Pub Date : 2025-05-01DOI: 10.1016/j.rceng.2025.102279
J. Ena , J. Carretero Gómez , M. Suárez Tembra , L. Lajara Villar , C. Fernández Peña , A. Rosales Castillo , N. Domínguez Pinilla , F.J. Carrasco Sánchez , A. Bustos Merlo , A. Rabassa Soler
Aim
To determine the prevalence and characteristics of chronic kidney disease (CKD) in a cross-sectional population of people with type 2 diabetes treated at internal medicine clinics in Spain.
Methods
We collected data from 25 hospitals that recruited 354 people with type 2 diabetes in an observational study carried out in May 2024. Information collected included demographic data, comorbidities, nutritional status, presence of sarcopenia and frailty, as well as laboratory data and therapy administered.
Results
We included a total of 314 subjects, of whom 185 (58.9%; 95% confidence interval: 53.4–64.3%) had CKD. Compared with people with no CKD, those with CKD were older (77.4 ± 9.7 vs. 65.9 ± 12.5 years; p < 0.001), more often male (53.1% vs. 46.9%; p = 0.021), with more prevalence of ischemic heart disease (22.4% vs. 10.9%; p = 0.006) and longer duration of diabetes disease (14.1 ± 8.6 vs. 10.0 ± 7.0 years; p < 0.001). Malnutrition (37.3% vs. 25%; p = 0.017), sarcopenia (24.6% vs. 11.2%; p = 0.003), and frailty (74.3% vs. 59%; p = 0.006) were more often associated in people with CKD compared with those without CKD.
Conclusion
Internal medicine specialists treat a significant number of people with diabetes and CKD. These people are characteristically elderly, with high proportion of cardiovascular disease showing malnutrition, sarcopenia, and frailty, which could determine the target for metabolic control.
目的确定在西班牙内科诊所接受治疗的2型糖尿病患者中慢性肾脏疾病（CKD）的患病率和特征。方法：我们收集了来自25家医院的数据，在2024年5月进行的一项观察性研究中招募了354名2型糖尿病患者。收集的信息包括人口统计数据、合并症、营养状况、肌肉减少症和虚弱的存在，以及实验室数据和给予的治疗。结果共纳入314例受试者，其中185例（58.9%）；95%可信区间：53.4-64.3%)患有CKD。与无CKD患者相比，CKD患者年龄较大(77.4 ± 9.7岁vs. 65.9 ± 12.5岁；P <； 0.001)，男性更常见(53.1% vs. 46.9%；P = 0.021)，缺血性心脏病患病率更高(22.4% vs. 10.9%；P = 0.006)，糖尿病病程更长(14.1 ± 8.6 vs. 10.0 ± 7.0年；p & lt; 0.001)。营养不良(37.3% vs. 25%；P = 0.017)，肌肉减少症(24.6% vs. 11.2%；P = 0.003)和虚弱(74.3% vs. 59%；p = 0.006)在CKD患者中与非CKD患者相比更常相关。结论内科专家治疗了相当数量的糖尿病和慢性肾病患者。这些人的特点是老年人，心血管疾病的比例高，表现为营养不良、肌肉减少和虚弱，这可以确定代谢控制的目标。
{"title":"Evaluating chronic kidney disease in Spanish people with diabetes: a study from internal medicine clinics","authors":"J. Ena , J. Carretero Gómez , M. Suárez Tembra , L. Lajara Villar , C. Fernández Peña , A. Rosales Castillo , N. Domínguez Pinilla , F.J. Carrasco Sánchez , A. Bustos Merlo , A. Rabassa Soler","doi":"10.1016/j.rceng.2025.102279","DOIUrl":"10.1016/j.rceng.2025.102279","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the prevalence and characteristics of chronic kidney disease (CKD) in a cross-sectional population of people with type 2 diabetes treated at internal medicine clinics in Spain.</div></div><div><h3>Methods</h3><div>We collected data from 25 hospitals that recruited 354 people with type 2 diabetes in an observational study carried out in May 2024. Information collected included demographic data, comorbidities, nutritional status, presence of sarcopenia and frailty, as well as laboratory data and therapy administered.</div></div><div><h3>Results</h3><div>We included a total of 314 subjects, of whom 185 (58.9%; 95% confidence interval: 53.4–64.3%) had CKD. Compared with people with no CKD, those with CKD were older (77.4 ± 9.7 vs. 65.9 ± 12.5 years; p < 0.001), more often male (53.1% vs. 46.9%; p = 0.021), with more prevalence of ischemic heart disease (22.4% vs. 10.9%; p = 0.006) and longer duration of diabetes disease (14.1 ± 8.6 vs. 10.0 ± 7.0 years; p < 0.001). Malnutrition (37.3% vs. 25%; p = 0.017), sarcopenia (24.6% vs. 11.2%; p = 0.003), and frailty (74.3% vs. 59%; p = 0.006) were more often associated in people with CKD compared with those without CKD.</div></div><div><h3>Conclusion</h3><div>Internal medicine specialists treat a significant number of people with diabetes and CKD. These people are characteristically elderly, with high proportion of cardiovascular disease showing malnutrition, sarcopenia, and frailty, which could determine the target for metabolic control.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 102279"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.rceng.2025.502281
