthma, childhood infections and tuberculosis was more common in women (all ps < 0.05). More men than women were chronic obstructive pulmonary disease-related bronchiectasis and colonized by Haemophilus influenzae ( p < 0.001 for both). Onset of symptoms was earlier in women. The diagnostic delay for women with bronchiectasis was 2.1 years more than for men ( p = 0.001). DISCUSSION: We recorded a substantial delay in the diagnosis of bronchiectasis. This delay was significantly longer in women than in men (>2 years). Independent factors associated with this sex bias were age at onset of symptoms, smoking history, daily expectoration and reduced lung function.

Comparison of Functional Outcome and Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source (ESUS) vs. Cardioembolic Stroke Patients.

BACKGROUND: Embolic stroke of undetermined source (ESUS) recurrence and functional outcome from long-term follow-up is not well delineated. The purpose of this study is to compare these functional variables between ESUS vs. cardioembolic stroke (CS) patients. METHODS: We analyzed data of consecutive ESUS and CS patients from our institutional database, from January 2003 until April 2015. The endpoints were stroke recurrence, mortality and poor clinical outcome (Modified Rankin Score 3-6), at discharge, 6 months and final follow-up. Adjusted multivariate Cox analysis and Kaplan-Meier curves were used to estimate the probability of recurrence and death. RESULTS: 149 ESUS (median age 44 years) and 235 CS (median age 66 years) consecutive patients were included in the study. Median follow-up period for the entire sample was 19 months (interquartile range 6.0-45.0 months). Stroke recurrence was similar between ESUS and CS patients (5.4% vs. 9.8% respectively, p = 0.12). Death occurred in 30 CS cases (12.8%), with a cumulative probability of survival of 77%. Poor functional outcome was present in 58.3%, 54.0% and 54.9% at discharge, 6 months and final follow-up respectively in CS patients, significantly worst compared to ESUS cases (HR 3.1; CI 95% 1.96-4.68). Oral anticoagulation presents with a HR 8.01 for recurrence, and antiplatelet therapy had the highest risk for recurrence for both groups (HR 24.3). CONCLUSION: ESUS patients are substantially younger than CS patients but have a stroke recurrence rate similar to CS patients, with a lower mortality rate, and better functional outcome on long-term follow-up.

Registros de enfermedades respiratorias en España: fundamentos y organización / Respiratory disease registries in Spain: fundamentals and organization

En el presente trabajo se describen las características generales, objetivos y aspectos organizativos de losregistros de enfermedades respiratorias existentes en España con el objetivo de dar a conocer su actividade incrementar su difusión.Se recoge información sobre los siguientes registros: Registro Español de Pacientes con Déficit de Alfa-1antitripsina, Registro Español de Bronquiectasias, Registro Internacional de Enfermedad Tromboembólica,Registro Español de Enfermedades de Origen Laboral, Registro Español de Hipertensión ArterialPulmonar, Registro de Mesotilioma Pleural, Registro Español de Tuberculosis y Estudio multicéntricoEspañol de Tumores Pulmonares Neuroendocrinos.Nuestro trabajo aporta información de cada uno de los citados registros.Cada registro ha recogido información clínica específica que aporta datos en situaciones reales, y completalos resultados obtenidos de los ensayos clínicos. Dicha información se ha difundido en publicacionestanto nacionales como internacionales y ha permitido la elaboración de varias normativas. Por tanto,las actividades llevadas a cabo por los profesionales vinculados a los registros han conseguido difundirel conocimiento sobre las enfermedades estudiadas propiciando el intercambio de información entregrupos(AU)

