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1.
Ann Emerg Med ; 74(2): 204-215, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31147102

RESUMO

STUDY OBJECTIVE: The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) is a validated clinical decision tool that characterizes risk of mortality in emergency department (ED) acute heart failure patients. The objective of this study is to compare the distribution of risk categories between hospitalized and discharged ED patients with acute heart failure. METHODS: We included consecutive acute heart failure patients from 34 Spanish EDs. Patients were retrospectively classified according to MEESSI-AHF risk categories. We calculated the odds of hospitalization (versus direct discharge from the ED) across MEESSI-AHF risk categories. Next, we assessed the following 30-day postdischarge outcomes: ED revisit, hospitalization, death, and their combination. We used Cox hazards models to determine the adjusted association between ED disposition decision and the outcomes among patients who were stratified into low- and increased-risk categories. RESULTS: We included 7,930 patients (80.5 years [SD 10.1 years]; women 54.7%; hospitalized 75.3%). Compared with that for low-risk MEESSI-AHF patients, odds ratios for hospitalization of patients in intermediate-, high-, and very-high-risk categories were 1.83 (95% confidence interval [CI] 1.64 to 2.05), 3.05 (95% CI 2.48 to 3.76), and 3.98 (95% CI 3.13 to 5.05), respectively. However, almost half (47.6%) of all discharged patients were categorized as being at increased risk by MEESSI-AHF, and 19.0% of all the increased-risk patients were discharged from the ED. Among the low-risk MEESSI-AHF patients, the 30-day postdischarge mortality did not differ by ED disposition (hazard ratio [HR] for discharged patients with respect to hospitalized ones 0.65; 95% CI 0.70 to 1.11), nor did it differ in the increased-risk group (HR 0.88; 95% CI 0.63 to 1.23). The discharged low-risk MEESSI-AHF patients had higher risks of 30-day ED revisit and hospitalization (HR 1.86, 95% CI 1.57 to 2.20; and HR 1.92, 95% CI 1.54 to 2.40, respectively) compared with the admitted patients, as did the discharged patients in the increased-risk group (HR 1.62, 95% CI 1.39 to 1.89; and HR 1.40, 95% CI 1.16 to 1.68, respectively), with similar results for the combined endpoint. CONCLUSION: The disposition decisions made in current clinical practice for ED acute heart failure patients calibrate with MEESSI-AHF risk categories, but nearly half of the patients currently discharged from the ED fall into increased-risk MEESSI-AHF categories.

2.
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.

3.
Rev. esp. quimioter ; 32(2): 156-164, abr. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: ibc-ET1-2314

RESUMO

Objetivo: Evaluar la capacidad del lactato o el índice de Charlson para mejorar la capacidad del SIRS y el qSOFA para identificar el riesgo de muerte a corto plazo de los pacientes ancianos, sin deterioro funcional grave, atendidos por sospecha de infección en urgencias. Metodología: Estudio de cohorte observacional prospectivo que incluyó a todos los pacientes de 75 años o más, sin deterioro funcional, atendidos por una infección aguda en 69 servicios de urgencias españoles durante 2 días en cada periodo estacional. Se recogieron datos demográficos, clínicos y analíticos. La variable de resultado principal fue la mortalidad por cualquier causa a los 30 días de la visita índice. Resultados: Se incluyeron 739 pacientes con una edad media de 84,9 (DE 6,0) años y 375 (50,7%) fueron mujeres. Noventa y un (12,3%) pacientes fallecieron dentro de los 30 días posteriores a la visita a urgencias. El ABC para el SIRS ≥ 2 y el qSOFA ≥ 2 fue de 0,637 (IC 95% 0,587-0,688; p<0,001) y 0,698 (IC 95% 0,635-0,761; p<0,001), respectivamente. La comparación entre esta curvas muestra una mejor capacidad de clasificación por parte del qSOFA ≥ 2 (p=0,041). Ambas escalas incrementan su capacidad de clasificación al añadir el lactato, siendo el ABC para SIRS más lactato de 0,705 (IC95% 0,652-0,758; p<0,001) y para qSOFA más lactato de 0,755 (IC95% 0,696-0,814; p<0,001), existiendo una tendencia estadística a un mejor rendimiento pronóstico de la segunda estrategia (p=0,0727). No ocurre lo mismo con el índice de Charlson, que no tiene efectos de mejora en la clasificación realizada con el SIRS (p=0,2269) ni con qSOFA (p=0,2573). Conclusiones: La inclusión de la valoración del lactato a las escalas SIRS y qSOFA mejoran su capacidad para identificar pacientes ancianos atendidos por infección en riesgo de muerte a corto plazo. La valoración del índice de Charlson no tiene efecto


