Two cosmoses, one universe: a narrative review exploring the gut microbiome's role in the effect of urban risk factors on vascular ageing.

In the face of rising global urbanisation, understanding how the associated environment and lifestyle impact public health is a cornerstone for prevention, research, and clinical practice. Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with urban risk factors contributing greatly to its burden. The current narrative review adopts an exposome approach to explore the effect of urban-associated physical-chemical factors (such as air pollution) and lifestyle on cardiovascular health and ageing. In addition, we provide new insights into how these urban-related factors alter the gut microbiome, which has been associated with an increased risk of cardiovascular disease. We focus on vascular ageing, before disease onset, to promote preventative research and practice. We also discuss how urban ecosystems and social factors may interact with these pathways and provide suggestions for future research, precision prevention and management of vascular ageing. Most importantly, future research and decision-making would benefit from adopting an exposome approach and acknowledging the diverse and boundless universe of the microbiome.

Factors associated with coronary artery disease among people living with human immunodeficiency virus: Results from the Colombian HIV/AIDS registry.

Background: People living with HIV (PLWHIV) are at a higher risk of developing coronary artery disease (CAD). We aimed to assess the factors associated with CAD among PLWHIV in Colombia. Methods: We conducted a retrospective cohort study based on adults newly diagnosed with HIV, reported to the Colombian HIV/AIDS registry from 2018 to 2021. Baseline demographic and clinical characteristics were compared by age (<50 and ≥ 50 years). Our main outcome was the presence of CAD. Logistic regression models were used to assess the association between traditional and HIV-related factors with CAD. These associations were also evaluated in stratified models by age. Effect measures were odds ratios (OR) and their 95% confidence intervals. Results: Among 36,483 PLWHIV, the frequency of CAD was 0.53% (n = 196). There was a high prevalence of impaired fasting glucose/diabetes mellitus (12.62%), overweight/obesity (27.79%), elevated LDL-c (86.69%), and hypertriglyceridemia (72.76%). Factors associated with CAD included male gender (OR: 2.01, 95% CI: 1.12-3.58), age ≥50 years (OR: 4.96, 95% CI: 3.29-7.45), lipoatrophy or lipodystrophy (OR 5.12, 95% CI: 1.12-23.33), AIDS-defining conditions (OR: 1.83, 95% CI: 1.07-3.12), obesity (OR: 2.95, 95% CI: 1.69-5.10), diabetes mellitus (OR: 2.50, 95% CI: 1.25-4.97), and renal impairment (OR: 3.15, 95% CI: 1.83-5.42). Conclusions: Traditional CAD risk factors are common in PLWHIV. There were traditional and disease-specific factors associated with increased odds of CAD. These findings may aid clinicians and decision-makers in reducing the impact of CAD in PLWHIV.

Efficacy of phage therapy in preclinical models of bacterial infection: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance of bacterial pathogens is an increasing clinical problem and alternative approaches to antibiotic chemotherapy are needed. One of these approaches is the use of lytic bacterial viruses known as phage therapy. We aimed to assess the efficacy of phage therapy in preclinical animal models of bacterial infection. METHODS: In this systematic review and meta-analysis, MEDLINE/Ovid, Embase/Ovid, CINAHL/EbscoHOST, Web of Science/Wiley, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar were searched from inception to Sept 30, 2021. Studies assessing phage efficacy in animal models were included. Only studies that assessed the efficacy of phage therapy in treating established bacterial infections in terms of survival and bacterial abundance or density were included. Studies reporting only in-vitro or ex-vivo results and those with incomplete information were excluded. Risk-of-bias assessment was performed using the Systematic Review Centre for Laboratory Animal Experimentation tool. The main endpoints were animal survival and tissue bacterial burden, which were reported using pooled odds ratios (ORs) and mean differences with random-effects models. The I2 measure and its 95% CI were also calculated. This study is registered with PROSPERO, CRD42022311309. FINDINGS: Of the 5084 references screened, 124 studies fulfilled the selection criteria. Risk of bias was high for 70 (56%) of the 124 included studies; therefore, only studies classified as having a low-to-moderate risk of bias were considered for quantitative data synthesis (n=32). Phage therapy was associated with significantly improved survival at 24 h in systemic infection models (OR 0·08 [95% CI 0·03 to 0·20]; I2=55% [95% CI 8 to 77]), skin infection (OR 0·08 [0·04 to 0·19]; I2 = 0% [0 to 79]), and pneumonia models (OR 0·13 [0·06 to 0·31]; I2=0% [0 to 68]) when compared with placebo. Animals with skin infections (mean difference -2·66 [95% CI -3·17 to -2·16]; I2 = 95% [90 to 96]) and those with pneumonia (mean difference -3·35 [-6·00 to -0·69]; I2 = 99% [98 to 99]) treated with phage therapy had significantly lower tissue bacterial loads at 5 ±â€ˆ2 days of follow-up compared with placebo. INTERPRETATION: Phage therapy significantly improved animal survival and reduced organ bacterial loads compared with placebo in preclinical animal models. However, high heterogeneity was observed in some comparisons. More evidence is needed to identify the factors influencing phage therapy performance to improve future clinical application. FUNDING: Swiss National Foundation and Swiss Heart Foundation.

