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Objectives No standard therapy, including anticoagulation regimens, is currently recommended for coronavirus disease 2019. Aim of this study was to evaluate the efficacy of anticoagulation in coronavirus disease 2019 hospitalized patients and its impact on survival. Design Multicenter international prospective registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019). Setting Hospitalized patients with coronavirus disease 2019. Patients Five thousand eight hundred thirty-eight consecutive coronavirus disease 2019 patients. Interventions Anticoagulation therapy, including prophylactic and therapeutic regimens, was obtained for each patient. Measurements and main results Five thousand four hundred eighty patients (94%) did not receive any anticoagulation before hospitalization. Two-thousand six-hundred one patients (44%) during hospitalization received anticoagulation therapy and it was not associated with better survival rate (81% vs 81%; p = 0.94) but with higher risk of bleeding (2.7% vs 1.8%; p = 0.03). Among patients admitted with respiratory failure (49%, n = 2,859, including 391 and 583 patients requiring invasive and noninvasive ventilation, respectively), anticoagulation started during hospitalization was associated with lower mortality rates (32% vs 42%; p Conclusions Anticoagulation therapy in general population with coronavirus disease 2019 was not associated with better survival rates but with higher bleeding risk. Better results were observed in patients admitted with respiratory failure and requiring invasive ventilation.

Resumen Antecedentes y objetivos La prevalencia de fibrilacion auricular (FA) y cardiopatia isquemica ( C I) aumenta con la edad. Coexisten en hasta un 20% de los pacientes octogenarios, situacion que supone un desafio terapeutico. Los ensayos que han abordado este escenario, que incluyeron un porcentaje bajo de octogenarios, demostraron que la doble terapia (antiagregacion simple + anticoagulacion) en comparacion con la triple terapia (doble antiagregacion + anticoagulacion) se asocia menos eventos hemorragicos, especialmente con anticoagulantes orales de accion directa. Estos estudios no tenian potencia suficiente para detectar diferencias en eventos isquemicos. Por otro lado, aspectos prevalentes en la poblacion mayor, como los sindromes geriatricos, no se valoraron en estos estudios, y tampoco en la practica clinica habitual, desconociendose su impacto pronostico en este contexto clinico. Material y metodos Estudio observacional, prospectivo y multicentrico, que incluira pacientes ≥ 80 anos con FA y CI en Espana. Se valoraran las caracteristicas basales y los sindromes geriatricos, asi como la eleccion del tratamiento antitrombotico. El objetivo primario es conocer la mortalidad cardiovascular y por todas las causas a uno y tres anos. Resultados Este estudio permitira conocer las caracteristicas y el pronostico de pacientes octogenarios con FA y CI en nuestro medio, los factores implicados en la eleccion del tratamiento antitrombotico y la incidencia de eventos isquemicos y hemorragicos durante el seguimiento a corto y largo plazo. Conclusiones Nuestro trabajo contribuira a mejorar el conocimiento en terminos de seguridad y eficacia de las distintas opciones terapeuticas en pacientes mayores con FA y CI y su impacto pronostico.

Objectives Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. Design Observational prospective study. Setting Multicenter registry conducted in 44 hospitals in Spain. Participants Consecutive patients with ACS aged 80≥years. Measurements A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. Results A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p

Background: Patients with sepsis with a concomitant coronavirus (COVID-19) infection are related to a high morbidity and mortality rate. We investigated a large cohort of patients with sepsis with a concomitant COVID-19, and we developed a risk score for the estimation of sepsis risk in COVID-19.Methods: We conducted a sub-analysis from the international Health Outcome Predictive Evaluation Registry for COVID-19 (HOPE-COVID-19-Registry, NCT04334291). Out of 5,837 patients with COVID-19, 624 patients were diagnosed with sepsis according to the Sepsis-3 International Consensus.Results: In multivariable analysis, the following risk factors were identified as independent predictors for developing sepsis: current smoking, tachypnoea (>22 breath per minute), hemoptysis, peripheral oxygen saturation (SpO2) 1.5 mg/dl. By assigning odds ratio (OR) weighted points to these variables, the following three risk categories were defined to develop sepsis during admission: low-risk group (probability of sepsis 3.1–11.8%); intermediate-risk group (24.8–53.8%); and high-risk-group (58.3–100%). A score of 1 was assigned to current smoking, tachypnoea, decreased SpO2, decreased BP, decreased GCS, elevated PCT, TnI, and creatinine, whereas a score of 2 was assigned to hemoptysis.Conclusions: The HOPE Sepsis Score including nine parameters is useful in identifying high-risk COVID-19 patients to develop sepsis. Sepsis in COVID-19 is associated with a high mortality rate.

Background Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet. The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs. Methods EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed. Results We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR Conclusion In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE

Background Atrial fibrillation (AF) increases the risk of stroke and mortality, and concomitant renal impairment confers a worse prognosis. However, those factors that may limit the use of direct-acting oral anticoagulants in AF patients with renal impairment have not been further investigated, as they confer a higher risk of adverse events in this patient population. Purpose To investigate predictors of adverse clinical outcomes in AF patients with renal impairment who were treated with rivaroxaban. Methods The EMIR study is an observational, multicenter study including patients with AF treated with rivaroxaban for at least the previous 6 months. During 2.5 years of follow-up, the occurrence of thromboembolic events (the composite of isquemic stroke, transient ischemic attack, systemic embolism and myocardial infarction [MI]), major bleeding (ISTH definition) and major adverse cardiovascular events (MACE: fatal/non-fatal MI, myocardial revascularization and cardiovascular death) were recorded. For the present analysis, creatinine clearance (CrCl) was estimated by using the Cockroft-Gault equation and renal impairment was defined as a CrCl Results 1433 patients were included (44.5% female; mean age 74.2±9.7 years), of which 498 (35.1%) had CrCl Conclusions Rivaroxaban showed excellent results in moderate renal impairment. However, the annual rate of major bleeding and MACE was higher in AF patients with impaired renal function. In patients with AF and renal impairment, male sex, the presence of heart failure, dependency, the concomitant use of antiplatelets, and greater comorbidity according to the CHA2DS2-VASc and HAS-BLED, were associated with higher risk of adverse clinical outcomes. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer

Background Management of patients with atrial fibrillation (AF) and malignancy is a clinical challenge given the paucity of evidence supporting the appropriate clinical management. Purpose To evaluate the outcomes of patients with active or prior malignancy in a large contemporary cohort of European AF patients. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. We stratified the population into three categories (i) No Malignancy (NoM) (ii) Prior Malignancy (PriorM) and (iii) Active Malignancy (ActM). The primary outcome for this analysis was all-cause death among the three groups. The association between anticoagulant treatment, all-cause death and haemorrhagic events was also evaluated. Results Among the original 11 096 AF patients enrolled, 10 383 were included in this analysis (median age 71 years (interquartile range [IQR] 63–77, males 59.7%). Of these, 9 597 (92.4%) were NoM patients, 577 (5.6%) PriorM and 209 (2%) ActM. Patients with malignancy (prior or active) had a higher median age, median CHA2DS2-VASc and HAS-BLED scores, compared to patients without malignancy (p After a median follow-up of 730 days [IQR 692–749], 982 (9.5%) patients died. Among all deaths, the proportion of cardiovascular death was different according to the three groups (40.0% in NoM, 26.0% in PrioM and 22.2% in ActM, p=0.002). For all cause-death, Kaplan-Meier analysis showed a progressively higher cumulative risk in the PriorM and ActM groups compared to NoM patients (Figure 1). On multivariable Cox regression analysis, adjusted for CHA2DS2-VASc score, use of AC, type of AF and chronic kidney disease, ActM group was independently associated with a higher risk for all cause death (hazard ratio [HR] 2.90, 95% confidence interval [CI] 2.23–3.76) while PriorM group was not. Among PriorM and NoM patients, multivariable adjusted Cox regression analysis found that the use of any AC was independently associated with a lower risk for all-cause death (HR 0.36, 95% CI 0.19–0.66; HR 0.66, 95% CI 0.54–0.81). No significant association between AC and all-cause death was found for ActM patients. Conclusions In a large contemporary cohort of European AF patients, active malignancy was found to be independently associated with all-cause death. Use of any AC was associated with a lower risk for all-cause death in patients with no malignancies and with prior malignancies, but with no significant association amongst patients with active malignancies. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022). Figure 1. Kaplan-Meier for all-cause death

Introduction Atrial fibrillation (AF) is not a benign arrhythmia, but is associated with an increase in mortality, above all related to the risk of suffering thromboembolic events, mainly stroke. The use of oral anticoagulants (OAC) reduces this risk, but increases the risk of serious bleeding. The DOACs have been shown to be superior to the classic vitamin K antagonists (VKAs). It is not as well known whether AF is associated with an increase in other serious cardiac events. Purpose The objective of this analysis was to assess the incidence of stroke, major bleeding, total mortality and major adverse cardiac events [MACE, defined as cardiac mortality (including death for coronary events, progressive heart failure death and sudden cardiac death), coronary revascularization, myocardial infarction] in a contemporary series of patients with AF anticoagulated with rivaroxaban. Methods To do this, we have analyzed a series of 1,433 patients with AF, anticoagulated with rivaroxaban for at least the previous 6 months, consecutively included in the first half of year 2017 in 79 Spanish centers (EMIR study), and followed for 2.5 years. Results Mean age was 74.2±9.7 years, 44.5% being women. Prevalence of diabetes was 27.1%, chronic renal failure 16.1%, coronary heart disease 16.4% and heart failure 22.7%. 2MACE score was 1.8±1.4, CHA2DS2-VASc was 3.5±1.5 and HAS-BLED 1.6±1.0. 77.1% of patients received 20 mg/ day of rivaroxaban and 22.9% 15 mg/day. After a follow-up of 2.5 years, the annual rate (events/100 patients/year) of myocardial infarction was 0.16 (all non-STEMI), coronary revascularization 0.28, cardiac death 0.63 (sudden 0.16, heart failure 0.41, other 0.06), overall MACE 1.07 and overall mortality 2.73, while the incidence of stroke was 0.57 / 100 patients / year (ischemic 0.35, haemorrhagic 0.22) and major bleeding 1.04 (gastrointestinal 0.63, intracranial 0.28). Conclusion In a current series of patients with AF anticoagulated with rivaroxaban, the incidence of embolic and hemorrhagic complications and mortality are low, while the incidence of serious cardiac events is significant, being overall similar to that of stroke and major bleeding. Attention must be paid to the prevention and diagnosis of these problems. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p &lt, 0.001) and more often had a history of hypertension (77% vs. 83.1%, p &lt, 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p &lt, 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78, p &lt, 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14, p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.