Objective: The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). Methods: We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. Results: We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0,001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). Conclusions: Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index

4.
Arch. bronconeumol. (Ed. impr.) ; 54(11): 568-575, nov. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-176701

RESUMO

El tratamiento no farmacológico es fundamental en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), sin embargo, este tratamiento, en ocasiones, no recibe la importancia que merece. Los pacientes diagnosticados de EPOC deberían beneficiarse de servicios de atención integral. Estos servicios son un conjunto articulado de acciones estandarizadas dirigidas a la cobertura de las necesidades de salud del paciente, considerando el entorno y las circunstancias. La rehabilitación pulmonar es uno de los componentes esenciales del tratamiento no farmacológico en los servicios de atención integral en la EPOC. En la Guía española de la EPOC (GesEPOC) 2017 detallamos de forma sistemática la evidencia científica de los programas de rehabilitación pulmonar en fase aguda y estable. Otro aspecto importante del tratamiento no farmacológico es la actividad física y en la guía GesEPOC 2017 describimos los puntos más esenciales sobre su prescripción y revisamos las estrategias más eficaces para su adhesión. GesEPOC 2017 quiere dejar constancia de la importancia del tratamiento no farmacológico como coadyuvante al tratamiento farmacológico


Non-pharmacological treatment is essential in patients with chronic obstructive pulmonary disease (COPD), but this treatment is sometimes not given the importance it deserves. Patients diagnosed with COPD should benefit from comprehensive care services. These services comprise a protocolized set of actions aimed at covering the health needs of the patient, taking into account their environment and circumstances. Pulmonary rehabilitation is one of the essential components of non-pharmacological treatment in comprehensive COPD care services. In the Spanish COPD Guidelines (GesEPOC) 2017, we provided a systematic report of the scientific evidence for pulmonary rehabilitation programs in acute and stable phase disease. Another important issue in the non-pharmacological treatment of COPD is physical activity, and the most essential considerations regarding prescription are described in the GesEPOC guidelines, along with a review of the most effective strategies to ensure adherence. GesEPOC 2017 aims to underline the importance of non-pharmacological treatment as a co-adjuvant to pharmacological treatment


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Guias de Prática Clínica como Assunto/normas , Fidelidade a Diretrizes/normas , Exercício , Espanha/epidemiologia , Autocuidado , Prestação Integrada de Cuidados de Saúde , Pneumopatias/reabilitação , Estado Nutricional
5.
Am J Cardiol ; 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30360888

RESUMO

To determine short-term outcomes after an episode of acute heart failure in patients with mid-range ejection fraction (40%-49%; HFmrEF) compared with patients with reduced (<40%) and preserved (>49%) ejection fractions (HFrEF and HFpEF, respectively) and according to their final destination after emergency department (ED) care. This is an exploratory, secondary analysis of the Epidemiology of Acute Heart Failure in the Emergency departments Registry, which includes consecutive acute heart failure patients diagnosed in 41 Spanish EDs. Patients with echocardiography data were included and divided into HFrEF, HFmrEF, and HFpEF. The primary outcome was 30-day all-cause mortality, and secondary outcomes were in-hospital all-cause mortality, hospital length of stay >10 days, and 30-day postdischarge ED revisit due to AHF and combined end point (ED revisit and/or death). We included 6,856 patients (age 79 [10]; 52.1% women): 21.6% had HFrEF, 14.3% HFmrEF, and 64.1% HFpEF. The main destinations for the 982 HFmrEF patients after ED management were internal medicine (293, 29.8%), cardiology (194, 19.9%) and not hospitalized (241, 24.5%), whereas the remaining 254 patients were admitted to other departments, including geriatric wards, short-stay units and intensive care units. Outcomes for HFmrEF did not differ compared with either HFrEF or HFpEF. Compared with HFmrEF admitted to cardiology, internal medicine admission or direct ED discharge increased the 30-day postdischarge ED revisit (hazard ratio [HR] 1.713, 95% confidence interval [CI] 1.042 to 2.816; and HR 1.683, 95% CI 1.046 to 2.708, respectively) and the 30-day postdischarge combined end point (HR 1.732, 95% CI 1.070 to 2.803; and HR 1.727, 95% CI 1.083 to 2.756, respectively). In conclusion, patients in the newly created HFmrEF category suffering from an acute decompensation have similar short-term outcomes as those in the classical HFrEF and HFpEF categories; nonetheless, HFmrEF patients handled in cardiology wards during decompensation obtain better outcomes, and reasons for these differences have to be unmasked and corrected.