Contribution of nursing research to fighting against COVID-19 pandemic. A systematic review

Introduction: The 2019 coronavirus disease (COVID-19) pandemic, should be an opportunity to ensure greater visibility of nursing in health systems and society worldwide. Objective: Review and synthesize the patterns on COVID-19 and nursing research, identifying the main journals, country of origin, language, topics, designs, and area of applicability of the results. Materials and Methods: Systematic review. Searches in PubMed, CINAHL, LILACS, and EMBASE databases (from the inception of the pandemic to May 15, 2020) were performed. Articles of any language related were related to SARS-CoV-2 infection or COVID-19 disease and nursing in any of its roles (care, management, education, among others) and using any epidemiological design or a scientific report were included. Two reviewers independently selected the studies and extracted the data. The main findings from the included studies were summarized through narrative synthesis and descriptive tables. The characteristics of the studies were presented as absolute values and proportions. Results: Three hundred and sixty-five articles were assessed for eligibility. Thirty-eight were included, published in 28 journals. Of those, 53.57% (n=15) were nursing specific. Most articles were "narrative reviews", accounting for 23.68% (n=9). Most studies were conducted in China (n=18, 47.37%), followed by the United Kingdom and the United States. Thirty-four (89.47%) articles were published in English, followed by Portuguese and Chinese. We identified five areas of application of the results, and the most frequent was the "clinical" setting with 47.00% (n=18). Discussion: These findings are crucial to give visibility to nursing work during the emergency of the COVID-19 pandemic. Mental health was the main research topic, while the clinical setting concentrates the major number of articles. This pattern was aligned with the challenges of the initial phase of the pandemic. Conclusion: Future research should explore the current state of evidence in the main topics identified in this review and continue to give visibility to work carried out by nursing in the emergency of the COVID-19 pandemic.

Introducción: La pandemia de la enfermedad de coronavirus 2019 (COVID-19), debería ser una oportunidad para asegurar una mayor visibilidad de la enfermería en los sistemas de salud y la sociedad en todo el mundo. Objetivo: Revisar y sintetizar los patrones de investigación en enfermería y COVID-19, identificando las principales revistas, país de origen, idioma, temas, diseños y área de aplicabilidad de los resultados. Materiales y Metodos: Una revisión sistemática. Se realizaron búsquedas en las bases de datos PubMed, CINAHL, LILACS y EMBASE (desde el inicio de la pandemia hasta el 15 de mayo de 2020). Se incluyeron artículos de cualquier idioma relacionados con la infección por SARS-CoV-2 o COVID-19 y enfermería en cualquiera de sus roles (cuidado, administración, educación, entre otros) que utilizaron cualquier diseño epidemiológico o informe científico. Dos revisores seleccionaron de forma independiente los estudios y extrajeron los datos. Los principales hallazgos de los estudios incluidos se resumieron mediante una síntesis narrativa y tablas descriptivas. Las características de los estudios se presentaron como valores absolutos y proporciones. Resultados: En 325 artículos se evaluaron los criterios de elegibilidad y se incluyeron 38 publicados en 28 revistas. De ellos, el 53,57% (n=15) eran específicos de enfermería. La mayoría de los artículos fueron "revisiones narrativas", que representan el 23,68% (n=9). La mayoría de los estudios se realizaron en China (n=18, 47,37%), seguido de Reino Unido y Estados Unidos. Treinta y cuatro (89,47%) artículos se publicaron en inglés, seguidos de portugués y chino. Identificamos cinco áreas de aplicación de los resultados y la más frecuente fue el ámbito "clínico" con un 47,00% (n=18). Discusión: Estos hallazgos son cruciales para dar visibilidad al trabajo de enfermería en la emergencia de la pandemia COVID-19. Se destaca que la salud mental fue el principal tópico de investigación mientras que el escenario clínico concentró el mayor número de artículo. Este patrón estuvo alineado con los desafíos impuestos por la fase inicial de la pandemia. Conclusión: Las investigaciones futuras deberán explorar el estado actual de la evidencia en los principales temas identificados en esta revisión y continuar dando visibilidad al trabajo realizado por enfermería en la emergencia de la pandemia por COVID-19.

Introdução: A pandemia da doença coronavírus (COVID-19) de 2019 deve ser uma oportu-nidade para garantir maior visibilidade da enfermagem nos sistemas de saúde e na sociedade em todo o mundo. Objetivo: Revisar e sintetizar os padrões de pesquisa em enfermagem e COVID-19, identificando as principais revistas, país de origem, língua, tópicos, desenhos e área de aplicabilidade dos resultados. Materiais e Métodos: Uma revisão sistemática. As ba-ses de dados PubMed, CINAHL, LILACS e EMBASE foram pesquisadas (Do início da pan-demia até 15 de maio de 2020). Artigos de qualquer língua relacionados à infecção por SARS-CoV-2 ou COVID-19 e enfermagem foram incluídos em qualquer das suas funções (assistên-cia, administração, educação, entre outras) que utilizassem qualquer desenho epidemiológico ou relatório científico. Dois revisores selecionaram independentemente estudos e extraíram os dados. As principais conclusões dos estudos incluídos foram resumidas através de uma síntese narrativa e tabelas descritivas. As características dos estudos foram apresentadas em valores absolutos e proporções. Resultados: Em 325 artigos foram avaliados os critérios de elegibili-dade e incluídos 38 publicados em 28 revistas. Destes, 53,57% (n=15) eram específicos da enfermagem. A maioria dos artigos eram "revisões narrativas", representando 23,68% (n=9). A maioria dos estudos foi realizada na China (n=18, 47,37%), seguida do Reino Unido e dos Estados Unidos. Trinta e quatro (89,47%) artigos foram publicados em inglês, seguidos de português e chinês. Identificamos cinco áreas de aplicação dos resultados e a mais frequente foi a área "clínica" com 47,00% (n=18). Discussão: Estas conclusões são cruciais para dar vi-sibilidade ao trabalho de enfermagem durante a emergência da pandemia da COVID-19. A saúde mental foi o principal tema de investigação, enquanto que o cenário clínico concentra o maior número de artigos. Este padrão foi alinhado com os desafios da fase inicial da pande-mia. Conclusão: A investigação futura deve explorar o estado atual das provas nos principais tópicos identificados nesta revisão e continuar a dar visibilidade ao trabalho realizado pela enfermagem na emergência da pandemia da COVID-19.

Burden and magnitude of risk in HIV/AIDS in the Colombian health system: a real-world data approach / Carga y magnitud del riesgo en VIH/SIDA en el sistema de salud colombiano: enfoque de datos del mundo real

Abstract Aim: To assess the epidemiological situation of people living with HIV and AIDS (PLWHA) in the municipalities and regions of Colombia in 2018. Materials and methods: A cross-sectional study was conducted with secondary data from the High-Cost Diseases Fund from February 1st, 2018 to January 31st, 2019. We included sociodemographic, clinical variables, and related to geographic location. We calculated incidence, prevalence, and mortality according to the Colombian geographical regions, department and municipality of residence. Crude and age-standardized rates were estimated. Results: By 2018, 10,930 new cases of PLWHA were reported, being more frequent in males, aged between 25 to 49 years. 39.32% were reported with AIDS and 35.27% had undetectable HIV viral load. During 2018, there are 109,056 PLWHA in Colombia. The highest age-standardized incidence and prevalence were reported in Florencia (Cauca) (354.28 per 100,000 and 3.32 per 100people, respectively). The age-standardized incidence rate was 22.12 per 100,000 population (95% CI 21.71-22.54). Age-standardized prevalence and mortality were 0.23 per 100 population (95% CI 0.22-0.23) and 3.78 per 100,000 population (95% CI 3.61-3.96), respectively. Conclusion: Different strategies should be implemented to improve the identification of risk factors in the population, especially in some regions of Colombia and prevent transmission.