E. Fuentes , J. Jacob , J.G.d. 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 1569 (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 8967–14,314); ambulation with assistance, OR 5687 (95% CI 4759–6796); cognitive impairment, OR 2802 (95% CI 2448–3208); and age over 85 years, OR 2191 (95% CI 1821–2636). 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 1472 (95% CI 1236–1753) and 1421 (95% CI 1282–1576), 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，并评估其结果。方法：纳入2019年4月一周内在52个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23,629例患者，其中1,569例（6.6%）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比住在家里的患者基线状况更差。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":"Short- and long-term characteristics and outcomes in patients aged 65 or older living in nursing homes. EDEN-40 study","authors":"E. Fuentes , J. Jacob , J.G.d. Castillo , F.J. Montero-Pérez , A. Alquezar-Arbé , Ò. Miró , en representación del grupo EDEN","doi":"10.1016/j.rceng.2025.502281","DOIUrl":"10.1016/j.rceng.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 1569 (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 8967–14,314); ambulation with assistance, OR 5687 (95% CI 4759–6796); cognitive impairment, OR 2802 (95% CI 2448–3208); and age over 85 years, OR 2191 (95% CI 1821–2636). 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 1472 (95% CI 1236–1753) and 1421 (95% CI 1282–1576), 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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502281"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.rceng.2025.502286
M.Á. Gómez, F.J. Hermida
Objectives
Some of the monoclonal gammopathy of uncertain significance are transient monoclonal gammopathies, characterized by the appearance of a small serum paraprotein followed by its disappearance after a variable period of time. The aim of the present study is to examine the transient monoclonal gammopathies in our health area by describing their characteristics, as well as the pathology they presented at the time of the development of the monoclonal gammopathy.
Methods
A retrospective study was undertaken, in which all serum protein electrophoresis patterns performed during a 6-month period (January-2024/June-2024) were reviewed. All these serum protein electrophoresis were processed in the clinical analysis service of the Clinical Universitary Hospital of Santiago de Compostela from primary and secondary care of the Sanitary Area of Santiago de Compostela and Barbanza. Only patients without hematologic pathology who presented a serum protein electrophoresis without monoclonal gammopathy and who had previously presented a serum protein electrophoresis with the presence of monoclonal gammopathy were selected.
Results
A total of 80 transient monoclonal gammopathies were identified, of which 68 had a monoclonal pattern (85%) and 12 had an oligoclonal pattern (15%). We found different diagnoses coinciding with the presence of transient monoclonal gammopathy, among which we can highlight: 35 cases (43.7%) were infectious processes, 20 cases (25%) were autoimmune diseases and 12 cases (15%) were transplant patients.
Conclusions
Clinicians should consider the likelihood of a transient paraprotein to avoid unnecessary investigations and invasive procedures, which are used in case of suspected malignancy or persistent monoclonality.
