Gender differences in clinical features and outcomes of patients over 75 years presenting with acute heart failure. Results of a nationwide study (2016-2019).

BACKGROUND: Heart failure (HF) is a major health problem in Western countries, and a leading cause of hospitalizations and death. There is a scarcity of data on the influence of sex on HF outcomes in elderly patients. The aim of the present study was to analyze differences between men and women in clinical characteristics, in-hospital mortality, 30-day HF readmission rates, cardiovascular mortality and HF readmission rates at 1 year after discharge in patients older than 75 years hospitalized for HF in Spain. METHODS: Retrospective analysis of patients discharged with a main diagnosis of HF from all Spanish public hospitals between 2016 and 2019. Patients aged 75 years or older were selected, and a comparison was made between male and female patients. RESULTS: From 2016 to 2019, a total of 354,786 episodes of HF in this age subgroup were identified, 59.2% being women. The overall mean age was 85.2 ± 5.4 years, being higher in women (85.9 ± 5.5 vs. 84.2 ± 5.3 years, p < 0.001). Risk-adjusted in-hospital mortality was lower in women (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.92-0.97; p < 0.001). Female sex also showed a protective effect for 30-day readmissions, with an OR of 1.06 (95% CI: 1.04-1.09; p < 0.001). One-year cardiovascular mortality (24.1% vs. 25.0%; p < 0.001) and one-year HF readmission rates (30.8% vs. 31.6%; p = 0.001) were lower in women. CONCLUSIONS: Almost 60% of hospital admissions for HF in people aged 75 years or older between 2016 and 2019 in Spain were female patients. Female sex seems to play a protective role on in-hospital mortality and the rate of admissions and mortality at 1 year after discharge.

Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction.

INTRODUCTION AND OBJECTIVES: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.

Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost.

Background: There is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF). Methods: Retrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF. Results: Out of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient. Conclusion: Hospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients.

INTRODUCTION AND OBJECTIVES: Composite endpoints are widely used but have several limitations. The Clinical outcomes, healthcare resource utilization and related costs (COHERENT) model is a new approach for visually displaying and comparing composite endpoints including all their components (incidence, timing, duration) and related costs. We aimed to assess the validity of the COHERENT model in a patient cohort. METHODS: A color graphic system displaying the percentage of patients in each clinical situation (vital status and location: at home, emergency department [ED] or hospital) and related costs at each time point during follow-up was created based on a list of mutually exclusive clinical situations coded in a hierarchical fashion. The system was tested in a cohort of 1126 patients with acute heart failure from 25 hospitals. The system calculated and displayed the time spent in each clinical situation and health care resource utilization-related costs over 30 days. RESULTS: The model illustrated the times spent over 30 days (2.12% in ED, 23.6% in index hospitalization, 2.7% in readmissions, 65.5% alive at home, and 6.02% dead), showing significant differences between patient groups, hospitals, and health care systems. The tool calculated and displayed the daily and cumulative health care-related costs over time (total, €4 895 070; mean, €144.91 per patient/d). CONCLUSIONS: The COHERENT model is a new, easy-to-interpret, visual display of composite endpoints, enabling comparisons between patient groups and cohorts, including related costs. The model may constitute a useful new approach for clinical trials or observational studies, and a tool for benchmarking, and value-based health care implementation.

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)

Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion.

Normothermic regional perfusion (NRP) allows the in situ perfusion of organs with oxygenated blood in donation after the circulatory determination of death (DCDD). We aimed at evaluating the impact of NRP on the short-term outcomes of kidney transplants in controlled DCDD (cDCDD). This is a multicenter, nationwide, retrospective study comparing cDCDD kidneys obtained with NRP versus the standard rapid recovery (RR) technique. During 2012-2018, 2302 cDCDD adult kidney transplants were performed in Spain using NRP (n = 865) or RR (n = 1437). The study groups differed in donor and recipient age, warm, and cold ischemic time and use of ex situ machine perfusion. Transplants in the NRP group were more frequently performed in high-volume centers (≥90 transplants/year). Through matching by propensity score, two cohorts with a total of 770 patients were obtained. After the matching, no statistically significant differences were observed between the groups in terms of primary nonfunction (p = .261) and mortality at 1 year (p =  .111). However, the RR of kidneys was associated with a significantly increased odds of delayed graft function (OR 1.97 [95% CI 1.43-2.72]; p < .001) and 1-year graft loss (OR 1.77 [95% CI 1.01-3.17]; p = .034). In conclusion, compared with RR, NRP appears to improve the short-term outcomes of cDCDD kidney transplants.

Differences in in-hospital mortality after STEMI versus NSTEMI by sex. Eleven-year trend in the Spanish National Health Service.

