Pub Date : 2025-06-01DOI: 10.1016/j.rce.2025.502309
X. Chen , Y. Zhou , X. Li , W. Zhu
Background
The relationship between atrial fibrillation (AF) and retinal vascular occlusions has been inconsistently reported. Therefore, we conducted a systematic review and meta-analysis to evaluate the occurrence of AF in individuals with and without retinal vascular occlusions.
Methods
A thorough search of the PubMed database was conducted for relevant studies published from its inception through November 2023. Inclusion criteria were set for studies that reported on AF occurrence in patients with retinal vascular occlusions. The pooled effect sizes were determined using either a fixed-effects or random-effects model, as dictated by the I2 statistic.
Results
Our meta-analysis included 12 studies. In the meta-analysis, five studies (9,418 retinal artery occlusion [RAO] patients and 26,116,452 controls) showed a significantly higher prevalence of AF in RAO patients (odds ratio [OR] = 1.74, 95% confidence interval [CI] 1.15–2.63, P = 0.009, I2 = 94%). Four studies (1,622 retinal vein occlusion [RVO] patients and 92,910 controls) indicated a higher prevalence of AF in RVO patients (OR = 2.28, 95% CI 1.93–2.69, P < 0.00001, I2 = 0%). For follow-up incidence, two studies (806 RAO patients and 7,840 controls) reported a higher rate of AF detection in RAO patients (hazard ratios [HR] = 1.60, 95% CI 1.25–2.04, P = 0.0002, I2 = 0%). Similarly, two studies (2,330 RVO patients and 8,641 RVO controls) revealed a higher rate of AF detection in RVO patients (HR = 1.25, 95% CI 1.04–1.51, P = 0.02, I2 = 49%).
Conclusions
Our evidence from this study suggests a significantly elevated prevalence and incidence of AF in patients with retinal vascular occlusions, indicating a potential association that warrants further investigation.
背景心房颤动（AF）与视网膜血管闭塞之间的关系报道不一致。因此，我们进行了一项系统回顾和荟萃分析，以评估有或没有视网膜血管闭塞的个体发生房颤的情况。方法对PubMed数据库从建立到2023年11月发表的相关研究进行全面检索。为报道视网膜血管闭塞患者发生房颤的研究设定了纳入标准。集合效应大小由I2统计量决定，使用固定效应或随机效应模型。结果我们的荟萃分析包括12项研究。在荟萃分析中，5项研究（9,418例视网膜动脉闭塞[RAO]患者和26,116,452例对照）显示，RAO患者AF患病率显著高于其他患者（优势比[OR] = 1.74, 95%可信区间[CI] 1.15-2.63, P = 0.009, I2 = 94%）。四项研究（1,622例视网膜静脉闭塞[RVO]患者和92,910例对照）表明，RVO患者房颤患病率较高(OR = 2.28, 95% CI 1.93-2.69, P <；0.00001, i2 = 0%)。随访发生率方面，两项研究（806例RAO患者和7840例对照）报告RAO患者AF检出率较高（风险比[HR] = 1.60, 95% CI 1.25-2.04, P = 0.0002, I2 = 0%）。同样，两项研究（2,330名RVO患者和8,641名RVO对照）显示，RVO患者的房颤检出率更高（HR = 1.25, 95% CI 1.04-1.51, P = 0.02, I2 = 49%）。结论本研究的证据表明，视网膜血管闭塞患者AF的患病率和发病率显著升高，这表明两者之间的潜在关联值得进一步研究。
{"title":"La fibrilación auricular en pacientes con oclusiones vasculares retinianas: un metaanálisis","authors":"X. Chen , Y. Zhou , X. Li , W. Zhu","doi":"10.1016/j.rce.2025.502309","DOIUrl":"10.1016/j.rce.2025.502309","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between atrial fibrillation (AF) and retinal vascular occlusions has been inconsistently reported. Therefore, we conducted a systematic review and meta-analysis to evaluate the occurrence of AF in individuals with and without retinal vascular occlusions.</div></div><div><h3>Methods</h3><div>A thorough search of the PubMed database was conducted for relevant studies published from its inception through November 2023. Inclusion criteria were set for studies that reported on AF occurrence in patients with retinal vascular occlusions. The pooled effect sizes were determined using either a fixed-effects or random-effects model, as dictated by the I<sup>2</sup> statistic.</div></div><div><h3>Results</h3><div>Our meta-analysis included 12 studies. In the meta-analysis, five studies (9,418 retinal artery occlusion [RAO] patients and 26,116,452 controls) showed a significantly higher prevalence of AF in RAO patients (odds ratio [OR]<!--> <!-->=<!--> <!-->1.74, 95% confidence interval [CI] 1.15–2.63, P<!--> <!-->=<!--> <!