{"title":"Transient monoclonal gammopathy: a single-center study","authors":"M.Á. Gómez, F.J. Hermida","doi":"10.1016/j.rceng.2025.502286","DOIUrl":"10.1016/j.rceng.2025.502286","url":null,"abstract":"<div><h3>Objectives</h3><div>Some of the monoclonal gammopathy of uncertain significance are transient monoclonal gammopathies, characterized by the appearance of a small serum paraprotein followed by its disappearance after a variable period of time. The aim of the present study is to examine the transient monoclonal gammopathies in our health area by describing their characteristics, as well as the pathology they presented at the time of the development of the monoclonal gammopathy.</div></div><div><h3>Methods</h3><div>A retrospective study was undertaken, in which all serum protein electrophoresis patterns performed during a 6-month period (January-2024/June-2024) were reviewed. All these serum protein electrophoresis were processed in the clinical analysis service of the Clinical Universitary Hospital of Santiago de Compostela from primary and secondary care of the Sanitary Area of Santiago de Compostela and Barbanza. Only patients without hematologic pathology who presented a serum protein electrophoresis without monoclonal gammopathy and who had previously presented a serum protein electrophoresis with the presence of monoclonal gammopathy were selected.</div></div><div><h3>Results</h3><div>A total of 80 transient monoclonal gammopathies were identified, of which 68 had a monoclonal pattern (85%) and 12 had an oligoclonal pattern (15%). We found different diagnoses coinciding with the presence of transient monoclonal gammopathy, among which we can highlight: 35 cases (43.7%) were infectious processes, 20 cases (25%) were autoimmune diseases and 12 cases (15%) were transplant patients.</div></div><div><h3>Conclusions</h3><div>Clinicians should consider the likelihood of a transient paraprotein to avoid unnecessary investigations and invasive procedures, which are used in case of suspected malignancy or persistent monoclonality.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502286"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.rceng.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
Hospital at Home (HaH) 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 HaH management. This document has been prepared jointly by the Venous Thromboembolism Group (VTE) and the Hospital at Home Group (HaH) 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 VTE and HaH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.
{"title":"Executive summary of the consensus document on home care treatment of pulmonary embolism","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.rceng.2025.502280","DOIUrl":"10.1016/j.rceng.2025.502280","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospital at Home (HaH) 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 HaH management. This document has been prepared jointly by the Venous Thromboembolism Group (VTE) and the Hospital at Home Group (HaH) 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 VTE and HaH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502280"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.rceng.2025.502284
I.M. Parra Salinas , J.A. García Erce , Grupo Español de Aféresis (GEA)
The Spanish Apheresis Group (GEA) presents the second edition of the "Urgent Indications for Therapeutic Apheresis" document, updated 12 years after its initial publication. This revision addresses the need to standardize its application, given the variability observed across different centers and the lack of resources in some provinces. A critical review of the most recent scientific evidence was conducted, including the latest edition of the American Society of Apheresis (ASFA) guidelines and other evidence-based recommendations. Through a methodological review and expert consensus, the list of conditions in which therapeutic apheresis—whether plasma exchange, red blood cell exchange, or cytoreductive apheresis—should be considered an urgent treatment has been redefined. This update introduces new indications and clinical scenarios where apheresis can provide significant therapeutic benefits.
{"title":"Urgent indications for therapeutic Apheresis. Spanish Apheresis Group (GEA). Second edition 2024","authors":"I.M. Parra Salinas , J.A. García Erce , Grupo Español de Aféresis (GEA)","doi":"10.1016/j.rceng.2025.502284","DOIUrl":"10.1016/j.rceng.2025.502284","url":null,"abstract":"<div><div>The Spanish Apheresis Group (GEA) presents the second edition of the \"Urgent Indications for Therapeutic Apheresis\" document, updated 12 years after its initial publication. This revision addresses the need to standardize its application, given the variability observed across different centers and the lack of resources in some provinces. A critical review of the most recent scientific evidence was conducted, including the latest edition of the American Society of Apheresis (ASFA) guidelines and other evidence-based recommendations. Through a methodological review and expert consensus, the list of conditions in which therapeutic apheresis—whether plasma exchange, red blood cell exchange, or cytoreductive apheresis—should be considered an urgent treatment has been redefined. This update introduces new indications and clinical scenarios where apheresis can provide significant therapeutic benefits.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502284"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.rceng.2025.02.001
L.S. Pinheiro
Clinical governance highlights the relevance of the combination of “quality” and “safety” with “excellence” and “improvement”. In hospitals, as highly complex organizations, the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model, can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.
