Pronóstico de la insuficiencia cardíaca aguda basado en datos clínicos de congestión / Prognosis of acute heart failure based on clinical data of congestion

Antecedentes y objetivos Evaluar si los síntomas/signos de congestión en pacientes con insuficiencia cardíaca aguda (ICA) atendidos en los servicios de urgencias hospitalarios (SUH) permiten predecir la evolución a corto plazo. Pacientes y métodos Pacientes consecutivos diagnosticados de ICA en 45 SUH del registro EAHFE. Recogimos variables clínicas de congestión sistémica (edemas en miembros inferiores, ingurgitación yugular, hepatomegalia) y pulmonar (disnea de esfuerzo, disnea paroxística nocturna, ortopnea y crepitantes pulmonares) analizando su asociación con la mortalidad por cualquier causa a 30 días, de forma cruda y ajustada por diferencias entre grupos. Resultado Analizamos 18.120 pacientes (mediana=83 años, rango intercuartil [RIC]=76-88; mujeres=55,7%). El 44,6% presentaba >3 síntomas/signos congestivos. Individualmente, el riesgo ajustado de muerte a 30 días se incrementó un 14% para la existencia de ingurgitación yugular (hazard ratio [HR]=1,14; intervalo de confianza al 95% [IC 95%]=1,01-1,28) y un 96% para la disnea de esfuerzo (HR=1,96; IC 95%=1,55-2,49). Valorados conjuntamente, el riesgo se incrementó progresivamente con el número de síntomas/signos presentes; así, respecto a los pacientes sin síntomas/signos de congestión, el riesgo incrementó un 109, 123 y 156% en pacientes con 1-2, 3-5 y 6-7 síntomas/signos, respectivamente. Estas asociaciones no mostraron interacción con la disposición final del paciente tras su atención en urgencias (alta/hospitalización), con excepción de edemas en extremidades inferiores, que tuvieron mejor pronóstico en pacientes dados de alta (HR=0,66; IC 95%=0,49-0,89) que en los hospitalizados (HR=1,01; IC 95%=0,65-1,57; p interacción <0,001). Conclusión La presencia de mayor número de síntomas/signos congestivos se asoció a una mayor mortalidad de cualquier causa a los 30 días. Individualmente, la ingurgitación yugular y la disnea de esfuerzo se asocian a mayor mortalidad a corto plazo (AU)

Background and objectives This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress. Patients and methods The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analyzed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups. Results We analyzed 18,120 patients (median=83 years, interquartile range [IQR]=76-88; women=55.7%). Of them, 44.6% had >3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR]=1.14, 95% confidence interval [95% CI]=1.01-1.28) and 96% for dyspnea on exertion (HR=1.96, 95% CI=1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123%, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR=0.66, 95% CI=0.49 -0.89) than hospitalized patients (HR=1.01, 95% CI=0.65-1.57; interaction p<0.001). Conclusion The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality (AU)

Prognosis of acute heart failure based on clinical data of congestion.

BACKGROUND AND OBJECTIVES: This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress. PATIENTS AND METHODS: The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analysed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups. RESULTS: We analysed 18,120 patients (median = 83 years, interquartile range [IQR] = 76-88; women = 55.7%). Of them, 44.6% had > 3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR] = 1.14, 95% confidence interval [95%CI] = 1.01-1.28) and 96% for dyspnea on exertion (HR = 1.96, 95% CI = 1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123 %, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR = 0.66, 95% CI = 0.49-0.89) than hospitalised patients (HR = 1.01, 95% CI = 0.65-1.57; interaction p < 0.001). CONCLUSION: The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality.

