397 results on '"FJ Martín-Sánchez"'
Search Results
152. Clinical presentation and outcome across age categories among patients with COVID-19 admitted to a Spanish Emergency Department.
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Martín-Sánchez FJ, Del Toro E, Cardassay E, Valls Carbó A, Cuesta F, Vigara M, Gil P, López Picado AL, Martínez Valero C, Miranda JD, Lopez-Ayala P, Chaparro D, Cozar López G, Del Mar Suárez-Cadenas M, Jerez Fernández P, Angós B, Díaz Del Arco C, Rodríguez Adrada E, Montalvo Moraleda MT, Espejo Paeres C, Fernández Alonso C, Elvira C, Chacón A, García Briñón MÁ, Fernández Rueda JL, Ortega L, Fernández Pérez C, González Armengol JJ, and González Del Castillo J
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- Adult, Aged, Aged, 80 and over, Betacoronavirus, COVID-19, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Retrospective Studies, SARS-CoV-2, Spain, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Coronavirus Infections mortality, Coronavirus Infections therapy, Hospitalization statistics & numerical data, Pandemics, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Pneumonia, Viral mortality, Pneumonia, Viral therapy
- Abstract
Purpose: To determine the differences by age-dependent categories in the clinical profile, presentation, management, and short-term outcomes of patients with laboratory-confirmed COVID-19 admitted to a Spanish Emergency Department (ED)., Methods: Secondary analysis of COVID-19_URG-HCSC registry. We included all consecutive patients with laboratory-confirmed COVID-19 admitted to the ED of the University Hospital Clinico San Carlos (Madrid, Spain). The population was divided into six age groups. Demographic, baseline and acute clinical data, and in-hospital and 30-day outcomes were collected., Results: 1379 confirmed COVID-19 cases (mean age 62 (SD 18) years old; 53.5% male) were included (18.1% < 45 years; 17.8% 45-54 years; 17.9% 55-64 years; 17.2% 65-74 years; 17.0% 75-84 years; and 11.9% ≥ 85 years). A statistically significant association was found between demographic, comorbidity, clinical, radiographic, analytical, and therapeutic variables and short-term results according to age-dependent categories. There were less COVID-specific symptoms and more atypical symptoms among older people. Age was a prognostic factor for hospital admission (aOR = 1.04; 95% CI 1.02-1.05) and in-hospital (aOR = 1.08; 95% CI 1.05-1.10) and 30-day mortality (aOR = 1.07; 95% CI 1.04-1.09), and was associated with not being admitted to intensive care (aOR = 0.95; 95% CI 0.93-0.98)., Conclusions: Older age is associated with less COVID-specific symptoms and more atypical symptoms, and poor short-term outcomes. Age has independent prognostic value and may help in shared decision-making in patients with confirmed COVID-19 infection.
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- 2020
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153. Iron deficiency and safety of ferric carboxymaltose in patients with acute heart failure. AHF-ID study.
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Jacob J, Miró Ò, Ferre C, Borraz-Ordás C, Llopis-García G, Comabella R, Fernández-Cañadas JM, Mercado A, Roset A, Richard-Espiga F, Valero-Domènech A, Martínez-Gimeno JL, Martín-Sánchez FJ, Llorens P, Berrocal-Gil P, Pérez-Durá MJ, Álvarez-Pérez JM, López-Díez P, Herrero-Puente P, and Comín-Colet J
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- Anemia, Iron-Deficiency complications, Female, Ferric Compounds adverse effects, Heart Failure complications, Humans, Male, Maltose adverse effects, Maltose therapeutic use, Middle Aged, Prospective Studies, Treatment Outcome, Anemia, Iron-Deficiency blood, Anemia, Iron-Deficiency drug therapy, Ferric Compounds therapeutic use, Ferritins blood, Heart Failure drug therapy, Maltose analogs & derivatives
- Abstract
Introduction: The presence of iron deficiency (ID) in patients with acute heart failure (AHF) is high. There are few studies on the characteristics of these patients and the safety of ferric carboxymaltose administration (FCM)., Objective: Study the differences among patients with AHF based on the presence and type of ID as well as the safety of FCM administration in these patients., Method: The AHF-ID study is a multicentre, analytical, prospective follow-up cohort including patients admitted to six Spanish hospitals for AHF. ID was defined as serum ferritin <100 μg/L (group A) or ferritin 100-299 μg/L with a TSAT <20% (group B). In cases receiving FCM the appearance of adverse events was analysed. Adjusted Cox regression was used to determine the association with 30-days reattendance for AHF after discharge., Results: A total of 221 patients were recruited; 191 (86.4%) presented ID, 121 (63.4%) group A and 70 (36.6%) group B. There were scarce differences between the groups analysed. No differences were found in 30-days reattendance for AHF. FCM was administered to 158 (71.5%) patients, with 8 (5.1%) presenting adverse events, the most frequent being digestive alterations. Treatment was not discontinued in any case., Conclusions: There are scarce differences between the presence and the type of ID in patients with AHF. The administration of FCM in patients with ID and AHF is safe., (© 2020 John Wiley & Sons Ltd.)
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- 2020
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154. Clinical value of malnutrition.
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Martín-Sánchez FJ and Cuesta Triana F
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- Humans, Nutrition Assessment, Nutritional Status, Predictive Value of Tests, Malnutrition diagnosis
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- 2020
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155. [Sex education questionnaires need a sexological approach.]
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Suarez-Cadenas MDM and Martín-Sánchez FJ
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- 2020
156. Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study.
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Llauger L, Jacob J, Arturo Moreno L, Aguirre A, Martín-Mojarro E, Romero-Carrete JC, Martínez-Nadal G, Tost J, Corominas-Lasalle G, Roset À, Cardozo C, Suñén-Cuquerella G, Alarcón B, Herrera-Mateo S, Ruibal JC, Alquézar-Arbé A, Gil V, Donea R, Berenguer M, Llorens P, Villanueva-Cutillas B, Martín-Sánchez FJ, Herrero P, and Miró Ò
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- Acute Disease, Emergency Service, Hospital, Humans, Kidney physiology, Prognosis, Heart Failure epidemiology
- Abstract
Objectives: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF)., Material and Methods: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group., Results: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences., Conclusion: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.
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- 2020
157. Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 - the Spanish ENCOVUR study.
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Alquézar-Arbé A, Piñera P, Jacob J, Martín A, Jiménez S, Llorens P, Martín-Sánchez FJ, Burillo-Putze G, García-Lamberechts EJ, González Del Castillo J, Rizzi M, Agudo Villa T, Haro A, Martín Díaz N, and Miró Ò
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- Absenteeism, Adult, COVID-19, COVID-19 Testing, Clinical Laboratory Techniques, Coronavirus Infections diagnosis, Disease Outbreaks, Emergency Service, Hospital organization & administration, Health Resources supply & distribution, Health Services Needs and Demand, Health Workforce statistics & numerical data, Hospital Bed Capacity, Hospitals, Public organization & administration, Hospitals, Public statistics & numerical data, Humans, Incidence, Personnel, Hospital statistics & numerical data, Pneumonia, Viral diagnosis, Resource Allocation, Respiratory Distress Syndrome diagnosis, Respiratory Distress Syndrome etiology, SARS-CoV-2, Spain epidemiology, Triage organization & administration, Betacoronavirus, Coronavirus Infections epidemiology, Emergency Service, Hospital statistics & numerical data, Health Care Surveys, Pandemics, Pneumonia, Viral epidemiology
- Abstract
Objectives: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area., Material and Methods: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates., Results: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population., Conclusion: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.
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- 2020
158. Frequency of five unusual presentations in patients with COVID-19: results of the UMC-19-S 1 .
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Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, and González Del Castillo J
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- Betacoronavirus, COVID-19, Guillain-Barre Syndrome virology, Humans, Myocarditis virology, Pancreatitis virology, Pandemics, Pericarditis virology, Pneumothorax virology, SARS-CoV-2, Spain epidemiology, Coronavirus Infections complications, Guillain-Barre Syndrome complications, Myocarditis complications, Pancreatitis complications, Pericarditis complications, Pneumonia, Viral complications, Pneumothorax complications
- Abstract
Despite SARS-CoV-19 infection has a stereotypical clinical picture, isolated cases with unusual manifestations have been reported, some of them being well-known to be triggered by viral infections. However, the real frequency in COVID-19 is unknown. Analysing data of 63 822 COVID patients attending 50 Spanish emergency department (ED) during the COVID outbreak, before hospitalisation, we report frequencies of (myo)pericarditis (0.71‰), meningoencephalitis (0.25‰), Guillain-Barré syndrome (0.13‰), acute pancreatitis (0.71‰) and spontaneous pneumothorax (0.57‰). Compared with general ED population, COVID patients developed more frequently Guillain-Barré syndrome (odds ratio (OR) 4.55, 95% confidence interval (CI) 2.09-9.90), spontaneous pneumothorax (OR 1.98, 95% CI 1.40-2.79) and (myo)pericarditis (OR 1.45, 95% CI 1.07-1.97), but less frequently pancreatitis (OR 0.44, 95% CI 0.33-0.60).
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- 2020
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159. [Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid].
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Martín-Sánchez FJ, Valls Carbó A, López Picado A, Martínez-Valero C, Miranda JD, Leal Pozuleo JM, and González Del Castillo J
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- Analysis of Variance, COVID-19, Coronavirus Infections prevention & control, Health Services Needs and Demand statistics & numerical data, Humans, Pandemics prevention & control, Pneumonia, Viral prevention & control, Public Health, Retrospective Studies, SARS-CoV-2, Spain epidemiology, Tertiary Care Centers, Betacoronavirus, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Emergency Service, Hospital statistics & numerical data, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Quarantine
- Abstract
Objective: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid., Methods: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate., Results: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts., Conclusions: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department., (©The Author 2020. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)
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- 2020
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160. Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review.
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Miró Ò, Rossello X, Platz E, Masip J, Gualandro DM, Peacock WF, Price S, Cullen L, DiSomma S, de Oliveira MT Jr, McMurray JJ, Martín-Sánchez FJ, Maisel AS, Vrints C, Cowie MR, Bueno H, Mebazaa A, and Mueller C
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- Acute Disease, Heart Failure epidemiology, Humans, Risk Factors, Disease Management, Emergency Service, Hospital statistics & numerical data, Heart Failure therapy, Hospitalization trends, Registries, Risk Assessment methods
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Aims: This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients., Methods and Results: A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4-13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74-0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80-0.84., Conclusions: There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.
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- 2020
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161. The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department.
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Llauger L, Jacob J, Herrero-Puente P, Aguirre A, Suñén-Cuquerella G, Corominas-Lasalle G, Llorens P, Martín-Sánchez FJ, Gil V, Roset A, Ruibal JC, Pérez-Durá MJ, Juan-Gómez MÁ, Garrido JM, Richard F, Lucas-Imbernon FJ, Alonso H, Tost J, Gil C, and Miró Ò
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- Acute Disease, Aged, Aged, 80 and over, Cardio-Renal Syndrome physiopathology, Cause of Death trends, Female, Follow-Up Studies, Glomerular Filtration Rate, Heart Failure mortality, Humans, Male, Prognosis, Prospective Studies, Spain epidemiology, Survival Rate trends, Anemia complications, Cardio-Renal Syndrome complications, Emergency Service, Hospital statistics & numerical data, Heart Failure complications, Registries
- Abstract
Background: The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes., Methods: We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m
2 , anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS-) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A-, RD-/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD-/A-). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups., Results: Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS- (hazard ratio = 1.46, 95% confidence interval = 1.26-1.68) and RD-/A- (hazard ratio = 1.83, 95% confidence interval = 1.46-2.28) control groups. The mortality level was also higher in RD+/A- (hazard ratio = 1.40, 95% confidence interval = 1.10-1.78) and higher, but not statistically significant, in RD-/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99-1.63) with respect to RD-/A-. All of the secondary outcomes, when related to CRAS- and RD-/A- control groups, were worse for CRAS+ and to a lesser extent, RD+/A-, being more rarely observed in RD-/A+., Conclusions: Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.- Published
- 2020
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162. [Transition care and follow-up for diabetic patients discharged].
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Matías Soler P, Álvarez-Rodríguez E, Gil Mosquera M, and Martín-Sánchez FJ
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- Follow-Up Studies, Humans, Patient Discharge, Diabetes Mellitus, Transitional Care
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- 2020
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163. [Cross-speciality geriatrics: A health-care challenge for the 21st century].
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, and Martín-Sánchez FJ
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- Aged, Aged, 80 and over, Cardiology, Clinical Decision-Making, Delivery of Health Care, Integrated, Frailty complications, Frailty epidemiology, General Surgery, Hematology, Humans, Medical Oncology, Patient-Centered Care, Prevalence, Treatment Outcome, Urology, Frailty diagnosis, Geriatric Assessment methods, Geriatrics organization & administration, Patient Care Team organization & administration
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Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years., (Copyright © 2019 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2020
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164. Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure.
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Harjola P, Miró Ò, Martín-Sánchez FJ, Escalada X, Freund Y, Penaloza A, Christ M, Cone DC, Laribi S, Kuisma M, Tarvasmäki T, and Harjola VP
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- Acute Disease, Electrocardiography, Europe epidemiology, Follow-Up Studies, Heart Failure diagnosis, Heart Failure mortality, Hospital Mortality trends, Humans, Retrospective Studies, Risk Factors, Surveys and Questionnaires, Survival Rate trends, Emergency Medical Services methods, Heart Failure therapy, Risk Assessment methods
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Aim: To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions., Methods and Results: A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke., Conclusions: The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions., (© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)
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- 2020
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165. Improve Management of acute heart failure with ProcAlCiTonin in EUrope: results of the randomized clinical trial IMPACT EU Biomarkers in Cardiology (BIC) 18.
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Möckel M, de Boer RA, Slagman AC, von Haehling S, Schou M, Vollert JO, Wiemer JC, Ebmeyer S, Martín-Sánchez FJ, Maisel AS, and Giannitsis E
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- Aged, Biomarkers, Europe epidemiology, Female, Humans, Male, Heart Failure drug therapy, Heart Failure epidemiology, Procalcitonin therapeutic use
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Aim: To determine whether initiation of antibiotic therapy (ABX) by procalcitonin (PCT) within 8 h of admission in patients presenting to the emergency department with symptoms and signs of acute heart failure (AHF) and elevated natriuretic peptides would improve clinical outcomes., Methods and Results: The study was a randomized multicentre clinical trial conducted at 16 sites in Europe. Patients were randomized to either a PCT-guided strategy or standard care. Patients with PCT-guided strategy (n = 370) had ABX initiated if PCT was > 0.2 μg/L. Patients with standard care (n = 372) had AHF care in accordance with published guidelines without PCT. The primary endpoint was 90-day all-cause mortality. Pre-specified secondary endpoints included 30-day all-cause mortality and readmission and rate of pneumonia. The Data Safety and Review Committee recommended stopping the study for futility when 762 of the planned 792 patients had been enrolled. A total of 742 patients could be analysed. Patients were elderly (median age: 77 years), 38% were women, and had typical signs and symptoms of AHF. All-cause mortality at 90 days was 10.3% in the PCT-guided group vs. 8.2% in standard care (P = 0.316). Thirty-day readmission was significantly higher in the PCT-guided group vs. standard care but the difference vanished until day 90. The rate of pneumonia was overall low (7.5%) and not different between groups., Conclusions: In patients with AHF, a strategy of PCT-guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes., (© 2019 The Authors.European Journal of Heart Failure © 2019 European Society of Cardiology.)
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- 2020
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166. Clinical characteristics and course in emergency department patients with chronic obstructive pulmonary disease and symptomatic acute venous thromboembolic disease: secondary analysis of the ESPHERIA registry.
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Carriel Mancilla J, Jiménez Hernández S, Martín-Sánchez FJ, Jiménez D, Fuentes Ferrer M, and Ruiz-Artacho P
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- Emergency Service, Hospital, Humans, Registries, Spain, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Embolism diagnosis, Pulmonary Embolism epidemiology, Venous Thrombosis
- Abstract
Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments., Material and Methods: Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry., Results: A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD., Conclusion: COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality.
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- 2020
167. A multidrug-resistant microorganism infection risk prediction model: development and validation in an emergency medicine population.
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González Del Castillo J, Julián-Jiménez A, Gamazo-Del Rio JJ, García-Lamberechts EJ, Llopis-Roca F, Guardiola Tey JM, Martínez-Ortiz de Zarate M, Navarro Bustos C, Piñera Salmerón P, Álvarez-Manzanares J, Ortega Romero MDM, Ruiz Grinspan M, García Gutiérrez S, Martín-Sánchez FJ, and Candel González FJ
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- Aged, Aged, 80 and over, Communicable Diseases diagnosis, Emergency Medicine statistics & numerical data, Female, Hospitalization, Humans, Male, Middle Aged, ROC Curve, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Communicable Diseases epidemiology, Communicable Diseases microbiology, Drug Resistance, Microbial, Drug Resistance, Multiple, Models, Theoretical
- Abstract
The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.
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- 2020
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168. Time-pattern of adverse outcomes after an infection-triggered acute heart failure decompensation and the influence of early antibiotic administration and hospitalisation: results of the PAPRICA-3 study.
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Miró Ò, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Escoda R, Pilar López-Díez M, Valero A, Fuentes M, Garrido JM, Salvo E, Rizzi MA, Aguirre A, Travería Bécquer L, Domínguez-Rodríguez A, Padrosa J, Martínez G, Arrigo M, Freund Y, and Mebazaa A
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Female, Heart Failure mortality, Humans, Infections drug therapy, Male, Patient Discharge, Patient Readmission statistics & numerical data, Registries, Time Factors, Anti-Bacterial Agents administration & dosage, Heart Failure etiology, Hospitalization statistics & numerical data, Infections complications
- Abstract
Objective: To investigate whether patients with an acute heart failure (AHF) episode triggered by infection present different outcomes compared to patients with no trigger and the effects of early antibiotic administration (EAA) and hospitalisation., Methods: Two groups were made according to the AHF trigger: infection (G1) or none identified (G2). The primary outcome was 13-week (91-days) all-cause mortality, and secondary outcomes were 13-week post-discharge mortality, readmission or combined endpoint. Comparisons are presented as unadjusted and adjusted (MEESSI risk score) hazard ratios (uHR/aHR) for G1 compared to G2 patients, also estimated by weeks. Stratified analysis by EAA (provided/not provided) and patient disposition (discharged/hospitalised) was performed., Results: We included 6727 patients (G1 = 3973; G2 = 2754). The 13-week mortality uHR was 1.11 (0.99-1.25; p = 0.06; with significant increases in the first 3 weeks), and the aHR was 0.91 (0.81-1.02; p = 0.11). There were no differences in unadjusted secondary post-discharge outcomes; however, G1 outcomes significantly improved after adjustment: aHR 0.83 (0.71-0.96; p = 0.01) for mortality, 0.92 (0.84-0.99; p = 0.04) for readmission, and 0.92 (0.85-0.99; p = 0.04) for the combined endpoint. We found a differentiated effect of hospitalisation (p < 0.05 for interaction; better post-discharge readmission and combined outcomes in G1), and a trend (p = 0.06) to lower mortality in G1 patients with EAA. Additionally, there were some differences between groups in baseline and acute episode characteristics., Conclusion: AHF triggered by infection is not associated with a higher mid-term mortality and has better post-discharge outcomes; however, the first 3 weeks are an extremely vulnerable period. Since hospitalisation could have a role in limiting adverse post-discharge events, and EAA in reducing mortality, these relationships should be prospectively explored in further studies.
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- 2020
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169. Identification of Senior At Risk scale predicts 30-day mortality among older patients with acute heart failure.
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Martín-Sánchez FJ, Llopis García G, González-Colaço Harmand M, Fernandez Pérez C, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Domínguez-Rodriguez A, Rossello X, and Miró O
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Area Under Curve, Emergency Service, Hospital, Female, Humans, Male, Odds Ratio, Regression Analysis, Risk Assessment methods, Time Factors, Frailty diagnosis, Heart Failure mortality
- Abstract
Objective: To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF)., Design: Observational multicenter cohort study., Setting: OAK-3 register., Subjects: Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016., Intervention: No., Variables: Variable of study was ISAR scale. The outcome was all-cause 30-day mortality., Results: We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value <.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P<.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points)., Conclusions: scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality., (Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)
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- 2020
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170. Author's reply.
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Martín-Sánchez FJ and Llopis García G
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- Aged, Emergency Service, Hospital, Humans, Patient Discharge, Physical Examination, Frailty, Heart Failure
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- 2020
171. The COVID-19 curve, health system overload, and mortality.
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Núñez-Gil IJ, Estrada V, Fernández-Pérez C, Fernández-Rozas I, Martín-Sánchez FJ, and Macaya C
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- Adolescent, Adult, Age Distribution, Age Factors, Aged, COVID-19, Cardiovascular Diseases mortality, Child, China epidemiology, Cohort Studies, Comorbidity, Coronavirus Infections complications, Coronavirus Infections diagnosis, Coronavirus Infections mortality, Female, Health Services Accessibility statistics & numerical data, Hospital Mortality, Humans, Male, Middle Aged, Pandemics, Patient Discharge statistics & numerical data, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Pneumonia, Viral mortality, SARS-CoV-2, Sex Distribution, Spain epidemiology, Symptom Assessment, United States epidemiology, Young Adult, Betacoronavirus, Coronavirus Infections epidemiology, Pneumonia, Viral epidemiology
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- 2020
172. Comprehensive heart failure assessment: A challenge to modify the course of heart failure.
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Martín-Sánchez FJ
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- Comorbidity, Humans, Italy, Cardiology, Heart Failure epidemiology
- Abstract
Competing Interests: Declaration of Competing Interest FJMS has received grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER(PI15/00773, and PI18/00456).
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- 2020
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173. Analysis of clinical characteristics and outcomes in patients with COVID-19 based on a series of 1000 patients treated in Spanish emergency departments.
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Gil-Rodrigo A, Miró Ò, Piñera P, Burillo-Putze G, Jiménez S, Martín A, Martín-Sánchez FJ, Jacob J, Guardiola JM, García-Lamberechts EJ, Espinosa B, Martín Mojarro E, González Tejera M, Serrano L, Agüera C, Soy E, Llauger L, Juan MÁ, Palau A, Del Arco C, Rodríguez Miranda B, Maza Vera MT, Martín Quirós A, Tejada de Los Santos L, Ruiz de Lobera N, Iglesias Vela M, Torres Garate R, Alquézar-Arbé A, González Del Castillo J, and Llorens P
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- Adolescent, Adult, Age Distribution, Age Factors, Aged, Aged, 80 and over, COVID-19, Cardiovascular Diseases epidemiology, Child, Child, Preschool, Comorbidity, Coronavirus Infections mortality, Coronavirus Infections therapy, Female, Hospital Mortality, Humans, Infant, Infant, Newborn, Intubation, Intratracheal statistics & numerical data, Logistic Models, Male, Middle Aged, Neoplasms epidemiology, Obesity complications, Odds Ratio, Pandemics, Pneumonia, Viral mortality, Pneumonia, Viral therapy, Prognosis, Prospective Studies, Respiration Disorders epidemiology, Respiration, Artificial statistics & numerical data, SARS-CoV-2, Sex Distribution, Spain epidemiology, Young Adult, Betacoronavirus, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Emergency Service, Hospital statistics & numerical data, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Symptom Assessment
- Abstract
Objectives: To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes., Material and Methods: Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments., Results: The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood., Conclusion: This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.
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- 2020
174. Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department.
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Martín-Sánchez FJ, González Del Castillo J, Valls Carbó A, López Picado A, Martínez-Valero C, D Miranda J, Chacón A, López-Ayala P, Chaparro D, Cozar López G, Suárez-Cadenas MDM, Jerez Fernández P, Del Toro E, Cardassay E, Angós B, Díaz Del Arco C, Rodríguez Adrada E, Montalvo Moraleda MT, Espejo Paeres C, Elvira C, García Briñón MÁ, Leal Pozuelo JM, Ortega L, Fernández Pérez C, and González Armengol JJ
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- Adult, COVID-19, Cause of Death, Comorbidity, Confidence Intervals, Coronavirus Infections complications, Coronavirus Infections therapy, Diagnosis-Related Groups, Emergency Service, Hospital statistics & numerical data, Female, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral therapy, Polymerase Chain Reaction statistics & numerical data, Registries statistics & numerical data, SARS-CoV-2, Spain epidemiology, Symptom Assessment, Time Factors, Treatment Outcome, Betacoronavirus, Coronavirus Infections diagnosis, Coronavirus Infections mortality, Pneumonia, Viral diagnosis, Pneumonia, Viral mortality
- Abstract
Objectives: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings., Material and Methods: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode., Results: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases., Conclusion: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.
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- 2020
175. [Impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly ambulatory patients with heart failure. A prospective and multicentre study].
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Díez-Villanueva P, Salamanca J, Ariza-Solé A, Formiga F, Martín-Sánchez FJ, Bonanad Lozano C, Vidán MT, Martínez-Sellés M, Terres B, Jiménez Méndez C, Bueno H, and Alfonso F
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- Aged, Aged, 80 and over, Cause of Death, Female, Frailty mortality, Frailty therapy, Functional Status, Heart Failure mortality, Heart Failure therapy, Humans, Male, Prevalence, Prognosis, Prospective Studies, Syndrome, Frailty epidemiology, Geriatric Assessment, Heart Failure epidemiology, Physical Functional Performance
- Abstract
Background and Objectives: Heart failure (HF) is a chronic disease that is often associated with ageing. There are predictive models based on variables that associate it with a poor prognosis, although those do not include common conditions in the elderly, such as frailty or comorbidity. The aim of this study is to determine the clinical and epidemiological characteristics of a cohort of elderly outpatients with HF followed-up by cardiologists. This will include a study of the prevalence of frailty and other geriatric syndromes, as well as their impact on the prognosis, and to evaluate whether these may improve predictive ability of such predictive models., Material and Methods: Observational, prospective, and multicentre study that will include 400 patients ≥75years old with chronic HF followed-up in Spanish tertiary hospitals by cardiology specialists in HF. Patients will undergo a comprehensive geriatric assessment, and prediction of events will be performed based on MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and Barcelona-Bio HF calculator scores. The primary endpoint is cardiovascular and overall mortality at 1 and 3years follow-up., Results: This study will assess both the characteristics and prognosis of elderly patients with HF followed-up by cardiologists in Spain and the applicability in the elderly population of scores used in the general population with chronic HF., Conclusion: This is the first prospective study that will systematically assess frailty and other geriatric syndromes in the elderly outpatient with HF in Spain and followed-up by cardiologists, thus contributing to improve knowledge about both its prevalence and impact on our patients., (Copyright © 2019 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2020
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176. NOVICA: Characteristics and outcomes of patients who have a first episode of heart failure (de novo).
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García Sarasola A, Alquézar Arbé A, Gil V, Martín-Sánchez FJ, Jacob J, Llorens P, Rizzi M, Fuenzalida C, Calderón S, and Miró Ò
- Abstract
Background and Objectives: To describe the clinical characteristics and prognosis (hospital mortality at 30 days and 12 months and emergency department readmission at 30 days for acute heart failure) of patients treated in hospital emergency departments for new-onset or de novo acute heart failure (NOAHF) and to compare the patients with those who consult for chronic decompensated heart failure (CDHF)., Patients: NOVICA is a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments registry. We compared demographic variables, baseline characteristics and data from acute episodes and follow-up at 30 days and 12 months of patients with NOAHF and CDHF., Results: We analysed 8647 patients, with 3288 cases of NOAHF (38%) and 5359 cases of CDHF (62%). NOAHF was associated with lower comorbidity, better baseline state, less severe acute episode data, less use of diuretics in intravenous infusion and oxygen therapy and lower hospitalization rates. The patients with NOAHF were admitted more often to cardiology and intensive care units, and the patients with CDHF were admitted more often to short-stay units. Rates of crude mortality at 30 days and 12 months and readmission at 30 days were higher for the patients with NOAHF. In the adjusted analysis, however, only the rate of readmission at 30 days was lower for NOAHF (p<.001)., Conclusions: Patients admitted to hospital emergency departments for NOAHF show a different clinical profile from patients with CDHF. In the adjusted analysis, there were no differences between the 2 groups regarding hospital mortality, 30-day mortality or 12-month mortality., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
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- 2019
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177. Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study.
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Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Tost J, Díez MPL, Traveria L, Torres-Gárate R, Alonso MI, Agüera C, Valero A, Javaloyes P, Peacock WF, Bueno H, Mebazaa A, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGY, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, Rodríguez-Adrada E, and Rodríguez B
- Subjects
- Aged, Aged, 80 and over, Female, Heart Failure physiopathology, Heart Failure therapy, Hospital Mortality trends, Humans, Male, Proportional Hazards Models, Risk Factors, Spain epidemiology, Stroke Volume, Survival Rate trends, Time Factors, Heart Failure mortality, Hospital Units statistics & numerical data, Length of Stay statistics & numerical data, Patient Discharge statistics & numerical data, Patient Readmission statistics & numerical data
- Abstract
Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation., Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units., Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH <6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) >15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk., Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2019
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178. 180-Day functional decline among older patients attending an emergency department after a fall.
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Miró Ò, Brizzi BN, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, Torres Machado V, Cenjor R, Gil A, Rico V, Álvarez Carretero M, Cuccolini L, Martínez Nadal G, Fernández Pérez C, Lázaro Del Nogal M, Platts-Mills TF, and Martín-Sánchez FJ
- Subjects
- Age Factors, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Fractures, Bone physiopathology, Hospitalization, Humans, Male, Prognosis, Registries, Retrospective Studies, Risk Factors, Time Factors, Accidental Falls, Activities of Daily Living, Health Status
- Abstract
Objectives: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall., Study Design: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors., Main Outcome Measures: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline., Results: 452 patients (mean age 80 ± 8 years; 70.8% women) were included. Baseline BI was 79.3 ± 23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline., Conclusion: Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2019
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179. Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self-care: impact on outcomes.
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Vidán MT, Martín Sánchez FJ, Sánchez E, Ortiz FJ, Serra-Rexach JA, Martínez-Sellés M, and Bueno H
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- Aged, Aged, 80 and over, Female, Heart Failure mortality, Humans, Male, Prognosis, Risk, Self Care statistics & numerical data, Spain, Surveys and Questionnaires, Survival Analysis, Activities of Daily Living psychology, Disability Evaluation, Heart Failure psychology, Heart Failure rehabilitation, Hospitalization, Outcome Assessment, Health Care, Self Care psychology
- Abstract
Aim: To evaluate the abilities to perform essential tasks for heart failure (HF) self-management in elderly patients, and its influence on post-discharge prognosis., Methods and Results: Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self-administered questionnaire European HF Self-care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self-care on 1-year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1 years. On average, patients could perform 2.9 ± 1.6 of self-care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self-care education had slight better performance (3.2 ± 1.6 vs 2.8 ± 1.6, P < 0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r = -0.135; P = 0.006). One-year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P = 0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32-1.03; and HR 0.40; 95% CI 0.21-0.77, respectively], without differences in readmissions., Conclusion: Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self-care. Self-perception of care was poorly correlated with real ability, and poor self-care ability was associated with higher 1-year mortality risk., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)
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- 2019
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180. Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes.
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Javaloyes P, Miró Ò, Gil V, Martín-Sánchez FJ, Jacob J, Herrero P, Takagi K, Alquézar-Arbé A, López Díez MP, Martín E, Bibiano C, Escoda R, Gil C, Fuentes M, Llopis García G, Álvarez Pérez JM, Jerez A, Tost J, Llauger L, Romero R, Garrido JM, Rodríguez-Adrada E, Sánchez C, Rossello X, Parissis J, Mebazaa A, Chioncel O, and Llorens P
- Subjects
- Acute Disease, Female, Heart Failure classification, Heart Failure therapy, Hospital Mortality, Humans, Male, Prognosis, Risk Factors, Treatment Outcome, Coronary Circulation, Emergency Service, Hospital, Heart Failure diagnosis, Phenotype
- Abstract
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., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)
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- 2019
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181. CORT-AHF Study: Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure.
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Miró Ò, Takagi K, Gayat E, Llorens P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Gil V, Wussler DN, Richard F, López-Grima ML, Gil C, Garrido JM, Pérez-Durá MJ, Alquézar A, Alonso H, Tost J, Lucas Invernón FJ, Mueller C, and Mebazaa A
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- Acute Disease, Aged, Aged, 80 and over, Diuretics therapeutic use, Dyspnea etiology, Early Medical Intervention, Emergency Service, Hospital, Female, Heart Failure complications, Humans, Length of Stay statistics & numerical data, Male, Mortality, Patient Readmission, Prognosis, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive complications, Adrenal Cortex Hormones therapeutic use, Bronchodilator Agents therapeutic use, Dyspnea therapy, Heart Failure drug therapy, Hospital Mortality, Pulmonary Disease, Chronic Obstructive drug therapy
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Objectives: This study investigated whether systemic corticosteroids (new onset) administered to patients with acute heart failure (AHF) have any association with outcomes, with differentiated analyses for patients with and without chronic obstructive pulmonary disease (COPD) as a comorbidity., Background: Patients with undiagnosed dyspnea frequently receive corticosteroids in emergency departments while determining a final diagnosis, but their effect on the outcomes of patients with AHF without overt COPD exacerbation is unknown., Methods: We selected patients with AHF from the EAHFE (Epidemiology of Acute Heart Failure in the Emergency Departments) registry, recording key data (new-onset corticosteroid therapy, COPD condition). Patients with and without COPD were analyzed separately. We calculated unadjusted and adjusted ratios for corticosteroid-treated compared with corticosteroid-untreated patients for 2 coprimary endpoints: 90-day all-cause mortality (from index episode) and 90-day post-discharge combined endpoint (all-cause mortality or readmission for AHF), with intermediate time-point estimations. Other secondary endpoints were calculated, and some sensitive and stratified analyses were performed., Results: We analyzed 11,356 patients: 8,635 without COPD (841 corticosteroid-treated, 9.7%) and 2,721 with COPD (753 corticosteroid-treated, 27.7%). There were several differences between treated and untreated patients, essentially because corticosteroid-treated patients were sicker. Although unadjusted outcomes were worse in corticosteroid-treated patients, especially in patients without COPD, these differences disappeared after adjustment: hazard ratios for 90-day mortality (without/with COPD) were 0.91 (95% confidence interval (CI): 0.76 to 1.10)/0.99 (95% CI: 0.78 to 1.26), and 1.09 (95% CI: 0.93 to 1.28)/1.02 (95% CI: 0.86 to 1.21) for the post-discharge combined endpoint. Analyses of intermediate time-point coprimary endpoints and secondary outcomes rendered similar estimations. Sensitivity and stratified analysis did not significantly modify these results., Conclusions: There is no evidence of harm related to the new onset of systemic corticosteroid therapy during an episode of AHF, either in patients with or without concomitant COPD., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2019
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182. Editor's Choice- Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients.
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Rossello X, Gil V, Escoda R, Jacob J, Aguirre A, Martín-Sánchez FJ, Llorens P, Herrero Puente P, Rizzi M, Raposeiras-Roubín S, Wussler D, Müller CE, Gayat E, Mebazaa A, and Miró Ò
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- Acute Disease, Aged, 80 and over, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Male, Precipitating Factors, Prognosis, Retrospective Studies, Risk Factors, Spain epidemiology, Survival Rate trends, Heart Failure mortality, Registries, Risk Assessment methods
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Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure., Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor., Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02-3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56-0.94) and hypertension (OR 0.34; 95% CI 0.21-0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors., Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient's gender and age. They can be managed with specific treatments and can sometimes be prevented.
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- 2019
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183. Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort.
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Miró Ò, García Sarasola A, Fuenzalida C, Calderón S, Jacob J, Aguirre A, Wu DM, Rizzi MA, Malchair P, Haro A, Herrera S, Gil V, Martín-Sánchez FJ, Llorens P, Herrero Puente P, Bueno H, Domínguez Rodríguez A, Müller CE, Mebazaa A, Chioncel O, and Alquézar-Arbé A
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- Aged, Aged, 80 and over, Female, Heart Failure mortality, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Spain, Emergency Service, Hospital statistics & numerical data, Heart Failure therapy, Hospital Departments, Patient Readmission statistics & numerical data
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Objectives: We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control., Methods and Results: We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78)., Conclusion: In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)
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- 2019
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184. Diagnosis of acute myocardial infarction in the presence of left bundle branch block.
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Nestelberger T, Cullen L, Lindahl B, Reichlin T, Greenslade JH, Giannitsis E, Christ M, Morawiec B, Miro O, Martín-Sánchez FJ, Wussler DN, Koechlin L, Twerenbold R, Parsonage W, Boeddinghaus J, Rubini Gimenez M, Puelacher C, Wildi K, Buerge T, Badertscher P, DuFaydeLavallaz J, Strebel I, Croton L, Bendig G, Osswald S, Pickering JW, Than M, and Mueller C
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- Area Under Curve, Biomarkers analysis, Clinical Decision Rules, Emergency Service, Hospital statistics & numerical data, Female, Humans, Male, Middle Aged, Prospective Studies, Time-to-Treatment, Algorithms, Bundle-Branch Block diagnosis, Bundle-Branch Block epidemiology, Diagnostic Errors prevention & control, Electrocardiography methods, Myocardial Infarction blood, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction therapy, Troponin I analysis
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Objective: Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician., Methods: We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. The final diagnosis of AMI was centrally adjudicated by two independent cardiologists according to the universal definition of myocardial infarction., Results: Among 8830 patients, LBBB was present in 247 (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1%-12%) but high specificity (95%-100%) for AMI. The diagnostic accuracy as quantified by the receiver operating characteristics (ROC) curve of hs-cTnT and hs-cTnI concentrations at presentation (area under the ROC curve (AUC) 0.91, 95% CI 0.85 to 0.96 and AUC 0.89, 95% CI 0.83 to 0.95), as well as that of their 0/1-hour and 0/2-hour changes, was very high. A diagnostic algorithm combining ECG criteria with hs-cTnT/I concentrations and their absolute changes at 1 hour or 2 hours derived in cohort 1 (45 of 45(100%) patients with AMI correctly identified) showed high efficacy and accuracy when externally validated in cohorts 2 and 3 (28 of 29 patients, 97%)., Conclusion: Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with hs-cTnT/I testing at 0/1 hour or 0/2 hours allows early and accurate diagnosis of AMI in LBBB., Trial Registration Number: APACE: NCT00470587; ADAPT: ACTRN12611001069943; TRAPID-AMI: RD001107;Results., Competing Interests: Competing interests: CM has received research grants from the Swiss National Science Foundation and the Swiss Heart Foundation, the European Union, the Cardiovascular Research Foundation Basel, 8sense, Abbott, Alere, AstraZeneca, Beckman Coulter, bioMerieux, BRAHMS, Critical Diagnostics, Nanosphere, Roche, Siemens, Singulex and the University Hospital Basel, as well as speaker or consulting honoraria from Abbott, Alere, AstraZeneca, BG Medicine, bioMerieux, BMS, Boehringer Ingelheim, BRAHMS, Cardiorentis, Daiichi Sankyo, Novartis, Roche, Sanofi, Singulex and Siemens. LC reports grants from Roche and from Abbott, during the conduct of the study, grants from Roche, grants and personal fees from Abbott Diagnostics, grants from Siemens, grants from Radiometer, personal fees from AstraZeneca, and grants from Alere, outside the submitted work. BL has served as a consultant for Roche Diagnostics, Beckman Coulter, Siemens Healthcare Diagnostics, Radiometer Medical, bioMérieux Clinical Diagnostics, Philips Healthcare and Fiomi Diagnostics. TR has received research grants from the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the University of Basel, the Professor Max Cloetta Foundation, and the Department of Internal Medicine, University Hospital Basel, as well as speaker’s honoraria from BRAHMS and Roche. EG has received honoraria for lectures from Roche Diagnostics, BRAHMS, Thermo Fisher and Mitsubishi Chemical Europe. MC has received research support and speaking honoraria from Roche, Thermo Fisher and Novartis. RT reports speaker honoraria from BRAHMS and Roche. WP reports grants from Roche and from Abbott, during the conduct of the study, and grants from Roche, grants and personal fees from Abbott Diagnostics, grants from Siemens, grants from Radiometer, personal fees from AstraZeneca, non-financial support from Bayer, personal fees from Hospira and grants from Alere, outside the submitted work. MRG has received speaking honoraria from Abbott and a research grant from the Swiss Heart Foundation. JB has received speaking honoria from Siemens. GB is an employee of Roche Diagnostics. JWP is supported by a Senior Research Fellowship from the Canterbury Medical Research Foundation, Emergency Care Foundation and Canterbury District Health. All other authors declare that they have no conflict of interest with this study., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
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185. Prognostic value of chest radiographs in patients with acute heart failure: the Radiology in Acute Heart Failure (RAD-ICA) study.
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Llorens P, Javaloyes P, Masip J, Gil V, Herrero-Puente P, Martín-Sánchez FJ, Jacob J, Garrido JM, Herrera-Mateo S, López Díez MP, Concepción-Aramendia L, and Miró Ò
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- Acute Disease, Aged, 80 and over, Cardiomegaly diagnostic imaging, Cardiomegaly mortality, Emergency Service, Hospital, Female, Heart Failure mortality, Hospital Mortality, Humans, Length of Stay, Lung blood supply, Lung diagnostic imaging, Male, Patient Readmission, Pleural Effusion diagnostic imaging, Pleural Effusion mortality, Prognosis, Pulmonary Edema diagnostic imaging, Pulmonary Edema mortality, Time Factors, Heart Failure diagnostic imaging, Radiography, Thoracic
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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.
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- 2019
186. Acute heart failure and adverse events associated with the presence of renal dysfunction and hyperkalaemia. EAHFE- renal dysfunction and hyperkalaemia.
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Jacob J, Llauger L, Herrero-Puente P, Martín-Sánchez FJ, Llorens P, Roset A, Gil V, Fuentes M, Lucas-Imbernón FJ, and Miró Ò
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- Acute Disease, Aged, Cause of Death, Female, Heart Failure mortality, Humans, Male, Prospective Studies, Registries, Heart Failure complications, Hyperkalemia etiology, Kidney Diseases etiology
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Objective: To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination., Method: We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality., Results: A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67-3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04-1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04-1.70); (p = 0.021) for the RD-Hk group., Conclusions: The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2019
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187. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction.
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Puelacher C, Gugala M, Adamson PD, Shah A, Chapman AR, Anand A, Sabti Z, Boeddinghaus J, Nestelberger T, Twerenbold R, Wildi K, Badertscher P, Rubini Gimenez M, Shrestha S, Sazgary L, Mueller D, Schumacher L, Kozhuharov N, Flores D, du Fay de Lavallaz J, Miro O, Martín-Sánchez FJ, Morawiec B, Fahrni G, Osswald S, Reichlin T, Mills NL, and Mueller C
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- Aged, Aged, 80 and over, Angina, Unstable diagnosis, Angina, Unstable mortality, Angina, Unstable therapy, Biomarkers blood, Cause of Death, Disease Progression, Europe epidemiology, Female, Humans, Incidence, Male, Middle Aged, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction mortality, Non-ST Elevated Myocardial Infarction therapy, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, Troponin blood, Angina, Unstable epidemiology, Non-ST Elevated Myocardial Infarction epidemiology
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Objective: Assess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI)., Design: Two independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year., Results: 8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0)., Conclusions: The relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar., Competing Interests: Competing interests: Dr CP reports a personal grant from the PhD Educational Platform Health Sciences, outside this study. Dr MG report no conflicts of interest. Dr PDA reports grants from New Zealand Heart Foundation, during the conduct of the study, and grants from AstraZeneca, outside the submitted work. Dr AS reports other from Abbott Diagnostics, during the conduct of the study. Dr AA reports personal fees from Abbott Diagnostics, outside the submitted work. Dr MRG received speaker honoraria from Abbott, outside the submitted work. Dr RT reports grants from Swiss National Science Foundation (grant number P300PB-167803), personal fees from Roche Diagnostics, personal fees from Abbott, personal fees from Siemens, outside the submitted work. Dr TR has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the Professor Max Cloëtta Foundation, the University of Basel and the University Hospital Basel as well as speaker honoraria from Brahms and Roche, outside the submitted work. Dr NLM reports grants and personal fees from Abbott Diagnostics, Roche Diagnostics and Singulex outside the submitted work. Dr CM has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the Stiftung für kardiovaskuläre Forschung Basel; Abbott, Alere, AstraZeneca, Beckman Coulter, Biomerieux, Brahms, Roche, Siemens, Singulex, Sphingotec and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria/consulting honoraria from Abbott, Alere, AstraZeneca, Biomerieux, Boehringer Ingelheim, BMS, Brahms, Cardiorentis, Novartis, Roche, Siemens and Singulex, during conduct of this study. All other authors report no conflicts of interest with this study., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
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188. Intervention programme for elderly frail patients discharged from the emergency department.
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Martín-Sánchez FJ, Gil Gregorio P, Calvo Manuel E, and Fernández Alonso C
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- 2019
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189. Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study).
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Bailón MM, Rodrigo JMC, Lorenzo-Villalba N, Cerqueiro JM, García JC, Manuel EC, Martín-Sánchez FJ, Freire RB, Romano PC, Espinosa LM, Arévalo-Lorido JC, Rojo JMC, and Macho JT
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- Adult, Aged, Aged, 80 and over, Female, Heart Failure drug therapy, Humans, Male, Middle Aged, Prognosis, Random Allocation, Single-Blind Method, Ultrasonography, Lung diagnostic imaging, Pulmonary Edema diagnosis, Pulmonary Edema diagnostic imaging
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Introduction and Objectives: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound has shown to be highly sensitive for detecting PC in HF. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF compared with conventional treatment., Materials and Methods: Randomized, multicenter, single-blind clinical trial in patients discharged from Internal Medicine Departments after hospitalization for decompensated HF. Participants will be assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus clinical assessment of congestion. The primary outcome is the combination of cardiovascular death and readmission for HF at 6 months., Conclusions: The results of this study will provide more evidence about the impact of lung ultrasound on treatment monitoring in patients with chronic HF.
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- 2019
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190. Analysis of How Emergency Physicians' Decisions to Hospitalize or Discharge Patients With Acute Heart Failure Match the Clinical Risk Categories of the MEESSI-AHF Scale.
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Miró Ò, Rossello X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P, Jacob J, Piñera P, Mojarro EM, Lucas-Imbernón FJ, Llauger L, Agüera C, López-Díez MP, Valero A, Bueno H, and Pocock SJ
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- Acute Disease, Aged, Aged, 80 and over, Emergency Service, Hospital standards, Female, Heart Failure epidemiology, Hospital Mortality trends, Hospitalization statistics & numerical data, Humans, Male, Observational Studies as Topic, Patient Discharge statistics & numerical data, Prospective Studies, Retrospective Studies, Risk Assessment methods, Risk Factors, Sensitivity and Specificity, Clinical Decision-Making methods, Heart Failure diagnosis, Heart Failure mortality, Physicians statistics & numerical data, Practice Patterns, Physicians' standards
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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., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
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191. Strategies for sepsis identification in the Emergency Department.
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Castillo JG, Nuñez-Orantos MJ, García-Lamberechts EJ, and Martín-Sánchez FJ
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- Emergency Service, Hospital, Humans, Sepsis
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192. Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments.
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Martín-Sánchez FJ, Cuesta Triana F, Rossello X, Pardo García R, Llopis García G, Caimari F, Vidán MT, Ruiz Artacho P, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Fernández Pérez C, Gil P, Bueno H, Miró Ò, Matía Martín P, Rodríguez Adrada E, Santos MC, Salgado L, Brizzi BN, Docavo ML, Del Mar Suárez-Cadenas M, Xipell C, Sánchez C, Aguiló S, Gaytan JM, Jerez A, Pérez-Durá MJ, Berrocal Gil P, López-Grima ML, Valero A, Aguirre A, Pedragosa MÀ, Piñera P, LázaroAragues P, Sánchez Nicolás JA, Rizzi MA, Herrera Mateo S, Alquezar A, Roset A, Ferrer C, Llopis F, Álvarez Pérez JM, López Diez MP, Richard F, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Andueza JA, Sevillano Fernández JA, Romero R, Merlo Loranca M, Álvarez Rodríguez V, Lorca MT, Calderón L, Soy Ferrer E, Manuel Garrido J, and Martín Mojarro E
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- Acute Disease, Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Malnutrition diagnosis, Prospective Studies, Registries, Risk Assessment, Risk Factors, Spain epidemiology, Emergency Service, Hospital statistics & numerical data, Heart Failure mortality, Malnutrition epidemiology, Nutrition Assessment
- Abstract
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., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2019
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193. The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure.
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Romero R, Gaytán JM, Aguirre A, Llorens P, Gil V, Herrero P, Jacob J, Martín-Sánchez FJ, Pérez-Durá MJ, Alquézar A, López ML, Roset À, Peacock WF, Hollander JE, Coll-Vinent B, and Miró Ò
- Subjects
- Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation mortality, Atrial Fibrillation therapy, Comorbidity, Electrocardiography, Emergency Service, Hospital, Female, Heart Failure diagnosis, Heart Failure mortality, Heart Failure therapy, Hospital Mortality, Humans, Male, Predictive Value of Tests, Prognosis, Registries, Risk Factors, Spain epidemiology, Time Factors, Atrial Fibrillation epidemiology, Heart Failure epidemiology
- Abstract
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.
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- 2019
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194. Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute Heart Failure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute Heart Failure in Emergency Departments Registry.
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Rossello X, Miró Ò, Llorens P, Jacob J, Herrero-Puente P, Gil V, Rizzi MA, Pérez-Durá MJ, Espiga FR, Romero R, Sevillano JA, Vidán MT, Bueno H, Pocock SJ, and Martín-Sánchez FJ
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- Aged, Aged, 80 and over, Female, Heart Failure therapy, Humans, Male, Predictive Value of Tests, Prognosis, Prospective Studies, Spain epidemiology, Emergency Service, Hospital, Heart Failure mortality, Registries statistics & numerical data
- Abstract
Study Objective: We assess the value of the Barthel Index (BI) in predicting 30-day mortality risk among patients with acute heart failure who are attending the emergency department (ED)., Methods: We selected 9,098 acute heart failure patients from the Acute Heart Failure in Emergency Departments registry who had BI score available both at baseline and the ED visit. Patients' data were collected from 41 Spanish hospitals during four 1- to 2-month periods between 2009 and 2016. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and BI score. c Statistics were used to estimate their prognostic value., Results: The mean baseline BI score was 79.4 (SD 24.6) and the mean ED BI score was 65.3 (SD 29.1). Acute functional decline (≥5-point decrease between baseline BI and ED BI score) was observed in 5,771 patients (53.4%). Within 30 days of the ED visit, 905 patients (9.9%) died. There was a steep inverse gradient in 30-day mortality risk for baseline BI and ED BI score. For instance, compared with BI score=100, a BI score of 50 to 55 doubled the mortality risk both at baseline and the ED visit. At the ED visit, a BI score of 0 to 5 carried a 5-fold increase in risk after adjustment for other risk predictors. In comparison with baseline BI score, ED BI score consistently provided greater discrimination. Neither baseline BI score nor the change in BI score from baseline to the ED visit added further prognostic value to the ED BI score., Conclusion: Functional status assessed by the BI score at the ED visit is a strong predictor of 30-day mortality in acute heart failure patients, with higher predictive value than baseline BI score and acute functional decline. Routine recording of BI score at the ED visit may help in decisionmaking and health care planning., (Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
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- 2019
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195. [Isolation of the patient from the emergency department: improvement strategy].
