Revista clinica espanola最新文献

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.

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.

Introduction: SMART (stroke-like migraine attacks after radiation therapy) syndrome is a possible complication of radiotherapy used in the treatment of brain tumours. The current prevalence is not well known, partly because it is underdiagnosed.

Material and methods: A descriptive, prospective study was designed over a period of 18 months. Demographic, clinical, analytical and neuroimaging variables were collected.

Results: Three patients were included who, after receiving holocranial radiotherapy, developed focal neurological symptoms after a variable latency period. After ruling out other possible aetiologies, the diagnosis of SMART syndrome was established.

Conclusion: This case series aims to raise awareness among professionals of the importance of training in this pathology, especially in view of the advances in oncological treatments and the expected increase in its incidence.

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have proven effective in chronic heart failure (CHF). However, evidence regarding their use in acute heart failure (AHF), particularly among elderly patients, is limited. This study aimed to assess the safety and tolerability of SGLT-2i in elderly patients hospitalized for AHF.

Methods: We conducted a multicenter retrospective study including 192 patients admitted with AHF, with a mean age of 83.3 ± 8.3 years, of whom 57.3% were female. The initiation of SGLT-2i during hospitalization, adverse events, mortality, and readmission rates were analyzed.

Results: SGLT-2i therapy was initiated within the first 48 hours of admission in 31.3% of patients. Only 5.7% experienced drug-related adverse effects. During follow-up, 10.4% of patients died and 25% required hospital readmission.

Conclusions: SGLT-2i treatment in elderly patients with AHF demonstrated good tolerance and safety, even in those with multiple comorbidities. These findings suggest that early initiation of SGLT-2i during hospitalization for AHF may represent an effective and safe therapeutic strategy, supporting the optimization of clinical management in this high-risk population.

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.

Objective: To describe the diuretic strategy used in patients hospitalized for acute heart failure (AHF), as well as to identify the clinical profiles of these patients according to the diuretic regimen received.

Materials and methods: A multicenter observational study of patients hospitalized for AHF in Internal Medicine departments and included in the Heart Failure Registry (RICA-2). Patients were categorized into three groups based on the diuretic treatment received: intravenous (IV) furosemide alone, IV furosemide plus thiazide diuretics (TD), and IV furosemide plus acetazolamide (ACZ).

Results: A total of 588 patients were analyzed (median age 84 [77-88] years; 51.2% female). IV furosemide alone was administered in 78% of cases, while 22% received combination diuretic therapy (17% with TD and 5% with ACZ). Patients treated with combination diuretics had a higher burden of comorbidities (diabetes, obesity, chronic kidney disease, and renal function impairment at admission), worse NYHA functional class, higher clinical and biochemical markers of congestion, and were more frequently on loop diuretics prior to admission. No significant differences were found in the length of hospital stay according to the diuretic strategy used. Combination diuretic therapy was associated with greater weight loss during hospitalization (3 kg in the TD group and 2.75 kg in the ACZ group) compared to IV furosemide alone (2 kg) (p = 0.005).

Conclusions: The most frequently used diuretic strategy in patients hospitalized for AHF in the Internal Medicine departments included in the RICA-2 registry is IV furosemide alone. The combination of diuretics (especially with TD) is more commonly used in patients with more comorbidities and congestion.