Search

Background: Telemonitoring with applications and connected devices facilitates a more accessible and efficient attention. Its implementation has been accelerated thanks to the pandemic by COVID-19, where they have allowed the continuity of care. Objective: To evaluate the efficacy of a remote monitoring platform for the outpatient follow-up after hospital discharge by COVID-19. Methods: Prospective observational study of patients discharged from the hospital with COVID-19 infection between March 23 and May 25, 2020, who were followed for one month with the Connected Health telemonitoring platform. The mobile phone application connected to a pulse oximeter, allowed to measure vital signs and answer health questionnaires (EQ5D3L and CAT) daily, and alert the medical team that could be contacted by video consultation. Results: 95 patients (64% male) with a mean age of 54 (SD 26-81) years were included. The application allowed the detection of alerts for pain (80% of patients) and a decrease in oxygen saturation (12%). No patient required hospital readmission or presented complications. The application allowed strict monitoring of symptoms and quality of life. The main symptom was severe pain (59% of patients) followed by anxiety or depression (25%). The average state of health was 65 (SD 20-100). COVID-19 caused a low impact on the quality of life of 62% of the patients, although 8% reported a significant limitation, due to shortness of breath and leaving the house. Conclusion: telemonitoring allows a safe remote monitoring of patients after hospital discharge by COVID-19. The Connected Health application has allowed the measurement of oxygen saturation, symptoms and quality of life, and the detection and management of alerts by the medical team through video consultation.

Background: Mobile technology has emerged as a potentially useful platform to facilitate weight management and tackle the current obesity epidemic. Objective: To evaluate the efficacy of a remote monitoring platform for overweight patients. Methods: Multicenter prospective observational study of overweight patients seen in an endocrinology clinic of 5 healthcare centers, between August 2017 and August 2020, who were followed with the Connected Health telemonitoring platform. The mobile phone application connected to a scale and activity wristband, allowed to measure weight, activity, answer health questionnaire and its management by the medical team that could be contacted by video consultation. Results: 79 patients (57% female) with a mean age of 46,8 (SD 23-70) years were included with a mean follow-up of 12.9 months (SD 4-36). The application allowed to measure weight, activity and quality of life and no patient presented complications. The mean weight of all patients at the beginning of the intervention was 84.1 kg and at the end of the follow-up it was 82.4 kg, with a mean reduction of 1.7 kg (p

Resumen El embarazo es predictor de riesgo cardiovascular futuro que puede desenmascarar trastornos metabolicos o vasculares latentes. El retraso en la edad reproductiva y su asociacion a otros factores de riesgo han incrementado los embarazos con complicaciones medicas. Actualmente existe un excelente protocolo nacional de atencion continuada a las mujeres que desarrollan estas complicaciones durante el embarazo. Pero tras el parto se inicia este periodo llamado «cuarto trimestre», que hace referencia al resto de la vida de la mujer tras el embarazo y donde disminuye el seguimiento. El objetivo de este documento es establecer recomendaciones en el «cuarto trimestre», avaladas por la Sociedad Espanola de Obstetricia y Ginecologia (SEGO), la Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN), la Sociedad Espanola de Medicina de Familia y Comunitaria (semFYC) y la Sociedad Espanola de Cardiologia (SEC), para asegurar el seguimiento de los factores de riesgo y potenciales complicaciones cardiovasculares que puedan desarrollarse a partir del «cuarto trimestre».

This document has been endorsed by the Diabetes and Obesity Working Group of the Spanish Society of Cardiology and the Diabetic Nephropathy Group of the Spanish Society of Nephrology. In this document on the management of patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease or very high cardiovascular risk, it is intended to cover all aspects that should be considered in the treatment of these patients in order to reduce their cardiovascular risk and improve their clinical outcome. A new paradigm is being witnessed in the treatment of T2DM. The reduction of cardiovascular complications and mortality in patients with T2DM and cardiovascular disease, or high cardiovascular risk, goes beyond blood glucose control, and seems to be related more to the specific benefit provided by the new drugs. These include the group of sodium-glucose co-transporter type 2 inhibitors and the group of agonists of the glucagon-like peptide-1 receptor. The objective of this work is to update the document published by this working group at the beginning of 2018, and to provide information to specialties such, as cardiology and nephrology, on these new families of drugs that improve cardiovascular and renal prognosis

The irruption of technology in healthcare is an increasingly evident reality, driven by the rise of digital health, which provides innovative patient-centered care solutions like artificial intelligence (AI) and bots, promoting accessibility, quality, safety and efficiency in all areas of health...

