Pub Date : 2026-03-01Epub Date: 2026-02-28DOI: 10.1016/j.rce.2026.502486
W.-Q. Zheng , S. Bielsa , Y. Niu , J.-X. Wen , L. Yan , Z.-D. Hu , J.M. Porcel
Objective
This study aimed to investigate the effects of age on the sensitivity, specificity, and accuracy of Light's criteria to differentiate exudative from transudative pleural effusion.
Methods
A testing cohort from China and a validation cohort from Spain were used for data analysis. The testing cohort included 302 patients (59 transudates and 243 exudates) with undiagnosed pleural effusion. The validation cohort comprised 400 patients (200 transudates and 200 exudates) divided into two groups according to age (200 patients aged 50-65 years and 200 patients aged 80-95 years). The effects of age on the sensitivity, specificity, and accuracy of Light's criteria were determined by sampling patients with different age limits.
Results
In the testing cohort, the sensitivity and specificity of Light's criteria for exudate were 0.91 and 0.73, respectively. In the validation cohort, the sensitivity was 0.99 and 0.97, and the specificity of Light's criteria for exudate was 0.73 and 0.68, respectively, by age group. The diagnostic accuracy metrics (sensitivity, specificity, and accuracy) of Light's criteria and its items tended to decrease with age.
Conclusion
Age should be considered when interpreting the Light's criteria.
{"title":"El efecto de la edad en la precisión de los criterios de Light","authors":"W.-Q. Zheng , S. Bielsa , Y. Niu , J.-X. Wen , L. Yan , Z.-D. Hu , J.M. Porcel","doi":"10.1016/j.rce.2026.502486","DOIUrl":"10.1016/j.rce.2026.502486","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the effects of age on the sensitivity, specificity, and accuracy of Light's criteria to differentiate exudative from transudative pleural effusion.</div></div><div><h3>Methods</h3><div>A testing cohort from China and a validation cohort from Spain were used for data analysis. The testing cohort included 302 patients (59 transudates and 243 exudates) with undiagnosed pleural effusion. The validation cohort comprised 400 patients (200 transudates and 200 exudates) divided into two groups according to age (200 patients aged 50-65<!--> <!-->years and 200 patients aged 80-95<!--> <!-->years). The effects of age on the sensitivity, specificity, and accuracy of Light's criteria were determined by sampling patients with different age limits.</div></div><div><h3>Results</h3><div>In the testing cohort, the sensitivity and specificity of Light's criteria for exudate were 0.91 and 0.73, respectively. In the validation cohort, the sensitivity was 0.99 and 0.97, and the specificity of Light's criteria for exudate was 0.73 and 0.68, respectively, by age group. The diagnostic accuracy metrics (sensitivity, specificity, and accuracy) of Light's criteria and its items tended to decrease with age.</div></div><div><h3>Conclusion</h3><div>Age should be considered when interpreting the Light's criteria.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502486"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-20DOI: 10.1016/j.rce.2026.502482
J. Pagán Escribano
{"title":"Respuesta a: Metodología GRADE en los consensos y guías de práctica clínica para el manejo de la oclusión venosa retiniana","authors":"J. Pagán Escribano","doi":"10.1016/j.rce.2026.502482","DOIUrl":"10.1016/j.rce.2026.502482","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502482"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-16DOI: 10.1016/j.rce.2026.502472
J. Cabañas Morafraile , L. Serrano Martín , E. de Rafael González , A. Julián-Jiménez , en nombre del grupo URGEN-LABQMIC del CHUT del Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM)
{"title":"La procalcitonina y la región medial de la proadrenomedulina (MR-proADM) podrían ayudar a hacer más segura la hospitalización a domicilio de los pacientes atendidos en urgencias por sospecha de infección","authors":"J. Cabañas Morafraile , L. Serrano Martín , E. de Rafael González , A. Julián-Jiménez , en nombre del grupo URGEN-LABQMIC del CHUT del Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM)","doi":"10.1016/j.rce.2026.502472","DOIUrl":"10.1016/j.rce.2026.502472","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502472"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-18DOI: 10.1016/j.rce.2026.502471
J.M. Fernández Rodríguez , M.B. Alonso-Ortíz , J. Casado Cerrada , D. Chivite Guillen , P. Cubo Romano , R. García Alonso , A. Lorenzo Almorós , J.P. Miramontes-González , L. Soler Rangel , J. Pérez-Silvestre
Heart failure (HF) is associated with high morbidity and mortality. HF with preserved left ventricular ejection fraction (HF-pEF) accounts for up to 50% of all HF cases, being the most common in elderly patients. In addition, these subjects frequently present other comorbidities. For all these reasons, the diagnosis of patients with HF-pEF is complex and requires a careful approach. In addition, there are «secondary» or HF-pEF forms that must also be discarded. The treatment of HF-pEF has evolved very significantly in recent years due to evidence from clinical trials. Until a few years ago, the management was based on the treatment of congestive symptoms with diuretics and comorbidities, to this was added the indication of treatment with SGLT2 inhibitors, after being shown to reduce hospitalizations due to HF, and more recently new evidence of clinical benefit with other drugs such as finerenone, semaglutide or tirzepatide has been published. All this makes it necessary to update the recommendations regarding the management of patients with HF-pEF.
