Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19.

BACKGROUND: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

Atención al ictus agudo durante la pandemia por COVID-19. Recomendaciones Plan Ictus Madrid / Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program

INTRODUCCIÓN: La pandemia por COVID-19 ha obligado a una reorganización de los sistemas sanitarios y una saturación excepcional de sus recursos. En este contexto es vital asegurar la atención al ictus agudo y optimizar los procesos asistenciales del código ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello desde el Grupo multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. MÉTODOS: Revisión bibliográfica no sistemática de las publicaciones disponibles con los términos "stroke" y "covid-19" o "coronavirus" o "SARS-COV-2", así como otras conocidas por los autores. En base a ésta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo multidisciplinar Ictus Madrid y su Comité de Neurología. RESULTADOS: Las recomendaciones se estructuran en cinco líneas fundamentales: (1) Coordinar la actuación para garantizar el acceso la asistencia hospitalaria de los pacientes con ictus, (2) Reconocer a los pacientes con ictus potencialmente infectados por COVID-19, (3) Organización adecuada para garantizar la protección de los profesionales sanitarios frente al riesgo de contagio por COVID-19, (4) la realización de Neuroimagen y otros procedimientos que conlleven contactos de riesgo de infección COVID-19 hay que procurar reducirlos y asegurar la protección, y (5) alta y seguimiento seguros procurando optimizar la ocupación hospitalaria. Resumimos el procedimiento de forma esquemática con el acrónimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). CONCLUSIONES: Estas recomendaciones pueden servir de apoyo para la organización del sistema sanitario en la atención al ictus agudo y la optimización de sus recursos, garantizando la protección de sus profesionales

BACKGROUND: The COVID-19 pandemic has forced a reorganization of healthcare systems and an exceptional saturation of their resources. In this context, it is vital to ensure acute stroke care and optimize the care processes of the stroke code to reduce the risk of contagion and rationalize the use of hospital resources. To do this, the Ictus Madrid multidisciplinary group proposes a series of recommendations. METHODS: Non-systematic bibliographic review of the available publications with the terms "stroke" and "covid-19" or "coronavirus" or "SARS-COV-2", as well as other already known for the authors. We provide a document of recommendations as a result of the consensus of the Ictus Madrid multidisciplinary group and its Neurology Committee. RESULTS: Our recommendations are structured on five lines: (1) Coordinate to guarantee the access to hospital care for stroke patients, (2) Recognize potentially COVID-19 infected stroke patients, (3) Organize to ensure the protection of healthcare professionals from COVID-19 infections, (4) Neuroimaging and other procedures potentially associated to risks for COVID-19 infection should be reduced and secured to avoid contagion, and (5) At home as soon as posible and supported follow-up to optimize hospital occupancy. The procedure is shown summarized under the acronym CORONA (Coordinate, Recognize, Organize, Neuroimaging, At home). CONCLUSIONS: These recommendations can support the organization of healthcare services for acute stroke care and the optimization of their resources, guaranteeing the protection of healthcare professionals

Letter by Garcia A, et al. regarding article: Coronary artery disease risk reclassification by a new acoustic-based score.

The best cost-effective non-invasive test for the diagnosis of coronary artery disease (CAD) in patients with intermediate pre-test probability (PTP) is unknown. Nevertheless one of the most common non invasive test used is the exercise treadmill testing (ETT) that is the less expensive non-invasive test but with the lowest sensitivity for the diagnosis of CAD, therefore many patients with intermediate PTP will required another non-invasive test with a higher cost and some of them require exposure to radiation. Despite all these measures, an estimated $108.9 billion is spent annually on CAD treatment. Some studies had showed that diastolic dysfunction is associated to CAD. A novel signal-processed surface ECG (MyoVista hsECG) can detection the abnormal myocardial relaxation and therefore identified CAD. The non-invasive acoustic device CADScore V3 algorithm had lower cost compared with any noninvasive test, with a high negative predictive value but not good enough specificity to diagnose CAD, hence should be the first approach in patients with a low and intermediate probability of CAD, and if to this evaluation will added the Myovista hs ECG to detection of CAD, therefore some patients with intermediate PTP could be reclassified into high risk and a better cost-effective decisions could be taken as referring directly to coronary angiography.