Introduction: Digital health facilitates patient-centered, accessible, safe, and more efficient care, through technologies such as telemedicine, big data, bots, artificial intelligence, and other technologies. Undoubtedly, its implementation has been accelerated thanks to the COVID-19 pandemic, where they have demonstrated their effectiveness, by maintaining continuity of care and facilitating early interventions thanks to the analysis of data and the deployment of bots, telemonitoring and virtual care platforms. Objective and methods: Prospective observational study to describe the digital health solutions implemented by Sanitas hospitals, a health insurance company with around 2 million costumers, 5 teaching hospitals and many outpatient health care facilities throughout Spain, to maintain continuity of care during COVID-19 pandemic. We outline the results of using the Sanitas telemedicine platform (video consultations and Connected Health application) and chatbot. Results: During the first 2 months of the COVID-19 outbreak, we have experienced an exponential increase in the number of video consultations, coming from an average of 300 a day before the COVID-19 crisis to around 5000 a day, going from 27.058 virtual visits made during 2019, to 114.598 in the first 5 months of 2020. The Connected Health mobile phone application allowed to remote monitoring 95 patients after hospital discharge for COVID-19 infection, measuring vital signs with a connected pulse oximeter, answer health questionnaires daily, and alert the medical team who received alerts for pain from 80% of patients and a decrease in oxygen saturation in 12% of cases. Bots has also helped to fight the COVID-19 crisis, making information available by providing the best answer to patients whenever they want it 24/7. Our bot SanIA has experienced 16.858 consultations about COVID-19 during the first 2 months of the outbreak. Conclusions: Digital health, throughout video consultations, telemonitoring platform and bots, has helped to maintain continuity of care during the COVID-19 crisis. The COVID-19 pandemic has brought a sudden change in the adoption of digital health strategies, which will undoubtedly continue in the long term, and has served us, both health staff and the population, to be better prepared for this next digital age.

Bleeding in ACS patients is an independent marker of adverse outcomes. Its prognostic impact is even worse in elderly population. Current bleeding risk scores include chronological age but do not consider biologic vulnerability. No studies have assessed the effect of frailty on major bleeding. The aim of this study is to determine whether frailty status increases bleeding risk in patients with ACS.This prospective and observational study included patients aged ≥75years admitted due to type 1 myocardial infarction. Exclusion criteria were severe cognitive impairment, impossibility to measure handgrip strength, cardiogenic shock and limited life expectancy due to oncologic diseases. The primary endpoint was 30-day major bleeding defined as a decrease of ≥3g/dl of haemoglobin or need of transfusion.A total of 190 patients were included. Frail patients (72, 37.9%) were older, with higher comorbidity features and with a higher CRUSADE score at admission. On univariate analysis, frailty predicted major bleeding during 30-day follow-up despite less frequent use of a P2Y12 inhibitor (66.2% vs 83.6%, p=0.007) and decreased catheterisation rate (69.4% vs 94.1%, p0.001). Major bleeding was associated with increased all-cause mortality at day 30 (18.2% vs 2.5%, p0.001). On multivariate analysis, frailty was an independent predictor for major bleeding.Frailty phenotype, as a marker of biological vulnerability, is an independent predictor of major bleeding in elderly patients with ACS. Frailty can play an important role in bleeding risk stratification and objective indices should be integrated into routine initial evaluation of these patients.