{"title":"Insuficiencia cardíaca con fracción de eyección preservada: actualización en estrategias diagnósticas y terapéuticas. Documento de consenso de la SEMI","authors":"J.M. Fernández Rodríguez , M.B. Alonso-Ortíz , J. Casado Cerrada , D. Chivite Guillen , P. Cubo Romano , R. García Alonso , A. Lorenzo Almorós , J.P. Miramontes-González , L. Soler Rangel , J. Pérez-Silvestre","doi":"10.1016/j.rce.2026.502471","DOIUrl":"10.1016/j.rce.2026.502471","url":null,"abstract":"<div><div>Heart failure (HF) is associated with high morbidity and mortality. HF with preserved left ventricular ejection fraction (HF-pEF) accounts for up to 50% of all HF cases, being the most common in elderly patients. In addition, these subjects frequently present other comorbidities. For all these reasons, the diagnosis of patients with HF-pEF is complex and requires a careful approach. In addition, there are «secondary» or HF-pEF forms that must also be discarded. The treatment of HF-pEF has evolved very significantly in recent years due to evidence from clinical trials. Until a few years ago, the management was based on the treatment of congestive symptoms with diuretics and comorbidities, to this was added the indication of treatment with SGLT2 inhibitors, after being shown to reduce hospitalizations due to HF, and more recently new evidence of clinical benefit with other drugs such as finerenone, semaglutide or tirzepatide has been published. All this makes it necessary to update the recommendations regarding the management of patients with HF-pEF.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502471"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-19DOI: 10.1016/j.rce.2025.502457
J.A. Cuenca-Gómez , M.S. Dawid-Milner , R. Sánchez-Martínez
Ehlers-Danlos Syndromes (EDS) are hereditary connective tissue disorders that affect multiple systems. Mast Cell Activation Syndrome (MCAS) is a clinical condition characterized by chronic and aberrant activation of mast cells. This activation leads to the release of chemical mediators that cause a wide variety of symptoms across multiple organ systems. Both conditions share phenotypic similarities, particularly in symptoms associated with dysautonomia and immune-mediated manifestations.
Various studies have linked both disorders at the pathophysiological and clinical levels. For example, pathophysiologically, the close and bidirectional interaction between fibroblasts and mast cells in the extracellular matrix has been highlighted; clinically, there is a high prevalence of MCAS-related symptoms in patients with EDS, especially the hypermobile type. In recent years, emerging evidence also points to a potential molecular association.
The objective of this review is to evaluate the scientific evidence that exists between these two syndromes, at the pathophysiological, molecular and clinical levels.
