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1.
Emergencias ; 31(5): 318-326, 2019 Oct.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31625303

RESUMO

OBJECTIVES: To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). MATERIAL AND METHODS: Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient's baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. RESULTS: A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30- day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. CONCLUSION: A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality.

2.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 318-326, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184121

RESUMO

Objetivos. Investigar si la radiografía de tórax en pacientes con insuficiencia cardiaca aguda (ICA) puede contribuir a establecer el pronóstico. Método. Se incluyeron pacientes consecutivos diagnosticados de ICA en urgencias. Se valoró: cardiomegalia radiológica (CR), derrame pleural (DP) y el patrón parenquimatoso pulmonar (PPP: redistribución vascular, edema intersticial, edema alveolar). Se recogieron variables del estado basal del paciente y del episodio. Las variables de resultado evaluadas fueron mortalidad intrahospitalaria y al año, ingreso prolongado (> 7 días) y evento combinado (reconsulta, rehospitalización o muerte) a 30 días postalta, para las cuales se calcularon las hazard ratio crudas y ajustadas para las tres variables radiológicas y su combinación entre ellas. Resultados. Se incluyeron 2.703 pacientes con una edad media de 81 (DE 19) años; el 54,5% eran mujeres. Se observó CR en 1.711 casos (76,8%), DP en 992 (36,7%) y todos los pacientes mostraron PPP (redistribución vascular el 61,9%, edema intersticial el 23,3% y edema alveolar el 14,9%). El análisis ajustado mostró que la CR no tuvo valor pronóstico; el DP incrementó un 23% (IC 95% 2-49%) los eventos combinados a los 30 días postalta; y el PPP edema alveolar aumentó un 89% (30-177%) la mortalidad intrahospitalaria y un 38% (14-67%) la mortalidad al año respecto al PPP redistribución vascular (referencia). El estudio de la combinación de estos tres hallazgos radiológicos mostró resultados similares y congruentes con los hallazgos del estudio individualizado. Conclusiones. La radiografía de tórax, además de ayudar a establecer el diagnóstico de ICA, puede contribuir a estimar el pronóstico de eventos adversos. Así, el DP se asocia a un incremento de eventos adversos postalta y el PPP edema alveolar a una mayor mortalidad


Objective. To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). Methods. Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient’s baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. Results. A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. Conclusions. A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Radiografia Torácica/métodos , Serviços Médicos de Emergência , Cardiomegalia/diagnóstico por imagem , Edema Pulmonar/complicações , Edema Pulmonar/diagnóstico por imagem , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem
3.
Eur J Heart Fail ; 21(11): 1353-1365, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31127677

RESUMO

OBJECTIVE: To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). METHODS AND RESULTS: Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. CONCLUSIONS: Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.

4.
Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345

RESUMO

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

5.
Rev. esp. cardiol. (Ed. impr.) ; 72(3): 198-207, mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182641

RESUMO

Introducción y objetivos: En los servicios de urgencias hospitalarios(SUH), la escala MEESSI estratifica a los pacientes diagnosticados de insuficiencia cardiaca aguda(ICA) según su riesgo de mortalidad a 30 días. Se valida la escala de riesgo MEESSI en una nueva cohorte de pacientes para evaluar su precisión al estratificar el riesgo y compararla en diferentes entornos. Métodos: Se incluyó a los pacientes consecutivos diagnosticados de ICA en 30 SUH durante enero y febrero de 2016. Se calculó la puntuación MEESSI de cada paciente. El estadístico C midió la capacidad discriminatoria para predecir la mortalidad a 30 días del modelo MEESSI completo y los modelos secundarios. Se realizaron comparaciones entre los subgrupos de pacientes de hospitales universitarios y comunitarios, de SUH con actividad alta, media o baja y de SUH que reclutaron o que no reclutaron a pacientes de la cohorte original de derivación de la escala MEESSI. Resultados: Se analizó a 4.711 pacientes (hospitales universitarios/comunitarios: 3.811/900; SUH alta/media/baja actividad: 2.695/1.479/537; SUH participantes/no participantes en el estudio de derivación original:3.892/819). La distribución de pacientes según las categorías de riesgo de la escala MEESSI fue: 1.673 (35,5%) de bajo riesgo, 2.023 (42,9%) de riesgo intermedio, 530 (11,3%) de alto riesgo y 485 (10,3%) de muy alto riesgo, con mortalidades a 30 días del 2,0, el 7,8, el 17,9 y el 41,4% respectivamente. El estadístico C para el modelo completo fue 0,810 (IC95%, 0,790-0,830) y varió de 0,731 a 0,785 para los modelos secundarios. La capacidad discriminatoria de la escala de riesgo MEESSI fue similar entre los subgrupos de hospitales, entre SUH de distinta actividad y entre hospitales reclutadores originales y nuevos. Conclusiones: La escala MEESSI estratifica con éxito a los pacientes con ICA en los SUH según el riesgo de muerte a 30días, lo cual puede ayudar en urgencias a la toma de decisiones sobre el destino de estos pacientes


Introduction and objectives: The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. Methods: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium-or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. Results: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. Conclusions: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/classificação , Risco Ajustado/métodos , Tratamento de Emergência/métodos , Qualidade da Assistência à Saúde/classificação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença
6.
Rev Esp Cardiol (Engl Ed) ; 72(3): 198-207, 2019 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29903688

RESUMO

INTRODUCTION AND OBJECTIVES: The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. METHODS: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. RESULTS: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. CONCLUSIONS: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.


Assuntos
Serviço Hospitalar de Emergência/normas , Insuficiência Cardíaca/diagnóstico , Sistema de Registros , Medição de Risco/métodos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Taxa de Sobrevida/tendências
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