Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain.

BACKGROUND: Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. METHODS: We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model. RESULTS: A total of 1 254 830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P < .001)], although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P < .001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P < .001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P = .32). CONCLUSIONS: From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.

Incidence and outcomes of hospital treated acute myocarditis from 2003 to 2015 in Spain.

BACKGROUND: There are no data on population-based epidemiological changes in acute myocarditis in Europe. Our aim was to evaluate temporal trends in incidence, clinical features and outcomes of hospital treated acute myocarditis (AM) in Spain from 2003 to 2015. METHODS: We conducted a retrospective longitudinal study using information of all hospital discharges of the Spanish National Health System. All episodes with a discharge diagnosis of AM from 1 January 2003 to 31 December 2015 were included. The risk-standardized in-hospital mortality ratio (RSMR) was calculated using a multilevel risk-adjustment model developed by the Medicare and Medicaid Services. Temporal trends for in-hospital mortality were modelled using Poisson regression analysis. RESULTS: A total of 11 147 episodes of AM were analysed, most of them idiopathic (94.7%). The rate of AM discharges increased along the period, from 13 to 30/million inhabitants/year (2003-2015), and this increase was statistically significant when weighted by age and sex (incidence rate ratio, IRR 1.06, 95% CI 1.04-1.08, P = .001). In-hospital crude mortality rate was 3.1%, diminishing significantly along 2003-2015 (IRR 0.95, 95% CI 0.92-0.99, P = .02). RSMR also significantly diminished along the period (IRR 0.95, 95% CI 0.92-0.99, P = .01). Renal failure (OR 7.03, 5.38-9.18, P = .001), liver disease (OR 4.61, 2.59-8.21, P = .001), pneumonia (OR 4.13, 2.75-6.20, P = .001) and heart failure (OR 1.91, 95% CI 1.47-2.47, P = .001) were the strongest independent factors associated with in-hospital mortality. CONCLUSIONS: Acute myocarditis is an uncommon entity, although hospital discharges have increased in Spain along the study period. Most of AM were idiopathic. Adjusted mortality was low and seemed to decrease from 2003 to 2015, suggesting an improvement in AM management.

Expresividad variable de una mutación fundadora en el gen EIF2AK4 en pacientes con enfermedad venooclusiva pulmonar hereditaria. Impacto en la supervivencia / Variable expressivity of a founder mutation in the EIF2AK4 gene in hereditary pulmonary veno-occlusive disease and its impact on survival

Introducción y objetivos: La enfermedad venooclusiva pulmonar (EVOP) hereditaria se relaciona con mutaciones bialélicas en EIF2AK4 y se ha descrito una mutación fundadora en pacientes ibéricos de etnia gitana con EVOP familiar. Los objetivos son la caracterización fenotípica y el análisis de supervivencia de pacientes ibéricos de etnia gitana con EVOP familiar portadores de la mutación fundadora p.Pro1115Leu en EIF2AK4, según su tolerancia clínica a vasodilatadores pulmonares (VDP). Estudio genético familiar y análisis de factores socioculturales de la etnia con potencial impacto en la propagación de la enfermedad. Métodos: Estudio observacional de pacientes de etnia gitana con EVOP familiar incluidos en el Registro Español de Hipertensión Arterial Pulmonar. Se realizó estudio genético de EIF2AK4 a casos afectados y familiares (noviembre 2011-julio 2016) y estudio histopatológico pulmonar en caso de trasplante pulmonar o fallecimiento. Los pacientes se clasificaron en tolerantes y no tolerantes a VDP, comparando sus características basales y la supervivencia libre de fallecimiento o el trasplante. Resultados: Se estudió a 18 pacientes (9 casos índice y 9 familiares afectados). Se halló la mutación fundadora en homocigosis en EIF2AK4 en todos ellos y en 2 familiares sanos, y en heterocigosis en el 34,2% de familiares sanos. Se observó elevada consanguineidad, edad joven de reproducción con multiparidad y pronóstico sombrío de nuestra cohorte existiendo diferencias significativas entre pacientes tolerantes y no tolerantes. Conclusiones: Se describen 2 fenotipos de EVOP hereditaria en etnia gitana según tolerancia a VDP e histología pulmonar, con impacto pronóstico y distribución familiar. Destacamos el papel de la consanguineidad en la propagación de la enfermedad y una alta rentabilidad del cribado genético familiar (AU)

