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[Abstract] Sensory issues impact participation and are frequent in people with schizophrenia. To provide clinicians in Spain with reliable and valid tools to assess sensory integration in adult mental health, we analyzed the internal reliability and discriminant validity of Adolescent/Adult Sensory Profile (AASP-Spain). Cross-sectional descriptive study that analyzed internal reliability (Cronbach’s Alpha; n = 434 neurotypical) and discriminant validity (n = 18 schizophrenia; n = 54 neurotypical). Cronbach’s Alpha for AASP categories ranged from 0.69 to 0.73. Individuals with schizophrenia had higher scores (more problems) than controls in the three categories. The AASP-Spain offers promising internal reliability and discriminant validity.

Background: A definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) was published by European Society of Cardiology in 2016. The aim of this study is to analyze the clinical profile and prognosis of these patients in a prospective single-center study and compare it with the literature data. Methods: During a 3-year period, information from every consecutive MINOCA patient was gathered (n = 109). It was then compared with 412 contemporaneous patients with myocardial infarction and obstructive coronary arteries (MIOCA). Univariate and multivariate analyses were performed. Prognosis analysis was adjusted by age and cardiovascular risk factors (CVRF). Results: MINOCA represented 16.9% of the total of patients admitted for myocardial infarction. Compared with MIOCA, they had more psychosocial disorders (22.9% vs. 10.7%; p < 0.01) and more pro-inflammatory conditions (34.9% vs. 14.0%; p < 0.01). Atrial fibrillation was twice as frequent in MINOCA (14.7% vs. 7.3%; p = 0.016). Predictors of MINOCA were as follows: female gender, absence of diabetes, absence of tobacco use, tachycardia, troponin above 10 times the 99 th percentile, and pro-inflammatory conditions. Median follow-up was 17.3 ± 9.3 months. Major adverse cardiovascular events (MACE; a composite of a recurrence of acute myocardial infarction, transient ischemic attack/stroke, or death from cardiovascular cause and death from any cause) occurred in 10.8% of the MINOCA group as compared with 10.7% in the MIOCA group (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.58–2.45; p = 0.645). Cardiovascular re-admission rates were higher in the MINOCA group: 19.8% vs. 13.9% (HR 1.85; CI 1.06–3.21; p = 0.030). Conclusions: The frequency of MINOCA is high, with fewer CVRF, and it is linked to atrial fibrillation, psychosocial disorders, and pro-inflammatory conditions. Mid-term prognosis is worse than previously thought, with a similar proportion of MACE as compared to MIOCA, and even a higher rate of cardiovascular re-admissions.

In this observational and multicenter study, that included all patients who underwent a heart transplantation (HT) in Spain from 1984 to 2018, we analyzed the incidence, management, and prognosis of colorectal cancer (CRC) after HT. Of 6,244 patients with a HT and a median follow-up of 8.8 years since the procedure, 116 CRC cases (11.5% of noncutaneous solid cancers other than lymphoma registered) were diagnosed, mainly adenocarcinomas, after a mean of 9.3 years post-HT. The incidence of CRC increased with age at HT from 56.6 per 100,000 person-years among under 45 year olds to 436.4 per 100,000 person-years among over 64 year olds. The incidence rates for age-at-diagnosis groups were significantly greater than those estimated for the general Spanish population. Curative surgery, performed for 62 of 74 operable tumors, increased the probability of patient survival since a diagnosis of CRC, from 31.6% to 75.7% at 2 years, and from 15.8% to 48.6% at 5 years, compared to patients with inoperable tumors. Our results suggest that the incidence of CRC among HT patients is greater than in the general population, increasing with age at HT.

