Consenso para la mejora de la atención integral de los pacientes con insuficiencia cardíaca aguda: versión resumida / Consensus for improving the comprehensive care of patients with acute heart failure: summarised version

El propósito de este documento de consenso fue alcanzar un acuerdo entre expertos sobre la atención multidisciplinar de los pacientes con insuficiencia cardíaca aguda. A partir de una revisión narrativa sobre la atención a estos pacientes y de un análisis crítico de los procedimientos asistenciales, se identificaron las carencias y mejoras potenciales y se formalizó un documento de recomendaciones para optimizar el abordaje clínico y terapéutico de la insuficiencia cardíaca aguda, validado mediante una sesión grupal presencial dirigida con técnicas participativas. El resultado del proceso es un conjunto de 36 recomendaciones formuladas por expertos de la Sociedad Española de Cardiología, la Sociedad Española de Medicina Interna y la Sociedad Española de Urgencias y Emergencias, orientadas a optimizar el reto asistencial que supone la atención de los pacientes con insuficiencia cardíaca aguda en el contexto del actual Sistema Nacional de Salud (AU)

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System (AU)

Consensus for improving the comprehensive care of patients with acute heart failure: summarised version.

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System.

Papel del factor precipitante de un episodio de insuficiencia cardiaca aguda en relación al pronóstico a corto plazo del paciente: estudio PAPRICA / The influence of precipitating factors on short-term prognosis in acute heart failure: the PAPRICA study

Objetivos: Hay pocos estudios que analicen el papel que juegan los factores precipitantes (FPre) en el manejo de la insuficiencia cardiaca aguda (ICA). El estudio PAPRICA pretende analizar la relación entre la identificación de diferentes FPre con la mortalidad precoz y las reconsultas a los 30 días. Método: Estudio retrospectivo, multicéntrico, con seguimiento de cohortes a partir del os datos incluidos en el registro EAHFE (Epidemiology Acute Heart Failure Emergency). Se recogieron datos de todos los episodios de ICA en 8 servicios de urgencias hospitalarios(SUH) españoles durante el mes de abril de 2007. Se recogieron datos del perfil clínico y la evolución a corto plazo (mortalidad y reconsulta a los 30 días). La variable clasificadora del estudio fue la ausencia o presencia conocida de FPre del episodio de ICA. Sólo se recogió un FPre por episodio. Resultados: Se incluyeron 662 casos. El 51,4% de los casos presentaron un FPre. A los30 días se registró una mortalidad del 6,2% y un índice de reconsultas del 26,6%. Los FPre más frecuentes fueron las infecciones (22,2%), las taquiarritmias (13%), la emergencia hipertensiva (4,9%), la transgresión del tratamiento (4,2%), la anemia (3,9%) yla isquemia coronaria (3,7%). En conjunto, no hubo diferencias (..) (AU)

Background and objective: Few studies have analyzed the impact of precipitating factors on the management of acute heart failure (AHF). The PAPRICA study sought to explore the relationship between identifying the precipitating factor in AHF and the 30-day mortality and emergency department revisit rates after the episode. Methods: Retrospective, multicenter study of AHF cases with follow-up data in the EAHFE registry (Epidemiology of Acute Heart Failure Emergencies). From the records of AHF episodes attended in 8 Spanish emergency departments in April 2007, we extracted the clinical characteristics of each episode and the short-term outcomes (30-day mortality and revisits). Patients were classified by absence or presence of a known precipitating factor for the AHF episode. Only the precipitating factor responsible for the episode was recorded. Results: Data for 662 cases were included. A precipitating factor was registered for 51.4% of the cases. At 30 days, overall mortality was 6.2% and revisits were made by 26.6% of the patients. The most common precipitating factors(..) (AU)

Síndrome de secreción inadecuada de hormona antidiurética secundario a carbamacepina / No disponible

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[Delays before and after arrival at the hospital in the treatment of strokes]. / Retraso extrahospitalario e intrahospitalario en el tratamiento del ictus.

INTRODUCTION: Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. AIMS: The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. PATIENTS AND METHODS: Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. RESULTS: From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. CONCLUSIONS: In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.

