Safety of benzodiazepines in patients with acute heart failure: A propensity score-matching study.

AIM: Benzodiazepines (BZDs) are one of the most used drugs to control symptoms in patients with acute heart failure (HF). However, the evidence on its safety is inconclusive. The objective was to describe the characteristics of patients admitted for HF and treated with BZDs and to assess the relationship of this treatment and mortality. PATIENTS AND METHODS: We performed a cross-sectional, multicentre (74 Spanish hospitals), cohort study. Patients admitted for HF were divided depending on whether they were treated with BZDs or not. Propensity score analysis matched patients in both groups in a 1:1 manner according to different factors. The primary outcome was mortality at day 7. Secondary outcomes were mortality at days 30 and 180, as well as readmissions and emergency room visits at 180 days. RESULTS: We included 1855 patients: 639 (34.4%) had prescribed BZDs treatment versus 1216 (65.6%) who had not been treated. Patients receiving BZDs had advanced heart disease, severe symptoms, need more HF intensive treatment and higher mortality. After propensity matching 381 balanced paired cases were included in each group. Treatment with BZDs was not associated with greater risk of mortality at day 7 of index hospitalization (7.6% vs 5.2%, adjusted OR 1.49, 95% CI 0.83-2.68, p = 0.186). There were also no differences between groups in terms of mortality at day 30 and 180, readmissions or visits to the emergency room. CONCLUSIONS: Our data support that benzodiazepines could be safely used for improving symptoms. in patients admitted for acute HF in terms of short-medium term mortality.

Different profiles of advanced heart failure among patients with and without diabetes mellitus. Findings from the EPICTER study.

AIM: This work aims to compare the characteristics of advanced heart failure (HF) in patients with and without type 2 diabetes mellitus (DM) and to determine the relevance of variables used to define advanced HF. PATIENTS AND METHODS: This cross-sectional, multicenter study included patients hospitalized for HF. They were classified into four groups according to presence/absence of advanced HF, determined based on general and cardiac criteria, and presence/absence of DM. To analyze the importance of variables, we grew a random forest algorithm (RF) based on mortality at six months. RESULTS: A total of 3153 patients were included. The prevalence of advanced HF among patients with DM was 24% compared to 23% among those without DM (p=0.53). Patients with advanced HF and DM had more comorbidity related to cardiovascular and renal diseases; their prognosis was the poorest (log-rank <0.0001) though the adjusted hazard ratio by group in the Cox regression analysis was not significant. The variables that were significantly related to mortality were the number of comorbidities (p=0.005) and systolic blood pressure (p=0.024). The RF showed that general criteria were more important for defining advanced HF than cardiac criteria. CONCLUSIONS: Patients with advanced HF and DM were characterized by DM in progression with macro and microvascular complications. The outcomes among advanced HF patients were poor; patients with advanced HF and DM had the poorest outcomes. General criteria were the most important to establish accurately a definition of advanced HF, being decisive the evidence of disease progression in patients with DM.

Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs-Analysis of the EPICTER Study.

Introduction: There are studies that evaluate the association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality in elderly patients with acute and advanced HF and the clinical manifestations and management from a palliative point of view. Methods: The EPICTER study ("Epidemiological survey of advanced heart failure") is a cross-sectional, multicenter project that consecutively collected patients admitted for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF <20%, intractable angina, HF despite optimal treatment), and general terminal criteria (estimated survival <6 months, patient/family acceptance of palliative approach, and one of the following: evidence of HF progression, multiple Emergency Room visits or admissions in the last six months, 10% weight loss in the last six months, and functional impairment) were collected. Terminal HF was considered if the patient met at least one organ-dependent criterion and all the general criteria. Both groups (HF with COPD and without COPD) were compared. A Kaplan−Meier survival analysis was performed to evaluate the presence of COPD on the vital prognosis of patients with HF. Results: A total of 3100 patients were included of which 812 had COPD. In the COPD group, dyspnea and anxiety were more frequently observed (86.2% vs. 75.3%, p = 0.001 and 35.4% vs. 31.2%, p = 0.043, respectively). In patients with a history of COPD, presentation of HF was in the form of acute pulmonary edema (21% vs. 14.4% in patients without COPD, p = 0.0001). Patients with COPD more frequently suffered from advanced HF (28.9% vs. 19.4%; p < 0.001). Consultation with the hospital palliative care service during admission was more frequent when patients with HF presented with associated COPD (94% vs. 6.8%; p = 0.036). In-hospital and six-month follow-up mortality was 36.5% in patients with COPD vs. 30.7% in patients without COPD, p = 0.005. The mean number of hospital admissions during follow-up was higher in patients with HF and COPD than in those with isolated HF (0.63 ± 0.98 vs. 0.51 ± 0.84; p < 0.002). Survival analysis showed that patients with a history of COPD had fewer survival days during follow-up than those without COPD (log Rank chi-squared 4.895 and p = 0.027). Conclusions: patients with HF and COPD had more severe symptoms (dyspnea and anxiety) and also a worse prognosis than patients without COPD. However, the prognosis of patients admitted to our setting is poor and many patients with HF and COPD may not receive the assessment and palliative care support they need. Palliative care is necessary in chronic non-oncologic diseases, especially in multipathologic and symptom-intensive patients. This is a clinical care aspect to be improved and evaluated in future research studies.

Cancer Impacts Prognosis on Mortality in Patients with Acute Heart Failure: Analysis of the EPICTER Study.

INTRODUCTION: Heart failure (HF) and cancer are currently the leading causes of death worldwide, with an increasing incidence with age. Little is known about the treatment received and the prognosis of patients with acute HF and a prior cancer diagnosis. OBJECTIVE: to determine the clinical characteristics, palliative treatment received, and prognostic impact of patients with acute HF and a history of solid tumor. METHODS: The EPICTER study ("Epidemiological survey of advanced heart failure") is a cross-sectional, multicenter project that consecutively collected patients admitted for acute HF in 74 Spanish hospitals. Patients were classified into two groups according to whether they met criteria for acute HF with and without solid cancer, and the groups were subsequently compared. A multivariable logistic regression analysis was conducted, using the forward stepwise method. A Kaplan-Meier survival analysis was performed to evaluate the impact of solid tumor on prognosis in patients with acute HF. RESULTS: A total of 3127 patients were included, of which 394 patients (13%) had a prior diagnosis of some type of solid cancer. Patients with a history of cancer presented a greater frequency of weight loss at admission: 18% vs. 12% (p = 0.030). In the cancer group, functional impairment was noted more frequently: 43% vs. 35%, p = 0.039). Patients with a history of solid cancer more frequently presented with acute HF with preserved ejection fraction (65% vs. 58%, p = 0.048) than reduced or mildly reduced. In-hospital and 6-month follow-up mortality was 31% (110/357) in patients with solid cancer vs. 26% (637/2466), p = 0.046. CONCLUSION: Our investigation demonstrates that in-hospital mortality and mortality during 6-month follow-up in patients with acute HF were higher in those subjects with a history of concomitant solid tumor cancer diagnosis.

Prevalence of advanced heart failure and use of palliative care in admitted patients: Findings from the EPICTER study.

INTRODUCTION AND AIM: Palliative care in patients with advanced heart failure is strongly recommended by Clinical Practice Guidelines. We aimed to calculate the prevalence of advanced heart failure in admitted patients, to describe their management, and to analyse the factors that influence their referral to specialised palliative care. PATIENTS AND METHODS: Cross-sectional, multicentre study that consecutively included patients admitted for heart failure in 74 Spanish hospitals. If they met criteria for advanced heart failure, their treatment, complications and procedures were recorded. RESULTS: A total of 3153 patients were included. Of them, 739 (23%) met criteria for advanced heart failure. They were more likely to be women, older and to have a history of anaemia, chronic kidney disease and cognitive impairment. For their management, furosemide infusions (30%) and vasodilators (21%) were used. Refractory symptoms were treated with opioids (47%) and benzodiazepines (44%). Palliative care was only provided in the last hours of life in 48% of them. A multidisciplinary approach, involving palliative care specialists was sought in 15% of these patients. Treatment with furosemide infusions, an advanced New York Heart Association functional class, to meet advanced HF criteria and the presence of cancer were associated with the referral to specialised palliative care. CONCLUSIONS: Almost one in four patients admitted with HF met criteria of advanced disease. They were older and had more comorbidities. Specialist palliative care services were involved in only a minority of patients, mainly those who were highly symptomatic or had cancer.

