Search

La cultura sobre seguridad se perfila como uno de los requisitos para evitar la aparición de efectos adversos, sin embargo no se ha estudiado en el ámbito de la cardiología. El objetivo es evaluar la cultura de seguridad en una unidad de cardiología que tiene implantado y certificado un sistema integrado de gestión de calidad y riesgos para la seguridad del paciente. Método: Se realizó un estudio observacional trasversal en 2 años consecutivos utilizando la encuesta Hospital Survey on Patient Safety Culture de la «Agency for Healthcare Research and Quality» en su versión española (42 ítems agrupados en 12 dimensiones) sobre todo el personal. Se comparó el porcentaje de respuestas positivas de cada dimensión en 2014 y 2015, así como con los datos a nivel nacional y en EE. UU., siguiendo las recomendaciones establecidas. Resultados: La valoración global, sobre un máximo de 5, fue de 4.5 en 2014 y de 4.7 en 2015. Identificamos 7 dimensiones como fortaleza. Las peor valoradas fueron: Dotación de personal, Apoyo de la gerencia y Trabajo en equipo entre unidades. La comparación mostró superioridad en todas las dimensiones a nivel nacional, y en 8 respecto a los datos del registro americano. Conclusiones: La cultura de seguridad en una unidad de cardiología con un sistema integrado de gestión de calidad y riesgos y seguridad del paciente es elevada, superior a la nacional en todas sus dimensiones y en la mayoría de ellas respecto al registro de EE. UU. The safety culture is one of the requirements to prevent the occurrence of adverse effects, however has not been studied in the field of cardiology. The objective is to evaluate the safety culture in a cardiology unit has implemented and certified an integrated quality and risk management for patient safety system. Methods: A transversal observational study was made in 2 consecutive years using the survey “Hospital Survey on Patient Safety Culture” of the “Agency for Healthcare Research and Quality” in its Spanish version (42 items grouped into 12 dimensions) in all staff. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules. Results: The overall assessment of a possible 5, was 4.5 in 2014 and 4.7 in 2015. We identified seven dimensions as a fortress. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions respect to national data, and 8 respect to American data. Conclusions: The safety culture in a Cardiology Unit with an integrated quality and risk management and patient safety system is high, higher than the national in all its dimensions and in most of them respect to the United States.

Safety culture is one of the requirements for preventing the occurrence of adverse effects. However, this has not been studied in the field of cardiology. The aim of this study is to evaluate the safety culture in a cardiology unit that has implemented and certified an integrated quality and risk management system for patient safety.A cross-sectional observational study was conducted in 2 consecutive years, with all staff completing the Spanish version of the questionnaire, "Hospital Survey on Patient Safety Culture" of the "Agency for Healthcare Research and Quality", with 42 items grouped into 12 dimensions. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules.The overall assessment out of a possible 5, was 4.5 in 2014 and 4.7 in 2015. Seven dimensions were identified as strengths. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions compared to national data, and in 8 of them compared to American data.The safety culture in a Cardiology Unit with an integrated quality and risk management patient safety system is high, and higher than nationally in all its dimensions and in most of them compared to the United States.

Introduccion y objetivos Un porcentaje variable de pacientes con infarto agudo de miocardio tratados con angioplastia primaria mantienen el segmento ST elevado a pesar de restablecer el flujo coronario, probablemente por inadecuada reperfusion celular. Analizamos si la persistencia del segmento ST elevado es un signo que puede predecir un peor pronostico. Pacientes y metodo Comparamos los resultados clinicos y angiograficos de 116 pacientes con infarto agudo de miocardio tratados con exito mediante angioplastia primaria, clasificados en dos grupos dependiendo de la persistencia (≥ 50%) o reduccion ( Resultados En 96 pacientes (grupo I) el segmento ST mejoro tras la angioplastia y en 20 pacientes (grupo II) no hubo mejoria. No existieron diferencias en las caracteristicas clinicas y angiograficas basales excepto mayor prevalencia de clase Killip 4 en el grupo II (7,2 frente a 25%; p = 0,01). Tampoco hubo diferencias en las caracteristicas y los resultados del procedimiento. La extension del dano miocardico fue mayor en el grupo II (CK 3.149 ± 1.636 frente a 2.185 ± 2.010 U/l; p = 0,02) y se asocio a una peor fraccion de eyeccion ventricular en el estudio angiografico tardio (47 ± 16 frente a 55 ± 16%; p = 0,05). La mortalidad al ano fue del 8,3% en grupo I y del 30% en grupo II (p = 0,01). Conclusiones La persistencia del segmento ST elevado tras una angioplastia primaria con exito permite diferenciar un grupo de pacientes en los que, a pesar de restablecer un buen flujo coronario epicardico, el riesgo de acontecimientos adversos esta incrementado. Introduction and objectives A variable percentage of patients with myocardial infarction treated with successful primary angioplasty and restoration of coronary flow show persistent ST-segment elevation, probably due to inadequate cellular reperfusion. We studied if persistent STsegment elevation was a predictor of worse prognosis. Patients and method We comparatively studied the clinical and angiographic results of 116 acute myocardial infarction patients after successful primary angioplasty, which were classified into two groups depending on the persistence (> 50%) or reduction (≤ 50%) of ST-segment elevation between the electrocardiograms recorded before and after coronary angioplasty. Results In 96 patients (Group I) the ST-segment elevation improved after angioplasty and in 20 patients (Group II) there was no improvement. Baseline characteristics were similar in both groups except for Killip class 4, which was more prevalent in group II (7.2 vs. 25%; p = 0.01). There were no differences in the characteristics or results of the procedure. There was more myocardial damage in group II (CK 3,149 ± 1,636 vs. 2,185 ± 2,010 U/l; p = 0.02), associated with a more impaired left ventricular ejection fraction in the late angiographic control (47 ± 16 vs 55 ± 16%; p = 0.05). At a one-year follow-up the mortality was 8.3% in group I and 30% in group II (p = 0.01). Conclusions The persistence of ST-segment elevation after successful primary angioplasty identifies a group of patients that may suffer an increased risk of adverse events in spite of good epicardial flow.

Cardiac transplantation is now a well-accepted therapy for patients with advanced heart failure. In appropriately selected recipients, it has shown to significantly improve the survival and quality of life. The shortage of appropriate cardiac donor hearts, the costs of cardiac transplantation and its associated long-term medical follow-up, and the potential morbidity and mortality associated with the procedure and with life after transplantation mandates the judicious application of cardiac transplantation to appropriate recipients. A review of current indications, contraindications and evaluation of patients for cardiac transplantation is presented.

A variable percentage of patients with myocardial infarction treated with successful primary angioplasty and restoration of coronary flow show persistent ST-segment elevation, probably due to inadequate cellular reperfusion. We studied if persistent ST-segment elevation was a predictor of worse prognosis.We comparatively studied the clinical and angiographic results of 116 acute myocardial infarction patients after successful primary angioplasty, which were classified into two groups depending on the persistence (50%) or reduction (/= 50%) of ST-segment elevation between the electrocardiograms recorded before and after coronary angioplasty.In 96 patients (Group I) the ST-segment elevation improved after angioplasty and in 20 patients (Group II) there was no improvement. Baseline characteristics were similar in both groups except for Killip class 4, which was more prevalent in group II (7.2 vs. 25%; p = 0.01). There were no differences in the characteristics or results of the procedure. There was more myocardial damage in group II (CK 3,149 1,636 vs. 2,185 2,010 U/l; p = 0.02), associated with a more impaired left ventricular ejection fraction in the late angiographic control (47 16 vs 55 16%; p = 0.05). At a one-year follow-up the mortality was 8.3% in group I and 30% in group II (p = 0.01).The persistence of ST-segment elevation after successful primary angioplasty identifies a group of patients that may suffer an increased risk of adverse events in spite of good epicardial flow.