Introduction and objectives Vitamin K antagonists (VKAs) are still widely used for stroke prevention in atrial fibrillation. However, the access to international normalised ratio (INR) determinations is sometimes difficult and the time in therapeutic range (TTR) is not always available. The aim of this study was to design and validate a simple and easy-to-use questionnaire that enables the identification of atrial fibrillation patients with poor quality of anticoagulation. Methods This is a national, multi-centre, observational, and cross-sectional study including consecutive non-valvular atrial fibrillation patients receiving VKA therapy and followed up at cardiology clinics. At inclusion, INR determinations during the last 6 months were analysed to determine the TTR and the ICUSI questionnaire was completed. A TTR < 65% was considered suboptimal. Results A total of 813 patients (55% men, 75±9 years old) were available for the analyses. The mean TTR was 62.2%±20.3% and 427 (52.5%) patients had a TTR < 65%. The final version of the ICUSI questionnaire included 4 questions and the mean ICUSI score was 1.19±1.17. The predictive ability of the ICUSI questionnaire for predicting TTR < 65% was moderate (c-index, 0.707; 95%CI, 0.670–0.740; P

Funding Acknowledgements Type of funding sources: None. OnBehalf ESC-EHRA EORP AF General Long-Term Registry Investigators Introduction Data derived from recent observational studies in atrial fibrillation (AF) show how the complexity of the clinical phenotype, beyond baseline thromboembolic risk, can increase risk of major adverse outcomes. Importantly, risk factors tend to occur in clusters, rather than occur individually in isolation. Aims To describe AF patients’ clinical phenotypes among a large contemporary European AF cohort and to analyse the differential impact of these clinical phenotypes on the occurrence of major adverse outcomes. Methods We performed a hierarchical cluster analysis based on Ward’s Method and using Squared Euclidean Distance using 22 clinical covariates. All variables were considered as binary. Examining the distances between cluster coefficients and by visual inspection of the dendrogram produced we identified the optimal number of clusters. Patients with data available for all 22 variables were included. We considered occurrence of cardiovascular events and all-cause death. Results Among the original 11096 patients included, 9363 (84.4%) were available for this analysis. The cluster analysis identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients with prevalent noncardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients mainly admitted for first detected and paroxysmal AF with low prevalence of concomitant conditions; Cluster 3 (n = 2955; 31.6%) included patients with high prevalence of permanent AF, cardiac risk factors and comorbidities. Thromboembolic and bleeding risks were higher in Cluster 3 and progressively lower in Cluster 1 and Cluster 2 (both p Conclusions In European AF patients, three main clinical clusters were identified, those with non-cardiac comorbidities, low risk and cardiac comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of cardiovascular events and all-cause death. Abstract Figure. Kaplan-Meier Curves for Outcomes

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2017), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2017), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2018). The Atrial Fibrillation NETwork (AFNET), conducting the registry in Germany, received support from The Bristol Myers Squibb/Pfizer Alliance (2014–2018) and the German Centre for Cardiovascular Research (DZHK). Funding from Daiichi-Sankyo and Boehringer-Ingelheim have been received for conducting the registry in Spain. Funding from BMS-Pfizer Alliance was received to support the programme in France Background The 4S-AF scheme (Stroke risk, Symptom severity, Severity of atrial fibrillation [AF] burden, Substrate severity) has recently been described as a novel approach to in-depth characterization of AF, and included in the 2020 European Society of Cardiology guidelines for the management of AF. Purpose In the present study, we validated for the first time the 4S-AF scheme in the Spanish and French cohorts of the EurObservational Research Programme (EORP)-AF Long-Term General Registry. Methods The Spanish and French cohorts of the EORP-AF Long-Term General Registry, were merged and included. The baseline 4S-AF scheme was calculated as follows: Symptom severity (according to EHRA symptom score: 0-2 points), Severity of AF burden (according to AF type: 0-3 points), Substrate severity (according to comorbidities/cardiovascular risk factors: 0-7 points); and related to the primary management strategy (rhythm or rate control). According to the results for these 3 domains, four code colors have been defined. Patients with all domains in "green" should be managed by rhythm control. In patients with one domain in "yellow" or two domains in "green" categories, rhythm control can be attempted. On contrary, for patients with "red" color category, the 4S-AF scheme suggests a rate control strategy. All-cause mortality and the composite of ischemic stroke/transient ischemic attack/systemic embolism, major bleeding and all-cause death, were the primary endpoints. These outcomes were recorded during 1-year of follow-up. Results 1479 patients (36.9% females, median age of 72 [IQR 64-80] years) were included (Table 1). The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both p Conclusion Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control, and could also help in identifying high-risk AF patients for worse clinical outcomes in a ‘real-world’ setting. Abstract Table 1 and Figures 1A-1B

Funding Acknowledgements Type of funding sources: None. Introduction The ESC-EHRA EORP AF General Long-Term Registry provides a contemporary snapshot of European atrial fibrillation (AF) patients’ characteristics and management. Aims: We present data about the final 2-years follow-up observation of AF patients enrolled in the ESC-EHRA EORP AF General Long-Term Registry. Methods A contemporary evaluation of residual risk of adverse outcomes in a cohort of largely anticoagulated AF patients according to the baseline thromboembolic and bleeding risk, defined according to CHA2DS2-VASc and HAS-BLED scores. We determined cardiovascular (CV) events, CV death and all-cause death as outcomes. Results Among the original 11069 patients enrolled, 8409 (76.0%) patients had available follow-up status at the end of the 2-years follow-up. Patients age, female sex and most comorbidities were progressively more prevalent across the spectrum of thromboembolic and bleeding risk. Data on adverse outcomes were available for 10087 (91.1%), over the 2-year observation period. Outcome rates were progressively higher across CHA2DS2-VASc and HAS-BLED scores (all p Conclusions In this large contemporary European-wide cohort of AF patients, both baseline thromboembolic and bleeding risks were associated to an increased risk of major clinical outcomes. Both scores are reflective of high risk clinical states, and are predictive of major adverse outcomes even in a large cohort of largely anticoagulated patients with a lower residual risk of adverse outcomes. Abstract Figure.

