Pablo Herrero

Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

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Publications (43)103.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and objective To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs). Patients and methods This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (> 72 h). A logistic regression model was used to control the effects of confounding factors. Results Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P = .040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P = .002), basal oxygen saturation < 90% on arrival to the Emergency Department (OR 2.21, 95% CI 1.51-3.23; P < .001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P = .028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P = .008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%). Conclusions Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization.
    Medicina Clínica. 09/2014; 143(6):245–251.
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    [Show abstract] [Hide abstract]
    ABSTRACT: To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs). This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (>72h). A logistic regression model was used to control the effects of confounding factors. Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P=.040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P=.002), basal oxygen saturation<90% on arrival to the Emergency Department (OR 2.21, 95% CI 1.51-3.23; P<.001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P=.028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P=.008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%). Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization.
    Medicina Clínica 09/2013; · 1.25 Impact Factor
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    ABSTRACT: To investigate possible age-related differences in the profile, clinical symptoms, management, and short-term outcomes of patients seen for acute heart failure in Spanish emergency departments. We performed a multipurpose, multicenter study with prospective follow-up including all patients with acute heart failure attended in 29 Spanish emergency departments. The following variables were collected: demographic, personal history, geriatric syndromes, data of acute episode, discharge destination, in-hospital and 30-day mortality and 30-day revisit. The sample was divided into 4 age groups: <65, 65-74, 75-84, and ≥85 years. We included 5819 patients: 493 (8.5%) were <65 years old, 971 (16.7%) were 65-74 years old, 2407 (41.4%) were 75-84 years old, and 1948 (33.5%) were ≥85 years old; 4424 patients (76.5%) were admitted from the emergency department, 251 of whom (4.5%) died during hospitalization. Statistically significant differences were observed in relation to cardiovascular risk factors, comorbidities, geriatric syndromes, clinical presentation, and diagnostic and therapeutic procedures based on an increase in the age of the groups. A statistically significant linear trend was observed between age group and the probability of hospital admission (P<.001), and hospital (P<.001) and 30-day mortality (P<.001). The management of acute heart failure in elderly patients requires a multidimensional approach which goes beyond merely cardiological aspects of treatment.
    Revista Espanola de Cardiologia 09/2013; 66(9):715-20. · 3.20 Impact Factor
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    ABSTRACT: The mainstay of treatment for acutely decompensated heart failure (ADHF) is intravenous diuretic therapy either as a bolus or via continuous infusion. We evaluated the clinical effects and safety of three strategies of intravenous furosemide administration used in emergency departments (EDs) for ADHF. We performed a multicentre, randomised, parallel-group study. Patients with ADHF were randomised within 2 h of ED arrival to receive furosemide by continuous infusion (10 mg/h, group 1) or boluses (20 mg/6 h, group 2; or 20 mg/8 h, group 3). The primary end point was total diuresis, and secondary end points were dyspnoea, orthopnoea, extension of rales and peripheral oedema, blood pressure, respiratory and heart rates, and pulse oximetry, which were measured at arrival and 3, 6, 12 and 24 h after treatment onset. We also measured serum creatinine, sodium and potassium levels at arrival and after 24 h. Group 1 patients (n=36) showed greater 24 h diuresis (3705 mL) than those in groups 2 (n=37) and 3 (n=36) (3093 and 2670 mL, respectively; p<0.01), and this greater diuretic effect was observed earlier. However, no differences were observed among groups in the nine secondary clinical end points evaluated. Creatinine deterioration developed in 15.6% of patients, hyponatraemia in 9.2%, and hypokalaemia in 19.3%, with the only difference among groups observed in hypokalaemia (group 1, 36.3%; group 2, 13.5%; group 3, 8.3%; p<0.01). In patients with ADHF attending the ED, boluses of furosemide have a smaller diuretic effect but provide similar clinical relief, similar preservation of renal function, and a lower incidence of hypokalaemia than continuous infusion. This randomised trial was registered in the European Clinical Trial Database (EudraCT) with the reference number 2008-004488-20.