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.

Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock.

BACKGROUND: The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. METHODS: Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. RESULTS: A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ 2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ 2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). CONCLUSIONS: Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.

Tendencias en el tratamiento del shock cardiogénico e impacto pronóstico del tipo de centros tratantes / Trends in cardiogenic shock management and prognostic impact of type of treating center

INTRODUCCIÓN Y OBJETIVOS: Las guías recomiendan centralizar la atención del shock cardiogénico (SC) en centros altamente especializados. El objetivo de este estudio fue evaluar la asociación entre las características de los centros tratantes y la mortalidad en el SC secundario a infarto de miocardio con elevación del segmento ST (IAMCEST). MÉTODOS: Se seleccionaron los episodios de alta con diagnóstico de SC-IAMCEST entre 2003-2015 del Conjunto Mínimo Básico de Datos del Sistema Nacional de Salud español. Los centros se clasificaron según disponibilidad de servicio de cardiología, laboratorio de hemodinámica, cirugía cardiaca y disponibilidad de Unidad de Cuidados Intensivos Cardiológicos (UCIC). La variable objetivo principal fue la mortalidad hospitalaria. RESULTADOS: Se identificaron 19.963 episodios. La edad media fue de 73,4±11,8 años. La proporción de pacientes tratados en hospitales con laboratorio de hemodinámica y cirugía cardiaca aumentó del 38,4% en 2005 al 52,9% en 2015; p <0,005). Las tasas de mortalidad bruta y ajustada por riesgo se redujeron progresivamente (del 82 al 67,1%, y del 82,7 al 66,8%, respectivamente, ambas p <0,001). La revascularización coronaria, tanto quirúgica como percutánea, se asoció de forma independiente con una menor mortalidad (OR = 0,29 y 0,25, p <0,001); La disponibilidad UCIC se asoció con menores tasas de mortalidad ajustadas (el 65,3±7,9% frente al 72±11,7%; p <0,001). CONCLUSIONES: La proporción de pacientes con SC-IAMCEST tratados en centros altamente especializados aumentó, mientras que la mortalidad disminuyó a lo largo del periodo de estudio. La revascularización y el ingreso en UCIC se asociaron con mejores resultados

INTRODUCTION AND OBJECTIVES: Current guidelines recommend centralizing the care of patients with cardiogenic shock in high-volume centers. The aim of this study was to assess the association between hospital characteristics, including the availability of an intensive cardiac care unit, and outcomes in patients with ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). METHODS: Discharge episodes with a diagnosis of STEMI-related CS between 2003 and 2015 were selected from the Minimum Data Set of the Spanish National Health System. Centers were classified according to the availability of a cardiology department, catheterization laboratory, cardiac surgery department, and intensive cardiac care unit. The main outcome measured was in-hospital mortality. RESULTS: A total of 19 963 episodes were identified. The mean age was 73.4±11.8 years. The proportion of patients with CS treated at hospitals with a catheterization laboratory and cardiac surgery department increased from 38.4% in 2005 to 52.9% in 2015 (P <.005). Crude- and risk-adjusted mortality rates decreased over time, from 82% to 67.1%, and from 82.7% to 66.8%, respectively (both P <.001). Coronary revascularization, either percutaneous or coronary artery bypass grafting, was independently associated with a lower mortality risk (OR, 0.29 and 0.25; both P <.001, respectively). Intensive cardiac care unit availability was associated with lower adjusted mortality rates (65.3%±7.9 vs 72±11.7; P <.001). CONCLUSIONS: The proportion of patients with STEMI-related CS treated at highly specialized centers increased while mortality decreased during the study period. Better outcomes were associated with the increased performance of revascularization procedures and access to intensive cardiac care units over time

Utilización de datos administrativos y el volumen de cirugía coronaria. Una nota de precaución. Respuesta / Administrative data and volume of surgical revascularization volume. A note of caution. Response

No disponible

Tendencias e impacto pronóstico de la duración de la estancia hospitalaria en el infarto de miocardio con elevación del segmento ST no complicado en España / Temporal trends and prognostic impact of length of hospital stay in uncomplicated ST-segment elevation myocardial infarction in Spain

