Consenso para la mejora de la atención integral de los pacientes con insuficiencia cardíaca aguda: versión resumida / Consensus for improving the comprehensive care of patients with acute heart failure: summarised version

El propósito de este documento de consenso fue alcanzar un acuerdo entre expertos sobre la atención multidisciplinar de los pacientes con insuficiencia cardíaca aguda. A partir de una revisión narrativa sobre la atención a estos pacientes y de un análisis crítico de los procedimientos asistenciales, se identificaron las carencias y mejoras potenciales y se formalizó un documento de recomendaciones para optimizar el abordaje clínico y terapéutico de la insuficiencia cardíaca aguda, validado mediante una sesión grupal presencial dirigida con técnicas participativas. El resultado del proceso es un conjunto de 36 recomendaciones formuladas por expertos de la Sociedad Española de Cardiología, la Sociedad Española de Medicina Interna y la Sociedad Española de Urgencias y Emergencias, orientadas a optimizar el reto asistencial que supone la atención de los pacientes con insuficiencia cardíaca aguda en el contexto del actual Sistema Nacional de Salud (AU)

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System (AU)

Consensus for improving the comprehensive care of patients with acute heart failure: summarised version.

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System.

Diagnóstico alternativo al tromboembolismo pulmonar en urgencias en pacientes oncológicos y no oncológicos / Suspected acute pulmonary embolism in patients with and without cancer: alternative diagnoses

Objetivo: Conocer los diagnósticos alternativos al tromboembolismo pulmonar (TEP)en los pacientes oncológicos y no oncológicos atendidos en un servicio de urgencias hospitalario (SUH) a los que se les solicitó una tomografía computarizada (TC).Método: Estudio retrospectivo con inclusión de todos los pacientes a los que se les practicó una TC desde un SUH por sospecha de TEP durante los años 2006 y 2007.Resultados: Se incluyeron un total de 265 pacientes, 93 oncológicos y 172 no oncológicos. El 98,5% presentaban, o bien una sospecha clínica alta de acuerdo a las escalas de Wells y de Geneva, o bien una sospecha clínica baja o intermedia con una determinación de dímero D positiva. En los pacientes oncológicos y no oncológicos, el porcentaje de diagnosticados de TEP fue del 25,8% y 39,5%, respectivamente. En los pacientes con sospecha de TEP en los que éste no se confirmó, la TC permitió determinar el diagnóstico alternativo en el 81,2% de los pacientes oncológicos y en el 67,3% de los no oncológicos. En los oncológicos el diagnóstico alternativo más frecuente fue la progresión neoplásica, que incluso fue más frecuente que el de TEP. Los diagnósticos alternativos más frecuentes en los no oncológicos, fueron la insuficiencia cardiaca aguda (ICA), la enfermedad pulmonar obstructiva crónica (EPOC) descompensada y la neumonía. Conclusiones: En los pacientes con sospecha de TEP, la TC permitió determinar el diagnóstico alternativo en un elevado porcentaje de pacientes. Los diagnósticos alternativos más frecuentes fueron la progresión neoplásica en los pacientes oncológicos yla EPOC descompensada y la ICA en los no oncológicos (AU)

Objectives: To determine the alternative diagnoses made in patients with and without cancer who undergo computed tomography (CT) to confirm or rule out a suspected diagnosis of acute pulmonary embolism in a hospital emergency department. Methods: Retrospective study of all patients who underwent CT with a suspected diagnosis of acute pulmonary embolism in 2006 and 2007. Results: A total of 265 case records (for 93 patients with cancer and 172 without cancer) were studied. In 98.5% of the patients, clinical suspicion of pulmonary embolism was high, based on the Wells or Geneva Scales, or low-intermediate clinical suspicion and positive D-dimer level. A diagnosis of pulmonary embolism was confirmed in 25.8% of the cancer patients and 39.5% of the non cancer patients. When pulmonary embolism was ruled out, an alternative diagnosis could be reached by CT in 81.2% of the cancer patients and 67.3% of the noncancer patients. The most common alternative diagnosis in cancer patients was tumor progression, which was even more common than the diagnosis of pulmonary embolism. In noncancer patients, the most common alternative diagnoses were acute heart failure, exacerbation of chronic obstructive pulmonary disease (COPD), and pneumonia. Conclusions: CT facilitates the differential diagnosis of a large percentage of patients suspected of having acute pulmonary embolism. The most common alternative diagnosis is tumor progression in patients with cancer; in noncancer patients the most common alternative diagnoses are exacerbated COPD and acute heart failure (AU)

Papel del factor precipitante de un episodio de insuficiencia cardiaca aguda en relación al pronóstico a corto plazo del paciente: estudio PAPRICA / The influence of precipitating factors on short-term prognosis in acute heart failure: the PAPRICA study