    Emergency Medicine Journal 06/2013; · 1.65 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate whether the addition of copeptin measurement to the first troponin determination allows non-ST-elevation acute myocardial infarction to be ruled out in patients consulting the emergency department (ED) for nontraumatic chest pain (NTCP) suggestive of acute coronary syndrome (ACS) whose first electrocardiogram and troponin determination are nondiagnostic, thereby avoiding a second determination of troponin and shortening ED stay. METHODS: We carried out a multicentric, prospective, observational, longitudinal, cohort study. Copeptin and troponin determination was performed on arrival of the patient to the ED. We selected consecutive patients with NTCP of less than 12 h of evolution suggestive of ACS with nondiagnostic electrocardiogram and normal troponin values on arrival to the ED. A second troponin determination was performed at 6 h. The negative predictive values and the global discriminative capacity of copeptin were calculated. RESULTS: We studied 1018 patients (66.4±14.9 years, 62.8% men), 107 (10.5%) having non-ST-elevation acute myocardial infarction. The negative predictive value of copeptin was 94.2% and was significantly greater in patients older than 70 years of age (95.1 vs. 92.6%; P<0.05), without diabetes mellitus (95.4 vs. 90.4%; P=0.01) and arriving at the ED 6 h after the onset of NTCP (97.8 vs. 93.9%; P<0.01). The area under the copeptin receiver operating characteristic curve was 0.71 (95% confidence interval: 0.65-0.76; P<0.001). CONCLUSION: The determination of copeptin on arrival to the ED in patients with NTCP suggestive of ACS, in addition to routine troponin determination, does not allow the presence of myocardial infarction to be ruled out quickly and safely and does not avoid ED stay for a second determination of troponin.
    European Journal of Emergency Medicine 06/2013; · 0.73 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine prognostic role of NT-proBNP as predictor of 30 day-mortality and readmission in the elderly with acute heart failure (AHF) treated in Spanish Emergency Departments (EDs), and to analyse the confounding factors when the NT-proBNP value is interpreted. MATERIAL AND METHODS: A multicentre and multi-purpose cohort study with prospective follow-up was conducted on all patients aged 65 years or older with AHF treated in Spanish EDs. The variables recorded include demographic characteristics, comorbidity, details of episode, and NT-proBNP value. The outcome variables were 30 day-mortality and readmission. An NT-proBNP≥5,180pg/ml was adopted as the cut-off limit. The statistical package SPSS(®) 18.0 was used to analyse the data. RESULTS: A total of 585 patients were included, with a mean age of 80.4 (SD: 6.9) years old. The cut-off NT-proBNP≥5,180pg/ml was independently associated with a severely impaired glomerular filtration (<30ml/h) (P<.001) and severe episode (NYHA II-IV) (P=.012). The NT-proBNP area under curve (AUC) for 30 day-mortality was 0.71 (CI95%: 0.63-0.77; P<.001) and for 30 day-readmission, was 0.50 (CI95%: 0.45-0.56; P=.846). A multivariable analysis showed that the cut-off NT-proBNP ≥5,180pg/ml was an independent factor associated with 30 day-mortality in the elderly with AHF attended in Spanish EDs. CONCLUSIONS: The NT-proBNP value is associated with short-term mortality in the elderly with AHF attended in the EDs independently of the presence of confounding factors, such as the severity of the episode and glomerular filtration reduction, but not with 30 day-readmission.