6.
Arch Bronconeumol ; 54(11): 568-575, 2018 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30241689

RESUMO

Non-pharmacological treatment is essential in patients with chronic obstructive pulmonary disease (COPD), but this treatment is sometimes not given the importance it deserves. Patients diagnosed with COPD should benefit from comprehensive care services. These services comprise a protocolized set of actions aimed at covering the health needs of the patient, taking into account their environment and circumstances. Pulmonary rehabilitation is one of the essential components of non-pharmacological treatment in comprehensive COPD care services. In the Spanish COPD Guidelines (GesEPOC) 2017, we provided a systematic report of the scientific evidence for pulmonary rehabilitation programs in acute and stable phase disease. Another important issue in the non-pharmacological treatment of COPD is physical activity, and the most essential considerations regarding prescription are described in the GesEPOC guidelines, along with a review of the most effective strategies to ensure adherence. GesEPOC 2017 aims to underline the importance of non-pharmacological treatment as a co-adjuvant to pharmacological treatment.

7.
Emergencias (Sant Vicenç dels Horts) ; 30(3): 149-155, jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-172955

RESUMO

Objetivos. Estudiar el impacto de las variables geriátricas en la mortalidad a 30 días entre los ancianos con insuficiencia cardiaca aguda (ICA). Método. Análisis retrospectivo del registro Older Acute heart failure Key data (OAK) que incluye prospectivamente a pacientes consecutivos 65 años con ICA en 3 servicios de urgencias españoles durante 4 meses (noviembre-diciembre 2011 y enero-febrero 2014). Se realizó una valoración geriátrica adaptada a urgencias durante los días laborales de 8 am a 10 pm. Se recogieron variables demográficas, clínicas, analíticas y geriátricas (comorbilidad, polifarmacia, fragilidad, situación basal funcional, cognitiva y social, despistaje de síndrome confusional, deterioro cognitivo y depresión, y situación nutricional). La variable de resultado fue la mortalidad por cualquier causa a los 30 días. Resultados. Se incluyeron 565 pacientes con edad media 83 años (DE 7,1), 346 mujeres (61,6%). Sesenta y cinco sujetos (11,5%) fallecieron a los 30 días. La presencia de síndrome confusional agudo (OR ajustada = 2,2; IC95% 1,0-4,8; p = 0,04), de enfermedad aguda (OR ajustada = 1,8; IC95% 0,9-3,4; p = 0,05) o pérdida de apetito (OR ajustada = 1,8; IC95% 1-3,4; p = 0,04) en los últimos 3 meses, y de fragilidad (OR ajustada = 2,0; IC95% 1,0-4,1; p = 0,05) o dependencia funcional grave (OR ajustada = 4,4; IC95% 1,9-11,4; p = 0,01) fueron factores independientes asociados con mortalidad a los 30 días. Conclusiones. Existen ciertas variables geriátricas que debieran contemplarse en la estratificación de riesgo a corto plazo de los pacientes ancianos con ICA


Objective. To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). Methods. Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. Results. We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0–4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9–3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0–3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0–4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9–11.4; P=.01). Conclusions. Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF


Assuntos
Humanos , Idoso , Avaliação Geriátrica/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Transtornos Cognitivos/epidemiologia , Doença Aguda/epidemiologia , Indicadores de Morbimortalidade , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Delírio/epidemiologia , Fatores de Risco , Idoso Fragilizado/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Polimedicação
8.
Emergencias ; 30(3): 149-155, 2018 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29687668

RESUMO

OBJETIVE: To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS: Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS: We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0­4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9­3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0­3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0­4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9­11.4; P=.01). CONCLUSIONS: Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.

