REC: CardioClinics最新文献

英文中文

¿Es el policomprimido CNIC la solución para mejorar la adherencia terapéutica de los pacientes con síndrome coronario agudo? CNIC 多药丸是改善急性冠状动脉综合征患者治疗依从性的解决方案吗？

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.07.003

Ana Viana Tejedor , Cosme García García , Rut Andrea Riba

引用次数: 0

Underuse of systemic thrombolysis in pulmonary embolism: A single center retrospective observational study 肺栓塞患者全身溶栓治疗使用不足：单中心回顾性观察研究

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.03.006

Introduction and objectives

Acute pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. Systemic thrombolysis is the treatment of choice in patients with high-risk PE. The aim of this study is to analyze the patients diagnosed with pulmonary embolism at the emergency department, acute treatment decisions and the main outcomes.

Methods

A single-center retrospective observational study was conducted in patients with the diagnosis of PE at the emergency department over a period of 3 years, followed by a one-year period of follow-up. Reported P values below .05 indicate statistical significance.

Results

A total of 240 patients presented the diagnosis of PE, with a mean age of 69.2 (± 17.4) years. Nearly a third of patients were classified with high or intermediate-high risk PE, but systemic thrombolysis was only performed in nine patients (3.8%). Among the high-risk PE subgroup, age (P = .06), gender (P = .54) and the existence of absolute and/or relative contraindications for thrombolysis (P = .99) were not predictors of the decision of non-revascularization. At the end of the follow-up period, 23.9% of the patients reported persisting symptoms, and chronic thromboembolic pulmonary hypertension was documented in 12.8% of the patients.

Conclusions

Acute treatment of pulmonary embolism is imperative to reduce mortality and prevent long-term sequelae. Systemic thrombolysis is the first line therapy in high-risk patients, but it is underused by medical population even in the absence of formal contraindications. It is necessary a new national-level model of actuation, implementing alternative strategies such as interventional ones to improve outcomes.

导言和目的急性肺栓塞（PE）是第三大最常见的急性心血管综合征。全身溶栓是高危肺栓塞患者的首选治疗方法。本研究旨在分析急诊科确诊的肺栓塞患者、急性治疗决策和主要结果。方法对急诊科确诊为肺栓塞的患者进行为期 3 年的单中心回顾性观察研究，然后进行为期 1 年的随访。结果共有 240 名患者被诊断为 PE，平均年龄为 69.2（± 17.4）岁。近三分之一的患者被归类为高风险或中高风险 PE，但只有 9 名患者（3.8%）接受了全身溶栓治疗。在高风险 PE 亚组中，年龄（P = .06）、性别（P = .54）以及是否存在溶栓的绝对和/或相对禁忌症（P = .99）都不能预测是否决定不进行血管重建。在随访期结束时，23.9%的患者报告有持续症状，12.8%的患者记录有慢性血栓栓塞性肺动脉高压。全身溶栓是高危患者的一线治疗方法，但即使没有正式的禁忌症，医疗人群对溶栓的使用率也很低。有必要建立一种新的国家级行动模式，实施替代性战略，如介入性战略，以改善治疗效果。

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引用次数: 0

Infrautilización del tratamiento de reperfusión en la embolia pulmonar: la capacidad para el cambio 肺栓塞再灌注疗法利用不足：改变的能力

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.07.007

Pablo Salinas

引用次数: 0

Uso de nuevas terapias hipolipemiantes en la práctica clínica. Consenso SEC/SEA/SEEN/SEMFYC/SEMERGEN/SEMG/SEN/SEACV/S.E.N. 在临床实践中使用新型降脂疗法。SEC/SEA/SEEN/SEMFYC/SEMERGEN/SEMG/SEN/SEACV/S.E.N.共识。

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.06.002

David Vivas , Carlos Escobar , Alberto Cordero , Rosa Fernández-Olmo , Armando Oterino , Agustín Blanco-Echevarría , Manuel Botana , Daniel Escribano , María del Mar Freijo , Pedro Martínez-Losas , Vicente Pascual , Borja Quiroga , Carmen Sánchez-Peinador , Mónica Torres-Fonseca , Román Freixa-Pamias , Vivencio Barrios , Gonzalo Barón-Esquivias