    Revista Española de Geriatría y Gerontología 03/2013;
  • Journal of cardiac failure 02/2013; 19(2):147. · 3.25 Impact Factor
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    ABSTRACT: AIMS: To test the utility of a single copeptin determination at presentation to the emergency department (ED) as a short-term prognosis marker in patients with non-ST-elevation acute coronary syndrome (NSTEACS). To compare the results with those achieved with conventional troponin. METHODS: A multicentric, prospective, observational, longitudinal, cohort study involving 15 Spanish EDs. Inclusion: consecutive patients with chest pain (<12 h) finally diagnosed of NSTEACS. Measurements: copeptin and troponin at arrival. Cut-off point for copeptin: 25.9 pmol/l. Follow-up: within 2 months after ED attendance to identify 30-day adverse events. Discriminatory capacity of copeptin and troponin was compared by receiver operating characteristic (ROC) curves. RESULTS: We included 377 patients with NSTEACS. Adverse events: 11 (2.9%) patients died, 27 (7.2%) had an adverse coronary event, 14 (3.7%) had a stroke, and 48 (12.7%) a composite endpoint. The initial copeptine value was over 25.9 pmol/l in 114 patients, and they presented a higher mortality rate (OR: 4.2, (95% CI 1.2 to 14.8); p=0.03). This association disappeared after adjusting by clinical variables or troponin level. No significant differences were found for the remaining endpoints. The area under the curve of the ROC curve of 30-day mortality was 0.73 (95% CI 0.58 to 0.87) for copeptin, and 0.80 (95% CI 0.73 to 0.87) for troponin. CONCLUSIONS: In patients with NSTEACS, determination of copeptin at presentation to the ED is associated with risk of death during the subsequent month. This association, however, disappears after adjusting by baseline features or troponin level, so copeptin does not add complementary prognostic information over that provided by troponin.
    Emergency Medicine Journal 01/2013; · 1.65 Impact Factor
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    ABSTRACT: Objective To determine prognostic role of NT-proBNP as predictor of 30 day-mortality and readmission in the elderly with acute heart failure (AHF) treated in Spanish Emergency Departments (EDs), and to analyse the confounding factors when the NT-proBNP value is interpreted. Material and methods A multicentre and multi-purpose cohort study with prospective follow-up was conducted on all patients aged 65 years or older with AHF treated in Spanish EDs. The variables recorded include demographic characteristics, comorbidity, details of episode, and NT-proBNP value. The outcome variables were 30 day-mortality and readmission. An NT-proBNP≥5,180 pg/ml was adopted as the cut-off limit. The statistical package SPSS® 18.0 was used to analyse the data. Results A total of 585 patients were included, with a mean age of 80.4 (SD: 6.9) years old. The cut-off NT-proBNP≥5,180 pg/ml was independently associated with a severely impaired glomerular filtration (<30 ml/h) (P<.001) and severe episode (NYHA II-IV) (P=.012). The NT-proBNP area under curve (AUC) for 30 day-mortality was 0.71 (CI95%: 0.63-0.77; P<.001) and for 30 day-readmission, was 0.50 (CI95%: 0.45-0.56; P=.846). A multivariable analysis showed that the cut-off NT-proBNP ≥5,180 pg/ml was an independent factor associated with 30 day-mortality in the elderly with AHF attended in Spanish EDs. Conclusions The NT-proBNP value is associated with short-term mortality in the elderly with AHF attended in the EDs independently of the presence of confounding factors, such as the severity of the episode and glomerular filtration reduction, but not with 30 day-readmission.
    Revista Española de Geriatría y Gerontología 01/2013; 48(4):155–160.
  • Atención Primaria 12/2012; 44(12):739–740. · 0.96 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVE: To determine whether positive or negative troponin values determined in the Emergency Department (ED) in patients with acute heart failure (AHF) can predict short-term evolution (30-day intrahospitalary mortality and reconsultation at 30 days). PATIENTS AND METHODS: A retrospective, analytical, multicenter study with a follow-up of cohorts including patients diagnosed with AHF using the Framingham clinical criteria. Patients with acute coronary syndrome concomitant with AHF were excluded. Data were collected at baseline and during the acute episode in each case. Troponin was considered as a dependent variable and variables of outcome results included intrahospitalary mortality and mortality and reconsultation to the ED within the following 30 days. Hazard ratios (HR) adjusted for differences in the basal state and during the acute episode, were calculated with their 95% confidence intervals (CI 95%) for troponin positive patients. RESULTS: We included 806 patients from 17 Spanish EDs, 250 of whom (31%) were troponin-positive. The global intrahospitalary mortality was 9.2%, being 10.4% at 30 days and 21.3% reconsulted to the ED within 30 days. The troponin positive patients had a greater intrahospitalary (HR: 3.85; CI 95%: 2.33-6.34) 30-day mortality (HR: 3.07; CI 95%: 1.98-4.78) but not a greater reconsultation to the ED within 30 days (HR: 0.88; CI 95%: 0.62-1.26). All these findings were maintained after adjustment for the presence of chronic renal insufficiency, functional dependence, reduced glomerular filtration, treatment with nitroglycerin, with angiotensin enzyme inhibitors or angiotensin ii receptor antagonists in the ED and on hospital admission. CONCLUSION: Troponin positivity in the ED in patients with AHF is independently associated with a greater intrahospitalary and 30-day mortality but not with a greater rate of reconsultation to the ED during the following 30 days. The availability of troponin analysis in all EDs makes its determination recommended in all patients with AHF to allow evaluation of early short-term prognosis.
