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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
2.
Emergencias ; 31(6): 377-384, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777208

RESUMO

OBJECTIVES: To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. MATERIAL AND METHODS: All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. RESULTS: A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). CONCLUSION: The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.

3.
Emergencias ; 31(5): 335-340, 2019 Oct.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31625305

RESUMO

OBJECTIVES: To analyze the safety of electric cardioversion performed for recent-onset atrial fibrillation in a hospital emergency department. MATERIAL AND METHODS: Observational retrospective analysis of consecutive emergency department cases of atrial fibrillation of less than 48 hours' duration in hemodynamically stable patients. All included cases were either treated with emergency electric cardioversion or referred for evaluation and scheduling of outpatient cardioversion. The outcome variable was the occurrence of a thromboembolic or hemorrhagic event within 90 days. RESULTS: A total of 718 cardioversions in 570 patients were analyzed. The mean (SD) age of the patients was 64 (13.5) years. Four hundred seventy-nine emergency cardioversions (66.7%) and 239 (33.3%) scheduled cardioversions were performed. Eleven adverse events (1.5% of the cohort) occurred: 2 were thromboembolic events (0.3%) and 9 were hemorrhagic (1.3%). All bleeds were minor. There were no statistically significant differences in the rate of adverse events between the emergency and scheduled cardioversion groups. CONCLUSION: Emergency cardioversion for recent-onset atrial fibrillation is safe.

4.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 335-340, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184123

RESUMO

Objetivo. Analizar la seguridad de la cardioversión de la fibrilación auricular (FA) de reciente comienzo realizada en un servicio de urgencias hospitalario (SUH). Método. Estudio observacional, retrospectivo y analítico en un SUH. Se recogieron de forma consecutiva los episodios de FA de menos de 48 horas de evolución y hemodinámicamente estables, en los que se realizó una cardioversión urgente (CVU) y los episodios derivados para valorar cardioversión programada ambulatoria (CVP). La variable de resultado fue la presencia de eventos embólicos (EE) o hemorrágicos (EH) a los 90 días. Resultados. Se analizaron 718 cardioversiones en 570 pacientes. La edad media fue de 64 años (DE 13,5). Se realizaron 479 (66,7%) CVU y 239 (33,3%) CVP. Se recogieron un total de 11 (1,5%) eventos: dos EE (0,3%) y 9 EH (1,3%). Todos los EH fueron hemorragias menores. No se encontraron diferencias estadísticamente significativas entre ambos grupos. Conclusión. La CVU de la FA de reciente comienzo en los SUH es una estrategia segura


Objective. To analyze the safety of electric cardioversion performed for recent-onset atrial fibrillation in a hospital emergency department. Methods. Observational retrospective analysis of consecutive emergency department cases of atrial fibrillation of less than 48 hours’ duration in hemodynamically stable patients. All included cases were either treated with emergency electric cardioversion or referred for evaluation and scheduling of outpatient cardioversion. The outcome variable was the occurrence of a thromboembolic or hemorrhagic event within 90 days. Results. A total of 718 cardioversions in 570 patients were analyzed. The mean (SD) age of the patients was 64 (13.5) years. Four hundred seventy-nine emergency cardioversions (66.7%) and 239 (33.3%) scheduled cardioversions were performed. Eleven adverse events (1.5% of the cohort) occurred: 2 were thromboembolic events (0.3%) and 9 were hemorrhagic (1.3%). All bleeds were minor. There were no statistically significant differences in the rate of adverse events between the emergency and scheduled cardioversion groups. Conclusion. Emergency cardioversion for recent-onset atrial fibrillation is safe


Assuntos
Humanos , Pessoa de Meia-Idade , Cardioversão Elétrica/instrumentação , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Cardioversão Elétrica/métodos , Cardioversão Elétrica/tendências , Segurança do Paciente , Estudos de Coortes , Estudos Retrospectivos , Análise Multivariada
5.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 227-233, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182762

RESUMO

Objetivos: Este estudio analiza el control del ritmo en los servicios de urgencias (SUH) y sus resultados en pacientes con fibrilación auricular (FA) de reciente comienzo, para identificar áreas de mejora en el manejo. Método: Estudio multicéntrico, observacional, prospectivo y transversal desarrollado en 124 SUH representativos del sistema sanitario español basado en el registro HERMES-AF (estrategias de manejo en el servicio de urgencias hospitalario de la FA) del 23 de mayo al 5 de junio de 2011. Se incluyeron pacientes con FA sintomática con menos de 48 h de evolución en los cuales se tomó la decisión de restaurar el ritmo sinusal. Resultados: Se incluyeron 337 pacientes, se optó por cardioversión farmacológica en 311 pacientes (92,3%), y por cardioversión eléctrica en 52 (15%), la mitad de los casos tras fracaso de los fármacos. Se obtuvo ritmo sinusal (RS) en 278 pacientes (82,5%) y el alivio de los síntomas en 297 (94%), con una tasa de efectos adversos del 0,9%, ninguno grave. Amiodarona se asoció de manera independiente a una menor tasa de RS al alta (OR = 0,442; IC 95% 0,238-0,823; p = 0,01), al contrario que la cardioversión eléctrica (OR = 4,0; IC 95% 1,2-13,3; p = 0,024). Los fármacos I-C se asociaron con una mayor proporción de altas en < 6 h (OR 2,6; IC 95% 1,6-4,3; p < 0,001) y amiodarona con más estancias prolongadas de > 24 h (OR 2,7, IC 95% 1,5-4,8; p < 0,003). Conclusiones: En los SUH, la restauración del RS en la FA de reciente comienzo es segura, efectiva y asocia beneficios clínicos para los pacientes. Reemplazar amiodarona por técnicas más efectivas y rápidas como la cardioversión eléctrica o los fármacos I-C es un área de mejora de la calidad asistencial


Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P<.003). Conclusions: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardioversão Elétrica/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Ritmo Circadiano/efeitos dos fármacos , Sistema de Registros/normas , Cardioversão Elétrica/tendências , Estudos Prospectivos , Estudos Transversais , Espanha , Antiarrítmicos/administração & dosagem , Sistemas de Saúde/organização & administração
6.
Emergencias ; 31(4): 227-233, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31347801

RESUMO

OBJECTIVES: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. MATERIAL AND METHODS: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. RESULTS: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003). CONCLUSION: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.

7.
Acad Emerg Med ; 26(9): 1034-1043, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30703274

RESUMO

BACKGROUND: Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF. METHODS: This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms. RESULTS: Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [OR] = 14.346, 95% confidence interval [CI] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy (OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20-4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment (OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure (OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001). CONCLUSION: In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.

8.
Clin Res Cardiol ; 108(6): 622-633, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30426240

RESUMO

AIMS: To investigate whether the presence of atrial fibrillation (AF) is independently associated with adverse short-term outcomes in patients diagnosed with acute heart failure (AHF) in the emergency department (ED). METHODS: We performed a secondary analysis of patients included in the EAHFE registries 4&5. Patients were divided by the presence of sinus rhythm (SR) or AF at ED arrival. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the 30-day post-discharge combined endpoint of ED revisit or hospitalisation due to AHF and all-cause mortality. We recorded 54 independent variables that can affect outcomes. Cox regression was used to investigate adjusted significant associations between AF and outcomes. Analyses were repeated according to whether AF was previously known and whether AF was considered responsible for the AHF episode. RESULTS: We analysed 6045 ED visits (mean age 80.4 years, 55.9% women), 3644 (60.3%) with AF. The cumulative 30-day mortality was 9.4%, and the adverse combined endpoint (ACE) was 25.9% (ED revisit with and without hospitalisation were 16.5 and 8.9% and death occurred in 4.7%). No differences were found in outcomes of AHF patients with SR and AF, and among the latter group, no differences were found depending on whether AF was considered responsible for the AHF episode. Patients with previously known AF had significantly lower 30-day mortality and higher post-discharge ACE rates, although these differences disappeared after adjustment for confounders HR 0.782, 95% CI 0.590-1.037, p = 0.087; and HR 1.131, 95% CI 0.924-1.385, p = 0.234). CONCLUSION: The coexistence of AF does not impact the short-term outcomes of patients diagnosed with AHF in the ED.


Assuntos
Fibrilação Atrial/epidemiologia , Insuficiência Cardíaca/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Comorbidade , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
10.
Emergencias ; 29(1): 18-26, 2017 02.
Artigo em Espanhol | MEDLINE | ID: mdl-28825264

RESUMO

OBJECTIVES: To evaluate the level of agreement between hematologists and emergency medicine physicians regarding the best clinical practices for managing bleeding and anticoagulant reversal. MATERIAL AND METHODS: Nationwide Spanish multicenter Delphi method study with a panel of experts on anticoagulation and the management of bleeding. Two survey rounds were carried out between April and September 2015. Consensus was reached when more than 75% of the panelists scored items in the same tertile. RESULTS: Fifteen hematologists and 17 emergency medicine specialists from 14 Spanish autonomous communities participated. Consensus was reached on the use of both hemodialysis and an activated prothrombin complex concentrate (PCC) to antagonize significant/major bleeding in patients taking dabigatran. Use of an activated PCC was considered sufficient for patients on rivaroxaban or apixaban. The panel did not consider any PCC to be both effective and safe. Tests for activated partial thromboplastin, thrombin, diluted thrombin, and ecarin clotting times were considered useful in patients treated with dabigatran. A specific anti-Xa activity assay was suggested for patients who developed bleeds while treated with rivaroxaban or apixaban. Specific antidotes for direct-acting oral anticoagulants would be useful when severe bleeding occurs according to 97% of the panelists. Such antidotes would substantially change current treatment algorithms. CONCLUSION: The points of consensus were generally in line with clinical practice guidelines, but the Delphi process revealed that there are aspects of the clinical management of bleeding that require unified criteria. The need for specific antidotes for direct-acting oral anticoagulants was emphasized.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/terapia , Padrões de Prática Médica , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Testes de Coagulação Sanguínea , Transfusão de Sangue , Carvão Vegetal/uso terapêutico , Técnica Delfos , Gerenciamento Clínico , Medicina de Emergência , Fator VIII/uso terapêutico , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Feminino , Fibrinogênio/uso terapêutico , Hematologia , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia
11.
Int Emerg Nurs ; 35: 7-12, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28599914

RESUMO

INTRODUCTION AND OBJECTIVE: Health education improves the prognosis of many diseases. A previous study in patients with atrial fibrillation (AF) showed that an educational intervention by nurses at discharge from the emergency room (ER) decreased AF-related complications at 3-month follow-up. Our objective was to determine whether this intervention had a long-term effect. PATIENTS AND METHODS: A prospective study assessed the outcomes of an intervention carried out upon discharge from the ER. Patients with a diagnosis of AF were randomized into two groups: the intervention group and the control group. The intervention consisted of a basic explanation about the arrhythmia and its treatment, precautions and warning signs, a training to take their pulse, and an individualized informational leaflet. At one year of follow-up, the clinical records for all participants were reviewed. The primary variable was the combined endpoint of AF-related or treatment-related complications and death. RESULTS: The study included 240 patients (116 intervention and 124 control), mean age 76.1±10.9years. The primary variable was significantly lower in the intervention group (31.9% vs 48.4%; p=0.005). CONCLUSION: Education by ER nurses at patient discharge helped to decrease AF-related complications at one year of follow-up.


Assuntos
Alta do Paciente/normas , Educação de Pacientes como Assunto/normas , Tempo , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/enfermagem , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Recursos Humanos
12.
Stroke ; 48(5): 1344-1352, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28389612

RESUMO

BACKGROUND AND PURPOSE: Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients. METHODS: Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models. RESULTS: We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294-3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231-0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results. CONCLUSIONS: Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.


Assuntos
Anticoagulantes/farmacologia , Fibrilação Atrial/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Espanha/epidemiologia , Acidente Vascular Cerebral/mortalidade
13.
Emergencias (St. Vicenç dels Horts) ; 29(1): 18-26, feb. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-160411

