New onset heart failure--Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study.

BACKGROUND: Heart failure (HF) is a growing global epidemic. The main study aims is to evaluate the differences between new-onset and chronic-decompensated HF patients. Secondary objectives related only to new-onset HF patients include the role of left ventricular ejection fraction (LVEF) and mid-term mortality related risk factors METHODS: We analyzed 2190 patients hospitalized for acute HF. We compare the 683 patients with a new-onset HF episode with the rest. Restricting the analysis to the new-onset HF patients, we also compare patients with preserved LVEF (EF>50%) with those with reduced LVEF, and analyze the factors associated with three-month mortality. RESULTS: A total of 683 (31.2%) patients fulfill the criteria for "new-onset HF". These patients are older, their HF is more often related to hypertension, show higher blood pressure and heart rate values upon admission, and present with less global and disease-specific comorbidity and better baseline overall functional status. New-onset HF is more often characterized by preserved LVEF, milder baseline NYHA class and lower plasma natriuretic peptide values. After 3 months; 33 (5.2%) new-onset HF patients had died (p<0.001). Cox multivariate analysis showed a correlation between mortality and older age (hazard ratio - HR - 1.08), higher global comorbidity (HR 1.20) and lesser prescription of beta-blockers at discharge (HR 0.34). LVEF was unrelated to mortality. CONCLUSIONS: New-onset HF patients show a clinical profile different to that of chronic-decompensated patients. For this subset of acute HF patients older age, higher comorbidity and beta-blocker nonprescription predict a higher risk of mid-term post-discharge mortality.

[Efficacy of a protocol for the diagnosis and management of syncope in an unselected population]. / Eficacia de un protocolo para el diagnóstico y tratamiento del síncope en una población no seleccionada.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of a protocol based on European guidelines for the management and diagnosis of syncope applied by a multidisciplinary team in unselected patients. PATIENTS AND METHODS: 402 unselected patients were followed prospectively in a second-level country hospital, between November 2003 and November 2008 with a protocol based on European Guidelines. RESULT: Syncope was diagnosed in 83.3% of patients and 26.6% required hospitalization. For every 100 cases, the number of tests carried out and their performance (percentage of positive diagnostic tests/number of tests carried out) was calculated. Tilt test: 31 and performance: 62.4%, Doppler-echocardiography. 17-8.3%, Holter 16-13.2%, cranial CT 5.2-0%, ergometry 1.9-0%, chest CT 1.4-16%, EPS 1.2-33%, ILR 0.7-33%. CONCLUSIONS: This study shows a high percentage of diagnoses with low number of tests carried out, emphasizing the performance of tilt test. The study of unselected patients with a protocol based on European Guidelines for the management and diagnosis of syncope applied by a multidisciplinary team was very effective.

Eficacia de un protocolo para el diagnóstico y tratamiento del síncope en una población no seleccionada / Efficacy of a protocol for the diagnosis and management of syncope in an unselected population

Fundamento y objetivo: Valorar la eficacia de un protocolo basado en las Guías Europeas para el manejo y diagnóstico del síncope y aplicado por un equipo multidisciplinario en una población no seleccionada.Pacientes y método: Fueron estudiados prospectivamente 402 pacientes no seleccionados en un hospital comarcal entre noviembre de 2003 y noviembre de 2008 mediante un protocolo basado en las Guías Europeas. Resultados:Se consiguió el diagnóstico en un 83,3% de los pacientes y un 26,6% precisaron ingreso hospitalario. Por cada 100 casos, se calculó el número de tests diagnósticos efectuados y su rendimiento (porcentaje de positivos/efectuados): tabla basculante 31-rendimiento 62,4%, ecocardiografía 17-8,3%, Holter 16-13,2%, tomografía computarizada (TC) craneal 5,2-0%, ergometría 1,9-0%, TC tórax 1,4-16%, estudio electrofisiológico 1,2-33%, Holter insertable 0,7-33%.Conclusiones: Este estudio muestra un alto porcentaje de diagnósticos con un bajo número de pruebas diagnósticas, destacando el rendimiento de la tabla basculante. El estudio de pacientes no seleccionados de síncope mediante un protocolo basado en las Guías Europeas y aplicado por un equipo multidisciplinario fue muy efectivo (AU)

Background and objective: To evaluate the efficacy of a protocol based on European guidelines for the management and diagnosis of syncope applied by a multidisciplinary team in unselected patients. Patients and methods: 402 unselected patients were followed prospectively in a second-level country hospital, between November 2003 and November 2008 with a protocol based on European Guidelines.Result: : Syncope was diagnosed in 83.3% of patients and 26.6% required hospitalization. For every 100 cases, the number of tests carried out and their performance (percentage of positive diagnostic tests/number of tests carried out) was calculated. Tilt test: 31 and performance: 62.4%, Doppler-echocardiography. 17-8.3%, Holter 16-13.2%, cranial CT 5.2-0%, ergometry 1.9-0%, chest CT 1.4-16%, EPS 1.2-33%, ILR 0.7-33%.Conclusions: This study shows a high percentage of diagnoses with low number of tests carried out, emphasizing the performance of tilt test. The study of unselected patients with a protocol based on European Guidelines for the management and diagnosis of syncope applied by a multidisciplinary team was very effective (AU)