Las revisitas a urgencias de los pacientes con fibrilación auricular / Emergency department re-presentation of patients with atrial fibrillation

No disponible

[Vernakalant in hospital emergency practice: safety and effectiveness]. / Seguridad y eficacia de vernakalant en la práctica clínica de los servicios de urgencias.

OBJECTIVES: To study the effectiveness and safety of vernakalant for restoration of sinus rhythm in patients with atrial fibrillation (AF) in routine hospital emergency department care, and to evaluate factors associated with a more effective response. MATERIAL AND METHODS: Prospective multicenter cohort study enrolling consecutive patients who were administered vernakalant for medical cardioversion of AF between September 2014 through March 2016 in 5 hospitals in the Spanish autonomous community of Valencia. RESULTS: We studied 165 cases. The median (interquartile range) was 68 years (56-77) years. Cardioversion with vernakalant was effective in 77.6% (95% CI, 71.1%-84%). The median time to conversion was 8 ( 6-12) minutes after a first dose and 34 (22-62) minutes after a second dose. A prior history of cardiac insufficiency was nonsignificantly less common in patients who converted with vernakalant (6.3%) than in those who did not (18.9%) (adjusted odds ratio [OR], 0.45 [95% CI, 0.13-1.56]; P=.208). Having no prior history of AF was nonsignificantly related to greater effectiveness (in 54.7% vs in 35.1% with prior AF). Duration less than 12 hours was significantly associated with greater effectiveness (83.6% vs 59.5%; adjusted OR, 2.76 [95% CI, 1.12-6.80]; P=.028). Adverse events were reported for 30 patients. None of the events had clinically important consequences, and in only 2 cases (1.2%) was it necessary to suspend treatment. CONCLUSION: Vernakalant is effective and safe for restoring sinus rhythm in the hospital emergency department.

OBJETIVO: Describir la eficacia y seguridad de vernakalant para la reversión de la fibrilación auricular (FA) a ritmo sinusal en la práctica clínica habitual de los servicios de urgencias hospitalarios (SUH), así como evaluar las características asociadas a mayor respuesta eficaz. METODO: Estudio de cohortes multicéntrico, analítico, prospectivo, con inclusión consecutiva de pacientes en los que se administra vernakalant para realizar cardioversión farmacológica de una FA, llevado a cabo desde Septiembre 2014 hasta Marzo 2016 en 5 hospitales de la Comunidad Valenciana. RESULTADOS: Se analizaron 165 casos con una mediana de edad de 68 años [rango intercuartil (RIC): 56-77]. La reversión eficaz fue de 77,6% (IC 95%: 71,1%-84,0%). La mediana del tiempo de reversión fue de 8 minutos (RIC: 6-12) con la primera dosis y de 34 minutos (RIC: 22-62) con la segunda. La presencia de insuficiencia cardiaca previa fue menos frecuente en el grupo que revirtió con vernakalant, 6,3% frente a 18,9%, con una OR ajustada de 0,45 (IC 95%: 0,13-1,56), p = 0,208. Ser un primer episodio de FA y tener una duración de menos de 12 horas se relacionó con mayores tasas de reversión, 54,7% frente a 35,1% y de 83,6% frente a 59,5%, respectivamente, pero solo la segunda fue significativa con una OR ajustada de 2,76 (IC 95%: 1,12-6,80), p = 0,028. Se notificaron eventos adversos en 30 pacientes. Ninguno de ellos tuvo consecuencias relevantes y sólo dos (1,2%) motivaron la suspensión del fármaco. CONCLUSIONES: Vernakalant es un fármaco eficaz y seguro para la restauración del ritmo sinusal en los SUH.

Seguridad y eficacia de vernakalant en la práctica clínica de los servicios de urgencias / Vernakalant in hospital emergency practice: safety and effectiveness