9.
J Comp Eff Res ; 7(4): 319-330, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29570366

RESUMO

AIM: To analyze treatment at discharge/follow-up of patients diagnosed with venous thromboembolism (VTE) in the emergency department (ED). MATERIALS & METHODS: Ambispective study (50 Spanish centers) of consecutive patients (October-December 2014) with VTE diagnosed in ED. RESULTS: VTE was diagnosed in 775 patients (295 pulmonary embolism [PE] without deep vein thrombosis [DVT], 389 DVT without PE and 91 PE + DVT); 95.5% received anticoagulants (90.7% low-molecular-weight heparin [LMWH], 4% LMWH + vitamin K antagonists and <1% direct oral anticoagulants). Overall, 23.3% were discharged from ED and 74.5% hospitalized (98.6% with PE and 50.4% with DVT). After discharge/90/180 days, 43.6/21.0/13.5% were taking LMWH, with similar rates in nononcologic patients. CONCLUSION: There is a poor adherence to international guidelines in management of VTE patients in Spain.

10.
J Infect ; 76(3): 249-257, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29246637

RESUMO

BACKGROUND: Midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP) and sepsis. In this paper, we examined the ability of MR-proADM to predict organ damage and long-term mortality in sepsis patients, compared to that of procalcitonin, C-reactive protein and lactate. METHODS: This was a prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to internal service department. The association between biomarkers and 90-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. The accuracy of biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS: A total of 148 patients with severe sepsis, according to the criteria of the campaign to survive sepsis, were enrolled. Eighty-five (57.4%) had sepsis according to the new criteria of Sepsis-3. MR-proADM showed the best AUROC to predict sepsis as defined by the Sepsis-3 criteria (AUROC of 0.771, 95% CI 0.692-0.850, p <0.001) and was the only marker independently associated with Sepsis-3 criteria (OR = 4.78, 95% CI 2.25-10.14; p < 0.001) in multivariate analysis. MR-proADM was the biomarker with the best AUROC to predict mortality in 90 days (AUROC of 0.731, CI 95% 0.612-0.850, p <0.001) and was the only marker that kept its independence [hazard ratio (HR) of 1.4, 95% CI 1.2-1.64, p <0.001] in multivariate analysis. The cut-off point of MR-proADM of 1.8 nmol/L (HR of 4.65, 95% CI 6.79-10.1, p < 0.001) was the one that had greater discriminative capacity to predict 90 days mortality. All patients with MR-proADM concentrations ≤0.60 nmol/L survived up to 90 days. In patients with SOFA ≤ 6, the addition of MR-proADM to SOFA score increased the ability of SOFA to identify non-survivors, AUROC of 0.65 (CI 95% 0.537-0.764) and AUROC of 0.700 (CI 95% 0.594-0.800), respectively (p < 0.05 for both). CONCLUSIONS: MR-proADM is a good biomarker in the early identification of high risk septic patients and may contribute to improve the predictive capacity of SOFA scale, especially when scores are low.

11.
Am J Cardiol ; 120(7): 1151-1157, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28826899

RESUMO

The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Sistema de Registros , Medição de Risco , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Seguimentos , Insuficiência Cardíaca/reabilitação , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
12.
Acad Emerg Med ; 24(3): 298-307, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27797432

RESUMO

OBJECTIVE: The objective was to determine the effect of frailty on risk of 30-day mortality in nonseverely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). METHODOLOGY: The Frailty-AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. RESULTS: A total of 465 patients with a mean (±SD) age of 82 (±7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index ≥ 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047). CONCLUSION: The presence of frailty is an independent risk factor of 30-day mortality in nonsevere dependent older patients attended with AHF in EDs.


Assuntos
Idoso Fragilizado , Insuficiência Cardíaca/mortalidade , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
13.
Medicine (Baltimore) ; 96(48): e8796, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29310357

