Cristina Roqueta

Evolución de la incidencia de caídas en un centro hospitalario de media y larga estancia

INTRODUCTION The characteristics of falls in older patients admitted to an institution in 2 different periods. MATERIAL AND METHODS We performed a prospective study of falls among inpatients admitted to an intermediate and long-term care center. Age, sex, Barthel index, main diagnoses, medication at the time of the fall, place, the shift when the fall occurred, lighting, characteristics of the floor, the use of walking aids and/or restraints, the kind of shoes worn, and activity at the moment of the fall were registered. During the first 2-year study period (period A), there were 332 beds (intermediate care and rehabilitation unit, long-term care unit, palliative care unit, psychogeriatric unit and assisted residential home). During the second 2-year period (period B), the palliative and intermediate care units were moved to another center (255 beds remaining). RESULTS Period A: there were 647 falls in 227 patients; the total number of patients admitted was 1387 (accumulated incidence of falls: 46.6%). Period B: there were 539 falls in 191 patients; the total number of patients admitted was 908 (accumulated incidence of falls: 59.3%). Significant differences between the two periods were found in age (79.8+/-10.6 versus 81.3 10.2) (p<0.02), the percentage of women (55.2% versus 66.4%) (p<0.001), neurological diagnoses (26.7% versus 36.1%) (p< 0.001), antidepressants (12.6% versus 16.4%), neuroleptics (10.3% versus 15.2%) (p<0.001), falls in the bedroom (39.7% versus 41.6%) (p<0.001), falls when moving from bed to chair (41.3% versus 30.8%) (p<0.001), and the use of walking aids (65.8% versus 40.5%) (p<0.001). CONCLUSIONS a) the incidence of falls increased in the second period of the study; b) in period A, risk factors for falls related to rehabilitation (moving from bed to chair, use of walking aids) were more frequent. In period B, risk factors related to the characteristics of psychogeriatric patients were predominant (neurological illness, use of psychotropic drugs, and c) the difference in the incidence of falls between the two study periods may be related to the distinct characteristics of the patients (case mix).

Prognostic Value of NT-proBNP and an Adapted Monin Score in Patients With Asymptomatic Aortic Stenosis

INTRODUCTION AND OBJECTIVES Our objective was to assess the prognostic value of NT-proBNP in patients with asymptomatic moderate/severe aortic stenosis and to validate an adapted Monin score using natriuretic peptide levels in our setting. METHODS Prospective study of 237 patients with degenerative asymptomatic moderate/severe aortic stenosis. NT-proBNP was determined in all patients, who were then followed up clinically. The adapted Monin score was defined as follows: (peak velocity [m/s]×2)+(logn NT-proBNP×1.5)(+1.5 if woman). A clinical event was defined as surgery, hospital admission due to angina, heart failure or syncope, or death. RESULTS A total of 51% were women, and the mean age was 74 years. Mean (SD) echocardiographic values were as follows: peak velocity 4.14 (0.87) m/s; mean gradient, 43.2 (16.0) mmHg; aortic valve area, 0.87 (0.72) cm(2), and aortic valve area index, 0.49 (0.14) cm(2)/m(2). The median NT-pro-BNP value was 490.0 [198.0-1312.0] pg/mL. There were 153 events during follow-up (median 18 months). The optimum NT-proBNP cut-point was 515 pg/mL, giving event-free survival rates at 1 and 2 years of 93% and 57%, respectively, in patients with NT-proBNP <515 pg/mL compared with 50% and 31% in those with NT-proBNP >515 pg/mL. Patients were divided into quartiles based on the Monin score. Event-free survival at 1 and 2 years was 87% and 79% in the first quartile, compared with 45% and 28% in the fourth quartile, respectively. CONCLUSIONS NT-proBNP determination provides prognostic information in patients with asymptomatic moderate/severe aortic stenosis. The adapted Monin score is useful in our setting and allows a more precise prognosis than does the use of NT-proBNP alone.

Effect of correction of anemia on echocardiographic and clinical parameters in patients with aortic stenosis involving a three-cuspid aortic valve and normal left ventricular ejection fraction.

The objective of the study is to investigate the impact of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) on prognosis and to study the effect of recovery from anemia on echocardiographic and clinical parameters in patients with aortic stenosis (AS). This was a prospective study in 315 patients with moderate or severe AS. Patients with anemia received oral iron (ferrous sulfate with mucoproteose, 160 mg iron/day) and erythropoietin, if needed, or intravenous iron, if necessary. The following tests were performed before and after normalization of hemoglobin values: echocardiogram, 6-minute walk test, N-terminal B-type natriuretic peptide, and measures of depression, cognitive impairment, and dependence. Patient mean age was 74 years (SD 9). Mean follow-up was 25 months (SD 8). Anemia prevalence in the overall group was 22% (n = 70). Patients who are anemic had a higher rate of complications at follow-up (mortality, hospital admission, or need for valve procedure; 80% vs 62%, p = 0.009). In total, 89% of patients recovered from anemia, with a mean time to recovery of 4.6 weeks (SD 1.4). Improvements were observed on echocardiographic parameters of peak velocity (4.1 to 3.7 m/s, p = 0.02) and mean gradient (44 to 35 mm Hg, p = 0.02). Performance on the 6-minute walk test improved from 235 to 303 m (p <0.001). Median N-terminal B-type natriuretic peptide value decreased from 612 to 189 pg/dl (p <0.001). In conclusion, patients with AS and anemia have a worse prognosis than those without anemia. Resolution of anemia is associated with improvements in echocardiographic parameters and functional status, suggesting that treatment of iron deficiency is a relevant option in the management of patients with AS, particularly in nonoperable cases.

Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers

BACKGROUND The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). OBJECTIVES We wanted to know more about the effects of SGB on cardiovascular parameters. METHODS We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). RESULTS At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73±8.61 to 73.53±11.10, p=0.015; on the left side from 70.66±13.01 to 77.93±10.40, p=0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. CONCLUSIONS Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.