[Resumen] Introducción y objetivos. Estudiar el valor pronóstico de un modelo de 5 ítems clínicos basado en las recomendaciones IC-BERG para la evaluación en consulta de pacientes ambulatorios con insuficiencia cardiaca (IC). Métodos. Estudio observacional basado en la cohorte histórica de pacientes con IC remitidos a una consulta monográfica entre 2010 y 2019. Se evaluó la presencia de 5 ítems clínicos de riesgo: NYHA III-IV, signos de congestión, ingreso por descompensación en el último año, dosis diaria de furosemida ≥ 40 mg o equivalente y NT-proBNP ≥ 1.000 pg/ml. Se estudió la incidencia de desenlaces clínicos adversos mediante el método de Kaplan-Meier y la regresión de Cox. Resultados. Se estudiaron 1.909 pacientes, que presentaban una media de 2,29 ítems de riesgo. El análisis de Kaplan-Meier mostró una tendencia incremental entre un mayor número de ítems de riesgo y el desenlace combinado muerte o ingreso por IC, la mortalidad global y la mortalidad cardiovascular (p < 0,001). Las hazard ratio ajustadas para el desenlace muerte o ingreso por IC, estimadas por regresión multivariante de Cox, fueron de 1,47 (IC95%, 1-2,15), 2,03 (IC95%, 1,41-2,92), 2,98 (IC95%, 2,08-4,28), 5,07 (IC95%, 3,51-7,32) y 7,73 (IC95%, 5,21-11,45) para pacientes con 1, 2, 3, 4 o 5 ítems de riesgo, respectivamente. El peso proporcional de las causas cardiovasculares de muerte, y en especial la IC, fue mayor en los pacientes con mayor número de ítems de riesgo. Conclusiones. Este estudio apoya el valor pronóstico de un modelo de evaluación clínica para pacientes ambulatorios con IC basado en las recomendaciones IC-BERG. [Abstract] Introduction and objectives. To assess the prognostic value of a 5-item clinical model based in the IC-BERG recommendations to evaluate ambulatory patients with heart failure (HF) in the clinic. Methods. Observational study based on the historical cohort of patients with HF referred to a specific facility since 2010 to 2019. The presence of 5 clinical ítems was evaluated: NYHA III-IV class, signs of congestion, admission due to decompensation in the previous year, daily dose ≥ 40 mg furosemide or equivalent, and NT-proBNP ≥ 1,000 pg/ml. The incidence of adverse clinical events was assessed by means of the Kaplan-Meier method and multivariable Cox's regression. Results. We studied 1909 patients, whose mean number of clinical ítems indicating risk was 2.29. Kaplan-Meier survival analysis showed an incremental trend between an increasing number of clinical ítems of risk and the combined event death or admission due to HF, overall mortality, and cardiovascular mortality (P < .001). Adjusted hazard-ratio for the combined end-point death or admission due to HF, as estimated by means of multivariable Cox's regression, were 1.47 (95%CI, 1–2.15), 2.03 (95%CI, 1.41–2.92), 2.98 (95%CI, 2.08–4.28), 5.07 (95%C,: 3.51–7.32), and 7.73 (95%CI, 5.21–11.45) for patients who showed 1, 2, 3, 4, or 5 clinical ítems indicating risk, respectively. The proportional weight of cardiovascular causes of risk, especially refractory HF, was higher in patients with a higher number of clinical ítems of risk. Conclusions. This study supports the prognostic value of a 5-item clinical model based on IC-BERG recommendations in ambulatory patients with HF.

[Abstract] Background. Primary graft dysfunction (PGD) still affects 2-28% of heart transplants (HT). Severe PGD requires mechanical circulatory support (MCS) and is the main cause of death early after HT. Earlier initiation has been suggested to improve prognosis but the best cannulation strategy is unknown. Methods. Analysis of all HT in Spain between 2010 and 2020. Early (

Resumen Antecedente y objetivo Los pacientes con insuficiencia cardiaca se caracterizan en 3 fenotipos en funcion de su fraccion de eyeccion ventricular izquierda. El proposito de este estudio fue comparar el perfil clinico, el tratamiento, el pronostico y las causas de muerte de los pacientes con insuficiencia cardiaca y fraccion de eyeccion ventricular izquierda reducida ( Metodologia Analisis de la informacion clinica recogida en un registro prospectivo de pacientes con insuficiencia cardiaca remitidos a una consulta monografica de Cardiologia entre 2010 y 2019. Resultados Se estudiaron 1.404 pacientes con IC-FEr, 239 pacientes con IC-FErm y 266 pacientes con IC-FEp. Se observaron diferencias significativas entre los 3 grupos en relacion con diversas caracteristicas clinicas, y en cuanto a la tasa de prescripcion de farmacos moduladores de la respuesta neurohormonal. La regresion de Cox multivariante revelo un incremento del riesgo de muerte por cualquier causa en los pacientes con IC-FEp (hazard-ratio 1,36; intervalo de confianza al 95% 1,03-1,80; p = 0,028) e IC-FErm (hazard-ratio 1,36; intervalo de confianza al 95% 1,03-1,78; p = 0,029) en comparacion con los pacientes con IC-FEr. La insuficiencia cardiaca fue la causa mas frecuente de muerte en los 3 grupos; se observo un mayor peso relativo de la muerte subita en los pacientes con IC-FEr, mientras que las causas no cardiovasculares de muerte tuvieron un peso relativo mayor en los pacientes con IC-FEp e IC-FErm. Conclusiones El estudio confirma la existencia de diferencias significativas en el perfil clinico, manejo terapeutico, pronostico y causas de muerte de los pacientes con IC-FEr, IC-FErm e IC-FEp.