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González Del Castillo J, García Lamberechts EJ, Martín-Sánchez FJ, and Núñez-Orantos MJ
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- Emergency Service, Hospital, Humans, Patient Isolation, Critical Illness, Emergency Nursing
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- 2019
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196. Effect of Milk and Other Dairy Products on the Risk of Frailty, Sarcopenia, and Cognitive Performance Decline in the Elderly: A Systematic Review.
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Cuesta-Triana F, Verdejo-Bravo C, Fernández-Pérez C, and Martín-Sánchez FJ
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- Aged, Aging, Animals, Dementia prevention & control, Dietary Fats administration & dosage, Dietary Proteins pharmacology, Humans, Milk, Muscle, Skeletal metabolism, Sarcopenia metabolism, Cognition drug effects, Dairy Products, Diet, Feeding Behavior, Frailty prevention & control, Muscle, Skeletal drug effects, Sarcopenia prevention & control
- Abstract
Nutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases [MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings., (Copyright © American Society for Nutrition 2019.)
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- 2019
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197. [Comparison of different strategies for short-term death prediction in the infected older patient].
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Yañez MC, Salido Mota M, Fuentes Ferrer M, Julián-Jiménez A, Piñera P, Llopis F, Gamazo Del Rio J, Martínez Ortiz de Zarate M, Estella A, Martín-Sánchez FJ, and González Del Castillo J
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- Aged, Aged, 80 and over, Area Under Curve, Cohort Studies, Comorbidity, Drug Resistance, Bacterial, Female, Hospital Mortality, Humans, Lactic Acid blood, Male, Predictive Value of Tests, Prognosis, Prospective Studies, Severity of Illness Index, Spain epidemiology, Infections mortality
- Abstract
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.The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed., 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., (©The Author 2019. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)
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- 2019
198. The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department.
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Miró Ò, Rosselló X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, López-Grima ML, Gil C, Lucas Imbernón FJ, Garrido JM, Pérez-Durá MJ, López-Díez MP, Richard F, Bueno H, and Pocock SJ
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- Acute Disease, Aged, Aged, 80 and over, Echocardiography, Female, Heart Failure epidemiology, Hospital Mortality trends, Humans, Incidence, Male, Retrospective Studies, Risk Factors, Severity of Illness Index, Spain epidemiology, Survival Rate trends, Emergency Service, Hospital standards, Heart Failure diagnosis, Registries, Risk Assessment methods
- Abstract
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., (Copyright © 2018 Sociedad Española de Cardiología. All rights reserved.)
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- 2019
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199. External Validation of the MEESSI Acute Heart Failure Risk Score: A Cohort Study.
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Wussler D, Kozhuharov N, Sabti Z, Walter J, Strebel I, Scholl L, Miró O, Rossello X, Martín-Sánchez FJ, Pocock SJ, Nowak A, Badertscher P, Twerenbold R, Wildi K, Puelacher C, du Fay de Lavallaz J, Shrestha S, Strauch O, Flores D, Nestelberger T, Boeddinghaus J, Schumacher C, Goudev A, Pfister O, Breidthardt T, and Mueller C
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- Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Heart Failure diagnosis, Humans, Logistic Models, Male, Prospective Studies, Reproducibility of Results, Spain epidemiology, Switzerland epidemiology, Heart Failure mortality, Risk Assessment methods
- Abstract
Background: The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in patients presenting with acute heart failure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown., Objective: To externally validate the MEESSI-AHF score in another country., Design: Prospective cohort study. (ClinicalTrials.gov: NCT01831115)., Setting: Multicenter recruitment of dyspneic patients presenting to the ED., Participants: The external validation cohort included 1572 patients with AHF., Measurements: Calculation of the MEESSI-AHF score using an established model containing 12 independent risk factors., Results: Among 1572 patients with adjudicated AHF, 1247 had complete data that allowed calculation of the MEESSI-AHF score. Of these, 102 (8.2%) died within 30 days. The score predicted 30-day mortality with excellent discrimination (c-statistic, 0.80). Assessment of cumulative mortality showed a steep gradient in 30-day mortality over 6 predefined risk groups (0 patients in the lowest-risk group vs. 35 [28.5%] in the highest-risk group). Risk was overestimated in the high-risk groups, resulting in a Hosmer-Lemeshow P value of 0.022. However, after adjustment of the intercept, the model showed good concordance between predicted risks and observed outcomes (P = 0.23). Findings were confirmed in sensitivity analyses that used multiple imputation for missing values in the overall cohort of 1572 patients., Limitations: External validation was done using a reduced model. Findings are specific to patients with AHF who present to the ED and are clinically stable enough to provide informed consent. Performance in patients with terminal kidney failure who are receiving long-term dialysis cannot be commented on., Conclusion: External validation of the MEESSI-AHF risk score showed excellent discrimination. Recalibration may be needed when the score is introduced to new populations., Primary Funding Source: The European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel, and University Hospital Basel.
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- 2019
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200. Analysis of the citation of articles published in the European Journal of Emergency Medicine since its foundation.
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Fernández-Guerrero IM, Martín-Sánchez FJ, Burillo-Putze G, Graham CA, and Miró Ò
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- Bibliometrics, Europe, History, 20th Century, History, 21st Century, Humans, Journal Impact Factor, Journalism, Medical history, Publishing, Emergency Medicine history, Periodicals as Topic statistics & numerical data
- Abstract
Objectives: The aim of this study was to evaluate the evolution of the citation of articles from the European Journal of Emergency Medicine (EJEM) from 1994 (EJEM foundation) to 2015 and identify highly cited articles and their principal characteristics and determine a possible correlation between the citations counted in different databases., Materials and Methods: We obtained the articles published in EJEM from 1994 to 2015 in ISI-WoS (main source) and Scopus, Google Scholar, and Medline databases (accessory sources). The citations were quantified and their annual evolution and the bibliometric indices derived (impact factor and SCImago Journal Rank) were evaluated. We identified and analyzed the highly cited EJEM articles and evaluated the possible correlation between the citations counted for these articles in the databases., Results: Overall, 1705 EJEM articles were cited 9422 times in 8122 different articles. The evolution of the global citation, impact factor, and SCImago Journal Rank from 1994 to 2015 increased significantly. The h-index of EJEM was 30, and 31 articles were considered highly cited (≥30 citations), 16.1% of them being clinical trials. By subjects, 22.5% corresponded to cardiology, 19.3% to emergency department management, and 12.9% to pediatrics; by countries, 81% were from Europe, with Belgian authors publishing four (12.9%) highly cited articles, and French, Spanish, British, and Swedish authors having three (9.7%) each. Two studies in the EJEM achieved the definition of 'citation classics' (more than 100 citations). The number of citations in all the databases, except Medline, showed statistically significant correlations., Conclusion: Citation of EJEM articles has progressively increased and EJEM bibliometric indicators have improved; most highly cited articles are mainly by European authors.
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- 2019
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