Cardiovascular diseases are the leading cause of death in the world. Coronary artery diseases, atrial fibrillation or hypertensive heart disease, are among the most important cardiovascular disorders. Hypertension represents a significant risk factor for cardiovascular mortality; thus, control of high blood pressure has become a priority to prevent major complications. Although the choice of drugs for treating hypertension remains controversial, extensive clinical evidences point to calcium channel blockers as first-line agents. Diltiazem, a non-dihydropyridine calcium channel blocker, is an effective and safe antihypertensive drug, alone or in combination with other agents. Diltiazem lowers myocardial oxygen demand through a reduction in heart rate, blood pressure, and cardiac contractility, representing also a good alternative for the treatment of stable chronic angina. Furthermore, diltiazem reduces conduction in atrioventricular node, which is also useful for heart rate control in patients with atrial fibrillation. In this review, clinical experts highlight studies on diltiazem effectiveness and safety for the treatment of several cardiovascular diseases and make evidence-based recommendations regarding the management of diltiazem in the clinical prac Sponsorship for this review and the article processing charges was funded by Lacer Spain. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Writing assistance in the preparation of this manuscript was provided by Patricia Rodriguez, PhD, and editorial assistance was provided by Springer Healthcare. Support for this assistance was funded by Lacer Spain.

Resumen La fibrilacion auricular, una de las arritmias mas frecuentes, suele aparecer en situaciones clinicas que dilatan las auriculas, aumentan la presion en el interior de estas cavidades o afectan a su pared, como ocurre con algunos procesos inflamatorios. En este articulo se revisan los principales agentes relacionados con el incremento del riesgo de fibrilacion auricular, aspecto intimamente conectado con las opciones actualmente disponibles para prevenirla.

Despite direct oral anticoagulants (DOACs) have overcome the most relevant limitations of vitamin K antagonists, many patients with atrial fibrillation are not receiving the appropriate anticoagulant therapy. In addition, when patients are anticoagulated with DOACs, some of them are not taking the dose recommended in the summary of product characteristics. This may be related, at least in part, to the concern about the applicability of findings from randomized clinical trials to real-life patients. In this context, performing studies in daily clinical practice to assess the efficacy and safety of DOACs in real-world setting is mandatory. The aim of this review is to update the current evidence regarding safety of rivaroxaban in clinical practice. The Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) showed that rivaroxaban was at least as effective as warfarin for preventing stroke or systemic embolism, with similar rates of major bleeding but with lesser risk of intracranial and fatal bleedings. Data from noninterventional studies and registries have confirmed the good results of ROCKET-AF. Even more, rates of bleeding may be inferior in real-life patients, since they have a lower risk profile than those included in ROCKET-AF.

The authors would like to thank Professor Halil Dogan (Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey) for informing them of the following error. The following sentence within the last paragraph of the ‘Diltiazem and Atrial Arrhythmias’ section, ‘‘A retrospective study evaluated 77 patients with supraventricular tachycardia treated with oral adenosine or intravenous diltiazem in the emergency department [21]’’, is incorrect. This sentence should read: ‘‘A retrospective study evaluated 77 patients with supraventricular tachycardia treated with intravenous adenosine or diltiazem in the emergency department [21]’’.

Almudena Castro Conde*, Domingo Marzal Martin, Regina Dalmau Gonzalez-Gallarza, Vicente Arrarte Esteban, Miren Morillas Bueno, Xavier Garcia-Moll Marimon, Alejandro Berenguel Senen, Nekane Murga y Manuel Abeytua a Servicio de Cardiologia, Unidad de Rehabilitacion Cardiaca, Hospital Universitario La Paz, Madrid, Espana b Servicio de Cardiologia, Complejo Hospitalario de Merida, Merida, Badajoz, Espana c Servicio de Cardiologia, Hospital Universitario La Paz, Madrid, Espana Unidad de Rehabilitacion Cardiaca, Hospital General Universitario de Alicante, Alicante, Espana e Servicio de Cardiologia, Hospital Osakidetza, Barakaldo, Vizcaya, Espana f Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Espana g Servicio de Cardiologia, Complejo Hospitalario de Toledo, Toledo, Espana h Servicio de Cardiologia, Seccion de Cardiologia Clinica, Hospital de Basurto, Bilbao, Vizcaya, Espana i Servicio de Cardiologia, Unidad de Rehabilitacion Cardiaca, Hospital General Universitario Gregorio Maranon, Madrid, Espana