- Email: [email protected]
Mean stay of patients with acute heart failure in short-stay units
182
Letters to the Editor / Med Clin (Barc). 2015;145(4):181–183
6. Browder J, Deveer JA. The varied pathologic basis for the symptomatology produced by tumors in the region of the pulmonary apex and upper mediastinum. Am J Cancer. 1935;24:507–21.
Departamento de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain ∗ Corresponding
Natalia Fouz-Rosón ∗ , Estefanía Luque-Crespo, María Pavón-Masa, Teodoro Montemayor-Rubio
author. E-mail address: natalie1 [email protected] (N. Fouz-Rosón).
Mean stay of patients with acute heart failure in short-stay units夽
with 14.8% average discharges, with significant differences among centers (range 0–31%). Eventually, a key factor to ensure efficient SSU management is the correct selection in the emergency department of patients with a suitable profile, and in this sense, there is little experience in the medical literature, only referring to patients with chronic obstructive pulmonary disease.4,5 This is why, in the absence of clinical guidelines validated by national and international companies, as in the case of pneumonia, works such as the one by Martin-Sanchez et al., analyzing prevalent diseases, are a useful tool in making decisions regarding the admission for this type of assistance, alternative to conventional hospitalization.
La estancia media de los pacientes con insuficiencia cardiaca aguda en las unidades de corta estancia Dear Editor, We have carefully read the article by Martín-Sánchez et al. “Extended-stay in patients admitted in the Short Stay Unit (EPICAUCE study) for heart failure: study of factors associated”.1 And, in light of the results presented, we deem appropriate to make some considerations. According to the data recently published by the Registry of short-stay units (SSUs) in Spain (REGICE 1 and REGICE 2),2,3 with over 45,000 patients in the analyzed period, heart failure (Group Associated with Diagnosis 127, 544 and 87) accounts for almost 9% of hospital admissions and has been reported as one of the first 3 diagnoses in 72.5% of the SSUs, with an overall mean stay of 3.4 days (SD 1.3). It is probably questionable, as suggested in the discussion section, the suitability of having considered 3 days from admission as a breakpoint. Even being statistically significant, the differences found from this reference may have a limited impact on the clinical management of SSUs and their overall activity data. This is why we believe it might be reasonable to analyze the potential factors associated with extending the mean stay, for example, over 5 days, which perhaps would allow consider other variables of interest. As commented by the authors, the cohort is a representative sample in both, volume and number of participating centers, and there is a large number of variables being analyzed. However, in relation to the analytical data, the number of determinations of brain natriuretic peptide, assumed as relatively low, has not been specified, which may influence the lack of differences. And no information on other prognostic markers, particularly troponin, has been reported. It is remarkable the penalty in terms of mean stay in hospital admissions occurring in Thursday in connection with the decreased discharge rate during the weekend, which has been corroborated by the results of REGICE project, 夽 Please cite this article as: Ferré C, Llopis F, Juan A. La estancia media de
los pacientes con insuficiencia cardiaca aguda en las unidades de corta estancia.
References 1. Martín-Sánchez FJ, Carbajosa V, Llorens P, Herrero P, Jacob J, Pérez-Dura MJ, et al., en representación del grupo ICA-SEMES. Estancia prolongada en los pacientes ingresados por insuficiencia cardiaca aguda en la Unidad de Corta Estancia (estudio EPICA-UCE): estudio de los factores asociados. Med Clin (Barc). 2014;143:245–51. 2. Llopis Roca F, Juan Pastor A, Ferré Losa C, Martín Sánchez FJ, Llorens Soriano P, Sempere Montes G, et al., en representación del Grupo de Colaboradores del Proyecto REGICE. Proyecto REGICE: registro de las unidades de corta estancia en ˜ Localización, aspectos estructurales y dotación de profesionales (REGICE Espana. 1). Emergencias. 2014;26:57–60. 3. Llopis Roca F, Ferré Losa C, Juan Pastor A, Martín Sánchez FJ, Sempere Montes G, Llorens Soriano P, et al., en representación del Grupo de Colaboradores del Proyecto REGICE. Proyecto REGICE. Gestión clínica de las unidades de corta ˜ (REGICE 2). Emergencias. 2014;26:359–62. estancia en Espana ˜ P, Pita S, Ramos V, Pellicer C, Nicolás R, et al. Factors predict4. De la Iglesia F, Valino ing a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease. J Intern Med. 2002;251:500–7. 5. Villalta J, Sequeira E, Cereijo AC, Sisó A, de la Sierra A. Factores predictivos de un ingreso corto en pacientes con enfermedad pulmonar obstructiva crónica agudizada. Med Clin (Barc). 2005;124:648–50.