Alcohol, salud y enfermedad cardiovascular / Alcohol, health and cardiovascular disease

Estudios epidemiológicos recientes han demostrado que el consumo de alcohol puede aumentar el riesgo de hipertensión arterial, fibrilación auricular y de cáncer digestivo y de mama, por lo que diversos estamentos están promoviendo la abstinencia. Sin embargo, también han vuelto a confirmar que el consumo ligero de alcohol puede reducir el riesgo de infarto de miocardio y de diabetes, no quedando claro el efecto en la enfermedad cerebrovascular. Por ello, la decisión del consumo de alcohol debe ser individual y basada en factores personales. Un nivel de consumo<100g/semana en hombres (menor en mujeres), parece que no aumenta la mortalidad por cualquier causa, mientras que consumos elevados o en forma de atracón (binge) incrementan significativamente el riesgo de mortalidad, por lo cual deben aplicarse todas las medidas para prevenir este tipo de consumo, especialmente en la población más joven. Hay datos que apuntan una ventaja del vino frente a las otras bebidas, pero no son concluyentes (AU)

Recent epidemiological studies have shown that alcohol consumption can increase the risk of arterial hypertension, atrial fibrillation and gastrointestinal and breast cancer. Various sectors are therefore promoting abstinence from alcohol. However, light alcohol consumption has once again been shown to reduce the risk of myocardial infarction and diabetes but with an unclear effect on cerebrovascular disease. The decision to consume alcohol should therefore be an individual one based on personal factors. A level of consumption <100g/week for men (less for women) appears not to increase all-cause mortality, while high consumption or binge drinking significantly increases mortality risk. All measures to prevent this type of consumption, especially among the younger population, should therefore be applied. There are data indicating an advantage of wine over other beverages, but they are not conclusive (AU)

Alcohol, health and cardiovascular disease.

Recent epidemiological studies have shown that alcohol consumption can increase the risk of arterial hypertension, atrial fibrillation and gastrointestinal and breast cancer. Various sectors are therefore promoting abstinence from alcohol. However, light alcohol consumption has once again been shown to reduce the risk of myocardial infarction and diabetes but with an unclear effect on cerebrovascular disease. The decision to consume alcohol should therefore be an individual one based on personal factors. A level of consumption <100 g/week for men (less for women) appears not to increase all-cause mortality, while high consumption or binge drinking significantly increases mortality risk. All measures to prevent this type of consumption, especially among the younger population, should therefore be applied. There are data indicating an advantage of wine over other beverages, but they are not conclusive.

Consensus on improving the comprehensive care of patients with acute heart failure.

The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.

Current status and needs for changes in critical care training: the voice of the young cardiologists.

AIMS: The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (<40 years) from ESC countries. METHODS AND RESULTS: The survey (March-July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26-43) years old, 55% males were surveyed. Place and duration of acc training differed between countries and between centres in the same country. Although the majority of the respondents (91%) had completed their acc training, the average self-confidence to perform invasive procedures and to manage acc clinical scenarios was low-44% (27.3-70.4). The opportunities for simulation-based learning were scarce-18% (5.8-51.3), as it was previous leadership training (32%) and knowledge about key teamwork principles was poor (48%). The need for further acc training was high-81% (61.9-94.3). Male gender, higher level of training centres, professional qualifications of respondents, longer duration of acc/intensive care training, debriefings, and previous leadership training as well as knowledge about teamwork were related to higher self-confidence in all investigated aspects. CONCLUSIONS: The current cardiology training program is burdened by deficits in acc technical/non-technical skills, substantial variability in programs across ESC countries, and a clear gender-related disparity in outcomes. The forthcoming ESC Core Curriculum for General Cardiology is expected to address these deficiencies.

Consensus on improving the comprehensive care of patients with acute heart failure. / Consenso para la mejora de la atención integral de los pacientes con insuficiencia cardíaca aguda.

The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.

Alcohol, health and cardiovascular disease. / Alcohol, salud y enfermedad cardiovascular.

Recent epidemiological studies have shown that alcohol consumption can increase the risk of arterial hypertension, atrial fibrillation and gastrointestinal and breast cancer. Various sectors are therefore promoting abstinence from alcohol. However, light alcohol consumption has once again been shown to reduce the risk of myocardial infarction and diabetes but with an unclear effect on cerebrovascular disease. The decision to consume alcohol should therefore be an individual one based on personal factors. A level of consumption <100g/week for men (less for women) appears not to increase all-cause mortality, while high consumption or binge drinking significantly increases mortality risk. All measures to prevent this type of consumption, especially among the younger population, should therefore be applied. There are data indicating an advantage of wine over other beverages, but they are not conclusive.

Primera hospitalización por insuficiencia cardiaca: mortalidad hospitalaria y perfil del paciente / First hospital admission due to heart failure: In-hospital mortality and patient profile

Objetivos: Evaluamos el perfil de paciente y los resultados del primer ingreso hospitalario asociado a un acontecimiento de insuficiencia cardiaca (IC) en el período de tiempo comprendido entre 2010-2014. Diseño: Estudio de cohorte retrospectivo de centro único. Contexto: Utilizamos los datos de un hospital de atención terciaria (Hospital Universitari de Bellvitge, Barcelona, España). Participantes: Se incluyeron todos los pacientes con diagnóstico primario de IC registrados en la base de datos de altas hospitalarias entre los años 2010 y 2014, excluyendo los casos en los que la IC se presentó 10 años antes del episodio objeto de estudio. Intervención: El diagnóstico de IC en atención primaria fue evaluado para diferenciar entre pacientes con IC de inicio y aquellos sin ella. Principales medidas: Los análisis descriptivo, bivariado y multivariado se realizaron usando como variables de agrupamiento la edad, el diagnóstico previo de IC en atención primaria y la muerte hospitalaria. Se ajustaron variables significativas en un modelo de regresión logística lineal para cada resultado. Resultados: Seleccionamos 3.868 primeros ingresos por IC (56,8% de todos los episodios de IC). En 1.220 pacientes (31,7%) el diagnóstico de IC fue realizado por el médico de atención primaria. El modelo principal fue el de una mujer (OR=2,4), con alta prevalencia de hipertensión (OR=1,7), fibrilación auricular (OR=1,3), enfermedad renal crónica (OR=1,6) y tasa de mortalidad del 9,8%. La tasa de muerte intrahospitalaria fue del 5,8%; los principales factores contribuyentes fueron la edad (mayor de 85 años; OR=5,57), la presencia de enfermedad renal crónica (OR=1,44) y la duración del ingreso (7 días; OR=1,90). Conclusiones: Los casos de primer ingreso asociado a IC representan el 56,7% de todos los casos de IC. Aproximadamente un tercio de los pacientes fueron diagnosticados en el momento de su primera hospitalización. El mayor número de casos se dio en el grupo de mujeres ancianas, aunque no solo en ellas. Los principales contribuyentes de muerte intrahospitalaria fueron la edad, la duración del ingreso y la presencia de enfermedad renal crónica

Objectives: We evaluated the patient profile and outcomes of first heart failure (HF) related hospital admission patients in the 2010-2014 period. Design: Retrospective, single-centre, cohort study. Setting: We used administrative data from a tertiary care hospital (Hospital Universitari de Bellvitge, Barcelona, Spain). Participants: All patients with primary diagnosis of HF registered at the hospital discharge database from 2010 to 2014 were included, ruling out that HF was present 10 years prior to the current episode. Intervention: Primary care HF diagnosis status was assessed in order to distinguish new onset from no-new onset patients. Main measures: Descriptive, bivariate and multivariate analysis were performed using age, previous primary care HF diagnosis and in-hospital death as grouping variables. Significant variables were fitted into a Linear logistic regression model for each outcome. Results: We selected 3,868 first HF-related admissions (56.8% of all HF episodes). In 1,220 patients (31.7%) HF was diagnosed by their primary care physician. Main pattern was a woman (OR=2.4), with higher prevalence of hypertension (OR=1.7), atrial fibrillation (OR=1.3), chronic kidney disease (OR=1.6) and mortality rate (9.8%). In-hospital death rate was 5.8%, age over 85 (OR=5.57), chronic kidney disease (OR=1.44) and length of stay over 7 days (OR=1.90) being the main contributors. Conclusions: First HF related admissions account for 56.7% of all HF episodes. Roughly one third of patients were already diagnosed by the time of their first hospital admission. Elderly women were the most frequent, but not the only, group of patients. Age, hospital stay and chronic kidney disease were the main contributors for in-hospital death

First hospital admission due to heart failure: In-hospital mortality and patient profile. / Primera hospitalización por insuficiencia cardiaca: mortalidad hospitalaria y perfil del paciente.

