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BACKGROUND: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. METHODS AND RESULTS: We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. CONCLUSIONS: The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. This work was supported by the SANCO EAHC grants (EUPHORIC 2003/134 and EURHOBOP 2008/1312), the Health Institute Carlos IIIFEDER (HERACLES Spanish Cardiovascular Research Network RD06/ 0009 and RD12/0042, CB06/02/0029 and CP12/03287 to MG) and the Catalan Agency for Management of University and Research Grants (2005SGR00577, 2009SGR1195 and 2014SGR240, and 2011BP-B00169 postdoctoral contract to IRD — Beatriu de Pinós Program co-financed by the European Commission

Background Diagnosis of unrecognized myocardial infarction (UMI) remains an open question in epidemiological and clinical studies, inhibiting effective secondary prevention of myocardial infarction. We aimed to determine the prevalence and incidence of Q-wave UMI in asymptomatic individuals aged 35 to 74years, and to ascertain the positive predictive value (PPV) of asymptomatic Q-wave to diagnose UMI. Methods Two population-based cross-sectional studies were conducted, in 2000 (with 10-year follow-up) and in 2005. A baseline electrocardiogram was obtained for each participant. Imaging techniques (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computerized tomography) were used to confirm UMI in patients with asymptomatic Q-wave. Results The prevalence of confirmed Q-wave UMI in the 5580 participants was 0.18% (95% confidence interval [CI]: 0.10–0.33) and the incidence rate was 27.1 Q-wave UMI per 100,000person-years. The proportion of confirmed Q-wave UMI with respect to all prevalent MI was 8.1% (95% CI: 4.4–14.2). The PPV of asymptomatic Q-wave to diagnose Q-wave UMI was 29.2% (95% CI: 18.2–43.2%) overall, but much higher (75%, 95% CI: 40.9–92.9%) in participants with 10-year CHD risk ≥10%, compared to lower-risk participants. Conclusion Opportunistic identification of asymptomatic Q-waves by routine electrocardiogram overestimates actual Q-wave UMI, which represents 8% to 13% of all myocardial infarction in the population aged 35 to 74years. This overestimation is particularly high in the population at low cardiovascular risk. In epidemiological studies and in clinical practice, diagnosis of a pathologic Q-wave in asymptomatic patients requires detailed analysis of imaging tests to confirm or rule out myocardial necrosis.

Background Evaluation of chest pain of uncertain origin in the emergency department is a challenge. Chest pain units, involving non-invasive stress testing, have logistic constraints. Our aim was to identify very low risk patients for early discharge using clinical data. Methods A total of 772 patients were studied. Ischemia in the electrocardiogram, troponin elevation or history of ischemic heart disease, were exclusion criteria. The primary end point was 30day cardiac events (death, myocardial infarction or revascularization). The secondary end point was 1year major events (death or myocardial infarction). Results The primary and secondary end point rates were 123 (18%) and 31 (4%). Predictive variables for the primary end point were typical chest pain (OR=1.8, p =0.007), ≥2 pain episodes in last 24h (OR=3.4, p =0.0001), age≥55years (OR=1.8, p =0.03), male (OR=2.2, p =0.001), diabetes (OR=1.8, p =0.01) and family history of ischemic heart disease (OR=2.0, p =0.02). A very low risk category could be distinguished ( n =114) that showed only 3 (2.6%) events at 30days (all 3 revascularizations), compared with 120 (18%) in the remaining patients ( p =0.0001). The very low risk criteria had 97% negative predictive for 30day cardiac events. No very low risk patient presented major events at 1year compared with 31 (4.7%) in the remaining patients ( p =0.009). Conclusion In patients presenting to the emergency department with chest pain of uncertain origin and without prior ischemic heart disease, very low risk patients can be identified using clinical data. These patients could be quickly discharged without further non-invasive stress testing.

Background Lone atrial fibrillation (LAF) is characterized by the presence of atrial fibrillation in the absence of structural heart disease or other identifiable cause of arrhythmia. In a recent study, we reported sport practice to be more frequent in LAF patients than in the general population. The aim of the study was to determine the association between sport practice and the prevalence of LAF in men. Methods An age-matched case–control study was designed. Cases were identified from consecutive patients who attended an outpatient clinic; 51 men with LAF were included, 20 of them with vagal characteristics. Controls were selected from the general population ( n =109). A questionnaire to assess former and current sport practice and the number of lifetime hours of sport practice was administered. Conditional logistic regression was used for statistical analysis. Results The proportion of patients with LAF who reported current sport practice (31%) was higher than that observed in controls (14%). In the logistic regression, current practice of sport was associated with a higher prevalence of LAF (OR=3.13; 95% CI: 1.39–7.05). The practice of more than 1500 lifetime hours of sport appears to be the threshold for the observed association. Current practice of sport with a lifetime practice greater than 1500 h was associated with LAF (OR=2.87; 95% CI: 1.20–6.91). Conclusion In men, the combination of current and prolonged lifetime sport practice is associated with higher risk of LAF.

Pending their work to have “high” impact factor and visibility. No one should pay for the honour and prestige... no one at all. Yet it is what is currently happening. SOME THOUGHTS ABOUT THIS WRITING It is true that there is too much stringency by the reviewers of many journals of high impact factor. It is also true that must have a double-blind between authors and reviewers in all the editorials. Thus, the bias of a possible tendentiousness would be disappeared. I personally know how wonderful clinical works have been rejected for the sake of a more or less gratuitous rigorously. Conversely, I have seen non-rigorous,even inconsistent clinical worksthat have been approved because these were signed by acclaimed authors. This should not be happening. A double-blind assessment is needed for any publication from any editorial. Maybe for this reason the aforementioned editorials (‘open access’) are taking advantage of these current circumstances. They buy vanity and sell publications. This must not be good for anyone. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology (Shewan and Coats 2010;144:1–2).

Background Most studies that have analysed the effect of secondary prevention of coronary heart disease come from hospitals. Those that are community-based have been conducted mainly by nurses and follow-up was generally too short to show impact on cardiovascular events. Methods This is a multi-centre randomised controlled clinical trial in which patients in the intervention group received periodic postal reminders to see their general practitioner every three months during a 3-year follow-up. General practitioners reinforced healthy lifestyle recommendations to patients and reviewed drug therapies at these quarterly intervals. Patients in the control group received usual care. Results A total of 983 patients aged 30–79 were included. During the 3-year follow-up, 67 patients died and 156 experienced a non-fatal cardiovascular event. The event rates and all-cause mortality were similar in the intervention and control groups (24.0% and 23.5%, and 8.1% and 9.9%, respectively). Improvement in quality of life was similar in both groups. Blood pressure and high-density lipoprotein cholesterol were more frequently within recommended levels in the intervention group than in controls: odds ratio 1.63, 95% confidence interval 1.05–2.51, and odds ratio 2.61, 95% confidence interval 1.32–5.18, respectively. Conclusions Intensive secondary prevention conducted by general practitioners may improve long-term blood pressure control and increase high-density lipoprotein cholesterol in patients with stable coronary disease.