Carles Ferré a , Ferran Llopis b,∗ , Antoni Juan c a
Unidad de Corta Estancia de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain b Servicio de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain c Institut Català de la Salut, Barcelona, Spain ∗ Corresponding
author. E-mail address: fl[email protected] (F. Llopis).
Endocrinol Nutr. 2015;145:182.
Reply夽 Respuesta Dear Editor, We have carefully read the letter to the Editor by Ferré et al. regarding the article “Prolonged hospitalization in patients
夽 Please cite this article as: Martín-Sánchez FJ, Carbajosa V, Llorens P. Respuesta. Endocrinol Nutr. 2015;145:182–183.
admitted in the Short Stay Unit (EPICA-UCE study) for acute heart failure: study of associated factors”.1,2 First, we would like to thank all the considerations by the authors as well as provide a number of clarifications to some of the comments that might be controversial. First, with regard to the definition of the result variable of prolonged hospitalization in Short Stay Unit (SSU) as one that exceeds 3 days, we would like to explain that the selection of the breakpoint was not arbitrary or based upon clinical management, but on statistical concepts inferred from the results of the Spanish records on acute heart failure (AHF) and SSU.3–5 The EAHFE records, which currently includes nearly 9000 patients from over 30 Spanish emergency departments, has documented that the first quartile of the
Letters to the Editor / Med Clin (Barc). 2015;145(4):181–183
6. Browder J, Deveer JA. The varied pathologic basis for the symptomatology produced by tumors in the region of the pulmonary apex and upper mediastinum. Am J Cancer. 1935;24:507–21.
Departamento de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain ∗ Corresponding
Natalia Fouz-Rosón ∗ , Estefanía Luque-Crespo, María Pavón-Masa, Teodoro Montemayor-Rubio
author. E-mail address: natalie1 [email protected] (N. Fouz-Rosón).
Mean stay of patients with acute heart failure in short-stay units夽
with 14.8% average discharges, with significant differences among centers (range 0–31%). Eventually, a key factor to ensure efficient SSU management is the correct selection in the emergency department of patients with a suitable profile, and in this sense, there is little experience in the medical literature, only referring to patients with chronic obstructive pulmonary disease.4,5 This is why, in the absence of clinical guidelines validated by national and international companies, as in the case of pneumonia, works such as the one by Martin-Sanchez et al., analyzing prevalent diseases, are a useful tool in making decisions regarding the admission for this type of assistance, alternative to conventional hospitalization.
