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Objective: Clinical practice guidelines suggest performing an electrocardiogram (EKG) in patients with chest pain within the first 10 minutes in the emergency department, warning about subdiagnosis in women. Possible differences based on sex were analyzed. Method: An observational and retrospective study in an Emergency Department, with adult patients admitted to the Chest Pain Unit in 2021. Results: There were 1,469 patients, of whom 774 were men (52.7%). The men were younger (60 vs. 65 years), were less overweight (17.18 vs. 22.16%), and had more previous admissions to the Coronary Unit (12 vs. 7%), compared to women. No gender differences were observed in EKG performance (91 vs. 90%), EKG time (median 4.1 vs. 4.5 minutes), or delay in care attention (median 25 vs. 26 minutes). In terms of healthcare resources, men underwent more biomarkers: troponins (63 vs. 55%; odds ratio [OR]: 1.35; 95% confidence interval [95%CI]: 1.10-1.67) and creatine phosphokinase (24.8 vs. 19.1%), received more aspirin (6.7 vs. 3.1%), nitrates/nitrites (6 vs. 3%), and hospitalization (17.18 vs. 10.50%; OR: 1.76; 95%CI; 1.30-2.40). Of 206 hospitalized, 112 had a final diagnosis of acute coronary syndrome (54%), more men than women (81 vs. 31). There were no significant differences in revascularization time, medication schedule at discharge, hospital stay, or mortality. Conclusions: Gender did not affect precordial pain care, diagnosis, and treatment times, highlighting the quality of hospital care. [ABSTRACT FROM AUTHOR]

Objective: Clinical practice guidelines suggest performing an electrocardiogram (EKG) in patients with chest pain within the first 10 minutes in the emergency department, warning about subdiagnosis in women. Possible differences based on sex were analyzed., Method: An observational and retrospective study in an Emergency Department, with adult patients admitted to the Chest Pain Unit in 2021., Results: There were 1,469 patients, of whom 774 were men (52.7%). The men were younger (60 vs. 65 years), were less overweight (17.18 vs. 22.16%), and had more previous admissions to the Coronary Unit (12 vs. 7%), compared to women. No gender differences were observed in EKG performance (91 vs. 90%), EKG time (median 4.1 vs. 4.5 minutes), or delay in care attention (median 25 vs. 26 minutes). In terms of healthcare resources, men underwent more biomarkers: troponins (63 vs. 55%; odds ratio [OR]: 1.35; 95% confidence interval [95%CI]: 1.10-1.67) and creatine phosphokinase (24.8 vs. 19.1%), received more aspirin (6.7 vs. 3.1%), nitrates/nitrites (6 vs. 3%), and hospitalization (17.18 vs. 10.50%; OR: 1.76; 95%CI; 1.30-2.40). Of 206 hospitalized, 112 had a final diagnosis of acute coronary syndrome (54%), more men than women (81 vs. 31). There were no significant differences in revascularization time, medication schedule at discharge, hospital stay, or mortality., Conclusions: Gender did not affect precordial pain care, diagnosis, and treatment times, highlighting the quality of hospital care.

Venous thromboembolic disease is the most common preventable cause of hospital death. Despite the existence of evidence of the usefulness of thromboprophylaxis and recommendations, adherence by physicians to them is highly variable, and frequently suboptimal. The objective was to evaluate the change in the adequacy of thromboprophylaxis before and after an intervention on thromboprophylaxis with multifaceted strategies for physicians. The intervention was a 6 years institutional program with multiple strategies: passive actions such as posters and active actions as continuous medical education, adaptation of an institutional clinical practice guide and a computerized clinical decision support system. The baseline adequacy of thromboprophylaxis improved from 59% to 82% and was maintained over time. The improvement in fitness was associated with a reduction in major bleeding, particularly in patients undergoing surgery.

Introduction and Objectives: There is controversy regarding the most appropriate goals for blood pressure control. We assess the benefits and risks of chossing different therapeutic thresholds., Methods: We perform a systematic review and meta-analysis of large clinical trials in order to assess the impact of different therapeutic strategies on the reduction of cardiovascular events and the development of serious adverse effects., Results: Four trials with 29,820 participants were included, with mean age of 65 ± 7.9 years; 42.2% were women and 22% were diabetic. Overall, intensive goals showed a non-significant trend towards reducing cardiovascular mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.68-1.07; p=0.16) with non-impact in total mortality (p=0.45) and with moderate heterogeneity among the included trials (I index [I]2:44 and 59% respectively). Nevertheless, intensive goals reduce non-fatal cardiovascular events (RR: 0.82; 95% CI: 0.70-0.91; p=0.0003), being consistent in all the analyzed trials (I2: 0%). Regarding adverse effects, intensive goals caused more emergency consultations or hospitalization (RR: 1.98; 95% CI: 1.59-2.46; p<0.0001; I2: 14%), with no clear increase in renal failure (RR: 1.65; 95% CI: 0.94-2.89) but with increase in falls and syncope (RR: 2.39; 95% CI: 1.56-3.67; p<0.0001; I2: 28%)., Conclusion: Intensive blood pressure goals reduce non-fatal cardiovascular events, without reduction in mortality, and with an increase of risk of adverse events. These results suggest that individual goals should be set according to the risk of each patient. ­, Clinical Trial Registration: PROSPERO (CRD42020149134).