OBJECTIVES: We evaluated the patient profile and outcomes of first heart failure (HF) related hospital admission patients in the 2010-2014 period. DESIGN: Retrospective, single-centre, cohort study. SETTING: We used administrative data from a tertiary care hospital (Hospital Universitari de Bellvitge, Barcelona, Spain). PARTICIPANTS: All patients with primary diagnosis of HF registered at the hospital discharge database from 2010 to 2014 were included, ruling out that HF was present 10 years prior to the current episode. INTERVENTION: Primary care HF diagnosis status was assessed in order to distinguish new onset from no-new onset patients. MAIN MEASURES: Descriptive, bivariate and multivariate analysis were performed using age, previous primary care HF diagnosis and in-hospital death as grouping variables. Significant variables were fitted into a Linear logistic regression model for each outcome. RESULTS: We selected 3,868 first HF-related admissions (56.8% of all HF episodes). In 1,220 patients (31.7%) HF was diagnosed by their primary care physician. Main pattern was a woman (OR=2.4), with higher prevalence of hypertension (OR=1.7), atrial fibrillation (OR=1.3), chronic kidney disease (OR=1.6) and mortality rate (9.8%). In-hospital death rate was 5.8%, age over 85 (OR=5.57), chronic kidney disease (OR=1.44) and length of stay over 7 days (OR=1.90) being the main contributors. CONCLUSIONS: First HF related admissions account for 56.7% of all HF episodes. Roughly one third of patients were already diagnosed by the time of their first hospital admission. Elderly women were the most frequent, but not the only, group of patients. Age, hospital stay and chronic kidney disease were the main contributors for in-hospital death.

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.

PURPOSE: Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings. RESULTS: Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries. CONCLUSION: A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.

Can meteorological factors forecast asthma exacerbation in a paediatric population?

BACKGROUND: Asthma exacerbations attended in emergency departments show a marked seasonality in the paediatric age. This seasonal pattern can change from one population to another and the factors involved are poorly understood. OBJECTIVES: To evaluate the association between meteorological factors and schooling with asthma exacerbations in children attended in the paediatric emergency department of a district hospital. METHODS: We conducted a retrospective review of the medical records of children 5---14 years of age attended for asthma exacerbations during a 4-year period (2007---2011). Climatic data were obtained from a weather station located very close to the population studied. The number of asthma exacerbations was correlated to temperature, barometric pressure, relative humidity, rainfall, wind speed, wind distance, solar radiation, water vapour pressure and schooling, using regression analyses. RESULTS: During the study period, 371 children were attended for asthma exacerbations; median age was eight years (IQR: 6---11), and 59% were males. Asthma exacerbations showed a bimodal pattern with peaks in spring and summer. Maximum annual peak occurred in week 39, within 15 days from school beginning after the summer holidays. A regression model with mean temperature, water vapour pressure, relative humidity, maximum wind speed and schooling could explain 98.4% (p < 0.001) of monthly asthma exacerbations. CONCLUSIONS: The combination of meteorological factors and schooling could predict asthma exacerbations in children attended in a paediatric emergency department

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Solar radiation and water vapor pressure to forecast chickenpox epidemics.

The clear seasonality of varicella infections in temperate regions suggests the influence of meteorologic conditions. However, there are very few data on this association. The aim of this study was to determine the seasonal pattern of varicella infections on the Mediterranean island of Mallorca (Spain), and its association with meteorologic conditions and schooling. Data on the number of cases of varicella were obtained from the Network of Epidemiologic Surveillance, which is composed of primary care physicians who notify varicella cases on a compulsory basis. From 1995 to 2012, varicella cases were correlated to temperature, humidity, rainfall, water vapor pressure, atmospheric pressure, wind speed, and solar radiation using regression and time-series models. The influence of schooling was also analyzed. A total of 68,379 cases of varicella were notified during the study period. Cases occurred all year round, with a peak incidence in June. Varicella cases increased with the decrease in water vapor pressure and/or the increase of solar radiation, 3 and 4 weeks prior to reporting, respectively. An inverse association was also observed between varicella cases and school holidays. Using these variables, the best fitting autoregressive moving average with exogenous variables (ARMAX) model could predict 95 % of varicella cases. In conclusion, varicella in our region had a clear seasonality, which was mainly determined by solar radiation and water vapor pressure.

