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Heart failure (HF), chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) are highly prevalent conditions that often coexist. Using electronic health records (EHRs), we evaluated the 1-year risk of all-cause death, major cardiovascular and kidney events in patients with HF, CKD, ASCVD and with combinations of these conditions, compared with an unselected control population aged ≥75 years.
Retrospective cohort study based on EHR data.
Integrated primary and secondary health unit located in the North of Portugal. Eligible adult patients were identified using EHRs from 2008 to June 2022.
Eight cohorts were defined: (1) control: patients with ≥75 years; (2) ASCVD alone; (3) HF alone; (4) CKD alone; (5) cardiorenal syndrome (CRS): combined HF+CKD; (6) atherosclerotic HF: combined ASCVD+HF without CKD; (7) atherosclerotic CKD: combined ASCVD+CKD without HF and (8) combined ASCVD+CRS. The risk of these conditions was compared with controls using propensity score age-sex matching. We identified 19 129 patients with ASCVD alone, 13 640 patients with HF alone, 40 545 with CKD alone and 10 499 with CRS. The control group comprised 36 532 patients aged 75 years or older.
The primary outcome was all-cause mortality. The main secondary outcomes were cardiovascular death, HF hospitalisations and end-stage renal disease.
The 1-year mortality rate was 0.65% in the control cohort, 5.6% for patients with ASCVD alone, 6.05% for patients with HF alone and 3.53% for patients with CKD alone. Adjusted risk of all-cause death was significantly increased in the ASCVD-alone (HR: 8.42, 95% CI 7.12 to 9.95), HF-alone (HR: 9.19, 95% CI 7.75 to 10.9) and CKD-alone (HR: 5.35, 95% CI 4.62 to 6.19) cohorts, compared with control population; however, patients with the combination of all three conditions (ie, ASCVD+CRS) had the highest mortality risk (HR: 14.18, 95% CI 11.62 to 17.3). A similar association pattern was observed for cardiovascular death, HF events and end-stage renal disease.
Our results support the concept of an atherosclerotic cardiorenal phenotype, with a very high risk of mortality, cardiovascular and renal adverse events. Implementation strategies are required to target these conditions simultaneously.
To determine the proportion of Aboriginal and/or Torres Strait Islander Peoples with diabetes who were monitored according to recommended national guidelines and had their clinical parameters within recommended targets. We also examined trends over time (2013–2022) and compared urban and rural areas.
A repeated cross-sectional study using data from a national general practice database (MedicineInsight, 2013–2022).
De-identified electronic health records (EHR) of people attending 427 mainstream general practices across Australia.
This study included all Aboriginal and/or Torres Strait Islander adults (18+ years) diagnosed with diabetes mellitus who were regular patients (attended at least once a year in three consecutive years) within the MedicineInsight database.
Outcomes measured were (i) monitoring of blood glucose, lipids, blood pressure (BP), renal function and Body Mass Index (BMI)/waist circumference (WC) and (ii) achieving recommended targets: glycosylated haemoglobin (HbA1c) ≤7.0%, fasting glucose 4–7 mmol/L, random glucose 5–10 mmol/L, total cholesterol ≤4.0 mmol/L, low-density lipoprotein 60 mL/min/1.73 m2, urine albumin-creatinine ratio (uACR) 2, WC
Between 70% and 90% of individuals were monitored for the clinical parameters above, except for BMI/WC (55%–75%). Trends in monitoring over time were similar across remoteness areas, increasing slightly in 2013–2014 and declining from 2019. Among those monitored, 53%–86% achieved targets for blood glucose, lipids and renal function; 32%–42% for BP; and
The risk of diabetes complications among Aboriginal and/or Torres Strait Islander Peoples could be reduced by improving management of blood pressure and overweight/obesity in all areas, and blood glucose and lipids in rural areas.
Objetivo: Actualizar la evidencia de investigación cualitativa primaria respecto de las percepciones y significados del impacto de la espiritualidad en el proceso de afrontar el tratamiento oncológico en las personas adultas y sus familiares. Metodología: Se realizó una metasíntesis, respondiendo a la pregunta en estructura SPICE y basada en el marco de trabajo para revisiones SALSA. Se recuperaron 149 artículos en las bases de datos, Scielo, BVS, PubMed, Scopus, CUIDEN, con los descriptores DeCS, espiritualidad y oncología, unidos con el booleano AND. Se aplicaron criterios de selección, se realizó lectura crítica con plantilla CASPe para estudios cualitativos, quedando finalmente incluidos en la revisión cinco estudios. Resultados: Los hallazgos de los estudios analizados se densificaron en tres categorías temáticas; la espiritualidad como una forma de resignificar las experiencias, como una forma de alivio del sufrimiento y finalmente como una estrategia de afrontamiento para lograr la resiliencia. Conclusión: La pregunta de investigación fue respondida en torno a tres principales subcategorías; resignificación de la experiencia del cuidar, como un alivio del sufrimiento físico/ emocional y como una estrategia de afrontamiento para lograr la resiliencia.
The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission.
To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days).
A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR.
A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital-acquired pressure ulcers.
Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital-acquired ulcers at hospital discharge.
Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation.
No direct patient contact was made during the data collection.
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