Although in the last years a better control of vascular risk factors has been achieved, «real-world» data showed that only a few percentage of patients reach low-density lipoprotein-cholesterol goal levels. Recently, new therapies for the management of dyslipidaemias have emerged, and they could help to achieve the goal targets recommended by currents practical clinical guidelines so as to reduce vascular outcomes. Nevertheless, it is still uncertain in daily clinical practice the ideal timing of prescribing these new drugs, and what are the patients more benefited, compared to «classical» therapies such as statins and/or ezetimibe. In this complex scenario, this consensus document is proposed. It is certified by most of the scientific societies of clinical specialties that may play a role in the patient-healthcare process of atherosclerotic disease (SEC/SEA/SEEN/SEMFYC/SEMERGEN/SEMG/SEN/SEACV/S.E.N.), and its aim is to recommend some practical and simple guidelines, based on current scientific evidence, for the management of new therapies for dyslipidaemias in different scenarios of daily clinical practice.

尽管在过去几年中，血管风险因素得到了更好的控制，但 "真实世界 "的数据显示，只有少数患者达到了低密度脂蛋白胆固醇的目标水平。最近，治疗血脂异常的新疗法不断涌现，它们有助于实现当前实用临床指南推荐的目标，从而减少血管疾病的发生。然而，在日常临床实践中，这些新药的理想处方时机以及与他汀类药物和/或依泽替米贝等 "经典 "疗法相比，哪些患者更能从中受益，仍是未知数。在这种复杂的情况下，我们提出了这份共识文件。它得到了大多数在动脉粥样硬化疾病患者-医疗保健过程中发挥作用的临床专科科学协会（SEC/SEA/SEEN/SEMFYC/SEMERGEN/SEMG/SEN/SEACV/S.E.N.）的认证，其目的是根据当前的科学证据，为在日常临床实践的不同情况下管理血脂异常新疗法推荐一些实用而简单的指南。

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引用次数: 0

Characterizing the “iceberg peak” in valvular heart disease: Outcomes and costs of in-hospital procedures in Spain 瓣膜性心脏病 "冰山高峰 "的特征：西班牙院内手术的结果和成本

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.02.006

Introduction and objectives

The aim was to describe the burden of disease of valvular heart disease (VHD) in-hospital interventions in Spain.

Methods

The analysis involved all cases between 2016 and 2019 in the Spanish Ministry of Health database under the International Classification of Diseases 10th Revision. Procedure rates by region and year (×10⁶), patient risk profile (comorbidities), health outcomes (death), length of stay (LoS), and costs were examined.

Results

A total of 57 878 procedures were analyzed, representing a national rate from 292 in 2016 to 321 in 2019 (×10⁶ inhabitants). Comorbidities measured by the age-adjusted Charlson Comorbidity Index ranged between 3.47 and 3.77 and increased over the period. The in-hospital complications have remained constant over the years with some exceptions. Death rate (×10⁶ inhabitants) was 18.0, and the in-hospital mortality per year range was statistically constant and between 5.23% and 6.20%. The unadjusted LoS ranged from 14.68 to 15.34 days (standard deviations [SD], 16.03 and 15.79) including 2.68 to 3.27 days (SD, 6.57–7.82) in the intensive care unit. VHD procedures costs amounted to €1403.13 million in the period, representing an annual cost of €350.8 million. These costs decreased by 3.17% over the period. Per-procedure mean cost also decreased from €24 801.81 (SD, €10 231.91) to €24 015.50 (SD, €9825.39).

Conclusions

VHD entails a large and increasing volume of procedures in Spain. While a decline in the per-procedure mean cost was noted, the overall annual cost increased. This underscores the substantial burden on the national health system, even when considering solely in-hospital procedures.