Objetivo: Explorar la asociación entre consumo de estatinas (CE) y desarrollo de síndrome postrombótico (SPT)., Método: Cohorte retrospectiva con pacientes con primer episodio de trombosis venosa profunda (TVP) entre el 06/2006 y el 12/2017, incluidos en el Registro Institucional de Enfermedad TromboEmbólica (RIET) del Hospital Italiano de Buenos Aires. Se consideró exposición al CE entre los 30 días previos y hasta 180 días posterior al diagnóstico de TVP. Se definió SPT según constaba este dato en la base de seguimiento del RIET. Se evaluó el desarrollo de SPT con un modelo de riesgos proporcionales de Cox, reportando hazard ratios (HR) crudas y ajustadas. Se consideró la confusión por indicación del CE y se utilizó un propensity score (PS) para el ajuste del riesgo estimado, reportando los HR con sus intervalos de confianza del 95% (IC 95%)., Resultados: Se incluyeron 905 pacientes, de los cuales 273 fueron CE y 632 no consumidor de estatinas (NCE). Al seguimiento, la incidencia de SPT fue: 6.59% (18) en el grupo CE y 8.07% (51) en el grupo NCE, con p = 0.412. La razón de riesgo para el desarrollo de SPT de CE resultó no significativa (HR cruda: 0.78; IC 95%: 0.43-1.41; p = 0.414). La HR de CE ajustada por edad, sexo, antiinflamatorios no esteroideos, corticosteroides, inmovilidad, anticoagulante, hipertensión arterial, diabetes, dislipidemia, insuficiencia renal crónica, enfermedad coronaria, accidente cerebrovascular, insuficiencia cardiaca y enfermedad oncológica fue 0.45 (IC 95%: 0.13-1.5; p = 0.196). La HR del CE ajustado por edad, sexo, antiinflamatorios no esteroideos, corticosteroides, inmovilidad, tratamiento anticoagulante, enfermedad oncológica y PS fue de 0.52 (IC 95%: 0.17-1.66; p = 0.272)., Conclusiones: El CE no se asoció con menor SPT, aunque hubo escaso número de eventos detectados., Objective: To evaluate the association between statin consumption and development of post-thrombotic syndrome (PTS)., Methods: Retrospective cohort study which included patients with a first episode of deep vein thrombosis (DVT) between 06/2006 and 12/2017, included in the Institutional Registry of ThromboEmbolic Disease of the Italian Hospital of Buenos Aires, Argentina. Exposure to statin use (SU) was considered between the 30 days before and up to 180 days after the diagnosis of DVT. PTS was defined as recorded dataset on registry. The development of PTS was evaluated with Cox proportional hazards model, raw and adjusted hazard ratios (HR) were reported. Confusion was considered by indication of SU and a propensity score (PS) was used for adjustment. We reported HR with their 95% confidence interval (CI); p value < 0.05 was considered statistically significant., Results: Of 1393 patients, 905 were included for the analysis, of which 273 were SU and 632 non-statin users (NSU). At follow-up, incidence of PTS was: 6.59% (18) in the SU group and 8.07% (51) in the NSU group, with p = 0.412. Crude HR for PTS for SU was not significant (0.78; 95% CI: 0.43-1.41; p = 0.414). Adjusted HR of SU by age, sex, non-steroidal anti-inflammatory drugs, corticosteroids, immobility, anticoagulant, high blood pressure, diabetes, dyslipidemia, chronic renal failure, coronary heart disease, stroke, heart failure and cancer disease was 0.45 (95% CI: 0.13-1.5; p = 0.196) for PTS. While HR for the development of PTS adjusted by age, sex, non-steroidal anti-inflammatory drugs, corticosteroids, immobility, anticoagulant treatment, cancer disease and PS of the SU was 0.52 (95% CI: 0.17-1.66; p = 0.272)., Conclusion: No statistically significant association was found between CE and the development of SPT, although there were a small number of events detected in both groups., (Copyright: © 2020 Permanyer.)