RESUMO

Objetivo. Evaluar el grado de acuerdo entre hematólogos y urgenciólogos respecto a las mejores prácticas para el manejo de hemorragias y la reversión de la anticoagulación oral. Método. Estudio Delphi multicéntrico español con médicos expertos en anticoagulación y manejo de hemorragias. Se realizaron dos rondas de preguntas entre abril y septiembre de 2015. Se obtenía consenso cuando el 75% o más de los panelistas puntuaban en el mismo tercil. Resultados. Se encuestó a 15 hematólogos y 17 urgenciólogos de 14 comunidades autónomas. La hemodiálisis y la administración de concentrados de complejo protrombínico (CCP) activado fueron tratamientos consensuados para antagonizar una hemorragia relevante/mayor en pacientes tratados con dabigatrán. Para rivaroxabán y apixabán solo se consideró el CCP. El panel no valoró ningún CCP como eficaz y seguro a la vez. Los tiempos de tromboplastina parcial activado, trombina, ecarina y de trombina diluido se indicaron para pacientes tratados con dabigatrán y la actividad anti-Xa específica para los tratados con rivaroxabán y apixabán cuando presentan una hemorragia. Disponer de un antídoto específico para el tratamiento de los anticoagulantes orales de acción directa (ACOD) sería útil en caso de hemorragia grave (97%) y supondría un cambio sustancial en el algoritmo de tratamiento actual (97%). Conclusiones. Los resultados estuvieron en general alineados con las guías de práctica clínica, pero mostraron que existen áreas de mejora en la unificación de criterios sobre el manejo de los pacientes con hemorragias, y destacan la necesidad de disponer de antídotos específicos para ACOD (AU)


Objective. To evaluate the level of agreement between hematologists and emergency medicine physicians regarding the best clinical practices for managing bleeding and anticoagulant reversal. Methods. Nationwide Spanish multicenter Delphi method study with a panel of experts on anticoagulation and the management of bleeding. Two survey rounds were carried out between April and September 2015. Consensus was reached when more than 75% of the panelists scored items in the same tertile. Results. Fifteen hematologists and 17 emergency medicine specialists from 14 Spanish autonomous communities participated. Consensus was reached on the use of both hemodialysis and an activated prothrombin complex concentrate (PCC) to antagonize significant/major bleeding in patients taking dabigatran. Use of an activated PCC was considered sufficient for patients on rivaroxaban or apixaban. The panel did not consider any PCC to be both effective and safe. Tests for activated partial thromboplastin, thrombin, diluted thrombin, and ecarin clotting times were considered useful in patients treated with dabigatran. A specific anti-Xa activity assay was suggested for patients who developed bleeds while treated with rivaroxaban or apixaban. Specific antidotes for direct-acting oral anticoagulants would be useful when severe bleeding occurs according to 97% of the panelists. Such antidotes would substantially change current treatment algorithms. Conclusion. The points of consensus were generally in line with clinical practice guidelines, but the Delphi process revealed that there are aspects of the clinical management of bleeding that require unified criteria. The need for specific antidotes for direct-acting oral anticoagulants was emphasized (AU)


Assuntos
Humanos , Anticoagulantes/uso terapêutico , Hemorragia/complicações , Tratamento de Emergência/métodos , Serviço Hospitalar de Emergência , Padrões de Prática Médica , Dabigatrana/antagonistas & inibidores , Diálise Renal , Rivaroxabana/antagonistas & inibidores , Antídotos/uso terapêutico
14.
Eur Heart J ; 38(17): 1329-1335, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27354046

RESUMO

Aims: Intravenous procainamide and amiodarone are drugs of choice for well-tolerated ventricular tachycardia. However, the choice between them, even according to Guidelines, is unclear. We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia. Methods and results: Patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min). The primary endpoint was the incidence of major predefined cardiac adverse events within 40 min after infusion initiation. Of 74 patients included, 62 could be analysed. The primary endpoint occurred in 3 of 33 (9%) procainamide and 12 of 29 (41%) amiodarone patients (odd ratio, OR = 0.1; 95% confidence interval, CI 0.03-0.6; P = 0.006). Tachycardia terminated within 40 min in 22 (67%) procainamide and 11 (38%) amiodarone patients (OR = 3.3; 95% CI 1.2-9.3; P = 0.026). In the following 24 h, adverse events occurred in 18% procainamide and 31% amiodarone patients (OR: 0.49; 95% CI: 0.15-1.61; P: 0.24). Among 49 patients with structural heart disease, the primary endpoint was less common in procainamide patients (3 [11%] vs. 10 [43%]; OR: 0.17; 95% CI: 0.04-0.73, P = 0.017). Conclusions: This study compares for the first time in a randomized design intravenous procainamide and amiodarone for the treatment of the acute episode of sustained monomorphic well-tolerated (probably) ventricular tachycardia. Procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Procainamida/administração & dosagem , Taquicardia Ventricular/tratamento farmacológico , Idoso , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Cardiomiopatias/complicações , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Procainamida/efeitos adversos , Resultado do Tratamento
15.
Europace ; 18(1): 57-63, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26333377