RESUMO

The objective of this study was to determine the clinical profile of and diagnostic and therapeutic approach to patients with venous thromboembolism (VTE) in Spanish Emergency Departments (EDs). Risk factors, adherence to clinical practice guidelines, and outcomes were also evaluated.Patients with VTE diagnosed in 53 Spanish EDs were prospectively and consecutively included. Demographic data, comorbidities, risk factors for VTE, index event characteristics, hemorrhagic risk, and mortality were evaluated. Adherence to clinical practice guidelines was assessed based on clinical probability scales, requests for determination of D-dimer, use of anticoagulant treatment before confirmation of diagnosis, and assessment of bleeding and prognostic risk. Recurrence, bleeding, and death during admission and at 30, 90, and 180 days after diagnosis in the EDs were recorded.From 549,840 ED visits made over a mean period of 40 days, 905 patients were diagnosed with VTE (incidence 1.6 diagnoses per 1000 visits). The final analysis included 801 patients, of whom 49.8% had pulmonary embolism. The most frequent risk factors for VTE were age (≥70 years), obesity, and new immobility. Clinical probability, prognosis, and bleeding risk scales were recorded in only 7.6%, 7.5%, and 1% of cases, respectively. D-dimer was determined in 87.2% of patients with a high clinical probability of VTE, and treatment was initiated before confirmation in only 35.9% of these patients. In patients with pulmonary embolism, 31.3% had a low risk of VTE. Overall, 98.7% of patients with pulmonary embolism and 50.2% of patients with deep venous thrombosis were admitted. During follow-up, total bleeding was more frequent than recurrences: the rates of any bleeding event were 4.4%, 3.9%, 5.3%, and 3.5% at admission and at 30 and 90, and 180 days, respectively; the rates of VTE recurrence were 2.3%, 1.3%, 1.7%, and 0.6%, respectively. Mortality rates were 3.4%, 3.1%, 4.1%, and 2.6% during hospitalization and at 30, 90, and 180 days, respectively.VTE had a substantial impact on Spanish EDs. The clinical presentation and risk profile for the development of VTE in patients diagnosed in the EDs was similar to that recorded in previous studies. During follow-up, bleeding (overall) was more frequent than recurrences. Adherence to clinical practice guidelines could improve significantly.


Assuntos
Serviço Hospitalar de Emergência , Tromboembolia Venosa/terapia , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
14.
Emergencias (St. Vicenç dels Horts) ; 28(6): 366-374, dic. 2016. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-158776

RESUMO

Objetivo. Identificar factores asociados a un tiempo de estancia hospitalaria (TDEH) corto en pacientes ingresados por insuficiencia cardiaca aguda (ICA) en hospitales con unidad de corta estancia (UCE). Método. Estudio de cohorte multipropósito y multicéntrico no intervencionista, con seguimiento prospectivo de pacientes con ICA ingresados en 10 hospitales españoles con UCE. Se recogieron variables demográficas, antecedentes personales, situación basal cardiorrespiratoria y funcional, de urgencias, del ingreso y de seguimiento a 30 días. La variable resultado fue un TDEH corto (_ 4 días). Se realizaron curvas de rendimiento diagnóstico (ROC) de modelos simples y mixtos predictivos de TDEH corto y se calculó el área bajo la curva (ABC) de la característica operativa del receptor (COR). Resultados. Se incluyeron 1.359 pacientes con una edad 78,7 (DE: 9,9) años, el 53,9% mujeres, 568 (41,8%) tuvieron un TDE de 4 o menos días. Ingresaron 590 pacientes (43,4%) en UCE y 769 (56,6%) en salas de hospitalización convencional. En el modelo de regresión mixto ajustado al centro, la crisis hipertensiva (OR 1,79, IC 95%: 1,17-2,73; p = 0,007) y el ingresar en UCE (OR 16,6, IC95%: 10,0-33,3; p < 0,001) se asociaron a TDEH corto, y la ICA hipotensiva (OR 0,49, IC 95%: 0,26-0,91; p = 0,025), la hipoxemia, (OR 0,68, IC 95%: 0,53-0,88; p = 0,004) e ingresar en miércoles, jueves o viernes (OR 0,62, IC 95%: 0,49-0,77; p < 0,001) a TDEH largo. El ABC COR del modelo mixto ajustada al centro fue 0,827 (IC 95%: 0,80-0,85; p < 0,001). La mortalidad a 30 días y el reingreso a 30 días no difirieron entre ambos grupos (0,5% frente a 0,5%, p = 0,959; y 22,9% frente a 27,7%, p = 0,059, respectivamente). Conclusiones. En pacientes con ICA existen factores clínicos y organizativos en cada centro que se relacionan de forma independiente con un TDEH corto, entre los que destaca el tener una UCE (AU)