Objetivo. Describir la eficacia y seguridad de vernakalant para la reversión de la fibrilación auricular (FA) a ritmo sinusal en la práctica clínica habitual de los servicios de urgencias hospitalarios (SUH), así como evaluar las características asociadas a mayor respuesta eficaz. Método. Estudio de cohortes multicéntrico, analítico, prospectivo, con inclusión consecutiva de pacientes en los que se administra vernakalant para realizar cardioversión farmacológica de una FA, llevado a cabo desde Septiembre 2014 hasta Marzo 2016 en 5 hospitales de la Comunidad Valenciana. Resultados. Se analizaron 165 casos con una mediana de edad de 68 anos [rango intercuartil (RIC): 56-77]. La reversión eficaz fue de 77,6% (IC 95%: 71,1%-84,0%). La mediana del tiempo de reversión fue de 8 minutos (RIC: 6-12) con la primera dosis y de 34 minutos (RIC: 22-62) con la segunda. La presencia de insuficiencia cardiaca previa fue menos frecuente en el grupo que revirtió con vernakalant, 6,3% frente a 18,9%, con una OR ajustada de 0,45 (IC 95%: 0,13-1,56), p = 0,208. Ser un primer episodio de FA y tener una duración de menos de 12 horas se relacionó con mayores tasas de reversión, 54,7% frente a 35,1% y de 83,6% frente a 59,5%, respectivamente, pero solo la segunda fue significativa con una OR ajustada de 2,76 (IC 95%: 1,12-6,80), p = 0,028. Se notificaron eventos adversos en 30 pacientes. Ninguno de ellos tuvo consecuencias relevantes y solo dos (1,2%) motivaron la suspensión del fármaco. Conclusiones. Vernakalant es un fármaco eficaz y seguro para la restauración del ritmo sinusal en los SUH (AU))

Objectives. To study the effectiveness and safety of vernakalant for restoration of sinus rhythm in patients with atrial fibrillation (AF) in routine hospital emergency department care, and to evaluate factors associated with a more effective response. Methods. Prospective multicenter cohort study enrolling consecutive patients who were administered vernakalant for medical cardioversion of AF between September 2014 through March 2016 in 5 hospitals in the Spanish autonomous community of Valencia. Results. We studied 165 cases. The median (interquartile range) was 68 years (56-77) years. Cardioversion with vernakalant was effective in 77.6% (95% CI, 71.1%-84%). The median time to conversion was 8 ( 6-12) minutes after a first dose and 34 (22-62) minutes after a second dose. A prior history of cardiac insufficiency was nonsignificantly less common in patients who converted with vernakalant (6.3%) than in those who did not (18.9%) (adjusted odds ratio [OR], 0.45 [95% CI, 0.13-1.56]; P=.208). Having no prior history of AF was nonsignificantly related to greater effectiveness (in 54.7% vs in 35.1% with prior AF). Duration less than 12 hours was significantly associated with greater effectiveness (83.6% vs 59.5%; adjusted OR, 2.76 [95% CI, 1.12-6.80]; P=.028). Adverse events were reported for 30 patients. None of the events had clinically important consequences, and in only 2 cases (1.2%) was it necessary to suspend treatment. Conclusion. Vernakalant is effective and safe for restoring sinus rhythm in the hospital emergency department (AU)

Frequency and management of diabetes and hyperglycemia at emergency departments: the GLUCE-URG Study. / Frecuencia y manejo de diabetes mellitus y de hiperglucemia en urgencias: Estudio GLUCE-URG.

INTRODUCTION: Hyperglycemia is a common finding at hospital emergency rooms in diabetic patients, but few data are available on its frequency, management, and subsequent impact based on the assessment made at Emergency rooms. OBJECTIVES: To ascertain the frequency of diabetes mellitus and hyperglycemia in patients admitted from Emergency rooms. Second, to describe management of hyperglycemia at Emergency rooms, and to analyze its potential impact on the course and management of patients during admission. PATIENTS AND METHODS: All patients admitted from the Emergency room for three consecutive weeks were enrolled. Hyperglycemia was defined as two blood glucose measurements ≥ 180mg/dl in the first 48hours after admission. RESULTS: 36.6% of patients admitted from the Emergency room were diabetic, and 58% of these had early, sustained hyperglycemia. On the other hand, 27% of patients admitted from the Emergency room had hyperglycemia (78.3% of diabetic patients and 21.7% with no known diabetes). Diabetic patients with hyperglycemia had higher blood glucose levels than non-diabetic patients (p<.01). Average hospital stay was 8±6.4 days, with no differences between the groups. Hyperglycemia is rarely reported as a diagnosis in the emergency rooms discharge report. In standard hospitalization, this diagnosis appears more commonly in patients with known diabetes (OR 2.5 p<.001). CONCLUSIONS: Prevalence of diabetic patients admitted from emergency rooms is very high. In addition, although hyperglycemia is very common in patients admitted from emergency rooms, there is a trend to underestimate its significance. Based on our results, we think that implementation of measures to give greater visibility to diagnosis of hyperglycemia could help improve application of established protocols.

