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National Heart, Lung, and Blood Institute's Framingham Heart Study (contract no. N01-HC- 25195), National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) grants R01 DK078616 and K24 DK080140, NIDDK Research Career Award K23 DK65978, NIDDK Grant R21 DK084527, Boston University Linux Cluster for Genetic Analysis (LinGA) funded by the National Institutes of Health National Center for Research Resources Shared Instrumentation Grant (1S10RR163736-01A1), Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background: We analyzed the association between atrial fibrillation or atrial flutter (AF) and in-hospital mortality (IHM) among patients who underwent solid organ transplants in Spain from 2004 to 2021. (2) Methods: We gathered information from all hospital admissions for lung, liver, kidney, and heart transplants. (3) Results: A total of 71,827 transplants were analyzed (4598 lung transplants; 18,127 liver transplants; 45,262 kidney transplants; and 4734 heart transplants). One third of these were for women. Overall, the prevalence of AF was 6.8% and increased from 5.3% in 2004-2009 to 8.6% in 2016-2021. The highest prevalence of AF was found for heart transplants (24.0%), followed by lung transplants (14.7%). The rates for kidney and liver transplants were 5.3% and 4.1%, respectively. The AF code increased over time for all of the transplants analyzed (p < 0.001). The patients' IHM decreased significantly from 2004-2009 to 2016-2021 for all types of transplants. AF was associated with a higher IHM for all of the types of transplants analyzed, except for heart transplants. (4) Conclusions: The prevalence of AF among patients admitted for solid organ transplants was highest for those who underwent heart transplants. The mortality rate during the patients' admission for lung, liver, kidney, or heart transplants decreased over time. AF was independently associated with a higher risk of dying in the hospital for those who underwent lung, liver, or kidney transplants., Comunidad Autónoma de Madrid, Universidad Complutense de Madrid, Depto. de Inmunología, Oftalmología y ORL, Fac. de Medicina, TRUE, pub

Background: To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. Methods: We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. Results: We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68–2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p < 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant de crease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88–0.95). Conclusions: The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Aims: The aim of this study was to test whether a newly designed polypharmacy-based scale would perform better than Charlson's Comorbidity Index (CCI) to predict outcomes in chronic complex adult patients after a reference Emergency Department (ED) visit. Methods: We built a polypharmacy-based scale with prespecified drug families. The primary outcome was 6-month mortality after the reference ED visit. Predefined secondary outcomes were need for hospital admission, 30-day readmission, and 30-day and 90-day mortality. We evaluated the ability of the CCI and the polypharmacy-based scale to independently predict 6-month mortality using logistic regression, receiver operating characteristic (ROC) curves, and cumulative survival curves using Kaplan-Meier estimates and the log-rank test for three-category distributions of the polypharmacy-based scale and the CCI. Finally, we sought to replicate our results in two different external validation cohorts. Results: We included 201 patients (53.7% women, mean age = 81.4 years), 162 of whom were admitted to the hospital at the reference ED visit. In separate multivariable analyses accounting for gender, age and main diagnosis at discharge, both the polypharmacy-based scale (P < .001) and the CCI (P = .005) independently predicted 6-month mortality. The polypharmacy-based scale performed better in the ROC analyses (area under the curve [AUC] = 0.838, 95% confidence interval [CI] = 0.780-0.896) than the CCI (AUC = 0.628, 95% CI = 0.548-0.707). In the 6-month cumulative survival analysis, the polypharmacy-based scale showed statistical significance (P < .001), whereas the CCI did not (P = .484). We replicated our results in the validation cohorts. Conclusions: Our polypharmacy-based scale performed significantly better than the CCI to predict 6-month mortality in chronic complex patients after a reference ED visit., Depto. de Medicina, Fac. de Medicina, TRUE, pub