INTRODUCCIÓN Y OBJETIVOS: La información sobre la seguridad de la duración de la estancia es escasa en el infarto de miocardio con elevación del segmento ST no complicado. Se han estudiado las tendencias y la seguridad en España de la estancia corta (≤ 3 días) frente a la prolongada. MÉTODOS: Se identificaron en el Conjunto Mínimo Básico de Datos los episodios de pacientes con infarto de miocardio con elevación del segmento ST no complicado tratados con intervención coronaria percutánea primaria y dados de alta vivos entre 2003 y 2015. La estancia media se ajustó mediante regresión de Poisson multinivel con efectos mixtos. El efecto de la estancia corta en el reingreso por causa cardiovascular a 30 días se evaluó en episodios de 2012-2014 mediante emparejamiento por puntuaciones de propensión y regresión logística multinivel, comparando las razones estandarizadas de reingreso y mortalidad por riesgo. RESULTADOS: La estancia ajustada disminuyó significativamente (razón de tasas de incidencia <1; p <0,001) cada año desde 2003. La estancia corta no fue un predictor independiente de reingreso (OR=1,10; IC95%, 0,92-1,32) ni de mortalidad (OR=1,94; IC95%, 0,93-14,03). Después del emparejamiento, tampoco hubo diferencias significativas en ambos casos (OR=1,26; IC95%, 0,98-1,62; y OR=1,50; IC95%, 0,48-5,13). Las comparaciones entre las razones estandarizadas de reingreso y mortalidad por riesgo confirmaron estos resultados, excepto en la de mortalidad a los 30 días, significativamente mayor en la estancia corta, aunque probablemente sin significado clínico (el 0,103 y el 0,109%; p <0,001). CONCLUSIONES: La estancia ≤ 3 días aumentó significativamente en España desde 2003 a 2015 y parece una opción segura en el infarto de miocardio con elevación del segmento ST no complicado

INTRODUCTION AND OBJECTIVES: There are few data on the safety of length of stay in uncomplicated ST-segment elevation myocardial infarction. We studied trends in hospital stay and the safety of short (≤ 3 days) vs long hospital stay in Spain. METHODS: Using data from the Minimum Basic Data Set, we identified patients with uncomplicated ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and who were discharged alive between 2003 and 2015. The mean length of stay was adjusted by multilevel Poisson regression with mixed effects. The effect of short length of stay on 30-day readmission for cardiac diseases was evaluated in episodes from 2012 to 2014 by propensity score matching and multilevel logistic regression. We also compared risk-standardized readmissions for cardiac diseases and mortality rates. RESULTS: The adjusted length of stay decreased significantly (incidence rate ratio <1; P <.001) for each year after 2003. Short length of stay was not an independent predictor of 30-day readmission (OR, 1.10; 95%CI, 0.92-1.32) or mortality (OR, 1.94; 95%CI, 0.93-14.03). After propensity score matching, no significant differences were observed between short and long hospital stay (OR, 1.26; 95%CI, 0.98-1.62; and OR, 1.50; 95%CI, 0.48-5.13), respectively. These results were confirmed by comparisons between risk-standardized readmissions for cardiac disease and mortality rates, except for the 30-day mortality rate, which was significantly higher, although probably without clinical significance, in short hospital stays (0.103% vs 0.109%; P <.001). CONCLUSIONS: In Spain, hospital stay ≤ 3 days significantly increased from 2003 to 2015 and seems a safe option in patients with uncomplicated ST-segment elevation myocardial infarction

Cirugía de revascularización aortocoronaria en España. Influencia del volumen de procedimientos en los resultados / Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes

INTRODUCCIÓN Y OBJETIVOS: Analizar la asociación entre volumen y resultados en cirugía de revascularización aortocoronaria (CABG) en el Sistema Nacional de Salud de España. MÉTODOS: Se analizaron los eventos de CABG entre 2013-2015. Las variables de resultado seleccionadas fueron la mortalidad hospitalaria en el evento índice, así como los reingresos por causa cardiaca a los 30 días y la mortalidad en el reingreso. Mediante regresión logística multinivel, se obtuvieron las tasas ajustadas a riesgo de mortalidad hospitalaria (RAMER) y de reingresos (RARER). Se discriminó entre centros de alto y bajo volumen mediante un análisis no condicionado (k-medias), utilizando también para CABG la recomendación de volumen de las guías de práctica clínica. RESULTADOS: Se incluyeron 17.335 eventos de CABG con una mortalidad bruta del 5,0%. Los eventos atendidos en centros de bajo volumen para CABG (< 155 CABG al año) mostraron una RAMER un 17% superior (5,81%±2,07 frente a 4,96%±1,76; p <0,001) y una correlación lineal negativa entre volumen y RARER (r=-0,318; p = 0,029), así como una mayor proporción de complicaciones durante el evento. La misma asociación entre volumen y mejores resultados se encontró en la CABG aislada. CONCLUSIONES: Los hospitales del Sistema Nacional de Salud tienen un bajo volumen promedio de CABG. Se ha hallado una asociación entre mayor volumen y mejores resultados en la CABG total y aislada. Los hallazgos de este estudio aconsejan una mayor concentración de CABG y la publicación de los resultados ajustados a riesgo de la intervención coronaria

INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMER) and 30-day readmissions (RARER) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07 vs 4.96±1.76; P <.001) and a negative linear correlation between volume and RARR (r=−0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention

Simultaneous determination of carvacrol and thymol in bee pollen by using a simple and efficient solvent extraction method and gas chromatography-mass spectrometry.