{"title":"Clinical governance in internal medicine: the challenge of length of stay","authors":"L.S. Pinheiro","doi":"10.1016/j.rceng.2025.02.001","DOIUrl":"10.1016/j.rceng.2025.02.001","url":null,"abstract":"<div><div>Clinical governance highlights the relevance of the combination of “quality” and “safety” with “excellence” and “improvement”. In hospitals, as highly complex organizations, the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model, can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 240-243"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.rceng.2025.02.006
S. Russo Botero , M. Ripoll Martínez , L. Fácila Rubio , A. Lamilla Álvarez , V. Montagud Balaguer , D. García Escrivá , E. Chover Sierra , Á. Sánchez Montagud , J. Pérez Silvestre
Introduction and objectives
The aim of this study is to assess the safety in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF).
Methods
Observational, retrospective and single-center study with patients on vericiguat treatment from the Cardiology and Internal Medicine outpatient clinic of the Valencia General University Hospital Consortium during 2023 year and with minimum follow-up of 6 months. Patients with HFpEF diagnosis and optimized treatment according to the ESC 2021 clinical practice guidelines were included, to whom treatment with vericiguat was started.
Results
We included 123 patients with a mean age of 78 years, mostly men (62%) and with NYHA II functional status (52%). 98 patients completed follow-up after a median follow-up of 162 days (IQR 13–343). The average dose of vericiguat used was 8,3 ± 2,7 mg and 75 patients achieved the target dose of 10 mg (71%). At the end of follow-up, no significant changes were observed in the values of proBNP (pg/mL), CA125, hemoglobin (mg/dl), electrolytes, glomerular filtration rate (mL/min/m2) and systolic blood pressure (mmHg). Of all the patients who completed follow-up, 11 (11%) discontinued treatment due to adverse effects, mostly symptomatic hypotension, digestive symptoms and pruritus; 25 died (20%).
Conclusions
The use of vericiguat is safe, if used according to the technical data sheet, in terms of the established parameters. Further long-term studies are needed to evaluate the impact of vericiguat as a potential disease-modifying treatment.
{"title":"VERICIDuAT: Real-life study of vericiguat in patients with heart failure with reduced ejection fraction","authors":"S. Russo Botero , M. Ripoll Martínez , L. Fácila Rubio , A. Lamilla Álvarez , V. Montagud Balaguer , D. García Escrivá , E. Chover Sierra , Á. Sánchez Montagud , J. Pérez Silvestre","doi":"10.1016/j.rceng.2025.02.006","DOIUrl":"10.1016/j.rceng.2025.02.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The aim of this study is to assess the safety in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Observational, retrospective and single-center study with patients on vericiguat treatment from the Cardiology and Internal Medicine outpatient clinic of the Valencia General University Hospital Consortium during 2023 year and with minimum follow-up of 6 months. Patients with HFpEF diagnosis and optimized treatment according to the ESC 2021 clinical practice guidelines were included, to whom treatment with vericiguat was started.</div></div><div><h3>Results</h3><div>We included 123 patients with a mean age of 78 years, mostly men (62%) and with NYHA II functional status (52%). 98 patients completed follow-up after a median follow-up of 162 days (IQR 13–343). The average dose of vericiguat used was 8,3 ± 2,7 mg and 75 patients achieved the target dose of 10 mg (71%). At the end of follow-up, no significant changes were observed in the values of proBNP (pg/mL), CA125, hemoglobin (mg/dl), electrolytes, glomerular filtration rate (mL/min/m<sup>2</sup>) and systolic blood pressure (mmHg). Of all the patients who completed follow-up, 11 (11%) discontinued treatment due to adverse effects, mostly symptomatic hypotension, digestive symptoms and pruritus; 25 died (20%).</div></div><div><h3>Conclusions</h3><div>The use of vericiguat is safe, if used according to the technical data sheet, in terms of the established parameters. Further long-term studies are needed to evaluate the impact of vericiguat as a potential disease-modifying treatment.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 204-210"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.rceng.2024.11.008
E. Moya Mateo , R. García Alonso , C. Sánchez Sánchez , Y. Tung-Chen , E. Rodilla , L. Beltrán Romero , J.A. García-Donaire , M.V. Bonilla-Hernández , N. Muñoz-Rivas , L. Castilla-Guerra
Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.
{"title":"Positioning for the use of multivessel clinicalultrasound in vascular risk evaluation: VASUS+protocol. 2024 Recommendations of the Vascular Risk WorkingGroup of The Spanish Society of Internal Medicine (SEMI), Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Hypertension-Spanish League for the Fight against Arterial Hypertension (SHE-LELHA)","authors":"E. Moya Mateo , R. García Alonso , C. Sánchez Sánchez , Y. Tung-Chen , E. Rodilla , L. Beltrán Romero , J.A. García-Donaire , M.V. Bonilla-Hernández , N. Muñoz-Rivas , L. Castilla-Guerra","doi":"10.1016/j.rceng.2024.11.008","DOIUrl":"10.1016/j.rceng.2024.11.008","url":null,"abstract":"<div><div>Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 223-230"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.rceng.2025.02.002
S. Carrasco-Molina , Á. Robles-Marhuenda , J.J. Ríos-Blanco , Y. Tung-Chen
Acute confusional syndrome (ACS) is a disruption of cognitive function and attention that affects up to 42% of hospitalised patients, most commonly in those over the age of 65. It is typically triggered by one or more precipitating factors in predisposed patients. Point-of-care ultrasound (POCUS) emerges as a tool that could be used to provide quick and accurate information in the diagnosis of patients with ACS, potentially reducing the waiting time for critical interventions, decreasing the need for invasive procedures, and possibly improving clinical outcomes. To date, no articles have been published describing the utility of POCUS in patients with ACS.
Therefore, this work presents a review of the utility of POCUS in various pathologies that may be related to the development of ACS. Additionally, we propose an action algorithm that integrates clinical evaluation with bedside ultrasound, which could be useful for allowing quick and accurate identification of the underlying causes of ACS and the guidance of appropriate treatment, although prospective studies are needed to confirm this utility.
{"title":"Utility of point-of-care ultrasound (POCUS) in hospitalized patients with acute confusional syndrome of unclear etiology","authors":"S. Carrasco-Molina , Á. Robles-Marhuenda , J.J. Ríos-Blanco , Y. Tung-Chen","doi":"10.1016/j.rceng.2025.02.002","DOIUrl":"10.1016/j.rceng.2025.02.002","url":null,"abstract":"<div><div>Acute confusional syndrome (ACS) is a disruption of cognitive function and attention that affects up to 42% of hospitalised patients, most commonly in those over the age of 65. It is typically triggered by one or more precipitating factors in predisposed patients. Point-of-care ultrasound (POCUS) emerges as a tool that could be used to provide quick and accurate information in the diagnosis of patients with ACS, potentially reducing the waiting time for critical interventions, decreasing the need for invasive procedures, and possibly improving clinical outcomes. To date, no articles have been published describing the utility of POCUS in patients with ACS.</div><div>Therefore, this work presents a review of the utility of POCUS in various pathologies that may be related to the development of ACS. Additionally, we propose an action algorithm that integrates clinical evaluation with bedside ultrasound, which could be useful for allowing quick and accurate identification of the underlying causes of ACS and the guidance of appropriate treatment, although prospective studies are needed to confirm this utility.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 231-239"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.rceng.2025.02.005
N. Ramírez-Perea , D. Orozco-Beltrán
{"title":"Present and future of internists in the Spanish public health system","authors":"N. Ramírez-Perea , D. Orozco-Beltrán","doi":"10.1016/j.rceng.2025.02.005","DOIUrl":"10.1016/j.rceng.2025.02.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 250-251"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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