Introducción y objetivos: La comorbilidad en ancianos con síndrome coronario agudo sin elevación del segmento ST empeora el pronóstico. El objetivo fue analizar la influencia de la carga de comorbilidad en la decisión del tratamiento invasivo en ancianos con SCASEST. Métodos: Se incluyeron 7.211 pacientes mayores de 70 años procedentes de 11 registros españoles. Los datos se analizaron en una base de datos conjunta. Se evaluó la presencia de 6 enfermedades simultáneas y su asociación con la realización de coronariografía durante el ingreso. Resultados: La edad media fue de 79 ± 6 años y la puntuación GRACE media fue de 150 ± 21 puntos. Fueron tratados de manera conservadora 1.179 pacientes (16%). La presencia de cada enfermedad se asoció con un menor abordaje invasivo (ajustado por variables clínicas predictivas): enfermedad cerebrovascular (odds ratio [OR] = 0,78; intervalo de confianza del 95% [IC95%], 0,64-0,95; p = 0,01), anemia (OR = 0,64; IC95%, 0,54-0,76; p < 0,0001), insuficiencia renal (OR = 0,65; IC95%, 0,56-0,75; p < 0,0001), arteriopatía periférica (OR = 0,79; IC95%, 0,65-0,96; p = 0,02), enfermedad pulmonar crónica (OR = 0,85; IC95%, 0,71-0,99; p = 0,05) y diabetes mellitus (OR = 0,85; IC95%, 0,74-0,98; p = 0,03). Asimismo, el aumento del número de enfermedades (carga de comorbilidad) se asoció con menor realización de coronariografías, ajustado por la escala GRACE: 1 enfermedad (OR = 0,66; IC95%, 0,54-0,81); 2 (OR = 0,55; IC95%, 0,45-0,69); 3 (OR = 0,37; IC95%, 0,29-0,47); 4 (OR = 0,33; IC95%, 0,24-0,45); ≥ 5 (OR = 0,21; IC95%, 0,12-0,36); todos p < 0,0001, en comparación con ninguna enfermedad. Conclusiones: Conforme aumenta la comorbilidad disminuye la realización de coronariografías en ancianos con síndrome coronario agudo sin elevación del segmento ST. Se necesitan estudios que investiguen la mejor estrategia diagnóstico-terapéutica en estos pacientes. Introduction and objectives: The presence of comorbidities in elderly patients with non-ST-segment elevation acute coronary syndrome worsens its prognosis. The objective of the study was to analyze the impact of the burden of comorbidities in the decision of using invasive management in these patients. Methods: A total of 7211 patients > 70 years old from 11 Spanish registries were included. Individual data were analyzed in a common database. We assessed the presence of 6 comorbidities and their association with coronary angiography during admission. Results: The mean age was 79 ± 6 years and the mean CRACE score was 150 ± 21 points. A total of 1179 patients (16%) were treated conservatively. The presence of each comorbidity was associated with less invasive management (adjusted for predictive clinical variables): cerebrovascular disease (OR, 0.78; 95%CI, 0.64-0.95; P = .01), anemia (OR, 0.64; 95%CI, 0.54-0.76; P < .0001), chronic kidney disease (OR, 0.65; 95%CI, 0.56-0.75; P < .0001), peripheral arterial disease (OR, 0.79; 95%CI, 0.65-0.96; P = .02), chronic lung disease (OR, 0.85; IC95%, 0.71-0.99; P = .05), and diabetes mellitus (OR, 0.85; 95%CI, 0.74-0.98; P < .03). The increase in the number of comorbidities (comorbidity burden) was associated with a reduction in coronary angiographies GRACE score: 1 comorbidity (OR, 0.66; 95%CI, 0.54-0.81), 2 comorbidities (OR, 0.55; 95%CI, 0.45-0.69), 3 comorbidities (OR, 0.37; 95%CI, 0.29-0.47), 4 comorbidities (OR, 0.33; 95%CI, 0.24-0.45), ≥ 5 comorbidities (OR, 0.21; 95%CI, 0.12-0.36); all P values < .0001 compared to 0. Conclusions: The number of coronary angiographies performed drops as the number of comorbidities increases in elderly patients with non-ST-segment elevation acute coronary syndrome. More studies are still needed to know what the best management of these patients should be. Instituto de Salud Carlos III (CIBERCV 16/11/00420) No data 2020 UEM

Background: Sepsis patients with a concomitant Coronavirus (COVID-19) infection are related to a high morbidity and mortality rate. We investigated a large cohort of sepsis patients with a concomitant COVID-19 to determine clinical characteristics, laboratory and radiological findings, and predictors of mortality. We developed a risk score for the estimation of sepsis risk in patients with COVID-19. Methods: In the present study, we conducted a sub-analysis from the international Health Outcome Predictive Evaluation Registry for COVID-19 (HOPE-COVID-19-Registry). Out of 5,837 patients with COVID-19, 624 patients were diagnosed with sepsis according to the Sepsis-3 International Consensus. Findings: In multivariable analysis, the following risk factors were identified as independent predictors for developing sepsis: current smoking, tachypnoea (>22 breath per minute), haemoptysis, peripheral oxygen saturation (SpO2) 1.5 mg/dl. By assigning odds ratio weighted points to these variables, the following three risk categories were defined to develop sepsis during admission: low-risk group (probability of sepsis 3.1-11.8%); intermediate-risk group (24.8-53.8%); high-risk-group (58.3-100%). A score of 1 was assigned to current smoking, tachypnoea, decreased SpO2, decreased blood pressure, decreased GCS, elevated PCT, TnI, and creatinine, whereas a score of 2 was assigned to haemoptysis. Interpretation: The HOPE Sepsis Score including 9 parameters is useful in identifying high-risk COVID-19 patients to develop sepsis. Sepsis in COVID-19 is associated with a high mortality rate. Funding Statement: Non-conditioned grant (FUNDACION INTERHOSPITALARIA PARA LA INVESTIGACION CARDIOVASCULAR, FIC. Madrid, Spain) Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was approved by the Ethics Committee in all involved centres.

Background Different “ex vivo” studies have shown both a greater platelet activation and higher rates of resistance to clopidogrel in obese patients. Although there is less evidence, less prasugrel activity has also been observed in these patients. Our aim was to study the variability of the response to clopidogrel, ticagrelor and prasugrel in obese patients, defined as a body mass index ≥30. Methods Prospective, multicenter, observational, pharmacodynamic study, conducted in a Spanish population of patients with an acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and double anti-aggregation with acetylsalicylic acid and a P2Y12 receptor inhibitor. Platelet function tests were performed the morning after the ICP and 30 days after it, including: 1) VerifyNow P2Y12 assay; 2) multiple electrode aggreometry (Multiplate); and 3) VASP analysis. Results Of the total patients included (988), 300 were obese (30.3%). The obese group was younger (62.8±12 years vs 64.9±12), had a higher incidence of arterial hypertension (76.3% vs. 56.7%), diabetes mellitus (35% vs. 27.5%); and lower incidence of chronic kidney disease (7.7% vs. 17%). There were no differences in the acute phase (day 1 after PCI) in the pharmacodynamic response to any of the P2Y12 inhibitors used. After 30 days, greater platelet aggregation (decreased response) was documented in obese patients treated with prasugrel according to VASP tests (PRI in non-obese 23.9±13% vs. 30.4±14.7% in obese, p 0.035) and MEA (area under the aggregation units curve in non-obese 251.7±104.1 vs 320±166.7 in obese, p 0.007) and a numerical trend with VerifyNow. A trend in the same direction was also observed in patients treated with clopidogrel that did not reach statistical significance with all the platelet function tests used. No differences were observed in the ticagrelor group. Conclusion Obese patients with an ACS treated with PCI have a worse response to thienopyridines than non-obese patients in the maintenance phase of antiaggregant treatment, while the response to ticagrelor is not affected by obesity. Completing the clinical follow-up proposed by the registry is necessary to know if these differences have an implication in cardiovascular events. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fondo de Investigaciones Sanitarias (FIS)

Background Atrial fibrillation (AF) significantly impacts on patients' quality of life (QoL). An impaired QoL has been associated with worse outcomes even in AF patients, but contemporary data in a large-scale pan-European population are limited. Purpose We aimed to assess temporal changes in AF patients' QoL across 2 years follow-up observation, and the relationship of QoL changes with all-cause death. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. The EQ-5D-5L questionnaire was used to assess QoL. A Health Utility Score (HUS), indicating the overall health state (1 equals perfect health), was derived. Differences throughout the follow-up (Baseline, 1-Y FU, 2-Y FU) observation were assessed. The study outcome was all-cause mortality. Results Out of a total of 11906 patients, 8097 (73.0%) were available for this analysis. Mean (SD) age was 69.1 (11.5) years; 60.8% males; median CHA2DS2-VASc and HASBLED scores were 3 (IQR 2–4) and 1 (1–2), respectively. The mean (SD) HUS at baseline was 0.815 (0.200) and 0.834 (0.196), 0.829 (0.195) at 1-year follow-up and 2-year follow-up, respectively (p Conclusions In a contemporary European-wide cohort of AF patients, significant temporal changes in QoL were found. Patients at higher stroke risk according to CHA2DS2-VASc score showed a significant reduction in the QoL. Age and CAD were independently associated with changes in QoL. A greater reduction in HUS (i.e. worsening QoL) over time was associated with a higher risk of all-cause death. Temporal changes in HUS Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants

Background Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. Purpose To investigate trends in HF hospitalization and in-hospital mortality rates. Methods We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated. Results A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p Conclusions From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change. Figure 1 Funding Acknowledgement Type of funding source: None

Background Heart failure (HF) is a major health care problem. Epidemiological data from hospitalized patients are scarce and the association between hospital volume and patient outcomes is largely unknown. Purpose The aim of this study was to analyze the relationship between hospital volume and outcomes (in-hospital mortality and 30-day cardiac readmission). Methods We conducted an observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) within 30 days after discharge by using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Information on the number of HF discharges at each hospital in 2015 was analysed to classify centres into 2 categories (high- and low-volume hospitals). To discriminate between high- and low-volume centers, a K-means clustering algorithm was used. The association between volume and RSMR or RSRR was tested with the Pearson correlation coefficient and linear regression models. Results A total of 117 233 episodes of HF were selected during 2015. The mean age was 80±10 years and 46% were women. The crude in-hospital mortality rate was 12.1% and 30-day cardiac readmission rate was 18%. The cut-off point was set at 517 HF discharges per hospital during 2015. High volume hospitals had a statistically lower RSMR (10.3±2.8 vs 11.3±3.6; p Conclusions We found that patients hospitalized for HF in 2105 had lower in-hospital mortality if they were admitted to a high-volume hospital. We have also found that high-volume hospitals had higher 30-day cardiac readmission rates. Funding Acknowledgement Type of funding source: None

Background There are no data on population-based epidemiological changes in acute myocarditis in Europe. Our aim was to evaluate temporal trends in incidence, clinical features and outcomes of hospital treated acute myocarditis (AM) in Spain from 2003 to 2015. Methods We conducted a retrospective longitudinal study using information of all hospital discharges of the Spanish National Health System. All episodes with a discharge diagnosis of AM from 1 January 2003 to 31 December 2015 were included. The risk-standardized in-hospital mortality ratio (RSMR) was calculated using a multilevel risk-adjustment model developed by the Medicare and Medicaid Services. Temporal trends for in-hospital mortality were modelled using Poisson regression analysis. Results A total of 11 147 episodes of AM were analysed, most of them idiopathic (94.7%). The rate of AM discharges increased along the period, from 13 to 30/million inhabitants/year (2003-2015), and this increase was statistically significant when weighted by age and sex (incidence rate ratio, IRR 1.06, 95% CI 1.04-1.08, P = .001). In-hospital crude mortality rate was 3.1%, diminishing significantly along 2003-2015 (IRR 0.95, 95% CI 0.92-0.99, P = .02). RSMR also significantly diminished along the period (IRR 0.95, 95% CI 0.92-0.99, P = .01). Renal failure (OR 7.03, 5.38-9.18, P = .001), liver disease (OR 4.61, 2.59-8.21, P = .001), pneumonia (OR 4.13, 2.75-6.20, P = .001) and heart failure (OR 1.91, 95% CI 1.47-2.47, P = .001) were the strongest independent factors associated with in-hospital mortality. Conclusions Acute myocarditis is an uncommon entity, although hospital discharges have increased in Spain along the study period. Most of AM were idiopathic. Adjusted mortality was low and seemed to decrease from 2003 to 2015, suggesting an improvement in AM management.

