New technologies for the diagnosis, treatment, and monitoring of cardiovascular diseases.

Telemedicine enables the remote provision of medical care through information and communication technologies, facilitating data transmission, patient participation, promotion of heart-healthy habits, diagnosis, early detection of acute decompensation, and monitoring and follow-up of cardiovascular diseases. Wearable devices have multiple clinical applications, ranging from arrhythmia detection to remote monitoring of chronic diseases and risk factors. Integrating these technologies safely and effectively into routine clinical practice will require a multidisciplinary approach. Technological advances and data management will increase telemonitoring strategies, which will allow greater accessibility and equity, as well as more efficient and accurate patient care. However, there are still unresolved issues, such as identifying the most appropriate technological infrastructure, integrating these data into medical records, and addressing the digital divide, which can hamper patients' adoption of remote care. This article provides an updated overview of digital tools for a more comprehensive approach to atrial fibrillation, heart failure, risk factors, and treatment adherence.

Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode.

Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.

Information and consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific associations, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options. The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology. The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.

Documento de información y consenso para la detección y manejo de la enfermedad renal crónica / Information and consensus document for the detection and management of chronic kidney disease

La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a más del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete años, han sido escasas las evidencias y los ensayos clínicos que hayan mostrado nuevas estrategias en el diagnóstico y tratamiento de la ERC, con excepción de los nuevos ensayos en la enfermedad renal diabética. Esta situación ha condicionado que no se hayan actualizado las guías internacionales específicas de ERC. Esta rigidez y actitud conservadora de las guías no debe impedir la publicación de actualizaciones en el conocimiento en algunos aspectos, que pueden ser clave en la detección y manejo del paciente con ERC. En este documento, elaborado en conjunto por diez sociedades científicas, se muestra una actualización sobre conceptos, aclaraciones, criterios diagnósticos, estrategias de remisión y nuevas opciones terapéuticas.Se han revisado las evidencias y los principales estudios publicados en estos aspectos de la ERC, considerándose más bien un documento de información sobre esta patología. El documento incluye una actualización sobre la detección de la ERC, factores de riesgo, cribado, definición de progresión renal, actualización en los criterios de remisión con nuevas sugerencias en la población anciana, monitorización y estrategias de prevención de la ERC, manejo de comorbilidades asociadas, especialmente en diabetes mellitus, funciones del médico de Atención Primaria en el manejo de la ERC y qué no hacer en Nefrología.El objetivo del documento es que sirva de ayuda en el manejo multidisciplinar del paciente con ERC basado en las recomendaciones y conocimientos actuales. (AU)

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge. (AU)

Selección del tratamiento anticoagulante óptimo para el paciente con fibrilación auricular y diabetes o enfermedad renal crónica: papel del rivaroxabán / Selecting the best anticoagulant treatment for patients with atrial fibrillation and diabetes or chronic kidney disease: the role of rivaroxaban

Tanto la diabetes mellitus como la enfermedad renal crónica aumentan el riesgo de fibrilación auricular. A su vez, la concomitancia de diabetes mellitus y enfermedad renal crónica incrementa de manera sinérgica el riesgo tromboembólico asociado con la fibrilación auricular, lo que pone al paciente en esta situación en especial riesgo y obliga a no fijar nuestra actuación solo en la reducción del riesgo embólico, sino a buscar una protección general. Aunque todos los anticoagulantes orales reducen eficazmente el riesgo de ictus en el paciente diabético con fibrilación auricular, hay datos que indican que el rivaroxabán podría disminuir además la mortalidad cardiovascular en esta población, ofreciendo una protección adicional. Por otra parte, se ha descrito un empeoramiento de la función renal con el empleo de los antagonistas de la vitamina K (nefropatía por warfarina). En consecuencia, sería deseable que el tratamiento anticoagulante no solo disminuyera el riesgo de complicaciones tromboembólicas, sino que además no se asociara con este deterioro de la función renal. En este sentido, parece que algunos anticoagulantes orales de acción directa, como el dabigatrán y el rivaroxabán, tendrían un menor riesgo de eventos renales adversos en comparación con warfarina

Both diabetes mellitus and chronic kidney disease increase the risk of atrial fibrillation. In turn, the coexistence of diabetes and chronic kidney disease synergistically increases the thromboembolic risk associated with atrial fibrillation, which puts affected patients at a particularly high risk and makes it necessary to focus treatment not only on reducing the risk of embolism but also on providing more general prophylaxis. Although all oral anticoagulants are effective in reducing the risk of stroke in diabetic patients with atrial fibrillation, there are indications that rivaroxaban could also reduce cardiovascular mortality in this population, thereby providing additional benefits. Moreover, it has been reported that renal function deteriorates on vitamin K antagonist treatment (i.e. warfarin-related nephropathy). Consequently, the ideal anticoagulant treatment would decrease the risk of thromboembolic complications without also being associated with impaired renal function. In this context, it appears that some direct oral anticoagulants, such as dabigatran and rivaroxaban, may have a lower risk of adverse renal events than warfarin

Predictores de hospitalización prolongada en cardiología / Predictors of prolonged hospitalization in cardiology

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[Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction]. / Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio.