Objetivos: Hay pocos estudios que analicen el papel que juegan los factores precipitantes (FPre) en el manejo de la insuficiencia cardiaca aguda (ICA). El estudio PAPRICA pretende analizar la relación entre la identificación de diferentes FPre con la mortalidad precoz y las reconsultas a los 30 días. Método: Estudio retrospectivo, multicéntrico, con seguimiento de cohortes a partir del os datos incluidos en el registro EAHFE (Epidemiology Acute Heart Failure Emergency). Se recogieron datos de todos los episodios de ICA en 8 servicios de urgencias hospitalarios(SUH) españoles durante el mes de abril de 2007. Se recogieron datos del perfil clínico y la evolución a corto plazo (mortalidad y reconsulta a los 30 días). La variable clasificadora del estudio fue la ausencia o presencia conocida de FPre del episodio de ICA. Sólo se recogió un FPre por episodio. Resultados: Se incluyeron 662 casos. El 51,4% de los casos presentaron un FPre. A los30 días se registró una mortalidad del 6,2% y un índice de reconsultas del 26,6%. Los FPre más frecuentes fueron las infecciones (22,2%), las taquiarritmias (13%), la emergencia hipertensiva (4,9%), la transgresión del tratamiento (4,2%), la anemia (3,9%) yla isquemia coronaria (3,7%). En conjunto, no hubo diferencias (..) (AU)

Background and objective: Few studies have analyzed the impact of precipitating factors on the management of acute heart failure (AHF). The PAPRICA study sought to explore the relationship between identifying the precipitating factor in AHF and the 30-day mortality and emergency department revisit rates after the episode. Methods: Retrospective, multicenter study of AHF cases with follow-up data in the EAHFE registry (Epidemiology of Acute Heart Failure Emergencies). From the records of AHF episodes attended in 8 Spanish emergency departments in April 2007, we extracted the clinical characteristics of each episode and the short-term outcomes (30-day mortality and revisits). Patients were classified by absence or presence of a known precipitating factor for the AHF episode. Only the precipitating factor responsible for the episode was recorded. Results: Data for 662 cases were included. A precipitating factor was registered for 51.4% of the cases. At 30 days, overall mortality was 6.2% and revisits were made by 26.6% of the patients. The most common precipitating factors(..) (AU)

Estudio ECO-EAHFE: análisis de los pacientes con ecocardiografía realizada previamente a una visita en urgencias por episodio de insuficiencia cardiaca aguda / EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure

Introducción y objetivos. Analizar el perfil clínico y la evolución a corto plazo de los pacientes atendidos en los servicios de urgencias hospitalarios españoles (SUH) por un episodio de insuficiencia cardiaca aguda (ICA) en función de si a estos pacientes se les había realizado o no una ecocardiografía, así como de la función ventricular estimada en dicha ecografía. Pacientes y método. Participaron 9 hospitales que incluyeron consecutivamente a todos los pacientes diagnosticados de ICA durante dos meses. Se recogieron datos del perfil clínico y la evolución a corto plazo (mortalidad intrahospitalaria y mortalidad y revisita a los 30 días). Se investigó de forma retrospectiva la existencia de una ecocardiografía previa y, si existía, la cuantificación de la fracción de eyección del ventrículo izquierdo (FEVI), también se consideró la función ventricular deprimida o preservada según la FEVI fuese mayor o igual al 45 o menor al 45% respectivamente. Resultados. Se incluyeron 997 pacientes, 547 pacientes (54,9%) disponían de una ecocardiografía y de ellos, en 476 se conocía el tipo de función ventricular: 273 (57,4%) la tenían deprimida y 203 (42,6%) la tenían preservada. Los pacientes sin ecocardiografía fueron mayores, con menos antecedentes patológicos, tenían formas menos avanzadas de cardiopatía, utilizaban menos los betabloqueantes y en urgencias se les trataba menos con diuréticos en bolo. Los pacientes con función sistólica deprimida fueron con mayor frecuencia varones, más jóvenes, fumadores activos, con cardiopatía isquémica y con signos de insuficiencia cardiaca izquierda (ortopnea y disnea paroxística nocturna); con menor frecuencia hipertensos, con cardiopatía valvular, con fibrilación auricular crónica y su presión arterial sistólica en urgencias fue menor, y fueron dados de alta directamente desde el SUH con mayor frecuencia. La mortalidad intrahospitalaria fue del 5,3%, la mortalidad a los 30 días del 8,9% y la reconsulta a los 30 días del 27,2%, pero no se encontraron diferencias significativas en ninguna de estas variables evolutivas en función de la existencia o no de ecocardiografía ni del tipo de disfunción encontrada en ésta. Conclusiones. Los pacientes que presentan un episodio de ICA no disponen de una ecocardiografía previa en un elevado número de casos. Este hecho obliga en estos casos a realizar un manejo terapéutico en el SUH guiado únicamente por los síntomas y signos como la presión arterial sistólica a su llegada a urgencias. A pesar de ello, el hecho de no conocer el estado funcional del ventrículo izquierdo no afecta a la mortalidad intrahospitalaria,a los 30 días y al reingreso(AU)

Introduction and objectives. Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography. Patients and methods. A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively. Results. A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it. Conclusions. The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission(AU)

[EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure]. / Estudio ECO-EAHFE: análisis de los pacientes con ecocardiografía realizada previamente a una visita en urgencias por episodio de insuficiencia cardiaca aguda.

INTRODUCTION AND OBJECTIVES: Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography. PATIENTS AND METHODS: A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively. RESULTS: A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it. CONCLUSIONS: The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission.