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Introduction and objectives

Restrictions on the prescription of direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation (NVAF) treatment imposed in Spain by the 2013 Therapeutic Positioning Report (TPR) may limit access to this medication. With the aim of assessing the impact of the TPR, we analysed the reasons to prescribe the DOAC rivaroxaban, the profile of patients with NVAF treated and how long it takes accessing to the treatment in hospitals belonging to the National Health System, both overall and by autonomous regions.

Methods

An observational, cross-sectional, multicenter study of patients with NVAF treated with rivaroxaban in specialist practice. The autonomous regions were grouped according to the most common prescribing practices: per Summary of Product Characteristics (SmPC), TPR or a more restrictive or modified TPR (mTPR).

Results

73 researchers providing data on 1,727 patients participated. 93.7% of patients were at high thromboembolic risk (CHA₂DS₂-Vasc ≥ 3) and 46.2% were at high risk for bleeding (HAS-BLED ≥ 3). Median time since diagnosis of NVAF for receiving rivaroxaban was 21.1 months. 57.0% patients had received vitamin K antagonists (VKA). With respect to autonomous regions where prescribing practices are guided by SmPC, patients where TPR/mTPR restrictions were followed were at higher thromboembolic and bleeding risk, had received VKA more frequently and waited a median of ∼ 20 months longer before receiving rivaroxaban.

Conclusions

Patients treated with rivaroxaban in Spain show high thromboembolic and bleeding risks. Median time for rivaroxaban prescription is 21.1 months. The differences in the adhesion to the TPR create inequalities between autonomous regions. Patients from autonomous regions following the TPR/mTPR receive rivaroxaban up to 20 months later and show higher thromboembolic and bleeding risks.

Background and objective

Syncope is a frequent reason for consulting the hospital emergency department. Finding the ethiology can be a challenge due to its presentation and the multiple causes that originate it; hence the need to create so-called “syncope units”. Our objective was to analyze the diagnostic reliability of these units.

Materials and methods

Prospective observational analysis of 465 patients evaluated in our syncope unit, where modifications of the initial etiological diagnosis during long-term follow-up are evaluated.

Results

After follow-up, the initial diagnosis was modified in a small percentage of cases (6.7%). The overall mortality was 5.6%, of which only 0.9% was of cardiovascular origin. Among the patients with syncope cataloged as cardiogenic after the follow-up, there were no deaths of cardiovascular origin.

Conclusions

There is a small percentage of change in the initial diagnosis of syncope after follow-up in the syncope unit. Our study suggests that the syncope units are reliable structures when it comes to finding the etiological diagnosis of it. Given the variability in the attendance of this syndrome between centers, more studies would be necessary to evaluate which organizational model presents the best results.

Pheochromocytomas and paragangliomas are catecholamine-secreting neuroendocrine tumors. Resecting a pheochromocytoma or paraganglioma is a high-risk surgical procedure due to lethal hypertensive crises, malignant arrhythmias, and multiorgan failure, requiring prior pharmacological preparation.

Below, we present the case of a 69-year-old man who underwent surgery whilst the presence of a paraganglioma was overlooked thus suffering ventricular tachycardia and hypertensive crises during the intervention and the postoperative period.

Background and objectives

The ischemic cardiopathy is the first cause of death in elderly. The geriatrics syndromes are related with an increase of morbidity and mortality in this age margin. The aim of the study was the influence evaluation of the geriatric syndromes in elderly patients undergoing percutaneous coronary revascularization.

Methods

We have included 220 patients prospectively with multivessel coronary disease. The geriatric syndromes evaluated were: frailty by Fried questionnaire, comorbidity by Charlson index and physical disability by Barthel index.

Results

The 42.1% of the patients had some level of frailty (Fried ≥ 1), it was observed some level of physical disability (Barthel < 100) in 21.8% and the mean of the Charlson index was 4 (3-6). The patients that suffered some major cardiovascular event (MACE, 12.7%) had more frailty (75 vs. 11%, P = .002), physical disability (45.8 vs. 17.2%, P = .002) and comorbidity (Charlson index 6 [4-7] vs. 4 [3-6], P = .004]. In the follow up we found a tendency of MACE decrease when a completed revascularization was done (OR 0.48, 95% CI 0.2-1.15, P ≤ .099).

Conclusions

In our population the geriatric syndromes studied are more frequent in patients that suffer MACE. We observe a tendency of decreasing mayor cardiovascular events when the coronary percutaneous revascularization is completed.