[Abstract] Aims. In the absence of previous direct comparative studies, we aimed to evaluate the effectiveness of spironolactone and eplerenone in patients with heart failure and reduced ejection fraction (HFrEF) in a real-world clinical setting. Methods. Using Fine-Gray´s competing risk regression, we compared the clinical outcomes of 293 patients with chronic HF and left ventricular ejection fraction

INTRODUCTION AND OBJECTIVES Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial. METHODS We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N=306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system. RESULTS The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9±6236.8 € vs 14 038.7±4958.5 €; P

[Abstract] Background: We aimed to describe recent trends in the use and outcomes of temporary mechanical circulatory support (MCS) as a bridge to heart transplantation (HTx) in Spain. Methods: Retrospective case-by-case analysis of 1,036 patients listed for emergency HTx while on temporary MCS in 16 Spanish institutions from January 1st, 2010 to December 31st, 2020. Patients were classified in 3 eras according to changes in donor allocation criteria (Era 1: January 2010/May 2014; Era 2: June 2014/May 2017; Era 3: June 2017/December 2020). Results: Over time, the proportion of candidates listed with intra-aortic balloon pumps decreased (Era 1 = 55.9%, Era 2 = 32%, Era 3 = 0.9%; p < 0.001), while the proportion of candidates listed with surgical continuous-flow temporary VADs (Era 1 = 10.6%, Era 2 = 32%, Era 3 = 49.1%; p < 0.001) and percutaneous VADs (Era 1 = 0.3%, Era 2 = 6.3%; Era 3 = 17.2%; p < 0.001) increased. Rates of HTx increased from Era 1 (79.4%) to Era 2 (87.8%), and Era 3 (87%) (p = 0.004), while rates of death before HTx decreased (Era 1 = 17.7%; Era 2 = 11%, Era 3 = 12.4%; p = 0.037) Median time from listing to HTx increased in patients supported with intra-aortic balloon pumps (Era 1 = 8 days, Era 2 = 15 days; p < 0.001) but remained stable in other candidates (Era 1 = 6 days; Era 2 = 5 days; Era 3 = 6 days; p = 0.134). One-year post-transplant survival was 71.4% in Era 1, 79.3% in Era 2, and 76.5% in Era 3 (p = 0.112). Preoperative bridging with ECMO was associated with increased 1-year post-transplant mortality (adjusted HR=1.71; 95% CI 1.15-2.53; p = 0.008). Conclusions: During the period 2010 to 2020, successive changes in the Spanish organ allocation protocol were followed by a significant increase of the rate of HTx and a significant reduction of waiting list mortality in candidates supported with temporary MCS. One-year post-transplant survival rates remained acceptable.

Resumen Introduccion y objetivos Evaluar el tratamiento y aplicacion de las recomendaciones de las guias europeas del tratamiento de fibrilacion auricular (FA), en una cohorte contemporanea de pacientes con FA. Metodos REGUEIFA es un estudio observacional, prospectivo y multicentrico de pacientes con diagnostico primario o secundario de FA que residen en la comunidad autonoma de Galicia y son valorados por cardiologos. Resultados Se incluyeron 1.007 pacientes con una edad media de 67 anos y 32% mujeres. Un 50% de pacientes tenia enfermedad cardiovascular. La amiodarona fue el farmaco antiarritmico mas utilizado (24,5%). El riesgo tromboembolico fue de 2,3 ± 1,5 en la escala CHA2DS2-VASc y el riesgo hemorragico de 0,7 ± 0,7 en la escala HAS-BLED. Se prescribio tratamiento con anticoagulantes orales (ACO) en el 91,1%. Una mayor puntuacion en la escala CHA2DS2-VASc, y la ablacion de FA se identificaron como factores independientes asociados a ACO mientras que la forma paroxistica se asocio a no anticoagulacion. Se identificaron la edad y la insuficiencia renal como factores independientes de prescripcion de antagonistas de la vitamina K mientras que la cardioversion electrica y la ablacion de FA se asociaron de forma independiente a la prescripcion de ACO de accion directa. Conclusiones El estudio REGUEIFA proporciona informacion contemporanea del tratamiento cardiologico de pacientes con FA. La prescripcion de ACO fue del 91,1%. Se describen los factores independientes asociados a la prescripcion de ACO y de ACO de accion directa.

INTRODUCTION: For a long time, vitamin K antagonists (VKA) were the only oral anticoagulation therapy available to reduce adverse events in atrial fibrillation (AF) patients. Direct-acting oral anticoagulants (DOAC) are at least as effective and safe as VKA with few drug interactions, rapid onset, and short half-life. Four DOACs, dabigatran, apixaban, rivaroxaban, and edoxaban, have demonstrated efficacy and safety for treatment in AF patients.AREAS COVERED: The purpose of this review article is to analyze the current evidence in clinical trials and in real-world populations and performed a new analysis with the estimated effect of those DOACs over the VKA population from the FANTASIIA registry.EXPERT OPINION: In the absence of randomized, controlled head-to-head comparisons between DOACs, high-quality observational data can provide useful information on the comparative effectiveness of DOACs. Current clinical guidelines recommend the management of oral anticoagulation in AF patients with DOACs over VKA for stroke prevention; however, many guidelines generally do not suggest a specific DOAC choice in clinical practice. The revised evidence in this manuscript and our real experience reflects that apixaban and dabigatran show the best efficacy and safety profile.