Dual antiplatelet therapy is one of the main treatments in acute coronary syndrome (ACS). Switching antiplatelet agents may be necessary in some patients to improve efficacy or safety. The objective of this study was to determine the prevalence, predictors, and implications of clinical switching in patients during hospital admission and 1-year follow-up at discharge. Observational, prospective, multicenter registry study in patients discharged following an admission for ACS and followed up for 1 year. We analyzed ischemic and bleeding events as well as treatment changes. We recruited 1717 patients; in-hospital switching occurred in 425 (24.8%): 15.1% to clopidogrel and 84.9% to newer antiplatelet drugs (prasugrel or ticagrelor). Those switched to newer antiplatelets were younger, with lower scores on the GRACE and CRUSADE scales, admitted more frequently for ST-elevation myocardial infarction and underwent more invasive management and percutaneous revascularization. The clinical cardiologist was responsible for most in-hospital switching to newer antiplatelets (79.6%). The loading dose of the second antiplatelet did not affect incidence of bleeding events. Post-discharge switching was infrequent (2%) and depended mainly on clinical indications; only 30% was related to a new ACS. In a contemporary registry with ACS, in-hospital switching of antiplatelet drugs was frequent. Those switched to newer antiplatelets were younger and admitted more frequently for ST-elevation myocardial infarction. Post-discharge switching was infrequent.

Resumen En los ultimos anos, el numero de pacientes anticoagulados y antiagregados esta aumentando significativamente. Al ser un tratamiento cronico, es de esperar que a lo largo de su vida necesiten un procedimiento quirurgico o intervencionista que pueda requerir la interrupcion del farmaco antitrombotico. La decision de retirar o mantener dicho tratamiento estara determinada, por un lado, por el riesgo trombotico y, por otro, por el hemorragico. De la interaccion entre estos 2 factores dependera la actitud ante la anticoagulacion y la antiagregacion. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Espanola de Cardiologia y certificado por un amplio numero de sociedades cientificas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones practicas y sencillas con el fin de homogeneizar la practica clinica diaria.

Registries and non-interventional studies offer relevant and complementary information to clinical trials, since they have a high external validity. Areas covered: The information regarding the efficacy and safety of rivaroxaban compared with warfarin, or rivaroxaban alone in clinical practice was reviewed in this manuscript. For this purpose, a search on MEDLINE and EMBASE databases was performed. The MEDLINE and EMBASE search included both medical subject headings (MeSH) and keywords including: atrial fibrillation (AF) OR warfarin OR clinical practice OR ROCKET AF AND rivaroxaban. Case reports were not considered. Expert commentary: In ROCKET AF, rivaroxaban was at least as effective as warfarin for the prevention of stroke in patients with nonvalvular AF at high risk of stroke, but, importantly, with a lesser risk of intracranial, critical and fatal bleedings. A number of observational comparative and non-comparative studies, with more than 60,000 patients included treated with rivaroxaban, have analyzed the efficacy and safety of rivaroxaban in real-life patients with AF in different clinical settings. These studies have shown that in clinical practice, rates of stroke and major bleeding were consistently lower than those reported in ROCKET AF, likely due to the lower thromboembolic and bleeding risk observed in these patients.

Objective: To describe major events at follow up in octogenarian patients with atrial fibrillation (AF) according to anticoagulant treatment: direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Methods: A total of 578 anticoagulated patients aged ≥80 years with AF were included in a prospective, observational, multicenter study. Basal features, embolic events (stroke and systemic embolism), severe bleedings, and all-cause mortality at follow up were investigated according to the anticoagulant treatment received. Results: Mean age was 84.0 ± 3.4 years, 56% were women. Direct oral anticoagulants were prescribed to 123 (21.3%) patients. Compared with 455 (78.7%) patients treated with VKAs, those treated with DOACs presented a lower frequency of permanent AF (52.9% vs 61.6%, P = .01), cancer history (4.9% vs 10.9%, P = .046), renal failure (21.1% vs 32.2%, P = .02), and left ventricular dysfunction (2.4% vs 8.0%, P = .03); and higher frequency of previous stroke (26.0% vs 16.6%, P = .02) and previous major bleeding (8.1% vs 3.6%, P = .03). There were no significant differences in Charlson, CHA2DS2VASc, nor HAS-BLED scores. At 3-year follow up, rates of embolic events, severe bleedings, and all-cause death (per 100 patients-year) were similar in both groups (DOACs vs VKAs): 0.34 vs 1.35 ( P = .15), 3.45 vs 4.41 ( P = .48), and 8.2 vs 11.0 ( P = .18), respectively, without significant differences after multivariate analysis (hazard ratio [HR]: 0.25, 95% confidence interval [CI]: 0.03-1.93, P = .19; HR: 0.88, 95% CI: 0.44-1.76, P = .72 and HR: 0.84, 95% CI: 0.53-1.33, P = .46, respectively). Conclusion: In this “real-world” registry, the differences in major events rates in octogenarians with AF were not statistically significant in those treated with DOACs versus VKAs.