-->0.009, I<sup>2</sup> <!-->=<!--> <!-->94%). Four studies (1,622 retinal vein occlusion [RVO] patients and 92,910 controls) indicated a higher prevalence of AF in RVO patients (OR<!--> <!-->=<!--> <!-->2.28, 95% CI 1.93–2.69, P<!--> <!--><<!--> <!-->0.00001, I<sup>2</sup> <!-->=<!--> <!-->0%). For follow-up incidence, two studies (806 RAO patients and 7,840 controls) reported a higher rate of AF detection in RAO patients (hazard ratios [HR]<!--> <!-->=<!--> <!-->1.60, 95% CI 1.25–2.04, P<!--> <!-->=<!--> <!-->0.0002, I<sup>2</sup> <!-->=<!--> <!-->0%). Similarly, two studies (2,330 RVO patients and 8,641 RVO controls) revealed a higher rate of AF detection in RVO patients (HR<!--> <!-->=<!--> <!-->1.25, 95% CI 1.04–1.51, P<!--> <!-->=<!--> <!-->0.02, I<sup>2</sup> <!-->=<!--> <!-->49%).</div></div><div><h3>Conclusions</h3><div>Our evidence from this study suggests a significantly elevated prevalence and incidence of AF in patients with retinal vascular occlusions, indicating a potential association that warrants further investigation.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502309"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288731","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 : 2025-06-01DOI: 10.1016/j.rce.2025.502306
N. Díez , B. Franchez , M.C. Rodríguez-Díez , M. Vidaurreta , M.T. Betés , S. Fernández , P. Palacio , F.J. Pueyo , N. Martín-Calvo
Introduction
Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.
Methods
Forty medical students per course (4 th, 5 th, and 6 th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.
Results
No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (P < .001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.
Conclusions
Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.
{"title":"Comparación de pacientes reales y estandarizados en el Grado de Medicina: un estudio de intervención aleatorizado y controlado","authors":"N. Díez , B. Franchez , M.C. Rodríguez-Díez , M. Vidaurreta , M.T. Betés , S. Fernández , P. Palacio , F.J. Pueyo , N. Martín-Calvo","doi":"10.1016/j.rce.2025.502306","DOIUrl":"10.1016/j.rce.2025.502306","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.</div></div><div><h3>Methods</h3><div>Forty medical students per course (4<!--> <!-->th, 5<!--> <!-->th, and 6<!--> <!-->th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.</div></div><div><h3>Results</h3><div>No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (<em>P</em> <!--><<!--> <!-->.001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.</div></div><div><h3>Conclusions</h3><div>Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502306"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288735","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 : 2025-06-01DOI: 10.1016/j.rce.2025.502310
M.C. Montes , J.A. Rueda-Camino , N. Rallón , S. Nistal-Juncos , R. Barba Martín
Background
People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV older than 50 years old.
Methods
A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a university hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into 10-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (> 2 diseases) was also evaluated. All prevalence were estimated with the exact method.
Results
We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9-29) years. Overall prevalence of multimorbidity was 37% (95% CI: 28.4-45.6%), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI: 29.6-46.6%), hypertension (26.2%; 95% CI: 19.2-34.7%), diabetes mellitus (14.8%; 95% CI: 9.5-22.1%) and non-AIDS defining cancers (15.6%; 95% CI: 10.2-23.0%). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7-16.4%), dementia (8.2%; 95% CI: 4.5-14.4%) and frailty (8.2%; 95% CI: 4.5-14.4%). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.
Conclusions
PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.
{"title":"Envejecimiento con VIH: un análisis transversal de las comorbilidades","authors":"M.C. Montes , J.A. Rueda-Camino , N. Rallón , S. Nistal-Juncos , R. Barba Martín","doi":"10.1016/j.rce.2025.502310","DOIUrl":"10.1016/j.rce.2025.502310","url":null,"abstract":"<div><h3>Background</h3><div>People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV older than 50 years old.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a university hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into 10-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (><!--> <!-->2 diseases) was also evaluated. All prevalence were estimated with the exact method.</div></div><div><h3>Results</h3><div>We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9-29) years. Overall prevalence of multimorbidity was 37% (95% <span>C</span>I<span>:</span> 28.4-45.6%), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI: 29.6-46.6%), hypertension (26.2%; 95% CI: 19.2-34.7%), diabetes mellitus (14.8%; 95% CI: 9.5-22.1%) and non-AIDS defining cancers (15.6%; 95% CI: 10.2-23.0%). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7-16.4%), dementia (8.2%; 95% CI: 4.5-14.4%) and frailty (8.2%; 95% CI: 4.5-14.4%). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.</div></div><div><h3>Conclusions</h3><div>PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502310"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288730","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 : 2025-06-01DOI: 10.1016/j.rce.2025.502300
P. Llorens , A. Haro , V. Gil , A. Alquézar-Arbé , J. Jacob , B. Espinosa , M.A. González de la Torre , J. Núñez , X. Rossello , O. Miró , en representación del grupo de investigación ICA-SEMES
Objectives
To analyze the factors associated with the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the association between use SGLT2i and post discharge adverse clinical endpoints (composite of 30-day visit to emergency department or acute heart failure [AHF] readmission or death) and 1-year mortality.
Methods
We included all patients diagnosed with AHF in 40 Spanish emergency departments (ED) in November-December 2022 with available data on chronic treatment and at discharge and grouped them according to whether they received SGLT2i at discharge. Treatment with SGLT2i was categorized in never user, prior use and initiation during decompensation. In multivariable models adjusted for 31 independent variables, we investigated factors associated with SGLT2i use at discharge and with new initiation of SGLT2i treatment at discharge, and the relationship between SGLT2i treatment and 30-day adverse events and 1-year mortality.
Results
3,554 patients were included (median age: 85 years, 56% women, 71% hospitalized): 495 (13.9%) were already receiving SGLT2i before decompensation and 733 (20.6%) were discharged with SGLT2i. The use of SGLT2i at discharge was directly associated with prior SGLT2i treatment, diabetes mellitus, hospitalization, and discharge prescription of other drugs recommended for heart failure, and inversely with previous episodes of AHF and dementia. Initiation of SGLT2i during decompensation was inversely associated with these factors and also inversely associated with chronic renal failure. Treatment with SGLT2i at discharge was associated with a lower risk of adverse events at 30 days (adjusted HR: 0.80; 95% CI: 0.65-0.99) and death at 1 year (0.78; 0.63-0.96). These beneficial effects were also observed when SGLT2i was initiated during decompensation (0.65; 0.49-0.87 and 0.71; 0.54-0.93, respectively), and the reduction in adverse events at 30 days was even better in new-onset cases (interaction p: 0.02).
Conclusion
The use of SGLT2i after an AHF episode is low, is higher in patients who were hospitalized, and is associated with fewer 30-day adverse events and deaths at 1 year compared with patients not receiving SGLT2i. Patients who initiate SGLT2i during decompensation have an even greater decrease in 30-day adverse events than patients on chronic therapy.