[Abstract] Introduction and objectives: The Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score was derived and validated as a predictor of mortality after heart transplantation (HT). The primary objective of this work is to externally validate the IMPACT score in a contemporary Spanish cohort. Methods: Spanish Heart Transplant Registry data were used to identify adult (>16 years) HT patients between January 2000 and December 2015. Retransplantation, multiorgan transplantation and patients in whom at least one of the variables required to calculate the IMPACT score was missing were excluded from the analysis (N = 2810). Results: Median value of the IMPACT score was five points (IQR: 3, 8). Overall, 1-year survival rate was 79.1%. Kaplan-Meier 1-year survival rates by IMPACT score categories (0-2, 3-5, 6-9, 10-14, ≥15) were 84.4%, 81.5%, 79.3%, 77.3%, and 58.5%, respectively (Log-Rank test: p < .001). Performance analysis showed a good calibration (Hosmer-Lemeshow chi-square for 1 year was 7.56; p = .47) and poor discrimination ability (AUC-ROC .59) of the IMPACT score as a predictive model. Conclusions: In a contemporary Spanish cohort, the IMPACT score failed to accurately predict the risk of death after HT.

La presencia de una masa en la aurícula izquierda en un paciente con una prótesis mecánica mitral es relativamente frecuente y supone un reto diagnóstico. Presentamos el caso de una paciente que, tras ser intervenida de una sustitución valvular mitral, presentó insuficiencia cardíaca hallándose en el ecocardiograma una masa de gran tamaño dependiente del techo de la aurícula. La asociación del ecocardiograma transtorácico con otras técnicas de imagen cardíaca, ayuda tanto a caracterizar la lesión y determinar de forma precisa su localización, como su repercusión y posible afectación de estructuras vecinas.

We present the case of a 16-year-old male patient with a history of anxiety disorder who presented with a cardiopulmonary arrest at his home. The first cardiac rhythm (+0) was remarkable for irregular and very wide, aberrated QRS complexes (320 ms) without identifiable atrial activity. Cardiopulmonary resuscitation manoeuvres were initiated. He was intubated and transferred to the acute cardiac care unit. In the immediate ECG (+2 hours) irregular, very wide (320 ms), aberrated and right-bundle-branch-like morphology QRS complexes persisted, but after several hours of treatment (+15 hours) a sinusal activity started, QRS complexes shortened (160 ms) and a specific ECG pattern was noted on right precordial …

Statin therapy might have a beneficial prognostic effect in patients with COVID-19, given its immunomodulative, anti-inflammatory and anti-atherosclerotic properties. Our purpose was to test this hypothesis by using the COVID-19 registry of a Spanish university hospital.We conducted a single-center, observational and retrospective study in which hospitalized patients with COVID-19 diagnosed by PCR between March 2020 and October 2020 were included. By means of logistic regression, we designed a propensity score to estimate the likelihood that a patient would receive statin treatment prior to admission. We compared the survival of COVID-19 patients with and without statin treatment by means of Cox regression with inverse probability of treatment weighting (IPTW). The median follow-up was 406 days.We studied 1122 hospitalized patients with COVID-19, whose median age was 71 years and of which 488 (43.5%) were women. 451 (40.2%) patients received statins before admission. In the IPTW survival analysis, prior statin treatment was associated with a significant reduction in mortality (HR: 0.76; 95% CI: 0.59-0.97). The greatest benefit of previous statin therapy was seen in subgroups of patients with coronary artery disease (HR: 0.32; 95% CI: 0.18-0.56) and extracardiac arterial disease (HR: 0.45; 95% CI: 0.28-0.73).Our study showed a significant association between previous treatment with statins and lower mortality in hospitalized patients with COVID-19. The observed prognostic benefit was greater in patients with previous coronary or extracardiac atherosclerotic disease.El tratamiento con estatinas podría presentar un efecto pronóstico beneficioso en pacientes con COVID-19, dadas sus propiedades inmunomoduladoras, antiinflamatorias y estabilizadoras de la placa de ateroma. Nuestro propósito fue analizar esta hipótesis tomando como base el registro de COVID-19 de un hospital universitario español.Realizamos un estudio observacional y retrospectivo en el que se incluyeron los pacientes hospitalizados con COVID-19 diagnosticado mediante PCR entre marzo de 2020 y octubre de 2020 en un centro. Mediante regresión logística, diseñamos una puntuación de propensión para estimar la probabilidad de que un paciente recibiese tratamiento con estatinas antes del ingreso. Comparamos la supervivencia de los pacientes con y sin tratamiento con estatinas mediante la regresión de Cox ponderada por la inversa de la probabilidad de recibir el tratamiento (IPT). La mediana de seguimiento fue de 406 días.Estudiamos 1.122 pacientes hospitalizados con COVID-19, cuya mediana de edad era de 71 años y de los cuales 488 (43,5%) eran mujeres. 451 (40,2%) pacientes recibían estatinas antes del ingreso. En el análisis de supervivencia ponderado por la IPT, el tratamiento previo con estatinas se asoció a una reducción significativa de la mortalidad (HR: 0,76; IC 95%: 0,59–0,97). El mayor beneficio del tratamiento previo con estatinas se observó en los subgrupos de pacientes con enfermedad arterial coronaria (HR: 0,32; IC 95%: 0,18–0,56) y enfermedad arterial extracardiaca (HR: 0,45; IC 95%: 0,28–0,73).Nuestro estudio mostró una asociación significativa entre el tratamiento previo con estatinas y una menor mortalidad en pacientes hospitalizados con COVID-19. El beneficio pronóstico observado fue mayor en los pacientes con enfermedad aterosclerótica coronaria o extracardiaca previa.