Objective. To identify factors associated with short hospital stays for patients admitted with acute heart failure (AHF) admitted to hospitals with short-stay units (SSU). Methods. Multicenter nonintervention study in a multipurpose cohort of patients with AHF to 10 Spanish hospitals with short-stay units; patients were followed prospectively. We recorded demographic data, medical histories, baseline cardiorespiratory and function variables on arrival in the emergency department, on admission, and at 30 days. The outcome variable was a short hospital stay (_ 4 days). We built receiver operating characteristic curves of simple and mixed predictive models for short stays and calculated the area under the curves. Results. A total of 1359 patients with a mean (SD) age of 78.7 (9.9) years (53.9% women) were included; 568 (41.8%) had short stays. Five hundred ninety patients (43.4%) were admitted to SSU and 769 (56.6%) were admitted to conventional wards. The variables associated with a short-stay according to the mixed regression model were hypertensive crisis (odds ratio [OR], 1.79; 95% CI, 1.17–2.73; P=.007) and admission to a SSU (OR, 16.6; 95% CI, 10.0–33.3; P<.001). Hypotensive AHF (OR, 0.49; 95% CI, 0.26–0.91; P=.025), hypoxemia (OR, 0.68; 95% CI, 0.53–0.88; P=.004); and admission on a Wednesday, Thursday, or Friday (OR, 0.62; 95% CI, 0.49–0.77; P<.001) were associated with a long stay. The area under the receiver operating characteristic curve was 0.827 (95% CI, 0.80–0.85; P<.001). Thirty-day mortality and readmission rates did not differ between patients with short vs long stays (mortality, 0.5% in both cases, P=.959; and readmission, 22.9% vs 27.7%, respectively; P=.059). Conclusion. Both clinical and administrative factors are independently related to whether patients with AHF have short stays in the hospitals studied, and among therapy, it is remarkable the existence of a SSU (AU)


Assuntos
Humanos , Insuficiência Cardíaca/epidemiologia , Tratamento de Emergência/métodos , Tempo de Internação/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exacerbação dos Sintomas , Comorbidade
17.
Emergencias ; 28(6): 366-374, 2016 Dic.
Artigo em Espanhol | MEDLINE | ID: mdl-29106080

RESUMO

OBJECTIVES: To identify factors associated with short hospital stays for patients admitted with acute heart failure (AHF) admitted to hospitals with short-stay units (SSU). MATERIAL AND METHODS: Multicenter nonintervention study in a multipurpose cohort of patients with AHF to 10 Spanish hospitals with short-stay units; patients were followed prospectively. We recorded demographic data, medical histories, baseline cardiorespiratory and function variables on arrival in the emergency department, on admission, and at 30 days. The outcome variable was a short hospital stay (<= 4 days). We built receiver operating characteristic curves of simple and mixed predictive models for short stays and calculated the area under the curves. RESULTS: A total of 1359 patients with a mean (SD) age of 78.7 (9.9) years (53.9% women) were included; 568 (41.8%) had short stays. Five hundred ninety patients (43.4%) were admitted to SSU and 769 (56.6%) were admitted to conventional wards. The variables associated with a short-stay according to the mixed regression model were hypertensive crisis (odds ratio [OR], 1.79; 95% CI, 1.17-2.73; P=.007) and admission to a SSU (OR, 16.6; 95% CI, 10.0-33.3; P<.001). Hypotensive AHF (OR, 0.49; 95% CI, 0.26-0.91; P=.025), hypoxemia (OR, 0.68; 95% CI, 0.53-0.88; P=.004); and admission on a Wednesday, Thursday, or Friday (OR, 0.62; 95% CI, 0.49-0.77; P<.001) were associated with a long stay. The area under the receiver operating characteristic curve was 0.827 (95% CI, 0.80-0.85; P<.001). Thirty-day mortality and readmission rates did not differ between patients with short vs long stays (mortality, 0.5% in both cases, P=.959; and readmission, 22.9% vs 27.7%, respectively; P=.059). CONCLUSION: Both clinical and administrative factors are independently related to whether patients with AHF have short stays in the hospitals studied, and among therapy, it is remaslcasle the existence of a SSU.