Background The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities. Purpose Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients. Methods The study group consisted of 1 training (n=920, 76±7 years) and 1 testing (n=532; 84±4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis. Results A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR=1.90, 95% CI 1.20–3.03, p=0.006); 2 comorbidities (16% mortality, HR=1.29, 95% CI 0.81–2.04, p=0.30); and 0–1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic= 0.80) and calibration (Hosmer-Lemeshow test, p=0.20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic=0.80; Hosmer-Lemeshow test, p=0.70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR=2.37, 95% CI 1.25–4.49, p=0.008; 2 comorbidities: 14% mortality, HR=1.59, 95% CI 0.82–3.07, p=0.20; 0–1 comorbidities: 7.5% reference category). Kaplan-Meyer curves for mortality Conclusion A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS Acknowledgement/Funding This work was supported by grants from Spain's Ministry of Economy and Competitiveness through the Carlos III Health Institute

Background Mitral regurgitation (MR) after acute coronary syndromes is associated with adverse prognosis. However, the prognostic impact of MR in older patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI) has not been well addressed. Methods The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Echocardiography performed during admission quantified mitral valve parameters in 497 patients, who were classified according to mitral regurgitation (MR) status in two groups: significant (moderate or severe) or no significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6-months. Results Mean age was 84.3±4.1 years, 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with patients without significant MR these patients had lower systolic blood pressure (132±28 vs 141±27 mmHg), higher heart rate (82±21 vs 74±17 bpm), worse Killip class (≥II 49.5% vs 22.5%), lower ejection fraction (47±14% vs 55±11%), higher pulmonary pressure (42±15 vs 35±11 mmHg), as well as more frequent new onset atrial fibrillation (16.4% vs 7.2%) (all p values=0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs 1.3%, p=0.04) and longer hospital stay (median 8 [5–12] vs 6 [4–10] days, p=0.002),and higher mortality/readmission at 6 months (HR 1,54, 95% CI 1.09–2.18). However, after adjusting for potential confounders, this last association was not significant. Conclusions Significant MR is seen in about one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, which is mainly determined by their clinical characteristics.

Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

Background Prasugrel and Ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with Acute Coronary Syndrome (ACS). However, the long-term prognosis and different clinical characteristics related with the type of antiplatelet prescription in current clinical practice ACS patients have not been analyzed in depth. Purpose The objective of this study was to analyze the clinical profile of ACS and the efficacy and safety of new antiplatelet drugs (NAD) in current clinical practice patients discharged after an ACS. Methods We collected data from ACHILLES registry, and observational, prospective and multicenter registry of patients discharged after an ACS. We analyzed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analyzed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted. Results Of 1,717 consecutive patients, 1,294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. NAD was indicated in 47%. Patients treated with clopidogrel were elderly (69.1±13.4 vs. 60.4±11.5 years; p Event Free Survival according NAD Use Conclusions In this prospective, observational and current clinical practice ACS registry, the use of NAD was associated with a reduction of adverse events compared with clopidogrel in patients with ACS. NAD prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high risk population.

Background CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We ought to study if this score predicts outcomes in elderly patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI). Methods The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Data to calculate CHA2DS2-VASc Score were available in 523 patients (98.3%). They were classified according to CHA2DS2-VASc Score: group 1 (score 0–4), and 2 (5–9). We studied outcomes in terms of mortality or readmission at 6 months follow-up. Results A total of 266 patients (51%) had a high CHA2DS2-VASc Score (group 2). They were more often women, with more cardiovascular risk factors like hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, p=0.001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment and frailty) and Charlson index were worse in this group (all, p=0.001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, p=0.001), and developed new onset AF more often during admission (12.4% vs. 6.6%, p=0,024). At six months follow-up, patients in group 2 had higher reinfarction, all cause mortality, and mortality or readmission rates (all, p=0.001). (Table) A CHA2DS2-VASc Score >4 predicted mortality (HR 2,60 [95% CI 1,48–4,55], p CHADS VASC2 0–4 (n=257) CHADS >4 (n=266) p Geriatric syndromes Barthel Index 94 (13) 85 (22) 0.001 Lawton brody 6.2 (2) 4.9 (3) 0.001 Charlson Index 1.5 (1) 3.3 (2) 0.001 Cognitive impairment 0.001 No 201 (79.1) 155 (58.7) Mild 49 (19.3) 100 (37.9) Severe 4 (1.6) 9 (3.4) Nutritional risk (MNA-SF*) 122 (48) 149 (57.1) 0.040 Frailty (FRAIL scale) 0.001 Non-frail 111 (43.2) 69 (25.9) Prefrail 102 (39.7) 101 (38) Frail 44 (17.1) 96 (36.1) Outcomes at 6 months Reinfarction 26 (6.9) 16 (13.9) 0.018 Mortality or readmission 111 (28.9) 60 (50.4) 0.001 All cause mortality 38 (9.9) 24 (20.2) 0.003 Conclusions A CHA2DS2-VASc sore>4 is present in half of octogenarians with NSTEMI and is associated with a poor outcome.

Background Different studies have observed a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular diseases.Several scores have been developed to assess frailty in elderly patients. The FRAIL scale is a bed-side and easy tool that evaluates 5 items: fatigue, resistance, ambulation, concomitant diseases and weight loss. However, the evaluation of frailty status in AF patients with ACS is scarce. Purpose The aim of this study was to analyze the management of elderly patients with AF and ACS and the predictive value of frailty for adverse events. Methods The prospective multicentre LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. In this substudy, we divided patients according to rhythm status (AF or sinus rhythm [SR]) and to frail status. We validated the predictive performance of FRAIL scores for adverse events at 6 months follow-up. Results We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis and 145 (27.3%) patients were frail. Frail AF patients had higher risk of global mortality [HR 2.61, (95% CI 1.28–5.31; p=0.008)], readmissions [HR 2.28, (95% CI 1.37–3.80); p=0.002)] and the composite endpoint [HR 2.28, (95% CI 1.44–3.60); p Event Free Survival according Frailty Conclusions In the LONGEVO-SCA registry, frail AF patients have 2-fold risk of adverse events compared to non-frail SR patients. Frailty status was an independent condition associated with high risk of adverse events at 6 months of follow-up.