{"title":"Factores asociados con el uso de inhibidores del cotransportador de sodio-glucosa 2 (SGLT2) tras un episodio de insuficiencia cardiaca aguda e impacto pronóstico","authors":"P. Llorens , A. Haro , V. Gil , A. Alquézar-Arbé , J. Jacob , B. Espinosa , M.A. González de la Torre , J. Núñez , X. Rossello , O. Miró , en representación del grupo de investigación ICA-SEMES","doi":"10.1016/j.rce.2025.502300","DOIUrl":"10.1016/j.rce.2025.502300","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the factors associated with the use of sodium-glucose cotransporter<!--> <!-->2 inhibitors (SGLT2i) and the association between use SGLT2i and post discharge adverse clinical endpoints (composite of 30-day visit to emergency department or acute heart failure [AHF] readmission or death) and 1-year mortality.</div></div><div><h3>Methods</h3><div>We included all patients diagnosed with AHF in 40 Spanish emergency departments (ED) in November-December 2022 with available data on chronic treatment and at discharge and grouped them according to whether they received SGLT2i at discharge. Treatment with SGLT2i was categorized in never user, prior use and initiation during decompensation. In multivariable models adjusted for 31 independent variables, we investigated factors associated with SGLT2i use at discharge and with new initiation of SGLT2i treatment at discharge, and the relationship between SGLT2i treatment and 30-day adverse events and 1-year mortality.</div></div><div><h3>Results</h3><div>3,554 patients were included (median age: 85<!--> <!-->years, 56% women, 71% hospitalized): 495 (13.9%) were already receiving SGLT2i before decompensation and 733 (20.6%) were discharged with SGLT2i. The use of SGLT2i at discharge was directly associated with prior SGLT2i treatment, diabetes mellitus, hospitalization, and discharge prescription of other drugs recommended for heart failure, and inversely with previous episodes of AHF and dementia. Initiation of SGLT2i during decompensation was inversely associated with these factors and also inversely associated with chronic renal failure. Treatment with SGLT2i at discharge was associated with a lower risk of adverse events at 30<!--> <!-->days (adjusted HR: 0.80; 95%<!--> <!-->CI: 0.65-0.99) and death at 1<!--> <!-->year (0.78; 0.63-0.96). These beneficial effects were also observed when SGLT2i was initiated during decompensation (0.65; 0.49-0.87 and 0.71; 0.54-0.93, respectively), and the reduction in adverse events at 30<!--> <!-->days was even better in new-onset cases (interaction p: 0.02).</div></div><div><h3>Conclusion</h3><div>The use of SGLT2i after an AHF episode is low, is higher in patients who were hospitalized, and is associated with fewer 30-day adverse events and deaths at 1<!--> <!-->year compared with patients not receiving SGLT2i. Patients who initiate SGLT2i during decompensation have an even greater decrease in 30-day adverse events than patients on chronic therapy.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502300"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288733","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 : 2025-06-01DOI: 10.1016/j.rce.2025.502307
J. Pagán Escribano , L. Castilla Guerra , E. Guitierrez-Sánchez , A. Gómez-Escobar , R. García Alonso , L. Arias-Barquet , O. Madridano Cobo , M. Martín Asenjo , E. Rubio Velázquez , A. Lorenzo Hernández , G. Puche Palao
Retinal vein occlusion (RVO) is associated with both local and systemic factors such as hypertension, diabetes mellitus, dyslipidemia, and thrombophilias. In addition to specific recommendations for ophthalmological management, a comprehensive systemic approach is crucial, with rigorous control of cardiovascular risk factors, which are implicated in approximately 90% of RVO cases. In cases where it is necessary, an in-depth differential diagnosis should also be performed. This position paper aims to provide a thorough review of this common condition, including its pathophysiology, clinical manifestations, diagnosis, and treatment, based on the latest scientific evidence and expert recommendations.
{"title":"Documento de posicionamiento sobre la oclusión venosa de la retina. Sociedad Española de Medicina Interna-Sociedad Española de Retina y Vítreo","authors":"J. Pagán Escribano , L. Castilla Guerra , E. Guitierrez-Sánchez , A. Gómez-Escobar , R. García Alonso , L. Arias-Barquet , O. Madridano Cobo , M. Martín Asenjo , E. Rubio Velázquez , A. Lorenzo Hernández , G. Puche Palao","doi":"10.1016/j.rce.2025.502307","DOIUrl":"10.1016/j.rce.2025.502307","url":null,"abstract":"<div><div>Retinal vein occlusion (RVO) is associated with both local and systemic factors such as hypertension, diabetes mellitus, dyslipidemia, and thrombophilias. In addition to specific recommendations for ophthalmological management, a comprehensive systemic approach is crucial, with rigorous control of cardiovascular risk factors, which are implicated in approximately 90% of RVO cases. In cases where it is necessary, an in-depth differential diagnosis should also be performed. This position paper aims to provide a thorough review of this common condition, including its pathophysiology, clinical manifestations, diagnosis, and treatment, based on the latest scientific evidence and expert recommendations.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502307"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288736","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 : 2025-05-01DOI: 10.1016/j.rce.2025.502281
E. Fuentes , J. Jacob , J. González del Castillo , F.J. Montero-Pérez , A. Alquezar-Arbé , Ò. Miró , en representación del grupo EDEN
Objective
To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.
Methods
Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.
Results
A total of 23,629 patients were analyzed, of which 1,569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11.330 (95% CI 8.967-14.314); ambulation with assistance, OR 5.687 (95% CI 4.759-6.796); cognitive impairment, OR 2.802 (95% CI 2.448-3.208); and age over 85 years, OR 2.191 (95% CI 1.821-2.636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1.472 (95% CI 1.236-1.753) and 1.421 (95% CI 1.282-1.576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.
Conclusions
Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.
目的确定65岁及以上急诊科（ED）患者在养老院生活的相关变量，并评估其预后。方法纳入2019年4月一周内在52家西班牙急诊科就诊的65岁及以上患者，并根据他们是住在养老院还是住在家里进行分类。采用logistic回归模型，计算95%可信区间（CI）的优势比（OR），分析两组患者的特征及差异。评估指标发作后30天和1年的死亡率、急诊科复诊率和住院率，计算风险比（HR）及其95% CI，并采用Cox回归进行对数秩统计。结果共分析23629例患者，其中1569例（6.6%）居住在养老院。在研究的18个变量中，有几个变量在多变量模型中与住在养老院有关，以下显示了显著的结果：无法行走，OR 11.330 (95% CI 8.967-14.314)；辅助行走，OR 5.687 (95% CI 4.759-6.796)；认知障碍，OR 2.802 (95% CI 2.448-3.208)；年龄大于85岁，OR 2.191 （95% CI 1.821-2.636）。30天和1年的总死亡率分别为4.4%和13.7%，在养老院患者中均较高，调整后的风险比分别为1.472 （95% CI 1.236-1.753）和1.421 （95% CI 1.282-1.576）。在调整后的全球模型中，30天和1年的ED复诊和住院率没有差异。结论65岁及以上在急诊科就诊并住在养老院的患者基线状况较住在家里的患者差。在30天和1年的随访期间，这些患者的总体死亡率也较高，尽管急诊科复诊或住院率没有差异。
{"title":"Características y resultados evolutivos a corto y largo plazo en los pacientes de 65 o más años que viven en residencia. Estudio EDEN-40","authors":"E. Fuentes , J. Jacob , J. González del Castillo , F.J. Montero-Pérez , A. Alquezar-Arbé , Ò. Miró , en representación del grupo EDEN","doi":"10.1016/j.rce.2025.502281","DOIUrl":"10.1016/j.rce.2025.502281","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.</div></div><div><h3>Methods</h3><div>Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.</div></div><div><h3>Results</h3><div>A total of 23,629 patients were analyzed, of which 1,569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11.330 (95% CI 8.967-14.314); ambulation with assistance, OR 5.687 (95% CI 4.759-6.796); cognitive impairment, OR 2.802 (95% CI 2.448-3.208); and age over 85 years, OR 2.191 (95% CI 1.821-2.636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1.472 (95% CI 1.236-1.753) and 1.421 (95% CI 1.282-1.576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.</div></div><div><h3>Conclusions</h3><div>Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502281"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892045","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 : 2025-05-01DOI: 10.1016/j.rce.2024.12.004
S. Sánchez Martínez , J. Solís García del Pozo , L. Cabeza Osorio , J. Gómez Garrido , M. Méndez Bailón , J.J. Alfaro Martínez
Introduction
Despite Internal Medicine's importance in our health system, there has been an impression of a lower demand for the choice of specialty in recent years. Our objective is to know the evolution of the choice of Internal Medicine places between 2001 and 2024 among medical graduates who aspire to specialized training in Spain through new parameters based on quotation and demand.
