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Aim: To study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome (OHS) as compared with CPAP-treated patients with obstructive sleep apnea syndrome (OSAS), and to identify independent predictors of mortality in OHS. Material and methods: Two retrospective cohorts of OHS and OSAS were matched 1:2 according to sex, age (±10 year) and length of time since initiation of CPAP/NIV therapy (±6 months). Results: Three hundred and thirty subjects (110 patients with OHS and 220 patients with OSAS) were studied. Mean follow-up time was 7±4 years. The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort (p< 0.05). Patients with OHS had a 2-fold increase (OR 2; 95% CI: 1.11–3.60) in the risk of mortality and 1.86 fold (OR 1.86; 95% CI: 1.14–3.04) increased risk of having a cardiovascular event. Diabetes, baseline diurnal SaO2 < 83%, EPAP < 7 cmH2O after titration and adherence to NIV < 4 hours independently predicted mortality in OHS. Conclusion: Mortality of severe OHS is high and substantially worse than that of OSAS. Severe OHS should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach. SI

espanolObjetivo: El objetivo de este estudio es determinar la repercusion de una consulta monografica para insuficiencia cardiaca cronica (ICC) y comorbilidad asociada,dirigida por internistas y enfermeria cualificada, sobre la hospitalizacion de estos pacientes. Material y Metodos: Estudio de cohortes prospectivo que incluye 456 pacientes ingresados en la unidad de Medicina Interna con ICC. Al alta los pacientes fueron distribuidos en dos grupos homogeneos, uno control que realizo seguimiento habitual, y otro de intervencion que fue seguido en consulta monografica de ICC. Se realizo un seguimiento desde en-06 hasta abril-09 y se compara en ambas cohortes el numero de visitas que realizan a urgencias, reingresos hospitalarios, promedio de reingresos y mortalidad en los ingresos. Resultados : Los pacientes del grupo intervenido frente a los del grupo control, acudieron a Urgencias significativamente menos (66% vs 155%) (p Conclusiones: El seguimiento por internistas y enfermeria de los pacientes con ICC y comorbilidad, basado en una atencion continuada e integral, en la informacion y en la disponibilidad; es un buen metodo para disminuir las visitas a urgencias y los reingresos, ademas de reducir la estancia y mortalidad hospitalaria. EnglishObjetive: The target of this study is to determine the impact of a monographic consultation for Chronic Heart Failure (CHF) which internists and specialized nursing have a main role, on the hospitalization of those patients. Material and Methods: Prospective cohort study included 456 patients admitted to the Internal Medicine Unit with CHF. Upon discharge patients were divided into two similar groups, one control group that went through routine monitoring, and one intervention group made of patients subject to monitoring through monographic consultation for CHF. The study was conducted from January 6th to April 9th. Both cohorts were compared in terms of the number of urgent service visits, hospital readmissions, readmission rates and mortality average at hospital admission. Results : The number of ER visits of patients subject to monitoring through monographic consultation as opposed to control group was considerably lower (66% vs 155%) (p Conclusion: In CHF and comorbility patients, following a health program in which internists and specialized nursing have a main role and which is based on a continuous and integral tracking, information / training and availability, is a good way to reducing urgents visits and readmissions, as well as reducing hospital stay and mortality.