This present paper describes the general characteristics, objectives and organizational aspects of therespiratory disease registries in Spain with the aim to report their activities and increase their diffusion.The document compiles information on the following registries: the Spanish Registry of Patients withAlpha-1 Antitrypsin Deficiency, Spanish Registry of Bronchiectasis, International Registry of ThromboembolicDisease, Spanish Registry of Occupational Diseases, Spanish Registry of Pulmonary Artery Hypertension, Registry of Pleural Mesothelioma, Spanish Registry of Tuberculosis and Spanish MulticenterStudy of Neuroendocrine Pulmonary Tumors.Our paper provides information on each of the registries cited.Each registry has compiled specific clinical information providing data in real situations, and completesthe results obtained from clinical assays. Said information has been published both in national as well asinternational publications and has lead to the creation of various guidelines. Therefore, the activities of theprofessionals involved in the registries have spread the knowledge about the diseases studied, promotingthe exchange of information among workgroups(AU)

[The future of inhaled antibiotic therapy. New products]. / El futuro de la antibioterapia inhalada. Nuevos productos.

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection, especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, major progress in this field has only been made in the last 10 years: the beneficial effects in this indication have been confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaled antibiotic formulations have appeared, administration systems have improved and their use has been broadened to include other infections. The speed of research indicates that major advances will be made in the indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems in the next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaled antibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism or the underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to the concentration achieved in the site of infection. Antibiotic administration through the inhaled route is subject to many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizer used and the patient's characteristics. Many features of the pharmacokinetics of this route remain unknown and, because of its complexity, it should be prescribed and monitored by specialist physicians to avoid underdosing, which could lead to bacterial resistance.

El futuro de la antibioterapia inhalada. Nuevos productos / The future of inhaled antibiotic therapy. New products

Los antibióticos inhalados están siendo utilizados desde hace más de 30 años para tratar la colonización o lainfección bronquial, especialmente en pacientes con fibrosis quística e infección bronquial crónica porPseudomonas. No ha sido hasta los últimos 10 años cuando más se ha avanzado en este campo: se han confirmadolos efectos beneficiosos en esta indicación con la evidencia científica, los ensayos clínicos se han incrementadode forma considerable, han aparecido formulaciones de antibióticos para vía inhalada, han mejoradolos sistemas de administración y se ha extendido su uso en otras infecciones. La velocidad de la investigaciónnos hace suponer que en los próximos 10 años habrá importantes avances en las indicaciones, en el arsenal deantibióticos disponibles por esta vía y en la eficacia de los sistemas de administración.El futuro inmediato de la investigación en este campo sería deseable que fuese dirigido a demostrar la eficaciade los antibióticos inhalados en el tratamiento de cualquier infección bronquial crónica, sea cual sea el microorganismocausante y la patología de base, incluso sin la presencia todavía de bronquiectasias. El efecto delantibiótico está en relación con la concentración que se alcanza en la zona de la infección. La administraciónde antibióticos por vía inhalada está sujeta a muchas variables: dosis administrada, dosis que llega a la zonade la infección, tipo de nebulizador usado y las características del paciente. Todavía desconocemos muchosaspectos de su farmacocinética, y su complejidad hace aconsejable que sea indicada y controlada por facultativosespecializados para evitar infradosificaciones que induzcan resistencias bacterianas(AU)

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection,especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, majorprogress in this field has only been made in the last 10 years: the beneficial effects in this indication havebeen confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaledantibiotic formulations have appeared, administration systems have improved and their use has beenbroadened to include other infections. The speed of research indicates that major advances will be made inthe indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems inthe next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaledantibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism orthe underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to theconcentration achieved in the site of infection. Antibiotic administration through the inhaled route is subjectto many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizerused and the patient’s characteristics. Many features of the pharmacokinetics of this route remain unknownand, because of its complexity, it should be prescribed and monitored by specialist physicians to avoidunderdosing, which could lead to bacterial resistance(AU)

[Respiratory disease registries in Spain: fundamentals and organization]. / Registros de enfermedades respiratorias en España: fundamentos y organización.