Introduction and objectives: Hereditary pulmonary veno-occlusive disease (PVOD) has been associated with biallelic mutations in EIF2AK4 with the recent discovery of a founder mutation in Iberian Romani patients with familial PVOD. The aims of this study were phenotypical characterization and survival analysis of Iberian Romani patients with familial PVOD carrying the founder p.Pro1115Leu mutation in EIF2AK4, according to their tolerance to pulmonary vasodilators (PVD). Familial genetic screening was conducted, as well as assessment of sociocultural determinants with a potential influence on disease course. Methods: Observational study of Romani patients with familial PVOD included in the Spanish Registry of Pulmonary Arterial Hypertension. Genetic screening of EIF2AK4 was performed in index cases and relatives between November 2011 and July 2016 and histological pulmonary examination was carried out in patients who received a lung transplant or died. The patients were divided into 2 groups depending on their tolerance to PVD, with comparison of baseline characteristics and survival free of death or lung transplant. Results: Eighteen Romani patients were included: 9 index cases and 9 relatives. The biallelic founder mutation in EIF2AK4 was found in all affected cases and 2 unaffected relatives. Family screening showed 34.2% of healthy heterozygotes, high consanguinity, young age at childbirth, and frequent multiparity. Prognosis was bleak, with significant differences depending on tolerance to PVD. Conclusions: We describe 2 phenotypes of hereditary PVOD depending on tolerance to PVD, with prognostic impact and familial distribution. Consanguinity may have a negative impact on the transmission of PVOD, with familial genetic screening showing high effectiveness (AU)

Variable Expressivity of a Founder Mutation in the EIF2AK4 Gene in Hereditary Pulmonary Veno-occlusive Disease and Its Impact on Survival.

INTRODUCTION AND OBJECTIVES: Hereditary pulmonary veno-occlusive disease (PVOD) has been associated with biallelic mutations in EIF2AK4 with the recent discovery of a founder mutation in Iberian Romani patients with familial PVOD. The aims of this study were phenotypical characterization and survival analysis of Iberian Romani patients with familial PVOD carrying the founder p.Pro1115Leu mutation in EIF2AK4, according to their tolerance to pulmonary vasodilators (PVD). Familial genetic screening was conducted, as well as assessment of sociocultural determinants with a potential influence on disease course. METHODS: Observational study of Romani patients with familial PVOD included in the Spanish Registry of Pulmonary Arterial Hypertension. Genetic screening of EIF2AK4 was performed in index cases and relatives between November 2011 and July 2016 and histological pulmonary examination was carried out in patients who received a lung transplant or died. The patients were divided into 2 groups depending on their tolerance to PVD, with comparison of baseline characteristics and survival free of death or lung transplant. RESULTS: Eighteen Romani patients were included: 9 index cases and 9 relatives. The biallelic founder mutation in EIF2AK4 was found in all affected cases and 2 unaffected relatives. Family screening showed 34.2% of healthy heterozygotes, high consanguinity, young age at childbirth, and frequent multiparity. Prognosis was bleak, with significant differences depending on tolerance to PVD. CONCLUSIONS: We describe 2 phenotypes of hereditary PVOD depending on tolerance to PVD, with prognostic impact and familial distribution. Consanguinity may have a negative impact on the transmission of PVOD, with familial genetic screening showing high effectiveness.

Estrategia invasiva en el SCASEST. Tratamiento antitrombótico / Invasive management of non-ST-segment elevation acute coronary syndrome. Antithrombotic treatment

Los fármacos anticoagulantes y antiagregantes, junto con intervencionismo coronario, son la base del tratamiento del síndrome coronario sin elevación del segmento ST (SCASEST). Diferentes estudios han mostrado que la estrategia intervencionista con coronariografía y revascularización precoz es la que ofrece mejor resultado clínico en pacientes de alto riesgo. El tratamiento médico asociado puede modificar tanto el pronóstico de la enfermedad como el resultado de la revascularización coronaria. Hasta el momento, la aspirina, el clopidogrel y la heparina (no fraccionada o de bajo peso molecular) se consideran el tratamiento estándar en la mayor parte de los pacientes con SCASEST, y los inhibidores de los receptores de la glucoproteína IIb/IIIa, en los de alto riesgo, aunque persisten dudas acerca del resultado, el momento y la dosis de la asociación de clopidogrel y los inhibidores de la glucoproteína IIb/IIIa. Sin embargo, los buenos resultados clínicos demostrados por el fondaparinux respecto al uso de enoxaparina y la disminución de hemorragias observada con la bivalirudina en comparación con la asociación de heparina e inhibidores de la glucoproteína IIb/IIIa en 2 recientes estudios obligan a replantear el tratamiento actual de los SCASEST (AU)