Background Despite of the effectiveness and safety profile of Non-vitamin K Antagonists Oral Anticoagulants (NOACs) even in real-world (RW) Atrial Fibrillation (AF) patients, Vitamin K Antagonists (VKAs) have remained widely used in clinical practice worldwide but the comparison with acenocoumarol therapy in RW is unknown. Purpose To estimate the potential absolute benefit in clinical adverse events if the AF patients anticoagulated with VKA therapy had been treated with NOACs. Methods We analyzed anticoagulated AF patients who were prospectively recruited into the multicentre FANTASIIA registry. Patients were treated with VKAs for at least 6 months prior to inclusion. The estimation of clinical adverse events avoided was calculated applying absolute risk reductions, relative risk reductions and hazard ratios from the meta-analysis of RW use of NOACs relative to VKAs. Results We analyzed 1,470 patients under VKA therapy (mean age 74.1±9.5 years; 56.4% male). Stroke rate with acenocoumarol treatment was 0.88%/year. The estimated rates for stroke using NOACs would be 0.80%/year for Dabigatran 150 mg; 0.76%/year for Rivaroxaban and 0.74%/year for Apixaban instead of VKA. No significant differences were observed between the different NOACs and VKA in stroke rate. Major bleeding with acenocoumarol was 3.40%/year. The estimated rates for major bleeding using NOACs would be 2.75%/year for Dabigatran 150 mg; 3.37%/year for Rivaroxaban and 2.18%/year for Apixaban instead of VKA. Apixaban was the only NOAC that showed a significant estimated reduction rates (p=0.046). Finally, the all-cause mortality rate with acenocoumarol was 4.69%/year. The estimated rates of all-cause mortality using NOACs would be 3.28%/year for Dabigatran 150mg; 4.88%/year for Rivaroxaban and 2.67%/year for Apixaban. Dabigatran and Apixaban showed significant estimated reduction rates with the highest reduction with Apixaban (Table). Annual Rate reduction of adverse events Conclusion The absolute estimated effect of NOACs in the AF patients anticoagulated with VKA showed a significant reduction in adverse clinical events. Apixaban performed the highest estimated reduction in major bleeding and all-cause mortality in comparison with acenocoumarol.

Background Sex differences are known to exist in the management of women presenting with ST elevation myocardial infarction (STEMI).Few studies have examined whether the clinical management and prognosis differs by sex when the STEMI network system is applied. Purpose To assess whether the STEMI network system improves management and prognosis both in men and women in Spain and to analyze possible differences according to sex. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system (MDBS) of the Spanish National Health System (SNHS) to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality and expected mortality, multiplied by the crude rate of mortality. The RSMR was calculated using multilevel risk adjustment models developed by the Medicare and Medicaid Services. The year of the development of organized systems of care for STEMI patients in the different Autonomous Communities was double-checked using data from the National Cardiac Catheterization and Interventional Cardiology Annual Registry. RSMR was used to compare outcomes related with gender and with the presence of regional AMI networks and the performance of PCI. Temporal trends for in-hospital mortality during the observed period were modeled using Poisson regression analysis with year as the only independent variable. In all models, incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) were calculated. Results A total of 325,017 STEMI were identified among patients aged 35–94 years old. Of them 273,182 were selected after exclusions, and 106,277 (38.8%) were women. Women were on average 10 years older than men and had more comorbidities burden. The overall proportion of STEMI patients underwent to PCI increased, when a regional STEMI network was present from 2005–2015: (63.7% vs 48.2% in men; and 47.4% vs 32.9% in women; p Conclusions Women were less likely to be treated with PCI and had higher in-hospital risk-adjusted mortality than men, despite the existence of STEMI network system.

Background The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss. Purpose The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores. Methods The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores. Results We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 Conclusions This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.

Background Patients with acute coronary syndrome (ACS) and previous cardiovascular disease (CVD) [stroke, peripheral arterial disease (PAD) or coronary artery disease (CAD)] are at high risk of serious events and mortality. Current clinical guidelines recommend new antiplatelet drugs (NAD) for high cardiovascular risk patients with ACS; however, these drugs are underused in different scenarios. Purpose The aim of this study was to analyze the use of NAD and advese events in patients with ACS an previous CVD. Methods ACHILLES registry is and observational, multicenter and prospective registry of ACS patients. 1717 ACS patients were consecutively included in this study from 3 tertiary Hospitals. Of them, 641 (37.33%) suffered from previous CVD: 149 patients with stroke, 154 patients with PAD and 541 patients with CAD. Bleeding, mortality and major adverse cardiac events (MACE) at 1 year of follow-up after hospital discharge were analyzed. Results NADs administration during hospital stay and at discharge was less frequent in patients with previous CVDs. Cox analysis in this cohort of patients showed that clopidogrel prescription at discharge was independently associated with MACEs [HR: 1.59 (95% CI 1.03–2.45); p=0.036] and with death [HR: 1.99 (95% CI 1.00–3.98); p=0.049] in multivariate analysis. More specifically, when ticagrelor prescription at discharge was compared with clopidogrel prescription, a significant death reduction was found in both, the univariate and the multivariate Cox analysis [HR: 4.54 (95% CI 2.26–9.13); p KM curves according NAD and CVD disease Conclusion New antiplatelet drugs, especially ticagrelor, showed lower rates of mortality in patients with CVD without differences for bleeding. Despite the recommendations of current clinical guidelines for high risk patients with ACS, the use of NADs is very low in “real-life” patients with previous CVD.