Retraso extrahospitalario e intrahospitalario en el tratamiento del ictus / Delays before and after arrival at the hospital in the treatment of strokes

Introducción. Sólo una minoría de pacientes con ictus agudo es candidata a fibrinólisis, y el principal motivo es sobrepasar temporalmente la ventana terapéutica. El principal retraso se produce hasta la llegada al hospital, pero también existe, y ha sido menos estudiado, un retraso intrahospitalario. Objetivo. Describir los datos de retraso extrahospitalario e intrahospitalario en una muestra de pacientes con ictus agudo y analizar los posibles factores asociados, entre ellos la sobrecarga asistencial en el área de Urgencias, aspecto previamente no evaluado. Pacientes y métodos. Se recogieron de forma sistemática los datos epidemiológicos, los tiempos de retraso extrahospitalario e intrahospitalario, el medio de trasporte empleado y la carga asistencial en Urgencias en el día del ingreso de todos los pacientes con ictus que ingresaron en la Unidad de Ictus del Hospital General Universitario de Alicante durante el período de estudio. Resultados. De una muestra inicial de 460 pacientes, se incluyeron en el estudio 423, con una mediana de retraso extrahospitalario e intrahospitalario de 3,99 y 2,36 horas, respectivamente. El uso de ambulancia y los subtipos hemorrágico y accidente isquémico transitorio se asociaron a un menor retraso extrahospitalario, mientras que la llegada durante el turno de noche fue el único factor asociado a un mayor retraso intrahospitalario. Conclusiones. Se evidencia la necesidad en nuestro medio de iniciar estrategias encaminadas a mejorar las latencias con la que los pacientes con enfermedad cerebrovascular acuden y se atienden en el ámbito hospitalario

Introduction. Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. Aims. The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. Patients and methods. Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. Results. From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. Conclusions. In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended

Lesiones de tobillo: diferencias entre lesiones deportivas y no deportivas / Ankle injuries: differences between sport and non sport injuries

Objetivos: El objetivo de nuestro estudio es evaluar lasdiferencias epidemiológicas existentes entre las lesiones detobillo producidas en la práctica deportiva y fuera de dichapráctica.Método: En el Servicio de Urgencias Traumatológicas delHospital General de Alicante; hemos sometido a estudio256 lesiones de tobillo (178 deportivas y 178 no deportivas),que han sido valoradas durante nueve meses.Resultados: La edad media de la muestra es de32,03±16,43 años. Aunque para las lesiones deportivas resultóuna edad media menor que para las lesiones no deportivas(de 22,82±6,91 años frente a 40,76±19,19 años).En general el sexo predominante fue el varón (65%). Aunquemayoritariamente las lesiones deportivas se producenen varones (93%), mientras que en las lesiones no deportivasse producen en mujeres (63%). El deporte más lesivoresultó ser el fútbol. En todos los grupos la lesión más frecuentefue la ligamentosa, predominando el alta hospitalariadesde urgencias, con tratamiento ortopédico.Conclusiones: Las lesiones deportivas ocurren en varonesde 22 años de edad, que juegan al fútbol, produciéndose unalesión ligamentosa que recibe tratamiento ortopédico y esdada de alta desde el Servicio de Urgencias. Las lesiones nodeportivas ocurren en mujeres de 40 años, ingresando conmayor frecuencia en el Servicio de Traumatología

Objective: The objective of our study is to evaluate thedifferences epidemiological existing between the injuriesof ankle produced in the sports practice and out of thispractice.Method: In the Service of Urgencies Traumatology ofthe General Hospital of Alicante; we have submitted tostudy 256 injuries of ankle (178 sports and 178 not sports),that have been valued for nine months.Result: The middle ages of the sample are of32,03±16,43 years. Though for the sports injuries it turnedout a minor middle ages that for the not sports injuries (of22,82±6,91 years opposite to 40,76±19,19 years). In generalthe predominant sex was the male (65%). Though forthe most part the sports injuries take place in males (93%),where as in the not sports injuries they take place inwomen (63%). The most harmful sport turned out to bethe football. In all the groups the most frequent injury wasligaments injuries, predominating over the hospital dischargefrom emergencies, with orthopaedic treatment.Conclusions: The sports injuries happen in males of 22years of age, that they play football, producing an injury tohim ligaments injuries that receive orthopaedic treatmentand is given of discharge from the Service of Urgencies.The not sports injuries happen in women of 40 years, joiningwith bigger frequency Traumatology Service

Influencia del fútbol en la frecuentación de los servicios de urgencias traumatológicas / Influence of soccer on attendance to traumatological emergency services

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