18.
J Am Med Dir Assoc ; 16(9): 799.e1-6, 2015 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-26170034

RESUMO

OBJECTIVE: Patients with heart failure (HF) seen at the emergency department (ED) are increasingly older and more likely to present delirium. Little is known, however, about the impact of this syndrome on outcome in these patients. We aimed to investigate the prognostic value and risk factors of delirium at admission (prevalent delirium) in ED patients with decompensated HF. METHODS AND RESULTS: We performed a prospective, observational study, analyzing the presence of prevalent delirium in decompensated HF patients attended at the ED in 2 hospitals in Spain in the context of the Epidemiology Acute Heart Failure Emergency project. We used the brief Confusion Assessment Method to assess the presence of delirium. Patients were followed for 1 month after discharge. Of 239 enrolled patients (81.7 ± 9.4 years, women 61.1%, long-term care [LTC] 11%), 35 (14.6%) had prevalent delirium (20% LTC vs 9.4% in-home, P = .078). The factors associated with delirium in the multivariate analysis were functional dependence (P = .001) and dementia (P = .005). Prevalent delirium was an independent risk factor of death within 30 days (OR 3.532; 95% CI 1.422-8.769, P = .007) whereas autonomy in basic activities of daily living was a protective factor (OR 0.971; 95% CI 0.956-0.986, P = .001). The area under the ROC curve for our 30-day mortality model was 0.802 (95% CI 0.721-0.883, P = .001). CONCLUSION: Prevalent delirium in patients with decompensated HF was a predictor of short-term mortality. Routine identification of delirium in patients at risk, particularly those with greater functional dependence, can help emergency physicians in decision-making and enhance care in patients with decompensated HF.


Assuntos
Delírio/epidemiologia , Insuficiência Cardíaca/epidemiologia , Idoso , Delírio/diagnóstico , Delírio/mortalidade , Feminino , Avaliação Geriátrica , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
19.
Med. clín (Ed. impr.) ; 143(6): 245-251, sept. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-126844

RESUMO

Fundamento y objetivo: Estudiar los factores asociados con una estancia prolongada de los pacientes ingresados por insuficiencia cardiaca aguda (ICA) en las unidades de corta estancia (UCE) españolas. Pacientes y método: Estudio de cohorte multipropósito y multicéntrico, con seguimiento prospectivo, que incluyó a todos los pacientes ingresados por ICA en las 11 UCE del registro EAHFE. Se recogieron variables demográficas, antecedentes personales, situación basal cardiorrespiratoria y funcional, datos del episodio de urgencias, del ingreso y del seguimiento a 60 días. La variable resultado fue la estancia prolongada en la UCE (mayor de 72 h). Se utilizó un modelo de regresión logística para controlar los efectos de los factores de confusión. Resultados: Se incluyeron 819 pacientes, con una edad media (DE) de 80,9 (8,4) años; 483 (59,0%) eran mujeres. La mediana de estancia fue de 3 días (intervalo intercuartílico 2,0-5,0), y la mortalidad intrahospitalaria del 2,7%. Fueron factores independientes asociados a una estancia prolongada, la coexistencia de enfermedad pulmonar obstructiva crónica (odds ratio [OR] 1,56, intervalo de confianza del 95% [IC 95%] 1,02-2,38; p = 0,040) y anemia (OR 1,72, IC 95% 1,21-2,44; p = 0,002), una saturación de oxígeno basal a la llegada a urgencias < 90% (OR 2,21, IC 95% 1,51-3,23; p < 0,001), una crisis hipertensiva como factor precipitante de la ICA (factor protector, OR 0,49, IC 95% 0,26-0,93; p = 0,028) e ingresar en jueves (OR 1,90, IC 95% 1,19-3,05; p = 0,008). No hubo diferencias significativas entre ambos grupos respecto a la mortalidad intrahospitalaria (2,4 frente a 3,0%), mortalidad (4,1 frente a 4,2%) ni revisita a 60 días (18,4 frente a 21,6%). Conclusiones: En los pacientes con ICA que ingresan en la UCE, se tienen que considerar factores como la presencia de crisis hipertensiva, insuficiencia respiratoria, anemia, antecedente de enfermedad pulmonar obstructiva crónica, e ingresar un jueves para evitar hospitalizaciones prolongadas (AU)


Background and objective: To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs). Patients and methods: This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (> 72 h). A logistic regression model was used to control the effects of confounding factors. Results: Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P = .040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P = .002), basal oxygen saturation < 90% on arrival to the Emergency Department (OR2.21, 95% CI 1.51-3.23; P < .001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P = .028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P = .008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%).Conclusions: Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization (AU)


Assuntos
Humanos , Insuficiência Cardíaca/epidemiologia , Hipertensão/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Anemia/epidemiologia , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Estudos de Coortes
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