Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación / Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: a validation cohort

Objetivos. Evaluar el impacto pronóstico del análisis del vector de bioimpedancia (bioelectrical impedance vector analysis [BIVA]) en pacientes ingresados por insuficiencia cardiaca (IC). Material y métodos. Cohorte prospectiva de 105 pacientes ingresados por IC. El BIVA se realizó previo al alta, y la muestra final se dividió en 3 grupos según el valor obtenido: hiperhidratación [hiperH] (>74,3%), normohidratación [normoH] (72,7-74,3%) y deshidratación [desH] (<72,7%). En el seguimiento, se consideraron eventos adversos la mortalidad total y los reingresos por IC. Resultados. Se observó una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH (Kaplan-Meier: log rank 2,1; p=0,04), con un incremento de riesgo independiente en el análisis multivariado (HR 2,6 [1,05-6,44]; p=0,039). Conclusiones. El análisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo (AU)

Objectives. To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). Material and methods. A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. Results. A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). Conclusions. BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF (AU)

Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort.

OBJECTIVES: To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). MATERIAL AND METHODS: A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. RESULTS: A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). CONCLUSIONS: BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.

Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario / Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital

Introducción. La fibrilación auricular es el principal motivo de anticoagulación oral en nuestro medio. Los nuevos anticoagulantes orales (NACO) superan las desventajas de los antagonistas de la vitamina K (AVK), aunque existen pocos datos de uso en nuestro medio. Nos planteamos evaluar el uso de NACO y el control en rango terapéutico (CRT) con AVK en un escenario clínico real. Métodos. Análisis de cohortes retrospectivo de 816 ingresos en cardiología durante 3 años con el diagnóstico de fibrilación auricular y tratamiento anticoagulante al alta, evaluando el porcentaje de prescripción de NACO y el CRT con AVK. Se compararon eventos de seguridad y eficacia durante un seguimiento de 15 meses entre los pacientes con NACO, los pacientes con AVK y buen CRT, y aquellos con mal CRT. Resultados. El porcentaje de prescripción de NACO fue del 7,6%. La determinación seriada de INR encontró un 71,3% de pacientes con mal CRT. Aunque los grupos no fueron comparables, se observó una mayor incidencia del evento combinado (ictus o infarto de miocardio, y mortalidad) en los tratados con AVK y mal CRT que en aquellos con NACO (p=0,01). Conclusiones. En pacientes con ingreso previo en cardiología en un hospital terciario y diagnóstico de fibrilación auricular, el índice de prescripción de NACO es bajo y el CRT con AVK es pobre (AU)

Introduction. Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. Methods. A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. Results. The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). Conclusions. For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor (AU)

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital. / Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario.

INTRODUCTION: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. METHODS: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. RESULTS: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). CONCLUSIONS: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Improving the waiting list by using 75-year-old donors for recipients with hepatocellular carcinoma.

The best treatment for hepatocellular carcinoma (HCC) associated with liver cirrhosis is liver transplantation and the best results are obtained when the tumors fulfill the Milan criteria. However, although the number of transplants is increasing, the organ deficit is growing, which lengthens time on the waiting list, increasing the risk of tumor progression of and exclusion from the list. The use of elderly donors is a valid option for patients on the transplant waiting list with HCC, reducing time on the waiting list. We report our experience with patients transplanted for HCC associated with hepatic cirrhosis using livers from donors >75 years of age. Our preliminary results supported the use of elderly suboptimal donors making it possible to give priority to these patients. All patients in the series achieved good graft function after a follow-up of 2 years with a 100% disease-free survival rate. More extensive long-term studies are needed to confirm these findings.

Las premisas para la Gestión Clínica / The premises for the Clinical Administration

La gestión clínica se ha impuesto como una nueva herramienta para gestión de los servicios sanitarios, basada en la gestión de procesos, que garantizando la práctica clínica apropiada, centrando la gestión en los pacientes, aporta un mayor grado de participación y autonomía de los profesionales clínicos en la gestión de los recursos sanitarios. Sin embargo, a pesar de las bondades teóricas de la herramienta una serie de premisas se han de cumplir antes de su implantación, para poder garantizar unos correctos resultados. Desde el desarrollo de un correcto Plan de Salud, hasta una fuerte inversión en tecnologías de la información, hasta la modificación de esquemas organizativos de diferentes empresas proveedoras de servicios sanitarios, son premisas necesarias para la gestión clínica (AU)