Regina Dalmau

Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO ( Indicadores de Calidad en Unidades Asistenciales del Área del Corazón ): A SEC/SECTCV Consensus Position Paper

Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.

Laws Restricting Smoking in Public Places Reduce the Incidence of Acute Coronary Syndrome in Spain

Tobacco use is the principle cause of cardiovascular disease (CVD). It puts at risk both the health of smokers and that of passive smokers. Epidemiologic evidence of the relation between tobacco and coronary disease was first published in 1940. The Minnesota Business Men and Framingham studies showed the relation between tobacco and mortality. Hence, today, the epidemiologic evidence is clearly unquestionable. Coronary risk increases markedly even with low levels of exposure, which explains why one or two cigarettes a day doubles cardiovascular risk and environmental tobacco smoke causes CVD in passive smokers.

Quality markers in cardiology: measures of outcomes and clinical practice--a perspective of the Spanish Society of Cardiology and of Thoracic and Cardiovascular Surgery.

The complexity of the individual patient and organization of medical practice results in important institutional and country quality of care variability.1–17 Attempts to assess the quality of clinical practice have established rating systems that may yield completely different results and rating for the same hospital during the same period of time, adding confusion rather than help to prove their usefulness and, questioning whether existing measures can actually measure quality.18–35 Most important, benchmarking may be associated with progressive improvement both in performance and outcomes,18,26,28,36–38 highlighting the relevance of standardization of quality measures and the responsibility of scientific societies. The Spanish Society of Cardiology (SSC) and the Spanish Society of Thoracic and Cardiovascular Surgery (SSTCS) organized a task force to identify and define two sets of quality metrics in hospital cardiology practice: (i) outcome measures (metrics of the final quality of the practice of cardiology) and (ii) performance measures (metrics of clinical practice which are known to positively influence desirable outcomes). Beyond this objective, Scientific Societies and Health Care Authorities should be responsible for the implementation of programmes to measure quality, ensure the quality of the data, benchmarking, and certification/accreditation of cardiology services. All European Society of Cardiology (ESC)32 and American Heart Association/American College of Cardiology33 guidelines were reviewed and recommendations related to quality standards were included in the document. ### Grading of quality markers Three levels were established both for class recommendation and level of evidence considering (i) clinical and practical …

Taquicardia ventricular incesante como manifestación de isquemia miocárdica

We describe four patients with incessant ventricular tachycardia after the acute phase of a myocardial infarction. Two of them had a slow heart rate, and myocardial revascularization resolved the arrhythmia after ischemia was demonstrated. In the other two cases, very fast tachycardias were interrupted by means of intravenous verapamil and clinical stabilization was achieved after failure of amiodarone and lidocaine. In one of them, revascularization prevented new recurrences, but it was not feasible in the second patient, who developed new arrhythmias. The possible mechanisms of these tachycardias and their clinical and therapeutic implications are discussed.

Cardiologists and Electronic Cigarettes

Jaime Fernandez de Bobadilla*, Regina Dalmau y Esteve Salto a Servicio de Cardiologia, Hospital La Paz, Madrid, Espana Comite Nacional para la Prevencion del Tabaquismo, Madrid, Espana Departamento de Salud Publica, Facultad de Medicina, Universidad de Barcelona, Barcelona, Espana Departamento de Salud, Direccion General de Planificacion e Investigacion en Salud, Generalitat de Catalunya, Barcelona, Espana

Recomendaciones para el manejo de la comorbilidad en la práctica clínica en pacientes con espondiloartritis axial

OBJECTIVES To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. METHODS A multidisciplinary group was selected (10 rheumatologists-six of them experts in AxSpA-, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panelists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panelists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. RESULTS The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favoring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. CONCLUSIONS Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.

Small airway dysfunction in smokers with stable ischemic heart disease

Background A higher prevalence of airflow limitation (AL) has been described in patients with ischemic heart disease (IHD). Although small airway dysfunction (SAD) is an early feature of AL, there is little information about its occurrence in IHD patients. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function. Methods In 118 consecutive smoking patients with stable IHD, comorbidities, utilization of healthcare resources, current treatment, blood biochemistry and health status were recorded. SAD was evaluated by impulse oscillometry, and pre- and post-bronchodilator spirometry was performed. Results The prevalence of AL and SAD were 20.3 (95% CI, 13.1–27.6%) and 26.3% (95% CI, 18.3–34.2%), respectively. Compared to the normal lung function group, patients with SAD and without AL had lower spirometric values, poorer quality of life and higher levels of C-reactive protein (CRP), as well as increased cardiovascular risk and more vascular age. In patients with normal spirometry, the presence of SAD was independently associated with pack-years, HDL-cholesterol and CRP levels. Conclusion In patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk.