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Resumen Objetivos La insuficiencia cardiaca (IC) y la diabetes son 2 procesos fuertemente asociados. El objetivo principal fue analizar la evolucion del pronostico de los pacientes con diabetes que ingresan por IC a lo largo de 2 periodos. Metodos Estudio prospectivo para comparar el pronostico a un ano de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018. Los pacientes proceden del Registro Nacional de Insuficiencia Cardiaca (RICA) de la Sociedad Espanola de Medicina Interna. El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses. Se utilizo una regresion multivariante de Cox para evaluar la fuerza de asociacion (hazard ratio [HR]) de la diabetes y los desenlaces entre ambos periodos. Resultados Se incluyo a un total de 936 pacientes en la cohorte de 2018, de los que 446 (48%) tenian diabetes. Las caracteristicas basales de la poblacion de los 2 periodos fueron similares. En los pacientes con diabetes se observo el desenlace combinado en 233 (47,5%) en la cohorte de 2008-2011 y 162 (36%) en la cohorte de 2018 (hazard ratio [HR] 1,48; intervalo de confianza del 95% [IC95%] 1,18-1,85; p Conclusiones En 2018 se observa una mejoria del pronostico de la mortalidad total y los reingresos durante un ano de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al periodo de 2008-2011.

Resumen Antecedentes y objetivos La heterogeneidad de los pacientes con insuficiencia cardiaca y fraccion de eyeccion preservada (ICFEP) es elevada, por lo que se tiende a agrupar en fenotipos para intervenir con precision. Dentro de estos, los pacientes con diabetes mellitus (DM) mantienen esta heterogeneidad. Nuestro objetivo es describir grupos de pacientes con ICFEP y DM basados en otras comorbilidades. Material y metodos Los pacientes se reclutan desde el registro nacional de insuficiencia cardiaca (RICA). Se incluyen pacientes con fraccion de eyeccion mayor o igual al 50% sin valvulopatia y con DM. Se realiza un analisis aglomerativo jerarquico con el metodo de Ward incluyendo las siguientes variables: dislipemia, hepatopatia, EPOC, demencia, enfermedad cerebrovascular, arritmia, presion arterial sistolica, indice de masa corporal (IMC), estimacion del filtrado glomerular y hemoglobina. Resultados Se incluyen 1.934 pacientes con ICFEP, de los que 907 (46,9%) tenian DM, con predominio de mujeres (60,9%) y con un IMC de 31,1 (5,9) kg/m2. Se obtienen 4 grupos: dos con elevado riesgo vascular (uno con arritmia y otro no), con 263 pacientes el primero y 201 el segundo, otro con predominio de EPOC (140 pacientes) y un ultimo grupo de 303 pacientes con mas edad pero menos comorbilidad. Conclusiones En nuestros pacientes con ICFEP y DM predomina la obesidad y el sexo femenino. Los cuatro grupos ofrecen oportunidades de tratamiento para mejorar su pronostico no solo basadas en la utilizacion de nuevos farmacos antidiabeticos sino por otras opciones que pueden suponer un punto de partida para nuevas investigaciones.

Aim The heterogeneity of patients with heart failure and preserved ejection fraction (HFpEF) is high, thus this entity tends to be grouped into phenotypes to act with precision. Within these groups, patients with type 2 diabetes mellitus (DM2) hold this heterogeneity. Our aim is to describe subgroups of patients with HFpEF and DM2 based on other comorbidities. Material and methods Patients were recruited from the national registry of heart failure (RCIA). Patients with ejection fraction greater than or equal to 50% without valvular disease and with DM2 were included. A hierarchical agglomerative analysis was performed with Ward's method including the following variables: dyslipidemia, liver disease, Chronic obstructive pulmonary disease (COPD), dementia, cerebrovascular disease, arrhythmia, systolic blood pressure, body mass index (BMI), estimation of glomerular filtration and hemoglobin. Results A total of 1934 patients with HFpEF were included, of which 907 (46.9%) had DM2 with a predominance of women (60.9%) and with a BMI of 31.1 (5.9) Kg/m2. Four groups were obtained, two with high vascular risk (one with arrhythmia and the other without it) with 263 patients the first and 201 the second. A third group had a predominance of COPD (140 patients) and a last group with 303 patients older but with less comorbidity. Conclusions In our patients with HFpEF and DM2, obesity and female sex predominated. All four groups offered treatment chances to improve their prognosis not only based on the use of new antidiabetic drugs but also on other options that may be a starting point for further research

Resumen En el presente articulo se revisa la utilidad del uso de la ecografia pulmonar (EP) en el diagnostico, la estratificacion pronostica y el tratamiento de los pacientes con insuficiencia cardiaca (IC). Se abordan aspectos tecnicos a la hora de realizar una ecografia pulmonar, asi como la importancia de la presencia de las lineas B en el diagnostico y el valor pronostico de la congestion pulmonar. Por otra parte, se revisan las evidencias mas recientes publicadas hasta la fecha en el empleo de la EP en la IC. Por ultimo, se hace referencia a los nuevos ensayos clinicos en marcha, como el estudio EPICC, realizado de forma conjunta por los Grupos de Trabajo de Insuficiencia Cardiaca y Ecografia Clinica de la Sociedad Espanola de Medicina Interna.

The present article reviews the usefulness of lung ultrasound in the diagnosis, prognostic stratification and treatment of patients with heart failure. The article addresses the technical aspects when performing lung ultrasonography, as well as the importance of the presence of B-lines in the diagnosis and the prognostic value of pulmonary congestion. Moreover, the article reviews the most recently published evidence on the use of lung ultrasound in heart failure. Lastly, the article references the new clinical trials currently underway, including the EPICC study conducted jointly by the Heart Failure and Clinical Ultrasonography Workgroups of the Spanish Society of Internal Medicine.

Objectives To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival. Methods Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, hemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. Results The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1 year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95% CI: 1.270–2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95% CI: 0.307–0.560) was associated with lower mortality. Conclusions Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Objectives To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival. Methods Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. Results The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1 year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95% CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95% CI: 0.307-0.560) was associated with lower mortality. Conclusions Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Aims To validate externally the CACE-HF clinical prediction rule, which predicts 1-year mortality in patients with heart failure (HF). Methods We performed an external validation of the CACE-HF risk score in patients included in the RICA heart failure registry who had completed 1 year of follow-up, comparing the characteristics of the derivation and validation cohorts. The performance of the risk score was evaluated in terms of calibration, using calibration-in-the-large (a), calibration slope (b), and the Hosmer-Lemeshow test, and in terms of discrimination, using the area under the ROC curve. Results In total, 3337 patients were included in the validation cohort. There were no significant differences between the derivation and validation cohorts in 1-year mortality (24.63% vs. 22.98%) or in the risk score and risk classes. The discrimination capacity in the validation cohort was slightly lower, 0.67 (95% CI: 0.65, 0.69), compared to that of the derivation cohort. Calibration results were a −0.05 (95% CI: −0.14, 0.03), indicating that the average predictions did not differ from the average outcome frequency, and b = 0.75 (95% CI: 0.64, 0.86), indicating a modest inconsistency in predictor effects. Observed mortality versus predicted mortality according to the deciles and risk classes were very similar in both cases, indicating good calibration. Conclusions The results of the external validation of the CACE-HF risk score show that although the capacity for discrimination was slightly lower than in the derivation cohort, the calibration was excellent. This tool, therefore, can assist in decision-making in the management of these patients.

Introduction and objectives Acute heart failure (AHF), can occur as decompensated chronic heart failure (HF) or as a first episode, “new onset”. The aim of this study was to analyse the clinical characteristics and prognosis at one-year in a cohort of patients with new onset AHF. Methods Prospective observational study of 3550 patients with AHF. We compared patients with new onset HF with the others. Restricting the analysis to new onset AHF patients, we analysed the clinical characteristics, readmissions, mortality and impact of left ventricular ejection fraction on the prognosis. Results A total of 1105 (31%) patients fulfil the criteria for new onset AHF. These patients versus the rest, were younger, had a higher aetiology of hypertension and preserved left ventricular ejection fraction, less global comorbidity and better baseline overall functional status. After one year, mortality in new onset HF was less than chronic decompensated HF (15 vs. 27%; p Conclusions New onset AHF shows a clinical profile and prognosis different to that of chronic decompensated HF. Higher comorbidity, renal function and treatment post-discharge predict a higher risk of mortality.

Resumen Introduccion y objetivos La insuficiencia cardiaca aguda (ICA) puede suceder como una descompensacion de una IC cronica o como un primer episodio “de novo”. Nuestro objetivo fue analizar las caracteristicas clinicas y el pronostico al ano, en una cohorte de ICA de novo. Metodos Estudio observacional y prospectivo de 3550 pacientes con ICA. Se analizan las caracteristicas clinicas, la fraccion de eyeccion ventricular izquierda, los reingresos y factores asociados a mayor mortalidad al ano de los pacientes con ICA de novo y se comparan con el resto. Resultados Un total de 1105 (31%) pacientes, presentaron ICA de novo. Este grupo fue mas joven, con mayor etiologia hipertensiva y fraccion de eyeccion ventricular izquierda preservada, mejor estado funcional y menor comorbilidad que el resto de la cohorte. Al ano de seguimiento, la mortalidad fue menor en ICA de novo frente a IC cronica descompensada (el 15 vs. el 27%; p Conclusiones Los pacientes con ICA de novo tienen un perfil clinico diferente a la IC cronica descompensada, con un mejor pronostico. Los principales factores predictores de mortalidad al ano en ICA de novo fueron la comorbilidad global, la funcion renal y el tipo de tratamiento al alta hospitalaria.

El último consenso sobre insuficiencia cardíaca aguda de la Sociedad Española de Cardiología, la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina de Urgencias y Emergencias se elaboró en 2015, por lo que era necesaria una actualización para revisar las diversas novedades relacionadas con la temática de insuficiencia cardíaca aguda que han ido apareciendo los últimos años. Entre ellas están la publicación de las nuevas guías europeas sobre insuficiencia cardíaca en el 2016, nuevos estudios sobre el manejo farmacológico de los pacientes durante la hospitalización y novedades sobre diversos aspectos relacionados con la insuficiencia cardíaca aguda, tales como el abordaje precoz, terapia intermitente, insuficiencia cardíaca avanzada y congestión refractaria. Por ello, este consenso se elaboró con la intención de actualizar todos los aspectos relacionados con la insuficiencia cardíaca aguda y proporcionar un documento que detallase de manera completa el diagnóstico, tratamiento y manejo de esta enfermedad. The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.

Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods.This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods.A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort.In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.

Renal insufficiency is associated with medical complications in patients with non-valvular atrial fibrillation (NVAF). However, data for elderly patients are scarce. Thus, the main objectives of the present study were to analyze the characteristics of elderly patients with NVAF and acute or chronic renal disease, describe their management in real-life conditions, and detect factors associated with complications. The NONAVASC registry includes patients > 75 years with NVAF, hospitalized by any cause in 64 Spanish Internal Medicine departments. Patients were categorized into acute kidney injury (AKI), chronic kidney disease (CKD) or preserved renal function (PRF). All variables associated with in-hospital mortality with P

AIM To determine the factors associated with discontinuing or not starting oral anticoagulation (OA) therapy in older patients with non-valvular atrial fibrillation (NVAF). METHODS A prospective, multicenter cohort study was carried out of patients aged >75 years with NVAF hospitalized in internal medicine departments in Spain. For each patient, we recorded creatinine, hemoglobin and platelets levels, as well as CHA2DS2-VASc and HAS-BLED scores and the Charlson Comorbidity Index. We measured the ability to carry out basic activities of daily life with the Barthel Index, and the cognitive state with the Short Portable Mental Status questionnaire. RESULTS We included 723 patients with NVAF, with a mean age of 84.8 years (SD 5.2 years); 390 (53.9%) of the patients were women. Before admission, 375 (51.9%) patients were treated with OA. Previously diagnosed NVAF (OR 4.099, 95% CI 1.824-9.211, P = 0.001), the number of errors in the Short Portable Mental Status questionnaire (OR 1.180, 95% CI 1.020-1.365, P = 0.026), peripheral arterial disease (OR 0.285, 95% CI 0.114-0.711, P = 0.007) and hemoglobin levels (OR 0.812, 95% CI 0.682-0.966, P = 0.019) were independently associated with not starting OA therapy at discharge. Of the 375 patients treated with OA at admission, 87 (23.2%) had their OA discontinued at discharge. The HAS-BLED score (OR 1.516, 95% CI 1.211-1.897, P