[Abstract] Background: Gender-based violence is a major public health problem. Healthcare providers' ability to identify this type of violence and support victims may be influenced by their knowledge, attitudes, and beliefs, which requires solid education. Objectives: To identify the gender-based violence attitudes and dating violence experiences of students in nursing and other health sciences. Design: A multicentre cross-sectional study was performed. Settings: This study was conducted in three faculties of the University of A Coruña, Spain. Participants: Participants were undergraduate students of nursing, podiatry, occupational therapy, and physiotherapy. Methods: The Attitudes towards Gender and Violence Questionnaire and the Dating Violence Questionnaire were used from October 2019 to March 2020. Descriptive and inferential statistics were calculated to determine associated factors and identify differences in gender-based violence attitudes and dating violence experiences between sexes and degrees. Results: Data from 459 students were analysed, of whom 180 (39.2 %) studied nursing. The mean age was 20.9 (SD = 3.6) and 76.0 % were women. Statistically significant differences were obtained in attitudes towards gender-based violence according to sex where men displayed more sexist attitudes and violence justification. Results showed a significant difference in attitudes regarding the biological usefulness of sexism and violence between students of nursing and other health sciences. 61.9 % of students had experienced one or more abusive behaviours in relationships; no significant differences were detected according to the degree. However, male students experienced dating violence more often than females. It was observed that students who had suffered dating violence showed greater agreement with sexist attitudes that justify violence. Conclusion: Students of health sciences, particularly males and nursing students, show sexist attitudes that justify gender-based violence. They also frequently experience dating violence, especially psychological violence. It is necessary to intensify or include education on these types of violence in the curricula of degrees in health sciences.

Introducción y objetivos El uso de dispositivos de asistencia circulatoria mecánica de corta duración como puente a trasplante es frecuente en España. Se desconocen la epidemiología y la repercusión de las complicaciones infecciosas en estos pacientes. Métodos Descripción sistemática de la epidemiología y análisis de la repercusión pronóstica de las complicaciones infecciosas en un registro multicéntrico retrospectivo de pacientes tratados con dispositivos de asistencia circulatoria mecánica de corta duración como puente a trasplante cardiaco urgente entre 2010 y 2015 en 16 hospitales españoles. Resultados Se estudió a 249 pacientes; 87 (34,9%) de ellos tuvieron un total de 102 infecciones. La vía respiratoria fue la localización más frecuente (n = 47; 46,1%). En 78 casos (76,5%) se obtuvo confirmación microbiológica; se aislaron en total 100 gérmenes causales, con predominio de bacterias gramnegativas (n = 58, 58%). Los pacientes con complicaciones infecciosas presentaron mayor mortalidad durante el periodo de asistencia circulatoria mecánica (el 25,3 frente al 12,3%; p = 0,009) y menor probabilidad de recibir un trasplante (el 73,6 frente al 85,2%; p = 0,025) que los pacientes sin infección. La mortalidad posoperatoria tras el trasplante fue similar en ambos grupos (con infección, el 28,3%; sin infección, el 23,4%; p = 0,471). Conclusiones Los pacientes tratados con dispositivos de asistencia circulatoria mecánica de corta duración como puente al trasplante cardiaco están expuestos a un alto riesgo de complicaciones infecciosas, las cuales se asocian con una mayor mortalidad en espera del órgano. Introduction and objectives Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. Methods Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. Results We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n = 47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n = 58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P = .009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P = .025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P = .471). Conclusions Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period. Sin financiación 6.975 JCR (2021) Q1, 33/143 Cardiac & Cardiovascular Systems 0.407 SJR (2021) Q3, 205/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Observational study [Abstract] Aims: To assess the incidence of cancer diagnosis and cancer-related mortality in patients with heart failure (HF). Methods: Observational study based in a prospective cohort of patients with HF referred to a specialized Spanish clinic between 2010 and 2019. The observed incidence of malignancies (excluding non-melanoma skin cancer) was compared to that expected for the general Spanish population according to the Global Cancer Observatory. Results: We studied 1909 consecutive patients with HF. Over a median follow-up of 4.07 years, 165 new cases of malignancy were diagnosed. Observed age-standardized incidence rates of cancer were 861 (95% CI 618.4-2159.4) cases per 100,000 patients-years in men and 728.5 (95% CI 451.1-4308.7) cases per 100,000 patients-years in women; while age-standardized incidence rates of cancer expected for the general Spanish population were 479.4 cases per 100,000 patients-years in men (risk ratio = 1.80) and 295.5 cases per 100,000 patients-years in women (risk ratio = 2.46). Both a history of pre-existing malignancy at baseline and the development of new malignancies during follow-up were associated with reduced survival. Observed age-standardized cancer-related mortality was 344.1 (95% CI 202.1-1675) deaths per 100,000 patient-years in men and 217.0 (95% CI 32.8-3949.3) deaths per 100,000 patient-years in women; while age-standardized cancer-related mortality expected for the general Spanish population was 201.4 deaths per 100,000 patients-years in men (risk ratio = 1.71) and 96.2 deaths per 100,000 patients-years in women (risk ratio = 2.26). Conclusion: Patients with HF showed higher incidence rates of cancer diagnosis and cancer-related mortality than those expected for the general population.