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending on their comorbidity. The Charlson Index (ChI) and its adaptations are well established and widely used tools to quantify a patient comorbidity. The aim of this study is to evaluate the influence of comorbidity quantified by the ChI in the treatment administered at admission and in the pharmacological treatment prescribed at discharge in the setting of an acute myocardial infarction with and without ST segment elevation. PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospital with the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day of admission applying the ChI. According to this value patients were classified from minor to major in 2 subgroups (ChI or= 2) and differences in the admission and discharge treatments between both groups were analyzed. RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI > 2 received less frequently betablockers at discharge, but there were no significant differences in the use of ACE inhibitors, calcium channel blockers or statins. In addition they were submitted less frequently to revascularization procedures or treadmills, and no differences were found in the use of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treated with betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms; furthermore, in these patients, there were no significant differences in the use of ACE inhibitors, calcium channel blockers, thrombolytics or revascularization procedures. CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifies in-hospital and ambulatory management of patients with acute myocardial infarction. There is a lower use of invasive techniques as well as a lower prescription of betablockers at discharge in patients with greater comorbidity.

Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio / Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction

FUNDAMENTO Y OBJETIVO: El tratamiento del paciente cardiológico varía según su comorbilidad. Elíndice de Charlson (ICh) y sus adaptaciones son herramientas utilizadas y contrastadas globalmenteque intentan objetivar la comorbilidad de un paciente. El objetivo del presente trabajoes evaluar la influencia de la comorbilidad, cuantificada mediante el ICh, en el tratamiento intrahospitalarioy farmacológico prescrito al alta hospitalaria en el infarto de miocardio con o sinelevación del segmento ST.PACIENTES Y MÉTODO: Se estudió a 955 pacientes consecutivos ingresados en un hospital por infartode miocardio. Se analizó la comorbilidad obtenida el primer día del ingreso mediante laaplicación del ICh, se clasificó a los pacientes en 2 subgrupos de menor o mayor comorbilidad(ICh ≤ 2; ICh > 2) y se determinó si había diferencias entre ambos subgrupos según el tratamientointrahospitalario y al alta.RESULTADOS: Los pacientes ingresados por infarto agudo de miocardio sin elevación del ST e IChsuperior a 2 recibieron con menor frecuencia bloqueadores beta al alta, mientras que no existendiferencias significativas en el tratamiento con inhibidores de la enzima de conversión de laangiotensina, antagonistas del calcio o estatinas. Además, se les practicaron menos procedimientosde revascularización y menos ergometrías, mientras que no hubo diferencias en la realizaciónde ecocardiogramas. Los pacientes con elevación del segmento ST e ICh superior a 2era menos probable que fueran tratados al alta con bloqueadores beta y estatinas, y se les realizaronmenos ergometrías y ecocardiogramas, mientras que no hubo diferencias significativasen el tratamiento con inhibidores de la enzima de conversión del la angiotensina, antagonistasdel calcio, trombólisis o tratamiento intervencionista (revascularización).CONCLUSIONES: La comorbilidad presente en el momento del ingreso y cuantificada mediante elICh condiciona de manera independiente el tratamiento intrahospitalario y el alta de los pacientescon infarto de miocardio. Hay un menor uso de técnicas invasivas, junto con una menorprescripción de bloqueadores beta al alta en los pacientes con mayor comorbilidad

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending ontheir comorbidity. The Charlson Index (ChI) and its adaptations are well established and widelyused tools to quantify a patient comorbidity. The aim of this study is to evaluate the influenceof comorbidity quantified by the ChI in the treatment administered at admission and in thepharmacological treatment prescribed at discharge in the setting of an acute myocardial infarctionwith and without ST segment elevation.PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospitalwith the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day ofadmission applying the ChI. According to this value patients were classified from minor to majorin 2 subgroups (ChI 2) and differences in the admission and discharge treatmentsbetween both groups were analyzed.RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI> 2 received less frequently betablockers at discharge, but there were no significant differences inthe use of ACE inhibitors, calcium channel blockers or statins. In addition they were submittedless frequently to revascularization procedures or treadmills, and no differences were found in theuse of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treatedwith betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms;furthermore, in these patients, there were no significant differences in the use of ACEinhibitors, calcium channel blockers, thrombolytics or revascularization procedures.CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifiesin-hospital and ambulatory management of patients with acute myocardial infarction.There is a lower use of invasive techniques as well as a lower prescription of betablockers atdischarge in patients with greater comorbidity

Hemoptysis as an unusual manifestation of right atrial myxoma.

Atrial myxoma is the most frequent tumor of the heart, though right-side locations and initial clinical manifestation in the form of hemoptysis are infrequent. We describe the case of a young woman with right atrial myxoma diagnosed by transthoracic echocardiography and presenting hemoptysis as the most important manifestation. The symptomatology disappeared after surgical removal of the lesion.