This present paper describes the general characteristics, objectives and organizational aspects of the respiratory disease registries in Spain with the aim to report their activities and increase their diffusion. The document compiles information on the following registries: the Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency, Spanish Registry of Bronchiectasis, International Registry of Thromboembolic Disease, Spanish Registry of Occupational Diseases, Spanish Registry of Pulmonary Artery Hypertension, Registry of Pleural Mesothelioma, Spanish Registry of Tuberculosis and Spanish Multi-center Study of Neuroendocrine Pulmonary Tumors. Our paper provides information on each of the registries cited. Each registry has compiled specific clinical information providing data in real situations, and completes the results obtained from clinical assays. Said information has been published both in national as well as international publications and has lead to the creation of various guidelines. Therefore, the activities of the professionals involved in the registries have spread the knowledge about the diseases studied, promoting the exchange of information among workgroups.

Tratamiento de las bronquiectasias en el adulto / Bronchiectasis treatment in adults

Las bronquiectasias se caracterizan por la dilatación y su destrucción progresiva de la pared bronquial. Su importancia actual radica especialmente en 2 puntos: el incremento en el número de diagnósticos, debido a la mayor cronicidad de las enfermedades y al uso de nuevas herramientas diagnósticas por la imagen, y el impacto negativo que suponen sobre la calidad de vida y la función pulmonar del paciente o sobre el pronóstico de la enfermedad que las genera. En términos prácticos, el tratamiento de las bronquiectasias en el adulto se basa en 8 pilares básicos: el tratamiento de la etiología si ésta es conocida, de la colonización o infección bronquial por microorganismos potencialmente patógenos, en especial Pseudomonas aeruginosa (antibióticos inhalados o sistémicos), el tratamiento de las secreciones bronquiales (fisioterapia respiratoria y mucolíticos), de la inflamación (glucocorticoides inhalados y macrólidos) e hiperreactividad bronquial (glucocorticoides y broncodilatadores inhalados), de las manifestaciones sistémicas (desnutrición), de las exacerbaciones (antibioterapia, eliminación de secreciones y broncospasmo asociado), de las complicaciones (hemoptisis, insuficiencia respiratoria y tapones mucosos); y, por último, en el tratamiento quirúrgico (trasplante pulmonar o cirugía de resección) (AU)

Bronchiectasis is characterized by the dilation and progressive destruction of the bronchial wall. Its actual importance lies in two points: the increased number of diagnoses due to increased chronic diseases and the use of new diagnostic tools, and its negative impact on quality of life and lung function of patients and the negative prognosis of the causative disease. In practical terms, the treatment of bronchiectasis in adults is based on eight basic pillars: treatment of the etiology if it is known, treatment of the bronchial colonization or infection by potentially pathogenic microorganisms including Pseudomonas aeruginosa (inhaled or systemic antibiotics), treatment of bronchial secretions (chest physiotherapy and mucolytics), treatment of bronchial inflammation (inhaled steroids and macrolides) and hyperresponsiveness (inhaled steroids and bronchodilators), treatment of systemic manifestations (malnutrition), treatment of exacerbations (oral antibiotics, removing secretions and the associated bronchospasm), treatment of complications (hemoptysis, respiratory failure and mucous plugs), and finally, surgical treatment (lung transplantation or resection surgery) (AU)

[Bronchiectasis treatment in adults]. / Tratamiento de las bronquiectasias en el adulto.

Bronchiectasis is characterized by the dilation and progressive destruction of the bronchial wall. Its actual importance lies in two points: the increased number of diagnoses due to increased chronic diseases and the use of new diagnostic tools, and its negative impact on quality of life and lung function of patients and the negative prognosis of the causative disease. In practical terms, the treatment of bronchiectasis in adults is based on eight basic pillars: treatment of the etiology if it is known, treatment of the bronchial colonization or infection by potentially pathogenic microorganisms including Pseudomonas aeruginosa (inhaled or systemic antibiotics), treatment of bronchial secretions (chest physiotherapy and mucolytics), treatment of bronchial inflammation (inhaled steroids and macrolides) and hyperresponsiveness (inhaled steroids and bronchodilators), treatment of systemic manifestations (malnutrition), treatment of exacerbations (oral antibiotics, removing secretions and the associated bronchospasm), treatment of complications (hemoptysis, respiratory failure and mucous plugs), and finally, surgical treatment (lung transplantation or resection surgery).