Editorial

Resumen Introduccion y objetivos Analizar la supervivencia de los pacientes con insuficiencia cardiaca (IC) tratados en una unidad especializada. Metodos Estudio prospectivo de una cohorte de pacientes con IC tratados en una unidad especializada entre 2011 y 2017. Se comparo la mortalidad observada a 1 y 3 anos con la mortalidad pronosticada por la puntuacion de riesgo del Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC). Resultados Se estudio a 1.280 pacientes, con una mediana de la puntuacion MAGGIC de 19 [intervalo intercuartilico, 13-24]. Las tasas de prescripcion de bloqueadores beta, inhibidores de la enzima de conversion de la angiotensina, antagonistas del receptor de la angiotensina II, antagonistas del receptor de mineralcorticoides y sacubitrilo-valsartan fueron del 93, el 67, el 22, el 73 y el 16% respectivamente. La puntuacion MAGGIC mostro una discriminacion adecuada de la mortalidad a 1 ano (estadistico c = 0,71) y a 3 anos (estadistico c = 0,76). La mortalidad observada fue significativamente menor que la pronosticada, tanto a 1 ano (el 6,2 frente al 10,9%; cociente observada/pronosticada = 0,57; p 40% (el 19,6 frente al 20,7%; cociente observada/pronosticada = 0,95; p = 0,640). Conclusiones Los pacientes con IC tratados en una unidad especializada presentaron una mortalidad inferior a la pronosticada por la puntuacion MAGGIC.

Resumen Introduccion y objetivos Se sabe muy poco del impacto que las redes de atencion del infarto agudo de miocardio con elevacion del segmento ST (IAMCEST) tienen en la poblacion. El objetivo de este estudio es averiguar si el PROGALIAM (Programa Gallego de Atencion al Infarto Agudo de Miocardio) mejoro la supervivencia en la zona norte de Galicia. Metodos Se recogieron todos los eventos codificados como IAMCEST entre 2001 y 2013. Se identifico a 6.783 pacientes, divididos en 2 grupos: pre-PROGALIAM (2001-2005), 2.878 pacientes, y PROGALIAM (2006-2013), 3.905 pacientes. Resultados En la etapa pre-PROGALIAM, la mortalidad ajustada a 5 anos fue superior tanto en la poblacion total (HR = 1,22; IC95%, 1,14-1,29; p Conclusiones El desarrollo del PROGALIAM en el area norte de Galicia disminuyo la mortalidad e incremento la equidad de los pacientes con IAMCEST tanto en general como en cada una de las areas donde se implanto. Estudio registrado en ClinicalTrials.gov (Identificador: NCT02501070 ).

Resumen Introduccion y objetivos Comparar los resultados a largo plazo de los anticoagulantes orales directos (ACOD) frente a los antagonistas de la vitamina K (AVK) en pacientes del mundo real con fibrilacion auricular no valvular (FANV) en un estudio nacional prospectivo. Metodos El estudio FANTASIIA incluyo consecutivamente a pacientes ambulatorios con FANV anticoagulados con ACOD o AVK desde junio de 2013 hasta octubre de 2014. Se compararon las tasas de eventos segun el anticoagulante administrado. Resultados Se incluyo a 2.178 pacientes (edad, 73,8 ± 9,4 anos; el 43,8% mujeres); de ellos, 533 (24,5%) recibian ACOD y 1.645 (75,5%), AVK. Tras una mediana de seguimiento de 32,4 meses, los pacientes con ACOD tuvieron tasas mas bajas de ictus —0,40 (IC95%, 0,17-0,97) frente a 1,07 (IC95%, 0,79-1,46) pacientes/ano; p = 0,032—, hemorragias mayores —2,13 (IC95%, 1,45-3,13) frente a 3,28 (IC95%, 2,75-3,93) pacientes/ano; p = 0,044—, muerte cardiovascular —1,20 (IC95%, 0,72-1,99) frente a 2,45 (IC95%, 2,00-3,00) pacientes/ano; p = 0,009— y muerte total —3,77 (IC95%, 2,83-5,01) frente a 5,54 (IC95%, 4,83-6,34) pacientes/ano; p = 0,016—. En el analisis de Cox modificado segun el metodo de Andersen-Gill para datos con multiples eventos, las razones de riesgos instantaneos para los pacientes con ACOD fueron 0,42 (0,16-1,07) para el ictus; 0,47 (0,20-1,16) para la embolia sistemica en general; 0,76 (0,50-1,15) para las hemorragias mayores; 0,67 (0,39-1,18) para la muerte cardiovascular; 0,86 (0,62-1,19) para la mortalidad total y 0,82 (0,64-1,05) para el combinado de ictus, embolias, hemorragias mayores y muerte. Conclusiones El tratamiento con ACOD se asocia con una tendencia a una menor tasa de todos los eventos graves, incluida la mortalidad, en relacion con los AVK en pacientes con FANV en Espana.