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Resumen Este documento de posicionamiento describe los aspectos mas importantes de la ecografia clinica en el ambito de la Medicina Interna, desde sus indicaciones fundamentales hasta el periodo de formacion recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la practica clinica habitual del internista en multiples escenarios clinicos y ambitos de actuacion (urgencias, planta de hospitalizacion, consulta general y especifica y atencion domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolucion del profesional, al aumentar su fiabilidad y seguridad diagnostica, ademas de proporcionar informacion pronostica y evolutiva importante. Ademas, en los ultimos anos se ha incorporado como una herramienta en la ensenanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formacion estructurada y la adquisicion de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografia Clinica y avalado por la Sociedad Espanola de Medicina Interna.

Introduction Purple urine bag syndrome (PUBS) is secondary to bacterial urinary tract infections in long-term catheterized patients. Our objective was to perform a systematic review of the literature to assess its predisposing factors, clinical presentation, management and outcomes. Methods The terms "purple AND urine" were searched in MEDLINE, EMBASE, LILACS, SciELO, Google Scholar and OpenGrey. A meta-analysis with individual patient-level data and another one with aggregate-level data were performed. Results Out of 6793 citations, 140 were included. A meta-analysis was done with 169 PUBS cases: 63.5% women, median age 78 years (IQR: 70–85), 59.4% asymptomatic. Outcome ( n =117): 7.7% deaths, 21.4% recurrence. Dementia was the only factor associated with recurrence (OR: 5.44; P =0.046). In an aggregate-level data, meta-analysis (281 PUBS cases) prevalence of PUBS in chronically-catheterized patients was 11.7%. Escherichia coli and Proteus mirabilis were the microorganisms most frequently isolated. Conclusion PUBS usually affects chronically-catheterized women. Neither antibiotics nor catheter removal were associated with better outcomes.

The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease. (C) 2020 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Resumen La fibrilacion auricular (FA) en el anciano es una entidad compleja debido al elevado numero de comorbilidades frecuentemente asociadas, como las enfermedades cardiovasculares y la enfermedad renal, los trastornos cognitivos, las caidas o la polimedicacion. Excepto cuanto este contraindicada, la anticoagulacion es necesaria para la prevencion de los eventos tromboembolicos en esta poblacion. Tanto los antagonistas de la vitamina K como los anticoagulantes orales de accion directa (dabigatran, rivaroxaban y apixaban) estan indicados en este contexto. En este grupo de edad la funcion renal debe ser estrechamente vigilada cuando se utilizan estos ultimos. En los ultimos anos se han publicado diferentes guias de practica clinica sobre el paciente con FA. La mayoria de estas guias realizan recomendaciones especificas sobre las caracteristicas clinicas y el tratamiento en los pacientes ancianos. En esta actualizacion se revisan los comentarios especificos sobre las recomendaciones referentes al tratamiento antitrombotico en los pacientes ancianos con FA no valvular.

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

Objectives: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. Methods: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. Results: We evaluated 804 patients with a mean age of 85 +/- 5.1 years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32). Conclusion: The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Resumen Objetivo Las alteraciones del ritmo cardiaco son una causa frecuente de ingreso hospitalario pero desconocemos sus caracteristicas y costes economicos. Hemos analizado la epidemiologia y costes de las hospitalizaciones por arritmias cardiacas en el Sistema Nacional de Salud. Metodos Se revisan las caracteristicas y costes en pacientes ingresados con un diagnostico principal de arritmia cardiaca (periodo 1997-2010; grupos relacionados por el diagnostico [GRD] 138 y 139 del conjunto minimo basico de datos del Sistema Nacional de Salud). El 65% de diagnosticos en tales GRD corresponden a fibrilacion auricular/aleteo. Se revisan tambien los diagnosticos secundarios frecuentes en tales GRD. Resultados Las hospitalizaciones permanecieron cercanas a 26.000/ano y la mortalidad al 1,6%. En 2010 hubo 26.416 hospitalizaciones con unos costes estimados de 65 millones €. Se registran frecuentemente comorbilidades como hipertension arterial (46%), insuficiencia cardiaca (12%) o diabetes mellitus (20%). Ingresaron en cardiologia el 43% y en medicina interna el 36%. Conclusiones Durante el periodo 1997-2010 se produjeron en Espana un importante numero de hospitalizaciones por arritmias (principalmente fibrilacion auricular), con apreciables costes. Mas de un tercio son atendidas por internistas.