Válvula aórtica cuadricúspide (VAC) en transposición de grandes arterias: Reporte de un caso diagnosticado por ecocardiografia bidimensional / Quadricuspid aortic valve in a patient with D- transposition of the great arteries

En este reporte presentamos el caso de un paciente con discordancia ventrículo arterial (d-TGA) en quien se diagnosticó por ecocardiografia bidimensional la presencia de válvula aórtica cuadricúspide, con el propósito de ampliar las lesiones asociadas a d-TGA y manifestar la preocupación de la repercusión clínica de anomalías en el número de velos valvulares en la evolución de este tipo de pacientes.

In this report we present the case of a patient with ventricular-arterial discordance in which a QAV was diagnosed by bidimensional echocardiogram with the purpose of expanding the anatomical spectrum of the anomalies associated with d-TGA and to manifest the clinical awareness of the consequence that the QAV has on the evolution of the patients that undergo to anatomic correction.

[Nocardiosis and bronchiectasis. An uncommon association?]. / Nocardiosis y bronquiectasias. 'Una asociación infrecuente?

OBJECTIVE: Nocardiosis is difficult to diagnose and infrequently associated with bronchiectasis or cystic fibrosis. This study analyzes the clinical and microbiological characteristics of 40 patients in whom microorganisms belonging to the Nocardia asteroides complex were isolated. METHODS: We studied 27 males and 13 females, with a mean age of 45 years (8-82). Nocardia spp. were isolated in 129 samples. Cultures were performed with conventional methods; additionally, when branching Gram-positive bacilli were visualized on microscopic examination, modified BCYE-alpha (m) medium was used. RESULTS: In 77.5% of the cases, investigation for Nocardia spp. was based on microscopy findings, in six patients it was a fortuitous finding in BCYE-alpha (m) medium, and in only three patients nocardiosis was clinically suspected. Twenty-five patients had nocardiosis (5 disseminated infection and 20 lung infection) and the remaining 15 were colonized. The most frequent risk factor in the infections, whether disseminated or not, was systemic glucocorticoid use (P 5 .001). The most frequent underlying pathology was bronchiectasis (80%), associated or not with cystic fibrosis. There were seven deaths and two patients had neurological sequelae. CONCLUSIONS: Bronchiectasis was an important risk factor for colonization by Nocardia spp. (P 5 0.01) in all the patients studied, and for infection (P 5 0.05) in patients without cystic fibrosis. The use of BCYE-alpha (m) medium in processing respiratory secretions highly facilitated the isolation of Nocardia spp.

Nocardiosis y bronquiectasias. ¿Una asociación infrecuente? / Nocardiosis and bronchiectasis. An uncommon association?