Resumen Objetivo: Evaluar la situación epidemiológica de las personas que viven con el VIH y el SIDA (PVVS) en los municipios y regiones de Colombia en 2018. Materiales y métodos: Se realizó un estudio transversal con datos secundarios del Fondo Colombiano de Enfermedades de Alto Costo entre febrero 1 de 2018 al 31 de enero de 2019. Incluimos variables sociodemográficas, clínicas y relacionadas con la ubicación geográfica. Calculamos la incidencia, prevalencia y mortalidad según la región geográfica colombiana, el departamento de residencia y el municipio. Se estimaron tasas crudas y estandarizadas por edad. Resultados: Para el 2018, 10.930 nuevos casos de PVVS fueron reportados, siendo más frecuentes en hombres, en edades entre 25 a 49 años. 39.32% fueron reportados con SIDA y 35.27% tuvieron una carga viral de VIH indetectable. 109,056 PVVS en Colombia. Las incidencia y prevalencia ajustadas por edad más altas se informaron en Florencia (Cauca) (354.28 por 100,000 y 3.32 por 100 personas, respectivamente). La tasa de incidencia estandarizada por edad fue de 22.12 por 100,000 habitantes (IC 95% 21.71-22.54). La prevalencia y mortalidad ajustadas por edad fueron 0.23 por 100 habitantes (IC 95% 0.22-0.23) y 3.78 por 100.000 habitantes (IC 95% 3.61-3.96), respectivamente. Se deben implementar diferentes estrategias para mejorar la identificación de los factores de riesgo en la población, especialmente en algunas regiones geográficas de Colombia y prevenir la transmisión.

Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry.

BACKGROUND: There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. OBJECTIVE: To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). METHODS: A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. RESULTS: By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. CONCLUSION: Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.

Validación de constructo de la escala Zung en pacientes con falla cardíaca / Zung Scale Construct Validation in Heart Failure Patients / Validação do construto da escala de Zung em pacientes com insuciência cardíaca

Introducción: la escala Zung para depresión ha sido previamente utilizada en pacientes con falla cardíaca; sin embargo, en nuestro conocimiento no se encuentra evidencia de su validez para la versión en español, ni su uso en población adulta con falla cardíaca en Colombia. Objetivo: determinar la validez de constructo de la escala Zung para depresión en su versión original y proponer una versión abreviada para pacientes adultos con falla cardíaca. Método: estudio de corte transversal, realizado en 200 pacientes de una clínica de falla y trasplante cardiaco, a quienes se aplicó la Zung Self-Rating Depression Scale. Se evaluó la consistencia interna por medio del alfa de Cronbach, y el análisis factorial fue utilizado para identificar las dimensiones del instrumento. Resultados: la consistencia interna de la versión original de la escala (20 ítems) fue de α = 0,811. El análisis de factores mostró una estructura compuesta por tres de ellos que explican el 51,59 % de la varianza total. La nueva versión abreviada (13 ítems) obtuvo un α = 0,819, y los ítems correlacionaron con un único factor que explicó el 33,54 % de la varianza total. Discusión: Nuestros hallazgos son similares a los encontrados por otros autores en diferentes poblaciones a la estudiada. Conclusiones: se evidenció validez de constructo tanto para la escala Zung, para depresión, en su versión original, como para la abreviada, creada en la población estudiada. Sin embargo, se requieren estudios adicionales que verifiquen estos hallazgos en una muestra representativa, y que otros aspectos de la psicometría sean evaluados.

Introduction: the Zung scale for depression has previously been used in patients with heart failure; However, to our knowledge, there is no evidence of its validity for the Spanish version, nor its use in the adult population with heart failure in Colombia. Objective: to determine the construct validity of the Zung scale for depression in its original version and propose an abbreviated version for adult patients with heart failure. Method: A cross sectional study was carried out in 200 patients from a heart failure and transplant clinic to whom the Zung Self-Rating Depression Scale was applied. Internal consistency was evaluated using Cronbach's alpha, and factor analysis was used to identify the instrument's dimensions. Results: the internal consistency of the original version of the scale (20 items) was α = 0.811. The factor analysis showed a structure composed of three that explains 51.59% of the total variance. The new abbreviated version (13 items) obtained α = 0.819, and the items correlated with a single factor that explained 33.54% of the total variance. Discussion: Our findings are similar to those found by other authors in different populations from the one studied. Conclusions: construct validity was evidenced for both the Zung scale for depression, in its original version, and the abbreviated version created in the studied population.