导言和目的目的是描述西班牙瓣膜性心脏病（VHD）院内介入治疗的疾病负担。方法分析涉及西班牙卫生部数据库中2016年至2019年期间的所有病例，以国际疾病分类第10次修订版为依据。结果共分析了57 878例手术，全国手术率从2016年的292例上升至2019年的321例（×106名居民）。根据年龄调整后的夏尔森合并症指数（Charlson Comorbidity Index）衡量的合并症介于 3.47 和 3.77 之间，并且在此期间有所增加。除个别情况外，院内并发症多年来保持不变。死亡率（×106 人）为 18.0，每年的院内死亡率在 5.23% 至 6.20% 之间，在统计上保持不变。未经调整的住院时间为14.68至15.34天（标准差[SD]为16.03和15.79），其中重症监护室住院时间为2.68至3.27天（SD为6.57至7.82）。在此期间，VHD 手术费用达 1.40313 亿欧元，年费用为 3.508 亿欧元。在此期间，这些费用下降了 3.17%。每例手术的平均费用也从 24 801.81 欧元（SD，10 231.91 欧元）降至 24 015.50 欧元（SD，9825.39 欧元）。虽然每次手术的平均费用有所下降，但每年的总费用却在增加。这突出表明，即使只考虑院内手术，国家医疗系统也承受着巨大的负担。

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引用次数: 0

Determinación de la lipoproteína (a) y prevalencia de valores elevados entre los asistentes a una reunión científica 脂蛋白（a）的测定和科学会议与会者中脂蛋白（a）值升高的流行率

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.06.001

Rosa Fernández Olmo , Armando Oterino , Miriam Martín Toro , Javier Mora , Mario Baquero , Alberto Cordero

引用次数: 0

Recurrent stroke despite correct anticoagulation therapy with DOACs: Analysis of the real-life therapeutic approach 尽管使用 DOACs 进行了正确的抗凝治疗，但仍会复发中风：实际治疗方法分析

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.05.004

Hakan Gökalp Uzun , Selim Ekinci , Muhammed Ali Şahin , Nazlıhan Ezgi Kavuk , Demet Funda Baş , Barış Kiliçaslan

Introduction and objectives

Recurrent strokes persist despite the use of guideline-recommended direct oral anticoagulants (DOACs). There is a scarcity of data concerning the current and optimal practices following a recurrent stroke while on DOACs. Consequently, our aim was to identify factors associated with this residual risk and to discern the current practice patterns among cardiologists and neurologists.

Methods

All consecutive patients with an acute cerebrovascular accident of any type and a diagnosis of atrial fibrillation (AF) were retrospectively screened at our stroke center. We gathered demographic information, clinical risk scores (CHA₂DS₂-VASc and HAS-BLED), echocardiographic and laboratory findings, risk factors, the modified Rankin score, and information about the treatment modality. DOAC usage was classified as either inappropriate (due to self-reported non-adherence and/or incorrect DOAC dosage) or appropriate.

Results

A total of 77 patients with stroke despite treatment with DOACs were included in the analysis. Of these, 28 (36%) had received inappropriate treatment (20 of them due to inadequate dosing). These patients tended to be older (P = .06) and had lower creatinine levels than the group receiving appropriate DOACs (0.9 vs 1; P = .01). At hospital discharge following the index stroke, various anticoagulants were administered to 75 patients (enoxaparin, n = 5; warfarin, n = 10; DOAC, n = 60). Two patients died and 20 patients were given antiplatelet therapy in addition to anticoagulants. The preferred DOACs after stroke were apixaban (n = 27), followed by rivaroxaban (n = 16), dabigatran (n = 14) and edoxaban (n = 3).

Conclusions

There is no standardized model or consensus among physicians regarding anticoagulant management. Despite the intended use of the drugs, strokes continue to occur in some patients. The 25% of strokes are related to inadequate dosage.

引言和目的尽管使用了指南推荐的直接口服抗凝药（DOACs），但复发性脑卒中依然存在。有关服用 DOACs 后复发脑卒中的当前和最佳治疗方法的数据非常少。因此，我们的目的是确定与这一残余风险相关的因素，并了解心脏病专家和神经科专家目前的实践模式。方法在我们的卒中中心对所有急性脑血管意外的连续患者进行回顾性筛查，患者类型不限，诊断为心房颤动（AF）。我们收集了人口统计学信息、临床风险评分（CHA2DS2-VASc和HAS-BLED）、超声心动图和实验室检查结果、风险因素、改良Rankin评分以及治疗方式的相关信息。DOAC 的使用被分为不适当（由于自我报告的不依从性和/或 DOAC 剂量不正确）或适当。其中 28 例（36%）接受了不当治疗（其中 20 例因剂量不足）。与接受适当 DOACs 治疗的患者相比，这些患者年龄更大（P = .06），肌酐水平更低（0.9 vs 1; P = .01）。中风后出院时，75 名患者接受了各种抗凝药物治疗（依诺肝素，n = 5；华法林，n = 10；DOAC，n = 60）。两名患者死亡，20 名患者在使用抗凝药物的同时还接受了抗血小板治疗。中风后首选的 DOAC 是阿哌沙班（n = 27），其次是利伐沙班（n = 16）、达比加群（n = 14）和依多沙班（n = 3）。尽管药物的预期用途是治疗脑卒中，但一些患者仍会发生脑卒中。25%的中风与剂量不足有关。