{"title":"Asociación entre síndromes de Ehlers-Danlos y síndrome de activación mastocitaria. ¿Existe evidencia científica?","authors":"J.A. Cuenca-Gómez , M.S. Dawid-Milner , R. Sánchez-Martínez","doi":"10.1016/j.rce.2025.502457","DOIUrl":"10.1016/j.rce.2025.502457","url":null,"abstract":"<div><div>Ehlers-Danlos Syndromes (EDS) are hereditary connective tissue disorders that affect multiple systems. Mast Cell Activation Syndrome (MCAS) is a clinical condition characterized by chronic and aberrant activation of mast cells. This activation leads to the release of chemical mediators that cause a wide variety of symptoms across multiple organ systems. Both conditions share phenotypic similarities, particularly in symptoms associated with dysautonomia and immune-mediated manifestations.</div><div>Various studies have linked both disorders at the pathophysiological and clinical levels. For example, pathophysiologically, the close and bidirectional interaction between fibroblasts and mast cells in the extracellular matrix has been highlighted; clinically, there is a high prevalence of MCAS-related symptoms in patients with EDS, especially the hypermobile type. In recent years, emerging evidence also points to a potential molecular association.</div><div>The objective of this review is to evaluate the scientific evidence that exists between these two syndromes, at the pathophysiological, molecular and clinical levels.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502457"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-22DOI: 10.1016/j.rce.2025.502456
A. Jiménez-Puente , M.D. Martín-Escalante , M. Noureddine-López , F. Rivas-Ruiz , A. Rubio-Gallo
Introduction
Patients who remain hospitalized due to the absence of adequate social support for discharge represent a growing challenge in an aging society where traditional family care networks are increasingly weakened.
Methods
We conducted a study in an acute care hospital in southern Spain, focusing on inpatients referred to the Social Work Department in whom social problems were identified as barriers to discharge (SPD). Data were reviewed from 2006 onwards, as well as across two 24-month periods: before and after the COVID-19 pandemic.
Results
2288 discharges with SPD were analyzed. From 2006 to 2024, the number of beds occupied by patients with SPD increased by an average of 0.62 beds per day each year. The rise was particularly marked in 2022 and 2024, when 1.3% of all hospital discharges were delayed due to SPD, equivalent to 11 beds occupied daily. Internal Medicine was the specialty with the highest proportion of patients with SPD: 4%.
Conclusions
Hospital stays prolonged by social problems represent a substantial burden and show a clear upward trend. The underlying causes are multifactorial, mainly related to social circumstances and the clinical complexity of patients.
{"title":"Análisis de los problemas sociales para el alta en hospitalización de agudos","authors":"A. Jiménez-Puente , M.D. Martín-Escalante , M. Noureddine-López , F. Rivas-Ruiz , A. Rubio-Gallo","doi":"10.1016/j.rce.2025.502456","DOIUrl":"10.1016/j.rce.2025.502456","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who remain hospitalized due to the absence of adequate social support for discharge represent a growing challenge in an aging society where traditional family care networks are increasingly weakened.</div></div><div><h3>Methods</h3><div>We conducted a study in an acute care hospital in southern Spain, focusing on inpatients referred to the Social Work Department in whom social problems were identified as barriers to discharge (SPD). Data were reviewed from 2006 onwards, as well as across two 24-month periods: before and after the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>2288 discharges with SPD were analyzed. From 2006 to 2024, the number of beds occupied by patients with SPD increased by an average of 0.62<!--> <!-->beds per day each year. The rise was particularly marked in 2022 and 2024, when 1.3% of all hospital discharges were delayed due to SPD, equivalent to 11<!--> <!-->beds occupied daily. Internal Medicine was the specialty with the highest proportion of patients with SPD: 4%.</div></div><div><h3>Conclusions</h3><div>Hospital stays prolonged by social problems represent a substantial burden and show a clear upward trend. The underlying causes are multifactorial, mainly related to social circumstances and the clinical complexity of patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502456"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-19DOI: 10.1016/j.rce.2025.502455
Álvaro Velasco , Ignacio Pascual Ramos , Pablo Rodríguez Alonso , Celia Denche Sanz , Rocío Tello , Jorge Solís
Introduction
GLP-1 receptor agonists, such as semaglutide, have demonstrated cardiovascular benefits in trials such as SELECT and SOUL. This study assesses the proportion of post-myocardial infarction patients who meet eligibility criteria to benefit from semaglutide.
Methods
A retrospective, single-centre observational study was conducted including 100 consecutive patients following myocardial infarction. Clinical, demographic, and laboratory data were analysed. Eligibility was assessed using the criteria from the SELECT trial (body mass index ≥27 kg/m2, no diabetes, established atherosclerotic disease) and the SOUL trial (type 2 diabetes mellitus and atherosclerotic cardiovascular disease).
Results
SELECT criteria were met by 42 patients, SOUL criteria by 34, and both by 76. This combined group was characterised by older age, greater comorbidity burden (hypertension, dyslipidaemia, type 2 diabetes mellitus), higher body mass index, and a more atherogenic lipid profile.
Discussion
The high proportion of eligible patients suggests that these trials truly represent real-world clinical practice. The SELECT + SOUL group exhibited features consistent with metabolic syndrome, potentially explaining their elevated cardiovascular risk and the likely benefit from semaglutide.
Conclusions
Semaglutide shows high potential for prescription in specialties managing patients with cardiovascular events, identifying a target group with characteristics typical of metabolic syndrome.
{"title":"Pacientes postinfarto agudo de miocardio: potencial de semaglutida en pronóstico de reducción de eventos y mortalidad","authors":"Álvaro Velasco , Ignacio Pascual Ramos , Pablo Rodríguez Alonso , Celia Denche Sanz , Rocío Tello , Jorge Solís","doi":"10.1016/j.rce.2025.502455","DOIUrl":"10.1016/j.rce.2025.502455","url":null,"abstract":"<div><h3>Introduction</h3><div>GLP-1 receptor agonists, such as semaglutide, have demonstrated cardiovascular benefits in trials such as SELECT and SOUL. This study assesses the proportion of post-myocardial infarction patients who meet eligibility criteria to benefit from semaglutide.</div></div><div><h3>Methods</h3><div>A retrospective, single-centre observational study was conducted including 100 consecutive patients following myocardial infarction. Clinical, demographic, and laboratory data were analysed. Eligibility was assessed using the criteria from the SELECT trial (body mass index ≥27<!--> <!-->kg/m<sup>2</sup>, no diabetes, established atherosclerotic disease) and the SOUL trial (type 2 diabetes mellitus and atherosclerotic cardiovascular disease).</div></div><div><h3>Results</h3><div>SELECT criteria were met by 42 patients, SOUL criteria by 34, and both by 76. This combined group was characterised by older age, greater comorbidity burden (hypertension, dyslipidaemia, type 2 diabetes mellitus), higher body mass index, and a more atherogenic lipid profile.</div></div><div><h3>Discussion</h3><div>The high proportion of eligible patients suggests that these trials truly represent real-world clinical practice. The SELECT<!--> <!-->+<!--> <!-->SOUL group exhibited features consistent with metabolic syndrome, potentially explaining their elevated cardiovascular risk and the likely benefit from semaglutide.</div></div><div><h3>Conclusions</h3><div>Semaglutide shows high potential for prescription in specialties managing patients with cardiovascular events, identifying a target group with characteristics typical of metabolic syndrome.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502455"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-30DOI: 10.1016/j.rce.2025.502458
A. Cotos Suárez , M. Alonso-Sardón , V. Velasco Tirado , A. López-Bernus , L. Sancha Domínguez , B. Rodríguez Alonso , J. Pendones Ulerio , J.L. Muñoz Bellido , M. Belhassen-García
Introduction
Cellulitis is a skin and soft tissue infection caused by the entry of a microorganism into the subcutaneous tissue. Nowadays it represents one of the main causes of hospital admission, mainly due to incorrect diagnosis or the need for intravenous treatment. The aim of this study is to observe the characteristics of cellulitis in patients admitted to our hospital during two years in order to determine whether admissions were really necessary.
Methods
Retrospective study of admissions for cellulitis between 2022 and 2023 at the Salamanca University Hospital, classified according to the CREST-SEWS criteria.
Results
During the study period, 332 patients with cellulitis were admitted to the Salamanca University Hospital. 56% of the patients were classified as grade II (those who do not have severe symptoms, but who are usually admitted due to their comorbidities). 70% of the patients had some comorbidity or risk factor such as skin disorders, type II diabetes mellitus or heart failure. The most common site of infection was the lower extremities. The etiologic agent of the infection could be established in 28% of the patients, and the most frequently isolated microorganism was methicillin-sensitive S.aureus. The most common treatment was β-lactams, specifically amoxicillin/clavulanic acid (39.5%) and piperacillin/tazobactam (23.8%).
Conclusions
In order to treat infectious cellulitis, it is essential to carry out a correct etiological diagnosis in order to establish the most appropriate treatment and reduce unnecessary admissions, especially in patients with class II cellulitis.
{"title":"Manejo actual de la celulitis infecciosa: desde la epidemiología hasta el abordaje hospitalario en España","authors":"A. Cotos Suárez , M. Alonso-Sardón , V. Velasco Tirado , A. López-Bernus , L. Sancha Domínguez , B. Rodríguez Alonso , J. Pendones Ulerio , J.L. Muñoz Bellido , M. Belhassen-García","doi":"10.1016/j.rce.2025.502458","DOIUrl":"10.1016/j.rce.2025.502458","url":null,"abstract":"<div><h3>Introduction</h3><div>Cellulitis is a skin and soft tissue infection caused by the entry of a microorganism into the subcutaneous tissue. Nowadays it represents one of the main causes of hospital admission, mainly due to incorrect diagnosis or the need for intravenous treatment. The aim of this study is to observe the characteristics of cellulitis in patients admitted to our hospital during two years in order to determine whether admissions were really necessary.</div></div><div><h3>Methods</h3><div>Retrospective study of admissions for cellulitis between 2022 and 2023 at the Salamanca University Hospital, classified according to the CREST-SEWS criteria.</div></div><div><h3>Results</h3><div>During the study period, 332 patients with cellulitis were admitted to the Salamanca University Hospital. 56% of the patients were classified as grade<!--> <!-->II (those who do not have severe symptoms, but who are usually admitted due to their comorbidities). 70% of the patients had some comorbidity or risk factor such as skin disorders, type<!--> <!-->II diabetes mellitus or heart failure. The most common site of infection was the lower extremities. The etiologic agent of the infection could be established in 28% of the patients, and the most frequently isolated microorganism was methicillin-sensitive <em>S.</em> <em>aureus</em>. The most common treatment was β-lactams, specifically amoxicillin/clavulanic acid (39.5%) and piperacillin/tazobactam (23.8%).</div></div><div><h3>Conclusions</h3><div>In order to treat infectious cellulitis, it is essential to carry out a correct etiological diagnosis in order to establish the most appropriate treatment and reduce unnecessary admissions, especially in patients with class<!--> <!-->II cellulitis.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502458"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-19DOI: 10.1016/j.rce.2025.502452
F. Aguilar Rodríguez , C. Díaz Pedroche , A. Guzmán Carreras , B. Sánchez Sauce , J.I. Molina-Puente , A.A. Kishta , M. Méndez Bailón
Background
Follow-up within Integrated Management Units for Heart Failure (UMIPIC) in patients with multiple comorbidities discharged after heart failure (HF) improves outcomes during the acute phase. However, many Internal Medicine departments use alternative models, and it remains unclear whether these alternative approaches provide additional benefits compared to exclusive follow-up in Primary Care (PC), as well as whether hospital-based consultations maintain their impact once patient stability is achieved.
Methods
We analyzed 709 HF discharges from the PROFUND-IC registry. After population weighting using inverse probability weighting (IPW), we assessed HF readmissions and all-cause mortality at 12 months, comparing patients followed in UMIPIC units, Internal Medicine outpatient clinics (non-UMIPIC), and exclusively in PC. Events occurring within the first 6 months after the acute phase were analyzed separately from those in the subsequent 6 months.
Results
Patients managed under the UMIPIC models experienced a lower 12-month risk of events compared with PC (HR: 0.56; 95% CI: 0.38-0.84; P < .01) and non-UMIPIC (HR: 0.58; 95% CI: 0.36-0.93; P = .02); the latter showed no benefit over PC. Event reduction in UMIPIC was significant during the first 6 months (HR: 0.56; 95% CI: 0.38-0.83; P < .01), with no differences between models during the stable phase.
Conclusions
Hospital-based follow-up of patients with multiple comorbidities during the first six months after an HF episode reduces HF readmissions and overall mortality compared with exclusive PC follow-up — provided it is conducted under the UMIPIC model rather than through conventional Internal Medicine consultations.
背景：心力衰竭综合管理单位（UMIPIC）对心力衰竭（HF）后出院的多重合并症患者的随访改善了急性期的预后。然而，许多内科部门使用替代模式，目前尚不清楚这些替代方法是否比初级保健（PC）的独家随访提供额外的好处，以及一旦患者稳定后，基于医院的会诊是否能保持其影响。方法我们分析了deep - ic登记的709例HF放电。在使用逆概率加权（IPW）对人群进行加权后，我们评估了12个月时HF再入院率和全因死亡率，比较了在UMIPIC单位、内科门诊诊所（非UMIPIC）和专门在PC进行随访的患者。急性期后6个月内发生的事件与随后6个月内发生的事件分开分析。结果与PC （HR: 0.56; 95% CI: 0.38-0.84; P < 0.01）和非UMIPIC （HR: 0.58; 95% CI: 0.36-0.93; P = 0.02）相比，在UMIPIC模型下管理的患者经历了较低的12个月事件风险；后者与PC相比没有任何优势。在前6个月，UMIPIC的事件减少是显著的（HR: 0.56; 95% CI: 0.38-0.83; P < 0.01），在稳定阶段，不同模型之间没有差异。结论：如果在UMIPIC模式下而不是通过传统的内科会诊，在心衰发作后的前6个月内对有多种合并症的患者进行基于医院的随访，与单独的PC随访相比，可以降低心衰再入院率和总死亡率。
{"title":"Impacto del modelo UMIPIC frente a otros modelos de seguimiento tras hospitalización por insuficiencia cardiaca en pacientes pluripatológicos","authors":"F. Aguilar Rodríguez , C. Díaz Pedroche , A. Guzmán Carreras , B. Sánchez Sauce , J.I. Molina-Puente , A.A. Kishta , M. Méndez Bailón","doi":"10.1016/j.rce.2025.502452","DOIUrl":"10.1016/j.rce.2025.502452","url":null,"abstract":"<div><h3>Background</h3><div>Follow-up within Integrated Management Units for Heart Failure (UMIPIC) in patients with multiple comorbidities discharged after heart failure (HF) improves outcomes during the acute phase. However, many Internal Medicine departments use alternative models, and it remains unclear whether these alternative approaches provide additional benefits compared to exclusive follow-up in Primary Care (PC), as well as whether hospital-based consultations maintain their impact once patient stability is achieved.</div></div><div><h3>Methods</h3><div>We analyzed 709 HF discharges from the PROFUND-IC registry. After population weighting using inverse probability weighting (IPW), we assessed HF readmissions and all-cause mortality at 12<!--> <!-->months, comparing patients followed in UMIPIC units, Internal Medicine outpatient clinics (non-UMIPIC), and exclusively in PC. Events occurring within the first 6<!--> <!-->months after the acute phase were analyzed separately from those in the subsequent 6<!--> <!-->months.</div></div><div><h3>Results</h3><div>Patients managed under the UMIPIC models experienced a lower 12-month risk of events compared with PC (HR: 0.56; 95%<!--> <!-->CI: 0.38-0.84; <em>P</em> <!--><<!--> <!-->.01) and non-UMIPIC (HR: 0.58; 95%<!--> <!-->CI: 0.36-0.93; <em>P</em> <!-->=<!--> <!-->.02); the latter showed no benefit over PC. Event reduction in UMIPIC was significant during the first 6<!--> <!-->months (HR: 0.56; 95%<!--> <!-->CI: 0.38-0.83; <em>P</em> <!--><<!--> <!-->.01), with no differences between models during the stable phase.</div></div><div><h3>Conclusions</h3><div>Hospital-based follow-up of patients with multiple comorbidities during the first six months after an HF episode reduces HF readmissions and overall mortality compared with exclusive PC follow-up — provided it is conducted under the UMIPIC model rather than through conventional Internal Medicine consultations.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502452"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-19DOI: 10.1016/j.rce.2025.502451
A. Fraile Sanz , D. Abad Pérez , M. Álvarez Bello , M. Laserna Martínez , I. Luis Saludes , J.A. Perea Egido , R. Mata Caballero , I.J. Thuissard-Vasallo , J. Casado
Introduction and objectives
Heart failure (HF) is a highly prevalent condition, particularly among the elderly, and is associated with high rates of readmission and mortality. To improve prognosis, risk assessment tools such as ELAN-HF and BCN-Bio-HF have been developed to estimate mortality after a hospitalization for HF. However, in clinical practice, risk evaluation is often based on the physician's subjective perception. This study aims to compare that perception with the mortality predictions generated by these tools.
Methods
A retrospective, observational study was conducted in a secondary-level hospital between 2019 and 2021, including patients recently discharged after hospitalization for HF. At the first follow-up visit, physicians subjectively classified the patients’ risk into three levels without access to the results of the risk scores. Afterwards, the ELAN-HF and BCN-Bio-HF scores were calculated and compared with clinical outcomes at 12 months. The predictive capacity of each method was evaluated.
Results
A total of 125 patients were included (median age: 76 years [71,5-83], 56% male). The overall mortality rate was 34.4%. The ELAN-HF and BCN-Bio-HF scores better identified high-risk patients than the clinical assessment, which underestimated mortality in the low-risk group. ROC curve analysis showed good predictive ability for mortality, particularly for the BCN-Bio-HF score (AUC: 74.6%).
Conclusions
The results support that risk scores are more accurate than physicians’ subjective evaluation in predicting mortality in patients with HF. Their integration into clinical practice is recommended, given their prognostic value and usefulness in patient follow-up.
{"title":"Valor pronóstico de la impresión clínica frente a las escalas ELAN-HF y BCN-Bio-HF tras un ingreso por insuficiencia cardíaca aguda","authors":"A. Fraile Sanz , D. Abad Pérez , M. Álvarez Bello , M. Laserna Martínez , I. Luis Saludes , J.A. Perea Egido , R. Mata Caballero , I.J. Thuissard-Vasallo , J. Casado","doi":"10.1016/j.rce.2025.502451","DOIUrl":"10.1016/j.rce.2025.502451","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Heart failure (HF) is a highly prevalent condition, particularly among the elderly, and is associated with high rates of readmission and mortality. To improve prognosis, risk assessment tools such as ELAN-HF and BCN-Bio-HF have been developed to estimate mortality after a hospitalization for HF. However, in clinical practice, risk evaluation is often based on the physician's subjective perception. This study aims to compare that perception with the mortality predictions generated by these tools.</div></div><div><h3>Methods</h3><div>A retrospective, observational study was conducted in a secondary-level hospital between 2019 and 2021, including patients recently discharged after hospitalization for HF. At the first follow-up visit, physicians subjectively classified the patients’ risk into three levels without access to the results of the risk scores. Afterwards, the ELAN-HF and BCN-Bio-HF scores were calculated and compared with clinical outcomes at 12<!--> <!-->months. The predictive capacity of each method was evaluated.</div></div><div><h3>Results</h3><div>A total of 125 patients were included (median age: 76<!--> <!-->years [71,5-83], 56% male). The overall mortality rate was 34.4%. The ELAN-HF and BCN-Bio-HF scores better identified high-risk patients than the clinical assessment, which underestimated mortality in the low-risk group. ROC curve analysis showed good predictive ability for mortality, particularly for the BCN-Bio-HF score (AUC: 74.6%).</div></div><div><h3>Conclusions</h3><div>The results support that risk scores are more accurate than physicians’ subjective evaluation in predicting mortality in patients with HF. Their integration into clinical practice is recommended, given their prognostic value and usefulness in patient follow-up.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502451"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号