Definition of baseline renal function in hospitalised patients with multiple preadmission measures of serum creatinine-A joint modelling approach.

Aim: With the use of a joint model (JM) we investigated how different definitions of baseline serum creatinine (SCr) would affect the association between an acute increase in inpatients' SCr and 30-day mortality and whether this effect depends on premorbid SCr trajectory.

Methods: This was a retrospective study including adult patients admitted to a tertiary acute-care hospital in Porto, Portugal, between January 1, 2013, and December 31, 2015, who had at least two preadmission ambulatory and two inpatients SCr measurements. The baseline SCr was defined as the lowest (-min), the most recent (-last) or the median (-medi) value over the preadmission period.

Estimation of Missing Baseline Serum Creatinine for Acute Kidney Injury Diagnosis in Hospitalized Patients.

Introduction: In hospitalized patients, information on preadmission kidney function is often missing, impeding timely and accurate acute kidney injury (AKI) detection and affecting results of AKI-related studies.

Objective: In this study, we provided estimates of preadmission serum creatinine (SCr), based on a multivariate linear regression (Model 1) and random forest model (Model 2) built with different parametrizations. Their accuracy for AKI diagnosis was compared with the accuracy of commonly used surrogate methods: (i) SCr at hospital admission (first SCr) and (ii) SCr back-calculated from the assumed estimated glomerular filtration rate of 75 mL/min/1.

Conversion methods for modified Jaffe reaction assays of serum creatinine.

Background: Modifications in Jaffe serum creatinine (sCr) assays question the suitability of the results for direct comparison.

Methods: sCr in adult in-patients was routinely measured either by SRM 909-standardized/noncompensated (method A) or isotope dilution mass spectrometry traceable/compensated method (reference). We converted values by method A into values by the reference using a formula provided by the manufacturer [Beckman Coulter (BC)] and traditional equating methods.

Serum creatinine trajectories in real-world hospitalized patients: clinical context and short-term mortality.

Fluctuations in serum creatinine (SCr) during hospitalization may provide additional prognostic value beyond baseline renal function. This study aimed to identify groups of patients with distinct creatinine trajectories over hospital stay and assess them in terms of clinical characteristics and short-term mortality. This retrospective study included 35 853 unique adult admissions to a tertiary referral center between January 2012 and January 2016 with at least three SCr measurements within the first 9 days of stay.

Early prediction of treatment failure in severe community-acquired pneumonia: The PRoFeSs score.

Purpose: To identify a single/panel of biomarkers and to provide a point score that, after 48 h of treatment, could early predict treatment failure at fifth day of Intensive Care Unit (ICU) stay in severe community-acquired pneumonia (SCAP) patients.

Materials And Methods: Single-center, prospective cohort study of 107 ICU patients with SCAP. Primary outcome included death or absence of improvement in Sequential Organ Failure Assessment score by ≥2 points within 5 days of treatment.

Prognostic Effect of Renal Function in Ambulatory Patients With Heart Failure and Reduced Ejection Fraction: The Kidney Is a Marker of Cardiac Function.

Background: Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased mortality. The impact of temporal evolution of kidney function in HF prognosis is largely unknown. We evaluated the effect of renal function over time in all-cause mortality among ambulatory patients with HF.

Quality of Care and 30-day Mortality of Women and Men With Acute Myocardial Infarction.

Introduction And Objectives: Despite increased awareness of sex disparities in care and outcomes of acute myocardial infarction (AMI), there appears to have been no consistent attenuation of these differences over the last decade. We investigated differences by sex in management and 30-day mortality using the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QIs) for AMI.

Methods: Proportions and standard errors of the 20 Acute Cardiovascular Care Association QIs were calculated for 771 patients with AMI who were admitted to the cardiology departments of 2 tertiary hospitals in Portugal between August 2013 and December 2014.

Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study.

Objectives: Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.

Design: Data were collected within a prospective cohort study (EPIHeart).

Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort.

Objectives: To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions.

Design: Prospective cohort study.

Setting: Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months.

Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study.

Objectives: The aim of this study was to assess the proportion of patients with a first episode of acute coronary syndrome (ACS) reporting preceding chest pain, having previously sought medical care and undergone the performance of exams, and to identify the determinants of seeking medical advice and undergoing electrocardiogram (ECG).

Methods: Within a cohort study, 690 patients with a first episode of ACS were evaluated. A questionnaire was applied to assess chest pain within the preceding 6 months of the event and health system resources utilization.

Sex-related inequalities in management of patients with acute coronary syndrome-results from the EURHOBOP study.

Background: Real-world data from different levels of hospital specialisation would help to understand if differences in management between women and men with acute coronary syndrome (ACS) are still a priority target. We aimed to identify sex inequalities in management of patients with different types of ACS.

Methods: We analysed 1757 patients with a non-ST-elevation ACS (NSTEACS) and 1184 with ST elevation myocardial infarction (STEMI) or left bundle branch block (non-classifiable (NC) ACS (STEMI/NC ACS group), consecutively discharged from ten Portuguese hospitals with different specialisation levels, between 2008 and 2010.

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure.

Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients.

Methods And Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years.

Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013.

Introduction And Objectives: Estimates of the burden of ischemic heart disease (IHD), including geographic differences, should support health policy decisions. We set out to estimate the burden of IHD in mainland Portugal in 2013 by calculating disability-adjusted life years (DALYs) and to compare this burden between five regions.

Methods: Years of life lost (YLLs) were calculated by multiplying the number of IHD deaths in 2013 (Statistics Portugal) by the life expectancy at the age at which death occurred.

Electronic Medical Record-Based Predictive Model for Acute Kidney Injury in an Acute Care Hospital.

Patients with acute kidney injury (AKI) are at risk for increased morbidity and mortality. Lack of specific treatment has meant that efforts have focused on early diagnosis and timely treatment. Advanced algorithms for clinical assistance including AKI prediction models have potential to provide accurate risk estimates.

Trends in pharmacological therapy following an acute coronary syndrome in Portugal: a systematic review.

Aims: To assess time trends in the use of main drug classes for secondary prevention, during hospitalization and at hospital discharge, following an acute coronary syndrome, in Portugal, using a systematic review.

Methods: We searched PubMed, from inception until 2012, to identify studies reporting the proportion of acute coronary syndrome patients treated with main pharmacological therapy. We used linear regression to quantify the annual variation in use of drugs, adjusting for the proportion of men in the sample and patients' mean age, and including a quadratic term of data collection year when relevant.

Prognostic Value of Osteoprotegerin in Acute Heart Failure.

Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF.

Prognostic value of sST2 added to BNP in acute heart failure with preserved or reduced ejection fraction.

Background: Natriuretic peptides and suppression of tumorigenicity 2 (ST2) represent two different physiopathological pathways. We evaluated the prognostic accuracy and complementarity of B-type natriuretic peptide (BNP) and soluble ST2 (sST2) plasma levels at discharge from a hospital admission for acute heart failure, both in patients with preserved (HFpEF) and depressed (HFrEF) systolic function.

Methods And Results: We enrolled 195 consecutive patients discharged alive and followed them prospectively for 6 months.

The use of reperfusion and revascularization procedures in acute coronary syndrome in Portugal: a systematic review.

Introduction And Objectives: Reperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal.

Methods: PubMed was searched in July 2012.

Medication adherence to specific drug classes in chronic heart failure.

Background: Adherence to medication is crucial to improve clinical outcomes in patients with heart failure (HF). However, at least 1 out of 4 patients is nonadherent to his or her medication. Several studies have quantified medication adherence in HF patients, monitoring only 1 drug with the Medication Event Monitoring System (MEMS).

Higher BMI in heart failure patients is associated with longer survival only in the absence of diabetes.

Aims: Obesity and diabetes are associated with an increased cardiovascular risk and mortality. Paradoxically, higher BMI is associated with longer survival in heart failure patients. The association between BMI and risk of death in heart failure patients depends on diabetes history.

Validity of the Seattle Heart Failure Model for prognosis in a population at low coronary heart disease risk.

Aim: Validation of the Seattle Heart Failure Model (SHFM) for predicting the risk of death in a population different than the derivation cohort.

Methods: In a retrospective analysis of a cohort of chronic heart failure patients with left ventricular systolic dysfunction, consecutively referred between 2000 and 2011, we computed the score, according to characteristics at referral. We compared the observed risk of death with that predicted by the model, using receiver operating characteristic (ROC) curves to assess discrimination and a goodness-of-fit test for the comparison of predicted and observed risks.

Prognostic value of worsening renal function in outpatients with chronic heart failure.

Introduction And Objectives: Renal function impairment predicts poor survival in heart failure. Attention has recently shifted to worsening renal function, based mostly on serum creatinine and estimated glomerular filtration rate. We assessed the prognostic effect of worsening renal function in ambulatory heart failure patients.