The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects<18 years with community-acquired pneumonia (CAP), assessing possible sex diferences. We used Spanish national hospital discharge data to select all patients<18 years with CAP. We identifed 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was signifcantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03–1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p<0.0001). There were no sex diferences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls. Conclusion: The incidence of hospital admissions for CAP was higher among boys than among girls and rose signifcantly from 2016 to 2019. There were no sex diferences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No diferences were found in IHM over time., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Purposes: We had previously demonstrated surviving sepsis campaign guidelines had not had enough impact at our Emergency Department. Basic procedures: Actions directed to increase the qualification of our staff and residents, to facilitate guidelines divulgation and to improve spatial conditions by creating a High Dependency Unit were implemented as a bundle. The impact of these actions on the achievement of early objectives of the campaign and on mortality was analyzed. Main findings: Following campaign guidelines was more frequent after the implementation of these actions, as shown by less restrictive fluids administration for more severe cases (P = .001), earlier administration of antibiotics (P = .001) and lactate determination rate (46% vs. 12%). In-hospital mortality difference did not reach statistical difference. Physicians were able to identify high-risk patients on clinical grounds. Principal conclusions: The bundle of actions has had a moderate beneficial effect on our Emergency Department. High Dependency Units are useful for managing patients not fulfilling criteria for Intensive Care Unit admission, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background: Type 2 diabetes mellitus (T2DM) is strongly related to the in‑hospital and short‑term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify fac‑tors associated with in hospital mortality (IHM) among patients undergoing these procedures.Methods: We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged≥ 40 years. We selected patients whose medical procedures included TAVI (ICD‑9‑CM codes 35.05, 35.06) and SAVR (ICD‑9‑CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD‑9‑CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, proce‑dures, and specific in‑hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).Results: We identified a total of 2141 and 16,013 patients who underwent TAVI (n= 715; 33.39% with T2DM) and SAVR (n= 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non‑T2DM, p= 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non‑diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66‑0‑96 for SAVR).Conclusions: T2DM diabetic patients with AS undergoing a valvular replac, Instituto de Salud Carlos III, Unión Europea, Grupo de Excelencia Investigadora URJC-Banco Santander, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background: There is limited information about factors associated with mortality of patients with chronic obstructive pulmonary disease (COPD) admitted to hospital because of an acute exacerbation. Methods: A retrospective cohort study including all patients admitted to hospital through our emergency department (ED) was conducted. A total of 972 electronic discharge reports were reviewed. Patient baseline features, aspects concerning acute exacerbation, as well as demographic, cardiac ultrasound, and microbiological data were collected. Results: In-hospital mortality rate was 6.4%. Of 315 patients with mild exacerbation according to Anthonisen criteria, only 1 died. In the univariate analysis, moderate to severe acute exacerbation of COPD, age older than 75 years, severe COPD, abnormal blood gas values, onset of complications during hospital stay, radiologic consolidation, a positive result in a microbiological respiratory sample, home oxygenotherapy, admission to the intensive care unit, left ventricular ejection fraction, and department of admission were statistically significant (P < .05). The multivariate analysis showed that moderate to severe COPD acute exacerbation (odds ratio [OR] 7.3; 95% confidence interval [CI], 3.6-17.7), age older than 75 years (OR 4.9; 95% CI, 2.3-10.8), severe COPD (OR 4.6; 95% CI, 2.1-10), abnormal blood gas values (OR 4.7; 95% CI, 1.1-19.8), and complication during hospital stay (OR 2.8; 95% CI 1.4-5.4) were independently related to mortality. Conclusion: We found that clinical aspect appears the most relevant of all potential determinants of in-hospital mortality for patients admitted for acute exacerbation of COPD. Thus, the clinical assessment and therapeutic decision taken in this first moment at the ED are the key that predict the prognosis of this patients. These data suggest that the risk of mortality after the admission to hospital of patients with COPD because of an acute exacerbation can be successfully predicted by making, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Depto. de Medicina, Fac. de Medicina, TRUE, pub

We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41–2.66; OR 1.19, 95%CI 1.05–1.35; and OR 1.79, 95%CI 1.38–2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era., Unión Europea, Instituto de Salud Carlos III, Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: To describe trends in the prevalence of depression in men and women with COPD hospitalized in Spain (2016–2020). (2) Methods: We used a nationwide discharge database to select all patients ≥35 years with COPD. (3) Results: The prevalence of depression was 3.54-times higher in women with COPD than in men (OR 3.54; 95%CI 3.48–3.6). It decreased significantly between 2016 and 2020, although the reduction was only significant in women (12.27% in 2016 vs. 10.56% in 2020). Older age, comorbidity and the most recent years of hospital admission were associated with lower prevalence of depression in both men and women, while obesity, obstructive sleep apnea (OSA) and use of oxygen prior to admission were risk factors. In-hospital mortality (IHM) increased significantly over time. Older age, comorbidity, the use of oxygen prior to admission and having been hospitalized in 2020 increased the risk of IHM. Female sex was associated with a lower IHM in patients with depression and COPD. (4) Conclusions: The prevalence of depression has decreased over time in women with COPD while it has not changed significantly in men with this disease. IHM increased over time both in men and women with COPD and depression, with higher prevalence in the former., Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid; Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Sociedad Española de Neumología y Cirugía de Tórax, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: The study aimed to analyze the influence of atrial fibrillation (AF) prior to hospital admission (“prevalent”) and new-onset AF diagnosed during hospital admission (“incident”) on in-hospital mortality (IHM) in women and men who developed hospital-acquired pneumonia (HAP) in Spain (2016–2019). (2) Methods: We used the Spanish Register of Specialized Care-Basic Minimum Database. (3) Results: We analyzed 38,814 cases of HAP (34.6% women; 13.5% ventilator-associated). Prevalent AF was coded in 19.9% (n = 7742), and incident AF in 5.5% (n = 2136) of HAP. Crude IHM was significantly higher for prevalent AF (34.22% vs. 27.35%, p < 0.001) and for incident AF (35.81% vs. 28.31%, p < 0.001) compared to no AF. After propensity score matching, IHM among women and men with prevalent AF was higher than among women and men with no AF (among women, 32.89% vs. 30.11%, p = 0.021; among men, 35.05% vs. 32.46%, p = 0.008). Similarly, IHM among women and men with incident AF was higher than among women and men with no AF (among women, 36.23% vs. 29.90%, p = 0.013; among men, 35.62% vs. 30.47%; p = 0.003). Sex was associated with a higher IHM only in people with incident AF (for female, OR = 1.21; 95% CI: 1.01–1.57). (4) Conclusions: Both prevalent and incident AF were associated with higher IHM in people who developed HAP. Female sex was associated with a higher IHM in incident AF., Universidad Complutense de Madrid, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: Type 2 diabetes mellitus (T2DM) is a risk factor for the development of heart failure with reduced ejection fraction (HFrEF). Aims: (1) To describe and compare the clinical characteristics and the use of diagnostic and therapeutic procedures among subjects hospitalized with HFrEF according to the presence of type 2 diabetes mellitus (T2DM) and sex; (2) to assess the effect of T2DM and sex on hospital outcomes among the patients hospitalized with HFrEF using propensity score matching (PSM); and (3) to identify which clinical variables were associated to in-hospital mortality (IHM) among the patients hospitalized with HFrEF and T2DM according to their sex. Methods: A retrospective cohort study from 2016 to 2019 using the Spanish National Hospital Discharge Database was conducted. The diagnosis and procedures were codified with the International Classification of Disease 10th version (ICD10). Subjects aged ≥ 40 with a primary diagnosis of HFrEF were included. We included those patients with a diagnosis of T2DM in any diagnosis position. The descriptive statistics used were total and relative frequencies (percentages), means with standard deviations, and medians with an interquartile range. To control the effect of confounding variables when T2DM patients and non-T2DM patients were compared, we matched the cohorts using PSM. Multivariable logistic regression models were used to identify which study variables independently affected the IHM among men and women with HF and T2DM. Also, this multivariable method was applied for sensitivity analyses to confirm the results of the PSM. Results: A total of 28,894 patients were included. T2DM was present in 39.59%. Women with T2DM more frequently had atrial fibrillation, valvular heart disease, anemia, dementia, depression, and hyponatremia than men with T2DM. However, men had more coronary heart disease, chronic renal disease, COPD, and obstructive sleep apnea. All the procedures were significantly more commonly used, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

CRUE-CSIC (Acuerdos Transformativos 2022), The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects<18 years with community-acquired pneumonia (CAP), assessing possible sex diferences. We used Spanish national hospital discharge data to select all patients<18 years with CAP. We identifed 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was signifcantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03–1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p<0.0001). There were no sex diferences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls. Conclusion: The incidence of hospital admissions for CAP was higher among boys than among girls and rose signifcantly from 2016 to 2019. There were no sex diferences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No diferences were found in IHM over time., Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016–2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We used propensity score matching (PSM) to compare the clinical characteristics and the in-hospital mortality (IHM) between men and women hospitalized with IE. (3) Results: We identified 10,459 hospitalizations for IE (33.26% women). The incidence of IE remained stable during this five-year period. The age-adjusted incidence of IE was two-fold higher among men vs. women (IRR = 2.08; 95%CI 2.0–2.17). Before PSM, women with IE were significantly older than men (70.25 vs. 66.24 years; p < 0.001) and had lower comorbidity according to the Charlson comorbidity index (mean 1.38 vs. 1.43; p = 0.019). After PSM, the IHM among women admitted for IE remained >3 points higher than that among men (19.52% vs. 15.98%; p < 0.001). (4) Conclusions: The incidence of IE was two-fold higher among men than among women. IHM was significantly higher among women after accounting for the potential confounders., Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: the purpose of this study is to analyze the incidence and in-hospital mortality (IHM) of community-acquired pneumonia (CAP) needing hospital admission and hospital-acquired pneumonia (HAP) in Spain (2016–2019). (2) Methods: using the Spanish Register of Specialized Care-Basic Minimum Database, we estimated the incidence of CAP and HAP. We matched each woman with a man with an identical age, according to comorbidities. (3) Results: we analyzed 518,838 cases of CAP and 38,705 cases of HAP, and 5192 ventilator-associated HAPs (13.4%). The incidence of CAP increased over time in both men (from 384.5 to 449.8 cases/105 population) and women (from 244.9 to 301.2 cases/105 population). Men showed a 47% higher adjusted incidence of CAP than women. The incidence of HAP increased over time in both men (from 302.3 to 342.2 cases/105 population) and women (from 139.2 to 167.6 cases/105 population). Men showed a 98% higher adjusted incidence of HAP than women. IHM was higher in men admitted for CAP than in women (12.9% vs. 12.2%; p < 0.001), but not in men who developed HAP (28.9% vs. 28.0%; p = 0.107). Men admitted for CAP (OR: 1.13; 95% CI: 1.10–1.15) and men who developed HAP (OR: 1.05; 95% CI: 1.01–1.10) had higher IHM than women. (4) Conclusions: men had higher incidence rates of CAP and HAP than women. Men admitted for CAP and men who developed HAP had higher IHM than women., Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the existence of sex differences. Methods: Matched-pair analysis using the Spanish National Hospital discharge. Results: IS was coded in 92,524 men and 79,731 women (29.53% with T2DM). The adjusted incidence of IS (IRR 2.02; 95% CI 1.99–2.04) was higher in T2DM than non-T2DM subjects, with higher IRRs in both sexes. Men with T2DM had a higher incidence of IS than T2DM women (IRR 1.54; 95% CI 1.51–1.57). After matching patients with T2DM, those with other comorbid conditions, however, significantly less frequently received endovascular thrombectomy and thrombolytic therapy. In-hospital mortality (IHM) was lower among T2DM men than matched non-T2DM men (8.23% vs. 8.71%; p < 0.001). Women with T2DM had a higher IHM rate than T2DM men (11.5% vs. 10.20%; p = 0.004). After adjusting for confounders, women with T2DM had a 12% higher mortality risk than T2DM men (OR 1.12; 95% CI 1.04–1.21). Conclusions: T2DM is associated with higher incidence of IS in both sexes. Men with T2DM have a higher incidence rates of IS than T2DM women. Women with T2DM have a higher risk of dying in the hospital., Instituto de Salud Carlos III (ISCIII)/FEDER, Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería), Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

(1) Background: To analyze incidence, clinical characteristics, procedures, and in-hospital outcomes among patients hospitalized with community-acquired pneumonia (CAP) according to the presence of T2DM in Spain (2016–2019) and to assess the role of gender among those with T2DM. (2) Methods: Using the Spanish National Hospital Discharge Database, we estimated hospitalized CAP incidence. Propensity score matching was used to compare population subgroups. (3) Results: CAP was coded in 520,723 patients, of whom 140,410 (26.96%) had T2DM. The hospitalized CAP incidence was higher in patients with T2DM (both sexes) (IRR 4.25; 95% CI 4.23–4.28). The hospitalized CAP incidence was higher in men with T2DM than in women with T2DM (IRR 1.46; 95% CI 1.45–1.47). The hospitalized CAP incidence among T2DM patients increased over time; however, the in-hospital mortality (IHM) decreased between 2016 and 2019. IHM was higher among non-T2DM men and women than matched T2DM men and women (14.23% and 14.22% vs. 12.13% and 12.91%; all p < 0.001, respectively), After adjusting for confounders, men with T2DM had a 6% higher mortality risk than women (OR 1.06; 95% CI 1.02–1.1). (4) Conclusions: T2DM is associated with a higher hospitalized CAP incidence and is increasing overtime. Patients hospitalized with CAP and T2DM have lower IHM. Male sex is a significant risk factor for mortality after CAP among T2DM patients., Instituto de Salud Carlos III (ISCIII) / FEDER, Depto. de Enfermería, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

Introduction: Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions. Objectives: The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy. Methods: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy. Results: A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04–1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41–0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55–0.64). Conclusion: In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitaliz, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016–2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29–1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96–2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75–3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03–1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01–1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men., Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Depto. de Enfermería, Fac. de Medicina, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

Background: We aimed to (1) analyze time trends in the incidence and in-hospital outcomes of heart failure (HF) patients suffering Clostridioides difficile infection (CDI); (2) compare clinical characteristics of CDI patients between those with HF and matched non-HF patients; and (3) identify predictors of in-hospital mortality (IHM) among HF patients suffering CDI. Methods: Retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. Patients of age ≥40 years with CDI were included. For each HF patient, we selected a year, age, sex, and readmission status-matched non-HF patient. Results: We found 44,695 patients hospitalized with CDI (15.46% with HF). HF patients had a higher incidence of CDI (202.05 vs. 145.09 per 100,000 hospitalizations) than patients without HF (adjusted IRR 1.35; 95% CI 1.31–1.40). IHM was significantly higher in patients with HF when CDI was coded as primary (18.39% vs. 7.63%; p < 0.001) and secondary diagnosis (21.12% vs. 14.76%; p < 0.001). Among HF patient’s predictor of IHM were older age (OR 8.80; 95% CI 2.55–20.33 for ≥85 years old), those with more comorbidities (OR 1.68; 95% CI 1.12–2.53 for those with Charlson Comorbidity index ≥2), and in those with severe CDI (OR 6.19; 95% CI 3.80–10.02). Conclusions: This research showed that incidence of CDI was higher in HF than non-HF patients. HF is a risk factor for IHM after suffering CDI., Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: We examine trends (2001–2015) in the use of non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) among patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). (2) Methods: Observational retrospective epidemiological study, using the Spanish National Hospital Discharge Database. (3) Results: We included 1,431,935 hospitalizations (aged ≥40 years) with an AE-COPD. NIV use increased significantly, from 1.82% in 2001–2003 to 8.52% in 2013–2015, while IMV utilization decreased significantly, from 1.39% in 2001–2003 to 0.67% in 2013–2015. The use of NIV + invasive mechanical ventilation (IMV) rose significantly over time (from 0.17% to 0.42%). Despite the worsening of clinical profile of patients, length of stay decreased significantly over time in all types of ventilation. Patients who received only IMV had the highest in-hospital mortality (IHM) (32.63%). IHM decreased significantly in patients with NIV + IMV, but it remained stable in those receiving isolated NIV and isolated IMV. Factors associated with use of any type of ventilatory support included female sex, lower age, and higher comorbidity. (4) Conclusions: We found an increase in NIV use and a decline in IMV utilization to treat AE-COPD among hospitalized patients. The IHM decreased significantly over time in patients who received NIV + IMV, but it remained stable in patients who received NIV or IMV in isolation., Instituto de Salud Carlos III (ISCIII)/FEDER, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

La Diabetes Mellitus 2 (DM2) es una enfermedad crónica del metabolismo. Suprevalencia no ha dejado de aumentar en las últimas décadas a consecuencia de la mayor longevidad poblacional, progresivo incremento de la obesidad y sedentarismo.La Atención Primaria juega un papel fundamental en la asistencia a las personas con DM2 por su accesibilidad y capacidad de continuidad asistencial. Por ello asume lasfunciones de detección, control, tratamiento y educación sanitaria. Son de especial interés las primeras semanas tras un ingreso hospitalario, dado que es en este periodo cuando se incrementa de forma importante el riesgo de sufrir descompensaciones agudas que representan un verdadero problema para la seguridad y calidad de vida del paciente, así como la probabilidad de aparición de eventos cardiovasculares. Dado que la mayoría de las veces el paciente se transfiere a Atención Primaria, es necesario mejorar la comunicación entre responsables de la Atención Hospitalaria y Primaria..., Diabetes Mellitus 2 (DM2) is a chronic metabolic disease. Its prevalence has grown inplays an essential role for patients with DM2, due to its accessibility and continuity ofcare. For this reason, Primary Care is responsible for the detection, control, treatmentand health education. In this sense, the first weeks after hospitalization are of specialinterest, since it is during this period that there is an increased risk of suffering an acutemedical decompensation, which may represent a paramount phenomenon for thepatient’s safety and quality of life, as well as an increased occurrence of cardiovascularevents. Since most of the times the patient is transferred to Primary Care after hospitaldischarge, it is necessary to improve communication between those in charge ofHospital and Primary Care...

La Diabetes Mellitus 2 (DM2) es una enfermedad crónica del metabolismo. Suprevalencia no ha dejado de aumentar en las últimas décadas a consecuencia de la mayor longevidad poblacional, progresivo incremento de la obesidad y sedentarismo.La Atención Primaria juega un papel fundamental en la asistencia a las personas con DM2 por su accesibilidad y capacidad de continuidad asistencial. Por ello asume lasfunciones de detección, control, tratamiento y educación sanitaria. Son de especial interés las primeras semanas tras un ingreso hospitalario, dado que es en este periodo cuando se incrementa de forma importante el riesgo de sufrir descompensaciones agudas que representan un verdadero problema para la seguridad y calidad de vida del paciente, así como la probabilidad de aparición de eventos cardiovasculares. Dado que la mayoría de las veces el paciente se transfiere a Atención Primaria, es necesario mejorar la comunicación entre responsables de la Atención Hospitalaria y Primaria...

Introducción: la Neumonía Adquirida en la Comunidad (NAC) es una de las principales causas de mortalidad en el mundo y el tercer motivo de consulta por enfermedad infecciosa en los servicios de urgencias hospitalarios. Las guías de práctica clínica recomiendan el uso de escalas pronósticas para tomar decisiones diagnostico-terapéuticas en urgencias. La escala de gravedad más extensamente validada en el ¿Pnemonia Severity Index¿ (PSI). En los últimos años se ha estudiado el papel pronóstico de la región medial de la proadrenomedulina (MR-proADM) en pacientes con NAC. El objetivo de esta tesis doctoral en confirmar el potencial de la MR-proADM como marcador pronóstico en pacientes diagnosticados de NAC en un servicio de urgencias hospitalarios, comparado con otros biomarcadores y el PSI y determinar si la MR-proADM añadida al PSI permite mejorar la precisión pronóstica del PSI aislado o permite una mejor clasificación de los pacientes en función del riesgo de mala evolución y de mortalidad. Metodología: pacientes consecutivos con diagnóstico de NAC en urgencias y que no presentaron ninguno de los criterios de exclusión fueron incluidos en el estudio y seguidos de forma prospectiva. Doscientos veintiséis pacientes formaron la cohorte estudiada. La variable dependiente principal fue mala evolución de la NAC, definida como la aparición de cualquiera de los siguientes eventos adversos: ingreso en UCI, reingreso o muerte a los 30 días del diagnóstico (mortalidad a corto plazo). Secundariamente se estudió la mortalidad tanto a los 30 como a los 90 días del diagnóstico de la NAC (mortalidad a medio plazo). Conclusiones: los niveles plasmáticos de la MR-proADM se correlacionaron con la gravedad de la NAC con un índice de correlación superior a otros biomarcadores. La capacidad de los niveles de la MR-proADM determinados en el servicio de urgencias para predecir mala evolución de pacientes con NAC fue satisfactoria. La combinación de la MR-proADM con el PSI permite una mejor r

Introducción: la Neumonía Adquirida en la Comunidad (NAC) es una de las principales causas de mortalidad en el mundo y el tercer motivo de consulta por enfermedad infecciosa en los servicios de urgencias hospitalarios. Las guías de práctica clínica recomiendan el uso de escalas pronósticas para tomar decisiones diagnostico-terapéuticas en urgencias. La escala de gravedad más extensamente validada en el ¿Pnemonia Severity Index¿ (PSI). En los últimos años se ha estudiado el papel pronóstico de la región medial de la proadrenomedulina (MR-proADM) en pacientes con NAC. El objetivo de esta tesis doctoral en confirmar el potencial de la MR-proADM como marcador pronóstico en pacientes diagnosticados de NAC en un servicio de urgencias hospitalarios, comparado con otros biomarcadores y el PSI y determinar si la MR-proADM añadida al PSI permite mejorar la precisión pronóstica del PSI aislado o permite una mejor clasificación de los pacientes en función del riesgo de mala evolución y de mortalidad. Metodología: pacientes consecutivos con diagnóstico de NAC en urgencias y que no presentaron ninguno de los criterios de exclusión fueron incluidos en el estudio y seguidos de forma prospectiva. Doscientos veintiséis pacientes formaron la cohorte estudiada. La variable dependiente principal fue mala evolución de la NAC, definida como la aparición de cualquiera de los siguientes eventos adversos: ingreso en UCI, reingreso o muerte a los 30 días del diagnóstico (mortalidad a corto plazo). Secundariamente se estudió la mortalidad tanto a los 30 como a los 90 días del diagnóstico de la NAC (mortalidad a medio plazo). Conclusiones: los niveles plasmáticos de la MR-proADM se correlacionaron con la gravedad de la NAC con un índice de correlación superior a otros biomarcadores. La capacidad de los niveles de la MR-proADM determinados en el servicio de urgencias para predecir mala evolución de pacientes con NAC fue satisfactoria. La combinación de la MR-proADM con el PSI permite una mejor r