Frecuencia y manejo de diabetes mellitus y de hiperglucemia en urgencias: Estudio GLUCE-URG / Frequency and management of diabetes and hyperglycemia at emergency departments: the GLUCE-URG Study

Introducción: La hiperglucemia es un hallazgo habitual en los Servicios de Urgencias Hospitalarios así como la atención de pacientes diabéticos, pero existen pocos datos sobre su frecuencia, manejo y repercusión posterior en función de la valoración que se le haya dado en dichos servicios. Objetivos: Determinar la frecuencia de diabetes mellitus y de hiperglucemia en los pacientes que ingresan desde Urgencias. En segundo lugar, describir el manejo en Urgencias de la hiperglucemia, y analizar la influencia que pudiera tener en la evolución y en el manejo del paciente durante su ingreso. Pacientes y métodos: Durante 3 semanas consecutivas se incluyeron todos los pacientes ingresados desde el Servicio de Urgencias del Hospital Universitario Severo Ochoa. La hiperglucemia se definió como 2 determinaciones de glucosa ≥ 180mg/dl, separadas al menos 8 h y en las primeras 48 h de estancia hospitalaria. Resultados: El 36,6% de los pacientes que ingresaron desde el Servicio de Urgencias eran diabéticos, y de ellos el 58% presentaban hiperglucemia precoz y mantenida. Por otro lado, el 27% de los pacientes que ingresaban desde urgencias presentaban hiperglucemia (78,3% de pacientes diabéticos y 21,7% sin diabetes conocida). La hiperglucemia de los pacientes que ya eran diabéticos era significativamente más intensa que la hiperglucemia de los no diabéticos conocidos (p<0,01). La estancia media en planta fue de 8±6,4 días, sin que se observaran diferencias entre los distintos grupos. En urgencias no se solía mencionar la hiperglucemia dentro de la lista de diagnósticos mientras que en el informe de alta desde planta existía mayor probabilidad de que se hiciera referencia a la hiperglucemia en los pacientes con diabetes previa que en las nuevas hiperglucemias (p<0,001, OR 2,5). Conclusiones: La prevalencia de pacientes diabéticos que ingresan desde Urgencias es muy alta. Además, a pesar de que la hiperglucemia es muy frecuente en los pacientes que ingresan desde el Servicio de Urgencias, se tiende a subestimar su importancia. En base a nuestros resultados, creemos que la implantación de medidas que ayuden a aportar mayor visibilidad al diagnóstico de hiperglucemia podrían ayudar en la mejora de la aplicación de los protocolos establecidos desde los Servicios de Urgencias Hospitalarios (AU)

Introduction: Hyperglycemia is a common finding at hospital emergency rooms in diabetic patients, but few data are available on its frequency, management, and subsequent impact based on the assessment made at Emergency rooms. Objectives: To ascertain the frequency of diabetes mellitus and hyperglycemia in patients admitted from Emergency rooms. Second, to describe management of hyperglycemia at Emergency rooms, and to analyze its potential impact on the course and management of patients during admission. Patients and methods: All patients admitted from the Emergency room for three consecutive weeks were enrolled. Hyperglycemia was defined as two blood glucose measurements ≥ 180mg/dl in the first 48hours after admission. Results: 36.6% of patients admitted from the Emergency room were diabetic, and 58% of these had early, sustained hyperglycemia. On the other hand, 27% of patients admitted from the Emergency room had hyperglycemia (78.3% of diabetic patients and 21.7% with no known diabetes). Diabetic patients with hyperglycemia had higher blood glucose levels than non-diabetic patients (p<.01). Average hospital stay was 8±6.4 days, with no differences between the groups. Hyperglycemia is rarely reported as a diagnosis in the emergency rooms discharge report. In standard hospitalization, this diagnosis appears more commonly in patients with known diabetes (OR 2.5 p<.001). Conclusions: Prevalence of diabetic patients admitted from emergency rooms is very high. In addition, although hyperglycemia is very common in patients admitted from emergency rooms, there is a trend to underestimate its significance. Based on our results, we think that implementation of measures to give greater visibility to diagnosis of hyperglycemia could help improve application of established protocols (AU)

Prevención de las complicaciones cardiovasculares asociadas a la diabetes mellitus en los servicios de urgencias / Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement

Objetivo: Analizar el perfil de riesgo y la prescripción de tratamiento para la prevención de complicaciones cardiovasculares en los pacientes diabéticos que acuden a los servicios de urgencias hospitalarios (SUH). Método: Estudio de series de casos con análisis transversal llevado a cabo en dos SUH españoles. Se incluyeron de forma consecutiva todos los pacientes con antecedentes o diagnóstico final de diabetes mellitus entre 1 de noviembre de 2010 y 30 de junio de 2011. Se analizó su perfil de riesgo cardiovascular y se consideró como variable de resultado principal la prescripción de tratamiento para la prevención de las complicaciones cardiovasculares al alta del SUH de acuerdo a las recomendaciones de la American Diabetes Association de 2012. Resultados: Se incluyeron 298 pacientes diabéticos, 275 (92%) tipo 2. De ellos 269 (90%) presentaban algún otro factor de riesgo cardiovascular, 147 (49%) lesión previa de órgano diana y 41 (14%) lesión nueva de órgano diana. Ciento setenta y dos pacientes (58%) fueron dados de alta desde el SUH. Aunque 215 pacientes (72%) no cumplían previamente alguna y 30 (10%) ninguna de las recomendaciones de prevención, sólo se modificó el tratamiento farmacológico en un rango de un 1,1% a 3,3% de los pacientes y no se recomendó seguimiento posterior en 42 casos (24%). Conclusiones: Aunque los pacientes diabéticos atendidos en los SUH presentan un elevado riesgo cardiovascular, no se aprovecha esta oportunidad para optimizar el tratamiento de la prevención de las complicaciones cardiovasculares ni garantizar un seguimiento adecuado (AU)

Objectives: To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Methods: Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient’s discharge from emergency care. Results: A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Conclusions: Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up (AU)

Formación desde urgencias para los pacientes atendidos con fibrilación auricular: un valor añadido / Health training for patients with atrial fibrillation attended in the emergency department: added value for service

No disponible

[Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement]. / Prevención de las complicaciones cardiovasculares asociadas a la diabetes mellitus en los servicios de urgencias.

OBJECTIVES: To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. MATERIAL AND METHODS: Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. RESULTS: A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). CONCLUSION: Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

OBJETIVO: Analizar el perfil de riesgo y la prescripción de tratamiento para la prevención de complicaciones cardiovasculares en los pacientes diabéticos que acuden a los servicios de urgencias hospitalarios (SUH). METODO: Estudio de series de casos con análisis transversal llevado a cabo en dos SUH españoles. Se incluyeron de forma consecutiva todos los pacientes con antecedentes o diagnóstico final de diabetes mellitus entre 1 de noviembre de 2010 y 30 de junio de 2011. Se analizó su perfil de riesgo cardiovascular y se consideró como variable de resultado principal la prescripción de tratamiento para la prevención de las complicaciones cardiovasculares al alta del SUH de acuerdo a las recomendaciones de la American Diabetes Association de 2012. RESULTADOS: Se incluyeron 298 pacientes diabéticos, 275 (92%) tipo 2. De ellos 269 (90%) presentaban algún otro factor de riesgo cardiovascular, 147 (49%) lesión previa de órgano diana y 41 (14%) lesión nueva de órgano diana. Ciento setenta y dos pacientes (58%) fueron dados de alta desde el SUH. Aunque 215 pacientes (72%) no cumplían previamente alguna y 30 (10%) ninguna de las recomendaciones de prevención, sólo se modificó el tratamiento farmacológico en un rango de un 1,1% a 3,3% de los pacientes y no se recomendó seguimiento posterior en 42 casos (24%). CONCLUSIONES: Aunque los pacientes diabéticos atendidos en los SUH presentan un elevado riesgo cardiovascular, no se aprovecha esta oportunidad para optimizar el tratamiento de la prevención de las complicaciones cardiovasculares ni garantizar un seguimiento adecuado.