    Medicina Clínica 10/2012; · 1.25 Impact Factor
  • Atención Primaria 09/2012; · 0.96 Impact Factor
  • Revista Clinica Espanola - REV CLIN ESPAN. 03/2012;
  • Revista Española de Cardiología. 03/2012; 65(3):300–301.
  • Revista Espanola de Cardiologia 03/2012; 65(3):300-1. · 3.20 Impact Factor
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    ABSTRACT: To evaluate whether the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) scale for 30-day prediction of mortality is applicable to elderly adults with acute heart failure (AHF) in emergency departments (EDs) and whether discriminatory power is added with the inclusion of the Barthel Index (BI) to this scale (BI-EFFECT scale). BI-EFFECT is a multipurpose, nonintervention, multicenter cohort study. Twenty EDs. Individuals aged 65 and older with AHF. Information on baseline and episode characteristics and 30-day mortality was collected, and participants were categorized according to the EFFECT scale. Baseline degree of functional dependence was measured using the BI. Receiver operating characteristic (ROC) curves were made of the EFFECT and BI-EFFECT scales to predict mortality. One thousand sixty-eight participants were included. Thirty-day mortality was 5.1% and was directly and independently associated with high and very high risk categories of the EFFECT scale and with severe dependence. These two variables remained significant after adjustment of the model for both (OR = 4.5, 95% CI = 1.8-11.1 and OR = 2.9, 95% CI = 1.6-5.4, respectively). The EFFECT and the BI-EFFECT scales had significant ROC curves (area under the ROC curve (AUC) = 0.69, 95% CI = from 0.62 to 0.76; and AUC = 0.75, 95% CI = 0.69-0.81, respectively), and the difference in discriminatory power between the second and the first was also statistically significant (P = .02). The EFFECT scale may be applied in the elderly population, and inclusion of functional status according to the BI in the new BI-EFFECT scale significantly improves the model for the prediction of 30-day mortality.
    Journal of the American Geriatrics Society 02/2012; 60(3):493-8. · 4.22 Impact Factor
  • Revista Clínica Española 02/2012; 212(3):161-2. · 2.01 Impact Factor
  • Atención Primaria 10/2011; 43(10):557-559. · 0.96 Impact Factor
  • Revista Española de Cardiología. 10/2011; 64(10):948.
  • Revista Espa de Cardiologia 08/2011; 64(10):948; author reply 849. · 3.20 Impact Factor

Publication Stats

46 Citations
103.21 Total Impact Points

Institutions

  • 2009–2014
    • Hospital Universitario Central de Asturias
      Oviedo, Asturias, Spain
  • 2009–2013
    • Hospital Clínic de Barcelona
      • Servicio de Urgencias
      Barcelona, Catalonia, Spain
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 2012
    • Hospital Universitari de Bellvitge
      l'Hospitalet de Llobregat, Catalonia, Spain
  • 2009–2012
    • Hospital Central de Asturias
      Oviedo, Asturias, Spain
  • 2009–2011
    • Hospital General Universitario de Alicante
      Alicante, Valencia, Spain