RESUMO

AIMS: The role of high-intensity exercise and other emerging risk factors in lone atrial fibrillation (Ln-AF) epidemiology is still under debate. The aim of this study was to analyse the contribution of each of the emerging risk factors and the impact of physical activity dose in patients with Ln-AF. METHODS AND RESULTS: Patients with Ln-AF and age- and sex-matched healthy controls were included in a 2:1 prospective case-control study. We obtained clinical and anthropometric data transthoracic echocardiography, lifetime physical activity questionnaire, 24-h ambulatory blood pressure monitoring, Berlin questionnaire score, and, in patients at high risk for obstructive sleep apnoea (OSA) syndrome, a polysomnography. A total of 115 cases and 57 controls were enrolled. Conditional logistic regression analysis associated height [odds ratio (OR) 1.06 [1.01-1.11]], waist circumference (OR 1.06 [1.02-1.11]), OSA (OR 5.04 [1.44-17.45]), and 2000 or more hours of cumulative high-intensity endurance training to a higher AF risk. Our data indicated a U-shaped association between the extent of high-intensity training and AF risk. The risk of AF increased with an accumulated lifetime endurance sport activity ≥ 2,000 h compared with sedentary individuals (OR 3.88 [1.55-9.73]). Nevertheless, a history of <2000 h of high-intensity training protected against AF when compared with sedentary individuals (OR 0.38 [0.12-0.98]). CONCLUSION: A history of ≥ 2,000 h of vigorous endurance training, tall stature, abdominal obesity, and OSA are frequently encountered as risk factors in patients with Ln-AF. Fewer than 2000 total hours of high-intensity endurance training associates with reduced Ln-AF risk.


Assuntos
Fibrilação Atrial/epidemiologia , Tolerância ao Exercício , Exercício , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Fibrilação Atrial/diagnóstico , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Apneia Obstrutiva do Sono/diagnóstico , Espanha/epidemiologia , Esportes
16.
Emergencias (St. Vicenç dels Horts) ; 27(4): 219-224, ago. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139337

RESUMO

Objetivo. Conocer la opinión de los médicos internos residentes (MIR) de Cataluña acerca de la necesidad y utilidad de la formación recibida en los servicios de urgencias. Métodos. Se envió un cuestionario electrónico a los MIR de Cataluña mediante la colaboración de sus jefes de estudio. El cuestionario contenía variables sociodemográficas, preguntas sobre la predisposición del residente hacia las urgencias, y variables relacionadas con la formación: valoración de la necesidad de una estancia en urgencias, y conocimientos y aptitudes adquiridos durante la rotación (historia clínica, relación con los familiares, trabajo en equipo, toma de decisiones, identificación y manejo de pacientes críticos y aprendizaje de técnicas diagnóstico-terapéuticas). Se hicieron análisis descriptivos y se compararon los resultados entre distintas especialidades. Resultados. Se envió el cuestionario a 1.431 residentes de 21 hospitales y unidades docentes. Respondieron 427 residentes (29,8%). Tanto la valoración sobre la necesidad de realizar una formación en urgencias como sobre los conocimientos adquiridos fueron elevadas [8,9 (1,7) y 8,2 (1,9) puntos, respectivamente, en una escala de 1 a 10]. Los aspectos en los cuales habían adquirido mayor conocimiento fueron la toma de decisiones y el manejo de pacientes críticos. Los residentes de Medicina Familiar y Comunitaria mostraron mayor predisposición a escoger la especialidad de urgencias (33,7% frente a 6,1%, p < 0,001). Su valoración acerca de la necesidad de formarse en urgencias también fue superior [9,2 (1,5) frente a 8,7 (1,8), p = 0,006]. Conclusiones. Los MIR de Cataluña opinan que una estancia en urgencias durante su residencia es necesaria y útil para su formación. Los residentes de Medicina Familiar y Comunitaria son los que más valoran esta formación (AU)


Objective. To know the opinion of medical residents in hospitals in Catalonia about the need for and usefulness of the training they receive in the emergency department. Methods. We sent an electronic questionnaire to all residents in Catalonia, through their cooperating supervisors. The questionnaire contained items to collect information on sociodemographic variables and attitudes toward emergency medicine. Items related to training covered the residents’ assessment of the need for a rotation in the emergency department and the knowledge and skills acquired during the rotation (case history writing, relations with patients’ relatives, teamwork, decision-making, identifying and managing critical patients, acquisition of diagnostic and therapeutic techniques). We compiled descriptive statistics and compared the results for residents from different specialties. Results. Questionnaires were sent to 1431 residents in 21 hospitals and other training facilities. Responses were received from 427 (29.8%). Mean (SD) scores expressed on a scale of 1 to 10 were high for both the need for training in emergency medicine (8.9 [1.7]) and knowledge acquired during the rotation (8.2 [1.9]). The residents reported that they had acquired more knowledge in the areas of decision-making and management of critical patients. Family medicine residents expressed greater interest in choosing the specialty of emergency medicine (33.7% vs 6.1% for other residents, P<.001), and their opinion of the need for training in emergency medicine was also higher than other residents’ (9.2 [1.5] vs 8.7 [1.8], P=.006). Conclusions. Medical residents in Catalonia believe that a rotation in the emergency department provides necessary and useful training. Family medicine residents are the ones who value emergency training most highly (AU)


Assuntos
Feminino , Humanos , Masculino , Serviços Médicos de Emergência , Serviços Médicos de Emergência/métodos , Medicina de Emergência/educação , Medicina de Emergência , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Internato e Residência/normas , Internato e Residência , Inquéritos e Questionários , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/estatística & dados numéricos , Internet/estatística & dados numéricos , Internet , Educação Continuada/legislação & jurisprudência , Educação Continuada/tendências , Conhecimentos, Atitudes e Prática em Saúde
17.
Europace ; 17(11): 1688-93, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26071233

RESUMO

AIM: Atrial fibrillation (AF) is associated with high morbidity and mortality. Early diagnosis is likely to improve therapy and prognosis. The study objective was to evaluate the usefulness of a programme for early diagnosis of AF in patients from an urban primary care centre. METHODS AND RESULTS: Participants were recruited from a randomized sample of patients not diagnosed with AF but having relevant risk factors: age ≥ 65 years, ischaemic and/or valvular heart disease, congestive heart failure, hypertension, and/or diabetes. Patients were randomly assigned to the intervention group (IG) or control group (CG). The intervention included (i) initial visit with clinical history, electrocardiogram, and instruction about pulse palpation and warning signs and (ii) electrocardiogram every 6 months during a 2-year follow-up. The main endpoint of the study was the proportion of new cases diagnosed at 6 months. Secondary endpoints were number of new AF diagnoses and complications associated with the arrhythmia in both groups. A total of 928 patients were included (463 IG and 465 CG). At 6 months, AF was diagnosed in 8 IG patients and 1 CG patient (1.7 vs. 0.2%, respectively, P = 0.018). After 2 years of follow-up, 11 IG patients and 6 CG patients had newly diagnosed AF (2.5 vs. 1.3%, respectively, P = 0.132). Time to first diagnosis of AF was shorter in IG patients [median (inter-quartile range): 7 (192) days vs. 227 (188.5) days in CG, P = 0.029]. CONCLUSION: The simple screening proposed could be useful for the early detection of AF in primary care.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Instalações de Saúde , Anamnese , Exame Físico , Atenção Primária à Saúde , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Projetos Piloto , Valor Preditivo dos Testes , Prognóstico , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Serviços Urbanos de Saúde
18.
Emergencias (St. Vicenç dels Horts) ; 27(2): 75-81, abr. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-138654