Can meteorological factors forecast asthma exacerbation in a paediatric population?

BACKGROUND: Asthma exacerbations attended in emergency departments show a marked seasonality in the paediatric age. This seasonal pattern can change from one population to another and the factors involved are poorly understood. OBJECTIVES: To evaluate the association between meteorological factors and schooling with asthma exacerbations in children attended in the paediatric emergency department of a district hospital. METHODS: We conducted a retrospective review of the medical records of children 5-14 years of age attended for asthma exacerbations during a 4-year period (2007-2011). Climatic data were obtained from a weather station located very close to the population studied. The number of asthma exacerbations was correlated to temperature, barometric pressure, relative humidity, rainfall, wind speed, wind distance, solar radiation, water vapour pressure and schooling, using regression analyses. RESULTS: During the study period, 371 children were attended for asthma exacerbations; median age was eight years (IQR: 6-11), and 59% were males. Asthma exacerbations showed a bimodal pattern with peaks in spring and summer. Maximum annual peak occurred in week 39, within 15 days from school beginning after the summer holidays. A regression model with mean temperature, water vapour pressure, relative humidity, maximum wind speed and schooling could explain 98.4% (p<0.001) of monthly asthma exacerbations. CONCLUSIONS: The combination of meteorological factors and schooling could predict asthma exacerbations in children attended in a paediatric emergency department.

Are hospitalizations for rotavirus gastroenteritis associated with meteorologic factors?

Local climatic factors might explain seasonal patterns of rotavirus infections, but few models have been proposed to determine the effects of weather conditions on rotavirus activity. Here, we study the association of meteorologic factors with rotavirus activity, as determined by the number of children hospitalized for rotavirus gastroenteritis on the Mediterranean island of Mallorca (Spain). We conducted a retrospective review of the medical records of children aged 0-5 years admitted for rotavirus gastroenteritis between January 2000 and December 2010. The number of rotavirus hospitalizations was correlated to temperature, humidity, rainfall, atmospheric pressure, water vapor pressure, wind speed, and solar radiation using regression and time-series techniques. A total of 311 patients were hospitalized for rotavirus gastroenteritis in the 11-year study period, with a seasonal pattern from December to June, and a peak incidence in February. After multiple regressions, weekly rotavirus activity could be explained in 82 % of cases (p < 0.001) with a one-week lag meteorologic model. Rotavirus activity was negatively associated to temperature and positively associated to atmospheric pressure, solar radiation, and wind speed. Temperature and solar radiation were the factors that contributed most to the model, with a peak rotavirus activity at 9 °C and 800 10KJ/m(2), respectively. In conclusion, hospitalization for rotavirus was strongly associated with mean temperature, but an association of rotavirus activity with solar radiation, atmospheric pressure, and wind speed was also demonstrated. This model predicted more than 80 % of rotavirus hospitalizations.

Trends in death attributed to myocardial infarction, heart failure and pulmonary embolism in Europe and Canada over the last decade.

BACKGROUND: Worldwide, cardiovascular diseases and cancer account for ∼40% of deaths. Certain reports have shown a progressive decrease in mortality. Our main objective was to assess mortality trends related to myocardial infarction (MI), heart failure (HF) and pulmonary embolism (PE). METHODS: MI, HF and PE were studied as cause of death based on the analysis of death certificates in Canada (C), England and Wales (E), France (F) and Sweden (S). We also used a multiple cause approach. Age-standardized death rates (SDR) were calculated. RESULTS: The SDR for MI, HF or PE as the underlying cause of death, all decreased during the last decade. The decrease in SDR secondary to MI exceeded that for HF or PE. Concerning multiple cause of death, a greater decrease was also found for MI, compared with HF or PE. CONCLUSIONS: We confirm the beneficial trends in SDR with MI, HF or PE both as underlying or multiple causes in the studied countries. For HF and PE, multiple cause approach seems more accurate to describe the burden of these two pathologies. Our study also suggests that more efforts should be dedicated to HF and PE in order to achieve similar trends than in MI.

SEOM clinical guidelines for the treatment of small-cell lung cancer 2013

In this updated SCLC guidelines the authors have reviewed the "SEOM recommendation" for diagnosis and treatment of patients, including consideration for elderly and unfit patients. We hope the SCLC guidelines will be useful for residents and oncology teams (AU)

SEOM clinical guidelines for the treatment of small-cell lung cancer 2013.

In this updated SCLC guidelines the authors have reviewed the "SEOM recommendation" for diagnosis and treatment of patients, including consideration for elderly and unfit patients. We hope the SCLC guidelines will be useful for residents and oncology teams.

Prognostic implications of tissue oxygen saturation in human septic shock.

PURPOSE: To analyze the prognostic value of tissue oxygen saturation (StO(2)) in septic shock patients with restored mean arterial pressure (MAP). METHODS: This was a prospective observational study of patients admitted to the ICU in the early phase of septic shock, after restoration of MAP. Demographic data, severity score, hemodynamics, blood lactate, acid-base status, and StO(2) were measured at inclusion followed by a transient vascular occlusion test (VOT) to obtain the StO(2)-deoxygenation (DeOx) and StO(2)-reoxygenation (ReOx) rates. Sequential organ failure assessment (SOFA) score was measured at inclusion and after 24 h. RESULTS: Thirty-three patients were studied. StO(2) was 76 ± 10%, DeOx -12.2 ± 4.2%/min, and ReOx 3.02 ± 1.70%/s. MAP showed a significant correlation with VOT-derived slopes (r = -0.4, p = 0.04 for DeOx; and r = 0.55, p < 0.01 for ReOx). After 24 h, 17 patients (52%) had improved SOFA scores. Patients who did not improve their SOFA showed less negative DeOx values at inclusion. The association between DeOx and SOFA evolution was not affected by MAP. Both DeOx and ReOx impairment correlated with longer ICU stay (r = 0.44, p = 0.05; and r = -0.43, p = 0.05, respectively). CONCLUSIONS: In a population of septic shock patients with restored MAP, impaired DeOx was associated with no improvement in organ failures after 24 h. Decrements in DeOx and ReOx were associated with longer ICU stay. DeOx and ReOx were linked to MAP, and thus, their interpretation needs to be made relative to MAP.

Peripheral venous blood gases and pulse-oximetry in acute cardiogenic pulmonary oedema.

BACKGROUND: The role of venous blood gases as an alternative to arterial blood gases in patients with severe acute heart failure has not been established. OBJECTIVE: To assess the correlation between arterial and peripheral venous blood gases together with pulse-oximetry (SpO2), as well as to estimate arterial values from venous samples in the first hours upon admission of patients with acute cardiogenic pulmonary oedema. METHODS: Simultaneous venous and arterial blood samples were extracted on admission and over the next 1, 2, 3, 4, and 10 hours. SpO2 was also registered at the same intervals. RESULTS: A total of 178 pairs of samples were obtained from 34 consecutive patients with acute cardiogenic pulmonary oedema. Arterial and venous blood gases followed a parallel course in the first hours, showing high correlation rates at all time intervals. Venous samples underestimated pH (mean difference -0.028) and overestimated CO2 (+5.1 mmHg) and bicarbonate (+1 mEq/l). Conversely, SpO2 tended to underestimate SaO2 (mean±SD: 93.1±9.1 vs. 94.2±8.4). Applying simple mathematical formulae based on these differences, arterial values were empirically calculated from venous samples, showing acceptable agreement in the Bland-Altman test. Likewise, a venous pH <7.32, pCO2 >51.3 mmHg, and bicarbonate <22.8 mEq/l could fairly identify arterial acidosis, either respiratory or metabolic, with a test accuracy of 92, 68, and 91%, respectively. CONCLUSIONS: In patients with cardiogenic pulmonary oedema, arterial blood gas disturbances may be estimated from peripheral venous samples. By monitoring SpO2 simultaneously, arterial punctures could often be avoided.