Proteína C reactiva en afecciones infecciosas e inflamatorias en el Hospital General Docente Héroes del Baire. Septiembre 2008 a Febrero 2010 / Protein C. reactive in infections affections and inflammatory in the General Educational ¨Héroes del Baire” Hospital. September 2008 to February 2010

Se estudiaron 1728 pacientes ingresados en el Hospital General Docente Héroes del Baire, que tenían indicada la determinación de proteína C reactiva en suero al ingreso, de ellos 963 casos de pediatría y 765 casos de adultos con el objetivo de determinar el comportamiento de los resultados de la proteína C reactiva e identificar las causas más frecuentes de proteína C reactiva positiva, para lo cual se utilizó el método cualitativo por Látex y semi- cuantitativo. Los resultados expresados como rango de proteína C reactiva negativo fueron menores de 6 mg/L (no aglutinación) y proteína C reactiva positivo mayor de 6 mg/L (presencia de aglutinación). Los hallazgos preliminares muestran que 1244 (71,9 porciento) de los pacientes estudiados presentan una proteína C reactiva positiva de ellos 779 niños y 465 adultos predominando el sexo femenino (75porciento) que junto a la identificación de las causas más frecuentes de proteína C reactiva positiva como son las neumopatías inflamatorias (52porciento) y las artritis (27porciento) en niños y adultos, señalan la necesidad de implementar un adecuado uso de la determinación de proteína C reactiva debido a sus ventajas técnicas e importancia para optimizar el diagnóstico, tratamiento y evolución de estas enfermedades(AU)

The were studied 1,728 pediatric and adults cases, admited in the General Educational Héroes del Baire Hospital that had indicated the determinations of the c- reactive protein in serums at the moment of be interned with objective determination of compotation of result c reactiva protein and identification of causes more frequent of positive C reactive protein, It was used the cualitative by latex and the semi-cualitative methods.The results expressed like negative rank of C- reactive protein were less than 6 (mg/L) no agglutination and positive C- reactive protein more than 6 (mg/L) agglutination presence The preliminary found that the 1244 (71, 9 %) of the studied patients present C- reactive protein Positive, 779 children and 565 adult, this results and the identification of the most frecuent causes of the positive C- reactive protein like inflammatory neumopathia (52percent) and the arthritis (27percent) paint to the need to implant the correct use of the C reactive protein. determination, because of the tecnical advantage for the perfection in the diagnose treatment and evolution of those diseases(AU)

Asistencia al control postparto de las madres atendidas en el servicio de patología obstétrica del Hospital Gineco Obstetrico Isidro Ayora / Attendance to the control postchildbirth of the mothers taken care of in the service of obstetrical pathology of the Hospital Gineco Obstetrico Isidro Ayora

Al conocer la magnitud de los problemas de salud de las madres atendidas en el Servicio de Patología Obstétrica, el grupo consideró fundamental indagar las características de las madres atendidas, podríamos en el futuro modificar la atención de enfermería, en el propósito de apoyar en la educación de la población materna y prevenir así las complicaciones post-parto...

O comportamento epidemiológico da difteria no Estado de São Paulo no período de 1970 a 1980

Pode-se observar através de dados fornecidos pelo Sistema de Vigilância Epidemiológica do CIS - que a incidência da Difteria nos últimos 10 anos decresceu sensivelmente para o conjunto do Estado, passando de 4,39/100.000 hab. em 1970 para 0,68/100,000 hab, em 1980. A partir de 1976 intensificou-se a vacinação e em 1977 observa-se o declínio mais acentuado da incidência. A Região Metropolitana, em geral, tem contribuído com a maior percentagem de casos, os quais vem ocorrendo principalmente nos Subdistritos e Distritos de Paz de São Miguel Paulista, Guaianazes e nos municípios de Ferraz de Vasconcelos, Itaquaquecetuba, Mogi ds Cruzes e Itapecerica da Serra, o que demonstra que a ocorrência da Difteria está relacionada às características sociais dos grupos populacionais, à migração, às condições de vida e acesso aos serviços de saúde. O grupo de maior risco tem sido o de menores de 5 anos, e, embora o maior percentual de casos venha ocorrendo em não vacinados, há ainda um grande número de casos com segunda ou terceira dose ou mesmo a de reforço, o que exige maiores estudos que expliquem essa incidência em vacinados, seja quanto à conservação, estocagem e técnica de aplicação da vacina, seja quanto aos fatores que interferem na resposta imunitária e mesmo quanto aos critérios diagnósticos. As ações de controle da Difteria na comunidade, como exame de comunicantes familiares e escolares, vacinação, orientações, etc., não vem sendo realizadas em nível desejado. Constatou-se que para a melhoria do Sistema de Vigilância Epidemiológica e do controle da Difteria há a necessidade de aumentar a cobertura vacinal, promover pesquisas, quanto a eficácia da vacina e o estado imunitário nos grupos de maior risco, melhorar o sistema de informações, o que implica em treinamento de pessoal, recursos humanos, implantação de unidades de vigilância em todos os níveis da Secretaria da Saúde e expansão dos serviços de saúde nas áreas carentes