Treatment of non-ST-segment elevation acute coronary syndrome (NSTEACS) is based on anticoagulant and antiplatelet therapy along with coronary revascularization. Numerous studies have shown that an invasive strategy involving early coronary angiography and revascularization provides the best clinical outcome in high-risk patients. Associated medical treatment can change both disease prognosis and the result of coronary revascularization. To date, treatment with aspirin, clopidogrel and (unfractionated or low-molecular-weight) heparin is considered standard therapy for most patients with NSTEACS, with glycoprotein IIb/IIIa inhibitors being given to high-risk patients. However, there is still some uncertainty about treatment outcomes, timing and dosage when clopidogrel is given with a glycoprotein IIb/IIIa inhibitor. In addition, the better clinical results obtained with fondaparinux compared with enoxaparin, and the reduction in bleeding observed with bivalirudin relative to that seen with combination treatment with heparin and glycoprotein IIb/IIIa inhibitors, as reported in two recent studies, necessitate the re-evaluation of current treatment for NSTEACS (AU)

Bases conceptuales y metodológicas del estudio MASCARA: el reto de la efectividad / Rationale and conceptual design of MASCARA study: a challenge in the evaluation of the effectiveness

No disponible

Guías de práctica clínica de la Sociedad Española de Cardiología en la angina inestable/infarto sin elevación ST / Guidelines of the Spanish Society of Cardiology for unstable angina/myocardial infarction with No ST elevation

Este trabajo representa la actualización, por parte de la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología, de las Guías de Actuación Clínica para el manejo de la Angina Inestable y del Infarto sin elevación del segmento ST. Además de las normas habituales referidas al manejo del enfermo ingresado, se ha considerado necesario ampliar estas recomendaciones al manejo extrahospitalario y en el área de urgencias, tanto porque es la fase de máxima mortalidad, como por la efectividad que un manejo adecuado tiene precisamente en esa fase inicial. La conducta en el área extrahospitalaria ante un enfermo con dolor torácico sospechoso de isquemia miocárdica debe centrarse en el traslado rápido al centro hospitalario, realización de ECG, y la administración de nitroglicerina sublingual y aspirina. El manejo en el área de urgencias se basa en la atención clínica inmediata y monitorización, así como acceso al desfibrilador. El trazado ECG determina, habitualmente en este entorno, la aplicación de un protocolo determinado de tratamiento. Si existe elevación del segmento ST debe organizarse el tratamiento de reperfusión en el menor tiempo posible (véanse Guías de infarto agudo de mioacrdio). Si no existe elevación del ST, debe valorarse primero la probabilidad de isquemia coronaria y seguidamente la estratificación de riesgo, que son esenciales para un adecuado manejo. En estas guías se propone una nueva estratificación de riesgo simplificada, que entre otras cosas determina el lugar adecuado de ingreso: ingreso en unidad coronaria, si existen factores de riesgo elevado o modificadores de riesgo; por el contrario, si existe estabilidad clínica y factores pronósticos de riesgo intermedio, ingreso en el área de hospitalización. En los casos de riesgo ligero se recomienda el tratamiento ambulatorio Manejo en la unidad coronaria. Se describen las medidas generales (monitorización, analgesia). En el tratamiento antitrombótico se añade a la antiagregación con ácido acetilsalicílico, las indicaciones de los nuevos antiplaquetarios y a la administración de heparina i.v., las heparinas de bajo peso molecular y los inhibidores directos de la trombina. El tratamiento antiisquémico se basa en: nitroglicerina i.v., betabloqueantes y antagonistas del calcio. Actualmente, el manejo de las complicaciones (angina refractaria, disfunción del ventrículo izquierdo, insuficiencia mitral, progresión a infarto agudo de miocardio, etc.) implica la indicación de coronariografía. Cuando el sustrato anatómico lo permite, la revascularización en la angina inestable, debe contemplar la intervención percutánea sobre la arteria responsable como primera opción. La utilización de stents y anti IIb-IIIa han mejorado el resultado de esta intervención. Manejo en la planta de hospitalización. En esta fase debe realizarse la instauración de tratamiento médico de mantenimiento y la estratificación de riesgo con pruebas funcionales, que pueden indicar la necesidad de coronariografía antes del alta para valorar la revascularizacion. El diseño de la estrategia en prevención secundaria debe realizarse en colaboración con asistencia primaria (AU)