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BACKGROUND: Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure (HF) and reduced ejection fraction. The PIONEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced NT-proBNP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths. Real-life studies in the elderly population are scarce. The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors (ACEI) in elderly patients who initiate this treatment during hospitalization for acute HF. METHODS: We conducted a retrospective cohort study using the Spanish acute heart failure registry (RICA) comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitril-valsartan during hospitalization for acute HF versus those treated with ACEI. RESULTS: One hundred and ninety-nine patients hospitalized between October 2016 and November 2020 were included, with a median age of 82 years and high rate of comorbidity. Of these, 107 were treated with sacubitril-valsartan and 92 with ACEI. The adjusted OR for readmission for HF at 3 months was 0.906 (95% CI: 0.241–3.404) and for the combined variable readmission for HF or death at 3 months was 0.696 (95% CI: 0.224–2.167). The adjusted OR for HF readmission at one year was 0.696 (95% CI: 0.224 –2.167). and for the combined variable HF readmission or death at one year 0.724 (95% CI: 0.325–1.612). CONCLUSION: Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI, which did not reach statistical significance either at 3 months or 1 year of follow-up.

RESUMEN: El turismo rural representa una de las ramas más importantes del turismo nacional, sin embargo, no fue hasta el año 2019, cuando la Organización Mundial del Turismo fue capaz de definir al turismo rural, así como dar una serie de características que debe cumplir todo alojamiento rural. Además, se puede clasificar al turismo rural en 9 tipos diferentes según la oferta que ofrecen. Actualmente, existen 6 tipos de sellos de calidad capaces de medir el nivel de compromiso y de calidad percibida por los clientes. Estos sellos son importantes para que las empresas puedan medir el grado de innovación que están llevando a cabo en la empresa. Sin embargo, no se puede afirmar que los alojamientos que posean algún sello rural sean percibidos más positivamente que otros que no lo tienen. El objetivo del trabajo es analizar si los alojamientos rurales de Cantabria que tienen sellos obtienen mejores valoraciones que aquellos que no. Para ello, se ha llevado a cabo un estudio que relaciona la posesión de sellos de calidad con las valoraciones de Booking. Para realizar dicho estudio, se han analizado 198 alojamientos registrados en la web Portal de Turismo Rural de Cantabria. El análisis de diferencias de medias se ha realizado a través de la hoja de cálculo desarrollada por Microsoft, Excel. Como las varianzas de las muestras son desiguales, hemos utilizado la herramienta “Prueba t para dos muestras suponiendo varianzas desiguales”. El resultado del estudio muestra la aceptación de la hipótesis nula y por lo tanto, se confirma que no existen diferencias significativas entre ambas muestras. Esto significa que no existe diferencia entre las diferentes valoraciones que hacen los clientes de los alojamientos que tienen sellos de calidad y los que no. ABSTRACT: Rural tourism represents one of the most important branches of national tourism. Nonetheless, it was not until 2019 that the World Tourism Organization was able to define rural tourism and to provide it with a range of characteristics that each rural lodging must fulfill. Moreover, rural tourism can be classified into nine different types depending on what they offer. At the moment there are six different types of quality certificates that can measure the level of compromise and the quality perceived by the clients. These certificates are essential so that the companies are able to measure the degree of innovation that they are carrying. However, it cannot be said that lodgings that are acquired with a rural seal are perceived more positively than others which do not. The aim of this project is to analyse whether rural lodgings in Cantabria that possess those certificates obtain better ratings than those which do not. To carry out this study, 198 lodgings registered in the web “Portal de Turismo Rural de Cantabria” have been analysed. The analysis of the difference in averages has been carried out using the spreadsheet developed by Microsoft, Excel. As the variances of the samples are unequal, the tool "Test t for two samples assuming unequal variances" has been used in the spreadsheet. The outcome of the study shows the rejection of the null hypothesis and therefore it is accepted that there are no significant differences between the two samples. This means that there is no difference between the different evaluations made by the clients of the accommodations that have quality certificates and those which do not. Grado en Administración y Dirección de Empresas