Material and methods
Based on the data published by the Ministry of Health, we analyze the index and the order of quotation, the order of demand, and the total demand for the period studied.
Results
The Internal Medicine quotation remained relatively stable throughout the period until the years 2022-2024, when it declined. The number of Internal Medicine places awarded when the first specialty is exhausted also remains stable. However, the overall demand has deteriorated in recent years, although it continues to maintain an order of total demand above other medical specialties.
Conclusion
Internal Medicine has maintained a very stable quotation and demand for years despite the development of different specialties, until the last three years when this quotation and demand worsened. It is essential to make medical students aware of the fundamental role that Internal Medicine plays in our health and hospital system to promote the paradigm shift from the disease to the sick person.
{"title":"Análisis de la demanda de la especialidad de Medicina Interna en las plazas MIR a través del índice de cotización entre los años 2001 y 2024","authors":"S. Sánchez Martínez , J. Solís García del Pozo , L. Cabeza Osorio , J. Gómez Garrido , M. Méndez Bailón , J.J. Alfaro Martínez","doi":"10.1016/j.rce.2024.12.004","DOIUrl":"10.1016/j.rce.2024.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite Internal Medicine's importance in our health system, there has been an impression of a lower demand for the choice of specialty in recent years. Our objective is to know the evolution of the choice of Internal Medicine places between 2001 and 2024 among medical graduates who aspire to specialized training in Spain through new parameters based on quotation and demand.</div></div><div><h3>Material and methods</h3><div>Based on the data published by the Ministry of Health, we analyze the index and the order of quotation, the order of demand, and the total demand for the period studied.</div></div><div><h3>Results</h3><div>The Internal Medicine quotation remained relatively stable throughout the period until the years 2022-2024, when it declined. The number of Internal Medicine places awarded when the first specialty is exhausted also remains stable. However, the overall demand has deteriorated in recent years, although it continues to maintain an order of total demand above other medical specialties.</div></div><div><h3>Conclusion</h3><div>Internal Medicine has maintained a very stable quotation and demand for years despite the development of different specialties, until the last three years when this quotation and demand worsened. It is essential to make medical students aware of the fundamental role that Internal Medicine plays in our health and hospital system to promote the paradigm shift from the disease to the sick person.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 102278"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892126","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 : 2025-05-01DOI: 10.1016/j.rce.2025.502280
L. Ordieres Ortega , J.L. Modesto dos Santos , P. Parra Caballero , T. Soriano Sánchez , C. Sánchez del Hoyo , E. Coloma Bazán , M. Anta Fernández , M. Martín del Pozo
Introduction
Home hospitalisation (HH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).
Objectives and methods
To establish a protocol for the identification and clinical management of patients with PE who are candidates for HH management. This document has been prepared jointly by the Venous Thromboembolic Disease Group (VTD) and the Home Hospitalisation Group (HH) of the Spanish Society of Internal Medicine (SEMI).
Results
A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.
Conclusions
The SEMI VTD and HH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.