A novel method is proposed to determine residues of carvacrol and thymol in bee pollen by means of gas chromatography coupled to mass spectrometry. This is an efficient and simple sample treatment (with average analyte recoveries between 90% and 104%) involving solvent extraction with hexane followed by evaporation. There is no need for any additional clean-up step, as the matrix did not affect determination of mass spectrometry for either compound. The chromatographic conditions are also optimized: a ZB-WAX column is employed, helium is the carrier gas at a flow rate of 1.1 mL/min, and a temperature program is included, allowing baseline separation of both compounds in less than 21 min. The method is fully validated in terms of selectivity, limits of detection and quantification, matrix effect, linearity, precision and trueness. Results show that not only is it selective, but that it also displays a wide linearity range (limit of quantification-1000 µg/kg), good precision (relative standard deviation values lower than 8%) and sensitivity (limits of detection and quantification lower than 15 µg/kg). Finally, several bee pollen samples are analysed, and thymol and carvacrol residues are found at low concentrations (limit of quantification-57 µg/kg) in some cases.

Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes.

INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.

Trends in cardiogenic shock management and prognostic impact of type of treating center.

INTRODUCTION AND OBJECTIVES: Current guidelines recommend centralizing the care of patients with cardiogenic shock in high-volume centers. The aim of this study was to assess the association between hospital characteristics, including the availability of an intensive cardiac care unit, and outcomes in patients with ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). METHODS: Discharge episodes with a diagnosis of STEMI-related CS between 2003 and 2015 were selected from the Minimum Data Set of the Spanish National Health System. Centers were classified according to the availability of a cardiology department, catheterization laboratory, cardiac surgery department, and intensive cardiac care unit. The main outcome measured was in-hospital mortality. RESULTS: A total of 19 963 episodes were identified. The mean age was 73.4±11.8 years. The proportion of patients with CS treated at hospitals with a catheterization laboratory and cardiac surgery department increased from 38.4% in 2005 to 52.9% in 2015 (P <.005). Crude- and risk-adjusted mortality rates decreased over time, from 82% to 67.1%, and from 82.7% to 66.8%, respectively (both P <.001). Coronary revascularization, either percutaneous or coronary artery bypass grafting, was independently associated with a lower mortality risk (OR, 0.29 and 0.25; both P <.001, respectively). Intensive cardiac care unit availability was associated with lower adjusted mortality rates (65.3%±7.9 vs 72±11.7; P <.001). CONCLUSIONS: The proportion of patients with STEMI-related CS treated at highly specialized centers increased while mortality decreased during the study period. Better outcomes were associated with the increased performance of revascularization procedures and access to intensive cardiac care units over time.

Temporal trends and prognostic impact of length of hospital stay in uncomplicated ST-segment elevation myocardial infarction in Spain.

INTRODUCTION AND OBJECTIVES: There are few data on the safety of length of stay in uncomplicated ST-segment elevation myocardial infarction. We studied trends in hospital stay and the safety of short (≤ 3 days) vs long hospital stay in Spain. METHODS: Using data from the Minimum Basic Data Set, we identified patients with uncomplicated ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and who were discharged alive between 2003 and 2015. The mean length of stay was adjusted by multilevel Poisson regression with mixed effects. The effect of short length of stay on 30-day readmission for cardiac diseases was evaluated in episodes from 2012 to 2014 by propensity score matching and multilevel logistic regression. We also compared risk-standardized readmissions for cardiac diseases and mortality rates. RESULTS: The adjusted length of stay decreased significantly (incidence rate ratio <1; P <.001) for each year after 2003. Short length of stay was not an independent predictor of 30-day readmission (OR, 1.10; 95%CI, 0.92-1.32) or mortality (OR, 1.94; 95%CI, 0.93-14.03). After propensity score matching, no significant differences were observed between short and long hospital stay (OR, 1.26; 95%CI, 0.98-1.62; and OR, 1.50; 95%CI, 0.48-5.13), respectively. These results were confirmed by comparisons between risk-standardized readmissions for cardiac disease and mortality rates, except for the 30-day mortality rate, which was significantly higher, although probably without clinical significance, in short hospital stays (0.103% vs 0.109%; P <.001). CONCLUSIONS: In Spain, hospital stay ≤ 3 days significantly increased from 2003 to 2015 and seems a safe option in patients with uncomplicated ST-segment elevation myocardial infarction.