La estancia media de los pacientes con insuficiencia cardiaca aguda en las unidades de corta estancia Dear Editor, We have carefully read the article by Martín-Sánchez et al. “Extended-stay in patients admitted in the Short Stay Unit (EPICAUCE study) for heart failure: study of factors associated”.1 And, in light of the results presented, we deem appropriate to make some considerations. According to the data recently published by the Registry of short-stay units (SSUs) in Spain (REGICE 1 and REGICE 2),2,3 with over 45,000 patients in the analyzed period, heart failure (Group Associated with Diagnosis 127, 544 and 87) accounts for almost 9% of hospital admissions and has been reported as one of the first 3 diagnoses in 72.5% of the SSUs, with an overall mean stay of 3.4 days (SD 1.3). It is probably questionable, as suggested in the discussion section, the suitability of having considered 3 days from admission as a breakpoint. Even being statistically significant, the differences found from this reference may have a limited impact on the clinical management of SSUs and their overall activity data. This is why we believe it might be reasonable to analyze the potential factors associated with extending the mean stay, for example, over 5 days, which perhaps would allow consider other variables of interest. As commented by the authors, the cohort is a representative sample in both, volume and number of participating centers, and there is a large number of variables being analyzed. However, in relation to the analytical data, the number of determinations of brain natriuretic peptide, assumed as relatively low, has not been specified, which may influence the lack of differences. And no information on other prognostic markers, particularly troponin, has been reported. It is remarkable the penalty in terms of mean stay in hospital admissions occurring in Thursday in connection with the decreased discharge rate during the weekend, which has been corroborated by the results of REGICE project, 夽 Please cite this article as: Ferré C, Llopis F, Juan A. La estancia media de
los pacientes con insuficiencia cardiaca aguda en las unidades de corta estancia.
References 1. Martín-Sánchez FJ, Carbajosa V, Llorens P, Herrero P, Jacob J, Pérez-Dura MJ, et al., en representación del grupo ICA-SEMES. Estancia prolongada en los pacientes ingresados por insuficiencia cardiaca aguda en la Unidad de Corta Estancia (estudio EPICA-UCE): estudio de los factores asociados. Med Clin (Barc). 2014;143:245–51. 2. Llopis Roca F, Juan Pastor A, Ferré Losa C, Martín Sánchez FJ, Llorens Soriano P, Sempere Montes G, et al., en representación del Grupo de Colaboradores del Proyecto REGICE. Proyecto REGICE: registro de las unidades de corta estancia en ˜ Localización, aspectos estructurales y dotación de profesionales (REGICE Espana. 1). Emergencias. 2014;26:57–60. 3. Llopis Roca F, Ferré Losa C, Juan Pastor A, Martín Sánchez FJ, Sempere Montes G, Llorens Soriano P, et al., en representación del Grupo de Colaboradores del Proyecto REGICE. Proyecto REGICE. Gestión clínica de las unidades de corta ˜ (REGICE 2). Emergencias. 2014;26:359–62. estancia en Espana ˜ P, Pita S, Ramos V, Pellicer C, Nicolás R, et al. Factors predict4. De la Iglesia F, Valino ing a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease. J Intern Med. 2002;251:500–7. 5. Villalta J, Sequeira E, Cereijo AC, Sisó A, de la Sierra A. Factores predictivos de un ingreso corto en pacientes con enfermedad pulmonar obstructiva crónica agudizada. Med Clin (Barc). 2005;124:648–50.
Carles Ferré a , Ferran Llopis b,∗ , Antoni Juan c a
Unidad de Corta Estancia de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain b Servicio de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain c Institut Català de la Salut, Barcelona, Spain ∗ Corresponding
author. E-mail address: fl[email protected] (F. Llopis).
Endocrinol Nutr. 2015;145:182.
Reply夽 Respuesta Dear Editor, We have carefully read the letter to the Editor by Ferré et al. regarding the article “Prolonged hospitalization in patients
夽 Please cite this article as: Martín-Sánchez FJ, Carbajosa V, Llorens P. Respuesta. Endocrinol Nutr. 2015;145:182–183.
admitted in the Short Stay Unit (EPICA-UCE study) for acute heart failure: study of associated factors”.1,2 First, we would like to thank all the considerations by the authors as well as provide a number of clarifications to some of the comments that might be controversial. First, with regard to the definition of the result variable of prolonged hospitalization in Short Stay Unit (SSU) as one that exceeds 3 days, we would like to explain that the selection of the breakpoint was not arbitrary or based upon clinical management, but on statistical concepts inferred from the results of the Spanish records on acute heart failure (AHF) and SSU.3–5 The EAHFE records, which currently includes nearly 9000 patients from over 30 Spanish emergency departments, has documented that the first quartile of the