{"title":"Resumen ejecutivo del documento de consenso sobre el tratamiento domiciliario de la embolia pulmonar","authors":"L. Ordieres Ortega , J.L. Modesto dos Santos , P. Parra Caballero , T. Soriano Sánchez , C. Sánchez del Hoyo , E. Coloma Bazán , M. Anta Fernández , M. Martín del Pozo","doi":"10.1016/j.rce.2025.502280","DOIUrl":"10.1016/j.rce.2025.502280","url":null,"abstract":"<div><h3>Introduction</h3><div>Home hospitalisation (HH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).</div></div><div><h3>Objectives and methods</h3><div>To establish a protocol for the identification and clinical management of patients with PE who are candidates for HH management. This document has been prepared jointly by the Venous Thromboembolic Disease Group (VTD) and the Home Hospitalisation Group (HH) of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Results</h3><div>A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.</div></div><div><h3>Conclusions</h3><div>The SEMI VTD and HH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502280"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892154","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 : 2025-05-01DOI: 10.1016/j.rce.2025.502283
J.C. Arévalo-Lorido , F. Alonso Ecenarro , P. Luque-Linero , D. García Calle , J.F. Varona Arche , E. Gañán Moreno , B. Seoane González , J. Carretero Gomez , A. Gullón , L. Castilla Guerra
Aim
To update the profile of patients with atrial fibrillation (AF) who are treated in internal medicine wards according to characteristics implicit in elderly patients.
Material and methods
Multicenter national registry with one-year follow-up that includes adult patients diagnosed with AF. The sample is divided into three groups based on comorbidity and dependency (group 1, functional patients with little comorbidity; group 2, partially dependent patients with comorbidity; group 3, dependent patients with comorbidity) and their characteristics are described, differentiating between inpatients and outpatients.
Results
One thousand two hundred fifteen subjects were analyzed (mean age 81.5 ± 8.7, with 52.1% women). An increase in comorbidities associated with AF is observed compared to previous analyses in the same setting. There is a high rate of frailty (44.4%), and risk of malnutrition (52.9%) with significant differences between the established groups. An increase in baseline anticoagulant therapy was observed with fewer individuals treated in group 3, and a greater use of direct anticoagulants (62.3%) than anti-vitamin K drugs (22.2%), especially in group 3.
Discussion
The current profile of AF patients treated in internal medicine shows an aged but heterogeneous population with a higher rate of baseline anticoagulant therapy than in previous records with a greater use of direct anticoagulants, especially in the more comorbid and dependent population. We observed a high prevalence of frailty and malnutrition with differences between the established groups. This situation could have implications for establishing differentiated approaches.
{"title":"Perfil de los pacientes con fibrilación auricular atendidos en servicios de medicina interna en España. Registro SUMAMOS-FA-SEMI","authors":"J.C. Arévalo-Lorido , F. Alonso Ecenarro , P. Luque-Linero , D. García Calle , J.F. Varona Arche , E. Gañán Moreno , B. Seoane González , J. Carretero Gomez , A. Gullón , L. Castilla Guerra","doi":"10.1016/j.rce.2025.502283","DOIUrl":"10.1016/j.rce.2025.502283","url":null,"abstract":"<div><h3>Aim</h3><div>To update the profile of patients with atrial fibrillation (AF) who are treated in internal medicine wards according to characteristics implicit in elderly patients.</div></div><div><h3>Material and methods</h3><div>Multicenter national registry with one-year follow-up that includes adult patients diagnosed with AF. The sample is divided into three groups based on comorbidity and dependency (group 1, functional patients with little comorbidity; group 2, partially dependent patients with comorbidity; group 3, dependent patients with comorbidity) and their characteristics are described, differentiating between inpatients and outpatients.</div></div><div><h3>Results</h3><div>One thousand two hundred fifteen subjects were analyzed (mean age 81.5<!--> <!-->±<!--> <!-->8.7, with 52.1% women). An increase in comorbidities associated with AF is observed compared to previous analyses in the same setting. There is a high rate of frailty (44.4%), and risk of malnutrition (52.9%) with significant differences between the established groups. An increase in baseline anticoagulant therapy was observed with fewer individuals treated in group 3, and a greater use of direct anticoagulants (62.3%) than anti-vitamin K drugs (22.2%), especially in group 3.</div></div><div><h3>Discussion</h3><div>The current profile of AF patients treated in internal medicine shows an aged but heterogeneous population with a higher rate of baseline anticoagulant therapy than in previous records with a greater use of direct anticoagulants, especially in the more comorbid and dependent population. We observed a high prevalence of frailty and malnutrition with differences between the established groups. This situation could have implications for establishing differentiated approaches.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502283"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892046","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}
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