Aim Cardiac rhythm alterations are a frequent cause of hospital admission. However, we do not know their characteristics and economic costs. We have analyzed the epidemiology and cost of hospitalizations due to cardiac arrhythmias in the National Health System. Methods The characteristics and costs were reviewed in patients admitted with a principal diagnosis of cardiac arrhythmia (1997–2010; diagnosis related groups [DRG] −138 and 139 of the National Health System minimum data base set). Atrial fibrillation/flutter accounted for 65% of these DRGs. The secondary diagnoses prevalent in such DRGs were also reviewed. Results Hospitalizations due to cardiac arrhythmias were approximately 26,000 per year and close to 1.6% for mortality. In 2010 there were 26,421 hospitalizations with an estimated cost of 65 million Euros. Frequent comorbidities were recorded, such as hypertension (43%), heart failure (12%) or diabetes mellitus (20%). A total of 43% were admitted to cardiology and 36% to internal medicine. Conclusions During the period 1997–2010, there was a significant annual number of hospitalizations for cardiac arrhythmias (mainly atrial fibrillation), with measurable costs, in Spain. More than one-third were attended by internists.

Background: Atrial Fibrillation (AF) is a common condition in the elderly and often occurs together with Heart Failure (HF). The differences between elderly patients with HF according to the presence or absence of AF were analysed. Material and methods: Patient data were collected from consecutively admitted patients 75 years of age and older with acute decompensated HF from the Spanish National Heart Failure Registry (RICA) with data retrieved from internal medicine settings. Results: Of a total of 1,473 patients (mean age 82.16 years), AF was present at enrolment in 851 (57.8%). Patients with AF had a higher Charlson index (3.76 vs. 3.46; p=0.03), lower Barthel index (80.15 vs. 82.8; p=0.03), more preserved EF (74.6% vs. 66.4; p=0.001), and more advanced NYHA functional classes IIIIV (46.8% vs. 34.9%; p

This paper presents a study of the spatial and temporal distribution of the large destructive earthquakes that occurred in El Salvador during January and February 2001, together with the static stress transfer after each main shock, associated with their respective rupture processes. The sequence began with the magnitude M W 7.7 earthquake of 13 January, located off the western Pacifi c Coast in the subduction zone between the Cocos and Caribbean plates. One month later, a second destructive earthquake of M W 6.6 occurred in the Caribbean plate farther inland, the epicenter of which was located near San Pedro Nonualco. This shock was linked to the local faults beneath the volcanic arc and also produced signifi cant damage. The two main shocks and their aftershock sequences, together with other minor events that followed successively, produced unusually intense activity in the zone, in a short interval of time. The aims of this study are to document the spatial and temporal evolution of each seismic sequence and also to understand the possible interaction between the different events. We have inferred that some events with M > 5 triggered other shocks with the same or different origin (subduction zone or local crustal faults). The Coulomb stress transfer has been studied, and some models developed, using the rupture parameters derived from the geometric distribution of aftershocks. These results suggest the existence of a dynamic interaction, since the 13 February event occurred in a zone where the Coulomb stress increased following the January 13 event. Subsequently, some further events with magnitude around M W 5 in turn were located in other zones of increased stress associated with the two previous large earthquakes.

Presentamos un nuevo caso de neumonia por Pasteurella multocida diagnosticado mediante lavado broncoalveolar. Se revisan las caracteristicas mas sobresalientes de esta rara afeccion pulmonar.