RESUMO

Objetivo. Conocer si una intervención educativa de enfermería al alta de urgencias en pacientes con fibrilación auricular(FA) aumenta el conocimiento sobre la arritmia y su tratamiento, y disminuye complicaciones e ingresos asociados. Pacientes y métodos. Estudio prospectivo de intervención. Pacientes diagnosticados de FA dados de alta de urgencias fueron aleatorizados en dos grupos: 1) Intervención: instrucción sobre FA, tratamiento, precauciones, síntomas de alarma y control del pulso; tríptico informativo individualizado y 2) Control: sin intervención específica. A los 30 y 90días se hizo un seguimiento telefónico y una revisión del historial clínico para evaluar el conocimiento de la arritmia, y la existencia de complicaciones, consultas a urgencias e ingresos hospitalarios. Resultados. Se incluyeron 240 pacientes, 116 intervención y 124 control, de edad media 76 (11) años, 138 (58%)mujeres. A los 30 y 90 días, los pacientes del grupo de intervención conocían más los signos de alarma de la FA o su tratamiento (p = 0,012 y p = 0,004 respectivamente). Menos pacientes del grupo intervención presentaron complicaciones relevantes asociadas a la arritmia (13,8% vs 24,2%, p = 0,040), además, ingresaron menos por insuficiencia cardiaca a los 30 días (0,8% vs 6,4%, p = 0,023) y menos por cualquier causa a los 90 días (11,2% vs 20,9%, p = 0,041).Conclusión. Una intervención educativa de enfermería al alta de urgencias aumenta el conocimiento sobre FA y disminuye complicaciones, ingresos por insuficiencia cardiaca a corto plazo e ingresos globales a medio plazo (AU)


Objectives. To assess whether a nurse-led patient educational intervention for patients with atrial fibrillation (AF) discharged from the emergency department (ED) can improve the patients’ understanding of arrhythmia and its treatment and reduce the number of complications and arrhythmia-related admissions. Patients and methods. Prospective study of an intervention. Patients diagnosed with AF discharged from the ED were studied in 2 groups. Intervention-group patients received instruction about AF, its treatment, precautions to take, warning signs, and pulse-taking. They also received an information leaflet. The control group patients were discharged without specific instruction. At 30 and 90 days, the patients’ records were reviewed and follow-up telephone interviews were undertaken in order to assess their understanding of arrhythmia, the presence of complications, and whether they had returned for emergency care or had been hospitalized. Results. We enrolled 240 patients (116 in the intervention group and 124 in the control group); the mean (SD) age was 76 (11) years and 138 (58%) were women. The intervention group patients remembered more warning signs of AF than did patients in the control group (P=.012) and they also understood their treatment better (P=.004). Fewer important arrhythmia-related complications were experienced in the intervention group (13.8%) than in the control group (24.2%) (P=.040). Fewer intervention patients had been admitted with heart failure at 30 days (0.8% vs 6.4%in the control group; P=.023); there were also fewer all-cause admissions at 90 days (11.2% vs 20.9%; P=.041).Conclusion. A nurse-led educational intervention on discharge from the ED improved patients’ understanding of AF and decreased the number of complications, short-term admissions for heart failure, and mid-term all-cause admissions (AU)


Assuntos
Humanos , Fibrilação Atrial/enfermagem , Sumários de Alta do Paciente Hospitalar/normas , Prevenção Secundária/organização & administração , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/enfermagem , Avaliação de Eficácia-Efetividade de Intervenções
20.
Emergencias ; 27(2): 75-81, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-29077347

RESUMO

OBJECTIVES: To assess whether a nurse-led patient educational intervention for patients with atrial fibrillation (AF) discharged from the emergency department (ED) can improve the patients' understanding of arrhythmia and its treatment and reduce the number of complications and arrhythmia-related admissions. MATERIAL AND METHODS: Prospective study of an intervention. Patients diagnosed with AF discharged from the ED were studied in 2 groups. Intervention-group patients received instruction about AF, its treatment, precautions to take, warning signs, and pulse-taking. They also received an information leaflet. The control group patients were discharged without specific instruction. At 30 and 90 days, the patients' records were reviewed and follow-up telephone interviews were undertaken in order to assess their understanding of arrhythmia, the presence of complications, and whether they had returned for emergency care or had been hospitalized. RESULTS: We enrolled 240 patients (116 in the intervention group and 124 in the control group); the mean (SD) age was 76 (11) years and 138 (58%) were women. The intervention group patients remembered more warning signs of AF than did patients in the control group (P=.012) and they also understood their treatment better (P=.004). Fewer important arrhythmia-related complications were experienced in the intervention group (13.8%) than in the control group (24.2%) (P=.040). Fewer intervention patients had been admitted with heart failure at 30 days (0.8% vs 6.4% in the control group; P=.023); there were also fewer all-cause admissions at 90 days (11.2% vs 20.9%; P=.041). CONCLUSION: A nurse-led educational intervention on discharge from the ED improved patients' understanding of AF and decreased the number of complications, short-term admissions for heart failure, and mid-term all-cause admissions.

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