The two different profiles in heart failure with preserved ejection fraction and type 2 diabetes mellitus: ischemic and diabetic.

OBJECTIVE: Two profiles of patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) can be discerned: those with ischemic and those with diabetic cardiomyopathy (DMC). We aim to analyze clinical differences and prognosis between patients of these two profiles. MATERIAL AND METHODS: This cohort study analyzes data from the Spanish Heart Failure Registry, a multicenter, prospective registry that enrolled patients admitted for decompensated heart failure and followed them for one year. Three groups were created according to the presence of T2DM and heart disease depending on the etiology (ischemic when coronary artery disease was present, or DMC when no coronary, valvular, or congenital heart disease; no hypertension; nor infiltrative cardiovascular disease observed on an endomyocardial biopsy). The groups and outcomes were compared. RESULTS: A total of 466 patients were analyzed. Group 1 (n = 210) included patients with ischemic etiology and T2DM. Group 2 (n = 112) included patients with DMC etiology and T2DM. Group 3 (n = 144), a control group, included patients with ischemic etiology and without T2DM. Group 1 had more hypertension and dyslipidemia; group 2 had more atrial fibrillation (AF) and higher body mass index; group 3 had more chronic kidney disease and were older. In the regression analysis, group 3 had a better prognosis than group 1 (reference group) for cardiovascular mortality and HF readmissions (HR 0.44;95%CI 0.2-1; p = .049). CONCLUSIONS: Patients with T2DM and HFpEF, who had the poorest prognosis, were of two different profiles: either ischemic or DMC etiology. The first had a higher burden of cardiovascular disease and inflammation whereas the second had a higher prevalence of obesity and AF. The first had a slightly poorer prognosis than the second, though this finding was not significant.

Coste enfermero asociado a los procedimientos realizados en un hospital de día médico / No disponible

Objetivo: identificar indicadores con los que poder evaluar anualmente los recursos consumidos en la realización de cada procedimiento realizado en el Hospital de Día Médico (HDM), así como el coste de los mismos. Metodología: estudio descriptivo retrospectivo de costes asociados a la ejecución de cada prestación realizada en el HDM del Hospital Universitario Infanta Cristina durante el año 2010. Para asignar un valor a cada prestación realizada en el HDM, se asignó un peso relativo a cada procedimiento realizado en la unidad, sobre la suma del coste del tiempo de Enfermería empleado en cada procedimiento, el coste del material fungible de cada procedimiento y los gastos indirectos que se pueden imputar al HDM. El tiempo de Enfermería es ponderado por medio de Unidades de Producción Enfermera (UPE). La asignación de UPEs a cada prestación se realiza por medio un de grupo nominal de expertos. Se realizó un análisis de idoneidad de las prestaciones en función del número de procedimientos asociados. Resultados: se ha cuantificado el coste de las prestaciones realizadas en la unidad y el coste asociado a cada procedimiento incluido. El HDM contaba con una cartera de servicios de 64 procedimientos gestionados por 39 prestaciones distintas. El número de visitas en este período fue de 11.395 sesiones. Un total de 10 prestaciones fueron catalogadas de no idóneas, bajo las cuales se gestionaron 211 sesiones. Se introdujeron tres nuevas prestaciones en las agendas de la unidad, cada una destinada a un procedimiento y se cambió la prestación asignada a dos procedimientos. Conclusiones: se considera factible la monitorización anual del coste del producto enfermero del HDM a partir de los indicadores propuestos, así como estudiar su evolución y realizar posteriores estudios de eficacia y eficiencia para optimizar los recursos de la unidad (AU)

Objective: to identify indicators with which to be able to evaluate on a yearly basis the resources consumed in each procedure at the Medical Day-Hospital (MDH) as well as the cost thereof. Methodology: descriptive retrospective study of costs associated with the performance of each procedure carried out at the MDH at the Hospital Universitario Infanta Cristina during the year 2010. In order to assign a value to each procedure carried out at the MDH, a relative weight was assigned to each procedure carried out at the unit, over the sum of the cost of nursing time employed in each procedure, the cost of fungible material of each procedure and the indirect expenses that might be charged to the MDH. The nursing time was weighted by means of the Nursing Production Units (NPU).The allocation of NPUs to each service was carried out by means of a nominal group of experts. An adequacy analysis of the services performed was carried out based on the number of associated procedures. Results: the cost of services provided in the unit and the cost associated with each procedure included were quantified. The MDH had a portfolio of services that includes 64 procedures managed by 39 different services. The number of visits in this period was 11,395 sessions. A total of 10 services were classified as unsuitable, under which 211 sessions were managed. Three new features were introduced to the agendas of the unit, each intended for a procedure, and the assigned service was changed to 2 procedures. Conclusions: the annual monitoring of the nursing product cost of the MDH is feasible based on the proposed indicators. It is also feasible to study its evolution and to perform subsequent efficacy and efficiency studies in order to optimize the unit's resources (AU)