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引用次数: 0

Gestión terapéutica con policomprimido CNIC al alta de un primer síndrome coronario agudo en España: el estudio PANDORA 西班牙首次急性冠状动脉综合征患者出院时的 CNIC 多药丸治疗管理：PANDORA 研究

Q4 Medicine

REC: CardioClinics

Pub Date : 2024-10-01 DOI: 10.1016/j.rccl.2024.03.004

Marisol Bravo Amaro , Francisco Marín , Joaquín Ruíz de Castroviejo , Elizabet Méndez Eirín , Lourdes García Bueno , Raquel Marzoa Rivas , Leopoldo Pérez de Isla , en representación de los investigadores del Grupo PANDORA

Introduction and objectives

The polypill from the Spanish National Centre for Cardiovascular Diseases (CNIC) contains drugs (acetylsalicylic acid/atorvastatin/ramipril) for adequate secondary prevention after acute coronary syndrome (ACS). The aim was to describe the 6-month management of drugs with an effect on cardiovascular prognosis in patients treated with CNIC polypill as a baseline treatment at discharge after a first ACS.

Methods

Observational, ambispective, multicenter, national study, according to standard clinical practice. Changes in baseline and adjuvant treatment were evaluated, as well as cardiovascular risk factors.

Results

In total, 288 patients were included and 285 were valid for analysis. Among them, 17.9% were women and the mean age was 62.2 (12.4) years. The most prescribed formulation of the CNIC polypill was 100 mg/40 mg/2.5 mg (55.8%). Of the participants, 76.5% maintained the baseline treatment prescribed at discharge. Also, in 8.8% of patients the dose was increased to optimize the treatment and in 3.5% decreased due to the need of therapeutic optimization or the appearance of side effects. All participants reported some adjuvant treatment, mainly antihypertensives (34.9%) and lipid-lowering agents (28.2%). A significant decrease in mean low-density lipoprotein cholesterol was observed between discharge and the following 2 visits (P < .0001).

Conclusions

After a first ACS, the treatment with CNIC polypill at discharge is effective and safe. CNIC polypill therapy remained unchanged as baseline treatment in most patients. Dose was increased or, at least, an adjuvant treatment was added according to standard clinical practices when it was required.

引言和目标西班牙国家心血管疾病中心（CNIC）的多丸药物（乙酰水杨酸/阿托伐他汀/雷米普利）可用于急性冠状动脉综合征（ACS）后的二级预防。目的是描述首次冠状动脉综合征（ACS）后出院时将 CNIC 多联药物作为基线治疗的患者 6 个月内对心血管预后有影响的药物管理情况。方法根据标准临床实践进行观察性、前瞻性、多中心、全国性研究。结果共纳入 288 例患者，其中 285 例有效。其中女性占 17.9%，平均年龄为 62.2 (12.4)岁。处方最多的 CNIC 多效丸配方是 100 毫克/40 毫克/2.5 毫克（55.8%）。在参与者中，76.5% 的人在出院时保持了处方中的基线治疗。此外，8.8% 的患者为优化治疗而增加了剂量，3.5% 的患者因需要优化治疗或出现副作用而减少了剂量。所有参与者都报告了一些辅助治疗，主要是降压药（34.9%）和降脂药（28.2%）。结论首次 ACS 后，出院时使用 CNIC 多丸治疗有效且安全。大多数患者的 CNIC 多药丸治疗与基线治疗相同。在需要时，根据标准临床实践增加剂量或至少增加辅助治疗。

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