Introdução: a escala de Zung para depressão foi usada anteriormente em pacientes com insuficiência cardíaca. No entanto, até onde sabemos, não há evidências de sua validade para a versão em espanhol, nem seu uso na população adulta com insuficiência cardíaca na Colômbia. Objetivo: determinar a validade de construto da escala de Zung para depressão em sua versão original e propor uma versão abreviada para pacientes adultos com insuficiência cardíaca. Método: estudo transversal, realizado com 200 pacientes de uma clínica de insuciência cardíaca e transplante, aos quais foi aplicada a Zung Self Rating Depression Scale. A consistência interna foi avaliada por meio do alfa de Cronbach e a análise fatorial foi utilizada para identificar as dimensões do instrumento. Resultados: a consistência interna da versão original da escala (20 itens) foi α = 0,811. A análise fatorial mostrou uma estrutura composta por três deles que explicam 51,59% da variância total. A nova versão abreviada (13 itens) obteve α = 0,819, e os itens se correlacionaram com um único fator que explicou 33,54% da variância total. Discussão: Nossos achados são semelhantes aos encontrados por outros autores em populações diferentes da estudada. Conclusões: a validade de construto foi evidenciada tanto para a escala de Zung, para depressão, em sua versão original, quanto para a versão abreviada, elaborada na população estudada. No entanto, estudos adicionais são necessários para verificar esses achados em uma amostra representativa e que forem avaliados outros aspectos da psicometria

Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol.

INTRODUCTION: Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS: A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION: Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER: CRD42020147655.

Contribution of MSMB promoter region gene polymorphism to early-onset prostate cancer risk in Mexican males.

Sexually transmitted infections and its contribution to prostate cancer (PC) development have been relevant in different populations. MSMB gene polymorphism (rs10993994) has exhibited an association both with PC as well as the susceptibility to sexually transmitted infections. Hitherto, these conditions have been not studied in Mexico yet, neither if sexually transmitted infections could modify the MSMB and PC association. Herein, socio-demographic features, sexually transmitted infections records, the reproductive backgrounds, and the genetic characterisation were analysed in 322 incident PC cases and 628 population healthy controls from Mexico City. Whole PC, early-onset PC (PC at < 60 years old), late-onset PC (≥ 60 years old), and PC aggressiveness were used to evaluate the genetic variants contribution to PC risk using unconditional logistic regression models. Overall, none associations between the allelic variants of rs10993994 polymorphisms with whole and PC aggressiveness were found. Howbeit, the TT genotype carriers presented the highest susceptibility to develop early-onset PC (OR = 2.66; 95% CI = 1.41, 5.04; p = 0.03) than CC+CT carriers, both with codominant and recessive models. Although none association between whole PC and MSMB gene polymorphism was found, our results were reinforced by prior studies in European descendent populations, suggesting a contribution between rs10993994 and early-onset PC development.

Usefulness of the Diagnosis "Decreased Cardiac Output (00029)" in Patients With Chronic Heart Failure.

OBJECTIVE: To determine the clinical and construct validity of the nursing diagnosis "decreased cardiac output" (DCO) in patients with chronic heart failure. METHODS: Cross-sectional study. RESULTS: A total of 200 people were studied. The defining characteristics with the highest prevalence were as follows: arrhythmia (62.5%) and fatigue (61.5%). Adjustment measures such as infit and outfit were maintained between 0.50 and 1.56 and the total variance explained by the measures was 29.3%. CONCLUSIONS: This study determined the clinical validity of the nursing diagnosis DCO. Regarding construct validity, adjustment of the defining characteristics to the Rasch model was observed. IMPLICATIONS FOR NURSING PRACTICE: This study improves the evidence-based practice of nursing and strengthened the role of the nurse who leads care to this population. OBJETIVO: Determinar la validez clínica y de constructo del diagnóstico de enfermería "Disminución del Gasto Cardíaco" en pacientes con falla cardíaca crónica. MÉTODOS: Estudio de corte transversal. RESULTADOS: Un total de 200 pacientes fueron estudiados. Las características definitorias con las mayores prevalencias fueron: arritmia (62.5%) y fatiga (61.5%). Medidas de ajuste como el infit y outfit se mantuvieron entre 0.50 y 1.56. El total de la varianza explicada por las medidas fue de 29.3%. CONCLUSIONES: Este estudio determinó la validez clínica del diagnóstico de enfermería "Disminución del Gasto Cardíaco". En cuanto a la validez de constructo, se observó que 19 de las 21 características definitorias se ajustaron al modelo Rasch. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: Este estudio mejora la práctica basada en la evidencia de enfermería y fortalece el rol de las enfermeras que lideran el cuidado en esta población.