OBJETIVO. La nocardiosis es una enfermedad de difícil diagnóstico que, en contadas ocasiones, se ha asociado a bronquiectasias y/o fibrosis quística. Se analizan las características clínico-microbiológicas de 40 pacientes en los que se aislaron microorganismos pertenecientes al complejo Nocardia asteroides. MÉTODOS. Se estudiaron 27 varones y 13 mujeres, con una media de edad de 45 años (8-82). Se aisló Nocardia spp. en 129 muestras. El cultivo se realizó por métodos convencionales, utilizándose además BCYE-alfa modificado(m) al visualizarse bacilos grampositivos ramificados en el examen microscópico. RESULTADOS. En el 77,5% de los casos la investigación de Nocardia spp. estuvo motivada por el examen microscópico, en 6 pacientes fue un hallazgo fortuito en medio BCYE-alfa (m) y sólo en 3 pacientes existía la sospecha clínica de nocardiosis. Tenían nocardiosis 25 pacientes (5 infecciones diseminadas y 20 pulmonares)y los 15 restantes estaban colonizados. El factor de riesgo más frecuente en las infecciones, diseminadas o no, fue la utilización de glucocorticoides por vía sistémica(p = 0,001), la enfermedad de base que más se asoció a todos los cuadros clínicos fueron las bronquiectasias (80%), asociadas o no a fibrosis quística (FQ). Se produjeron 7 muertes y 2 pacientes presentaron secuelas neurológicas. CONCLUSIONES. Las bronquiectasias suponen un factor importante de riesgo para la colonización (p = 0,01)en todos los pacientes y para la infección (p = 0,05)por Nocardia spp. en los pacientes sin fibrosis quística. La utilización del medio de BCYE-alfa (m) en el procesamiento de las secreciones respiratorias facilitó extraordinariamente el aislamiento de Nocardia spp (AU)

OBJECTIVE. Nocardiosis is difficult to diagnose and infrequently associated with bronchiectasis or cysticfibrosis. This study analyzes the clinical and microbiological characteristics of 40 patients in whom microorganisms belonging to the Nocardia asteroides complex were isolated. METHODS. We studied 27 males and 13 females, with a mean age of 45 years (8-82). Nocardia spp. were isolated in129 samples. Cultures were performed with conventional methods; additionally, when branching Gram-positive bacilli were visualized on microscopic examination, modified BCYE-alpha (m) medium was used. RESULTS. In 77.5% of the cases, investigation for Nocardiaspp. was based on microscopy findings, in six patients it was a fortuitous finding in BCYE-alpha (m) medium, and in only three patients nocardiosis was clinically suspected. Twenty-five patients had nocardiosis (5 disseminated infection and 20 lung infection) and the remaining 15 were colonized. The most frequent risk factor in the infections, whether disseminated or not, was systemic glucocorticoiduse (P = .001). The most frequent underlying pathology was bronchiectasis (80%), associated or not with cysticfibrosis. There were seven deaths and two patients had neurological sequelae. CONCLUSIONS. Bronchiectas is was an important risk factor for colonization by Nocardia spp. (P = 0.01) in all the patients studied, and for infection (P = 0.05) in patients without cystic fibrosis. The use of BCYE-alpha (m) medium in processing respiratory secretions highly facilitated the isolation of Nocardia spp (AU)

[Quadricuspid aortic valve in a patient with d-transposition of the great arteries]. / Válvula aórtica cuadricúspide (VAC) en transposición de grandes arterias. Reporte de un caso diagnosticado por ecocardiografía bidimensional.

In this report we present the case of a patient with ventricular-arterial discordance in which a QAV was diagnosed by bidimensional echocardiogram with the purpose of expanding the anatomical spectrum of the anomalies associated with d-TGA and to manifest the clinical awareness of the consequence that the QAV has on the evolution of the patients that undergo to anatomic correction.

Three-dimensional echocardiography in congenital malformations of the mitral valve.

Three-dimensional echocardiography has proved to be valuable in congenital heart disease by enhancing the evaluation of morphologic abnormalities and increasing the understanding of complex relationships. This study was undertaken to determine how 3-dimensional echocardiography could be best used to study some of the congenital malformations of the mitral valve such as mitral arcade, double orifice mitral valve, accessory mitral tissue, cleft mitral valve, and unicuspid mitral valve. Five patients were studied. Three-dimensional echocardiography was found to be helpful in defining spatial location and extent of deformities.

Clinical and echocardiographic aspects of double-outlet left atrium.

Double outlet left atrium is a very rare complex atrial malformation. We present 3 cases of double outlet left atrium with 2 atrioventricular valves diagnosed by transthoracic and transesophageal echocardiography.