Resumen Introduccion y objetivos Los valores plasmaticos de galectina-3 (Gal-3) estan elevados y se correlacionan con la mortalidad total y cardiovascular en pacientes con insuficiencia cardiaca, pero su correlacion con el pronostico tras el trasplante cardiaco (TxC) es desconocida. El objetivo fue describir la tendencia evolutiva y el valor pronostico de este biomarcador tras el TxC. Metodos Mediante enzimoinmunoensayo, se midieron las concentraciones plasmaticas de Gal-3 en muestras de suero de 122 receptores de TxC, antes y 1, 3, 6 y 12 meses despues de este. Mediante regresion de Cox se analizo el valor pronostico del valor plasmatico de Gal-3 a los 12 meses del TxC. El objetivo primario del estudio fue la variable combinada muerte o disfuncion del injerto. Resultados Las concentraciones de Gal-3 disminuyeron progresivamente durante el primer ano tras el TxC (medianas: pretrasplante, 19,1 ng/ml; 1 ano postrasplante, 14,6 ng/ml; p Conclusiones Las concentraciones plasmaticas de Gal-3 disminuyeron progresivamente durante el primer ano tras el TxC. Un valor plasmatico elevado de Gal-3 1 ano tras el TxC se correlaciono con un pronostico adverso.

[Abstract] Introduction and objectives: Circulating galectin-3 (Gal-3) is elevated and significantly correlates with all-cause and cardiovascular mortality in patients with heart failure. However, the relationship between serum Gal-3 and heart transplant (HT) outcomes is unclear. The aim of this study was to describe the longitudinal trend and prognostic value of Gal-3 levels after HT. Methods: Banked serum samples were available from 122 HT recipients, collected before transplant and at 1, 3, 6, and 12 months posttransplant. Gal-3 levels in these serum samples were measured by enzyme immune assay. Multivariable Cox regression was performed to determine the prognostic value of 12-month posttransplant Gal-3 serum levels. The primary endpoint was the composite variable all-cause death or graft failure over long-term posttransplant follow-up. Results: Circulating Gal-3 concentration steadily decreased during the first year after HT (median values: pretransplant, 19.1 ng/mL; 1-year posttransplant, 14.6 ng/mL; P

INTRODUCTION AND OBJECTIVES To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P

Resumen Introduccion y objetivos En un estudio de base poblacional, se analizaron las posibles diferencias en funcion del sexo en la atencion al dolor toracico o las palpitaciones como motivo de consulta. Metodos El estudio OFRECE incluyo una muestra aleatoria de la poblacion espanola de 8.400 participantes de edad ≥ 40 anos, de los que 1.132 (13,5%) tenian antecedentes de consulta por dolor en el pecho y 1.267 (15,1%), por palpitaciones y se incluyen en este estudio. Se calculo la odds ratio (OR) de que se practicaran determinadas pruebas y se comunicaran los resultados de las consultas en relacion con el hecho de ser mujer, tanto brutas como ajustadas por los factores de riesgo cardiovascular clasicos, antecedentes de enfermedad cardiovascular y diagnostico de angina estable o fibrilacion auricular confirmado en este estudio en cada caso. Resultados No se observaron diferencias en los antecedentes de consulta por dolor toracico entre mujeres y varones (el 13 y el 14,1%; p = 0,159) y si en las consultas por palpitaciones (el 19,0 y el 10,4% respectivamente; p Conclusiones Este trabajo no confirma un sesgo en razon del sexo en la atencion a estos sintomas, aunque no es descartable completamente un sesgo de genero en el diagnostico confirmado en el estudio que limite su capacidad para identificar diferencias en la atencion a las pacientes.

