Cardiac lymphoma as a cause of dyspnea in an immunosuppressed patient: the importance of the endomyocardial biopsy.

A 69-year-old man who underwent a liver transplant in 2014 due to hepatitis C virus hepatopathy was evaluated for dyspnea on exertion and chest pain.

Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia / Population-based study of first hospitalizations for heart failure and the interaction between readmissions and survival

Introducción y objetivos: La evolución tras una primera hospitalización por insuficiencia cardiaca (IC), en particular la interacción entre supervivencia y rehospitalizaciones, no está bien establecida. Métodos: Se estudió a todos los pacientes con una primera hospitalización y diagnóstico principal de IC en el periodo 2009-2013, mediante el análisis del Conjunto Mínimo Básico de Datos en la Región de Murcia. Se diferenció entre pacientes nuevos o incidentes y recurrentes, y se calcularon tasas poblacionales y tendencias mediante regresión de joinpoint. Se realizó un seguimiento por tarjeta sanitaria individual hasta el fin de 2015, y se registraron la mortalidad y los reingresos, sus causas y la cronología de los reingresos respecto al fallecimiento. Resultados: Se identificó a 8.258 incidentes, con una tendencia creciente de la tasa anual (+2,3%; p <0,05) hasta 1,24/1.000 habitantes; esto supuso el 71% de los hospitalizados por IC y el 57% del total de altas por IC. En el primer año, el 22% reingresó por IC, el 31% por causa cardiovascular y el 54% por cualquier causa. La supervivencia a los 5 años fue del 40%, significativamente inferior a la de la población general ajustada por edad y sexo (76%) (p <0,001). Entre los fallecidos en el seguimiento, las rehospitalizaciones (1,5/paciente/año; 0,4 debidas a IC) mostraron un patrón en J, donde el 48% de reingresos se acumularon en los últimos 3 deciles de tiempo de supervivencia antes del fallecimiento. Conclusiones: La primera hospitalización por IC mantiene tasas en aumento, con elevada mortalidad y reingresos en el seguimiento, que se acumulan principalmente en el periodo previo al fallecimiento

Introduction and objectives: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. Methods: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. Results: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. Conclusions: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death

Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival.

INTRODUCTION AND OBJECTIVES: Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS: We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS: A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS: Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.

Trends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data.

BACKGROUND: Reliable data are necessary if the burden of early readmissions following hospitalization for heart failure (HF) is to be addressed. We studied unplanned 30-day readmissions, their causes and timing over an 11-year period, using population-based linked data. METHODS: All hospitalizations from 2003 to 2013 were analyzed by using administrative linked data based on the Minimum Basic Set discharge registry of the Department of Health (Region of Murcia, Spain). Index hospitalizations with HF as principal diagnosis (n=27,581) were identified. Transfers between centers were merged into one discharge. Readmissions were defined as unplanned admissions to any hospital within 30-days after discharge. RESULTS: In the 2003-2013 period, 30-day readmission rates had a relative mean annual growth of +1.36%, increasing from 17.6% to 22.1%, with similar trends for cardiovascular and non-cardiovascular causes. The figure of 22.1% decreased to 19.8% when only same-hospital readmissions were considered. Most readmissions were due to cardiovascular causes (60%), HF being the most common single cause (34%). The timing of readmission shows an early peak on the fourth day post discharge (+13.29%) due to causes other than HF, followed by a gradual decline (-3.32%); readmission for HF decreased steadily from the first day (-2.22%). Readmission for HF (12.7%) or non-cardiovascular causes (13.3%) had higher in-hospital mortality rates than the index hospitalization (9.2%, p<0.001). Age and comorbidity burden were the main predictors of any readmission, but the performance of a predictive model was poor. CONCLUSION: These findings support the need for population-based strategies to reduce the burden of early-unplanned readmissions.