Resumen Introduccion y objetivos Las anomalias electrocardiograficas son muy comunes. El proposito de este estudio es analizar la prevalencia de hallazgos electrocardiograficos anormales y su significado clinico en la poblacion general espanola de 40 o mas anos. Metodos Subanalisis del estudio OFRECE; se selecciono una muestra representativa de la poblacion espanola de 40 o mas anos. Se dispuso de datos clinicos y electrocardiograma de todos los participantes. La lectura de los electrocardiogramas fue centralizada, los evaluaron de manera independiente 2 cardiologos expertos y se consulto con un tercero en caso de desacuerdo, para llegar al diagnostico final por consenso. Antes de iniciarse la lectura de los electrocardiogramas, se establecieron estrictamente los criterios diagnosticos de cada una de las anomalias analizadas. Se estudiaron la prevalencia y los factores clinicos asociados con: crecimiento de cavidades, trastornos de conduccion, anomalias de la repolarizacion, ondas Q patologicas, extrasistolia auricular y ventricular y preexcitacion. Resultados Se evaluo a 8.343 individuos (media de edad, 59,2 anos; el 52,4% mujeres). Solo 4.074 (51,2%) presentaron un electrocardiograma rigurosamente normal. Las anomalias mas frecuentes fueron las alteraciones inespecificas de la repolarizacion (16%) asociadas con enfermedad coronaria y fibrilacion auricular; el bloqueo de rama derecha (8,1%) asociado con enfermedad pulmonar obstructiva cronica; el hemibloqueo anterosuperior izquierdo (6,5%) relacionado con la hipertension y la insuficiencia cardiaca y el intervalo PR largo (3,7%) se asociaron con enfermedad coronaria. Conclusiones Las anomalias electrocardiograficas son muy comunes en la poblacion general de 40 o mas anos. Tan solo la mitad de la poblacion tenia un electrocardiograma rigurosamente normal.

[Resumen] Introducción y objetivos. En España, el balón de contrapulsación intraaórtico (BCIA) se ha usado frecuentemente como puente al trasplante cardiaco (TxC) urgente. El propósito es analizar los resultados de esta estrategia. Métodos. Se realizó una revisión retrospectiva caso por caso de los registros clínicos de 281 pacientes adultos listados para TxC urgente asistidos con BCIA en 16 hospitales españoles entre 2010 y 2015. Se analizaron la supervivencia antes y después del trasplante y la incidencia de eventos adversos. Resultados. Se trasplantó a 194 pacientes (69%; IC95%, 63,3-74,4) y 20 (7,1%; IC95%, 4,4-10,8) fallecieron durante la asistencia, cuya duración media fue de 10,9 ± 9,7 días. El BCIA se explantó antes de obtener un órgano a 32 pacientes (11,4%). En 35 pacientes (12,5%; IC95%, 8,8-16,9) se implantó un dispositivo de asistencia circulatoria mecánica completa. El tiempo en la lista de espera urgente se incrementó desde 5,9 ± 6,3 días en 2010 hasta 15 ± 11,7 días en 2015 (p = 0,001). La supervivencia a 30 días y a 1 y 5 años tras el TxC fue del 88,1% (IC95%, 85,7-90,5), 76% (IC95%, 72,9-79,1) y 67,8% (IC95%, 63,7-71,9) respectivamente. La tasa de incidencia de eventos adversos mayores —disfunción del BCIA, ictus, hemorragia o infección— durante la asistencia fue de 26 (IC95%, 20,6-32,4) eventos/1.000 pacientes-día. La tasa de incidencia de explante del BCIA por complicaciones fue de 7,2 (IC95%, 4,5-10,8) casos/1.000 pacientes-día. Conclusiones. En el contexto de listas de espera cortas, el BCIA puede utilizarse como puente al TxC urgente con resultados aceptables. Esta estrategia conlleva una incidencia significativa de eventos adversos. [Abstract] Introduction and objectives. In Spain, intra-aortic balloon pump (IABP) has been used frequently as a bridge to urgent heart transplant (HT). We sought to analyze the clinical outcomes of this strategy. Methods. We conducted a case-by-case, retrospective review of clinical records of 281 adult patients listed for urgent HT under IABP support in 16 Spanish institutions from 2010 to 2015. Pre- and post-transplant survival and adverse clinical events were analyzed. Results. A total of 194 (69%, 95%CI, 63.3-74.4) patients were transplanted and 20 (7.1%, 95%CI, 4.4-10.8) died during a mean period of IABP support of 10.9 ± 9.7 days. IABP support was withdrawn before an organ became available in 32 (11.4%) patients. Thirty-five (12.5%, 95%CI, 8.8-16.9) patients transitioned from IABP to full-support mechanical devices. Mean urgent waiting list time increased from 5.9 ± 6.3 days in 2010 to 15 ± 11.7 days in 2015 (P = .001). Post-transplant survival rates at 30-days, 1-year, and 5-years were 88.1% (95%CI, 85.7-90.5), 76% (95%CI, 72.9-79.1), and 67.8% (95%CI, 63.7-71.9), respectively. The incidence rate of major adverse clinical outcomes—device dysfunction, stroke, bleeding or infection—during IABP support was 26 (95%CI, 20.6-32.4) episodes per 1000 patient-days. The incidence rate of IABP explantation due to complications was 7.2 (95%CI, 4.5-10.8) cases per 1000 patient-days. Conclusions. In a setting of short waiting list times, IABP can be used to bridge candidates to urgent HT with acceptable postoperative results, but there were significant rates of adverse clinical events during support.