Person: Calvo Manuel, Elpidio
Universidad Complutense de Madrid
Faculty / Institute
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PublicationPrognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure(MPDI, 2021-10-23) Méndez Bailón, Manuel; Iguarán Bermúdez, Rosario; López García, Lidia; Sánchez Sauce, Beatriz; Pérez Mateos, Pablo; Barrado Cuchillo, Julia; Villar Martínez, Miguel; Fernández Castelao, Santiago; García Klepzig, José Luis; Fuentes Ferrer, Manuel; García García, Alejandra; Vilacosta, Isidre; Miguel Yanes, José de; Casas Rojo, José; Calvo Manuel, Elpidio; Andrès, Emmanuel; Lorenzo Villalba, NoelBackground and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/− 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/− 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508–0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results. PublicationPropuesta de mejora del Sistema Interno de Garantía de Calidad de la Facultad de Medicina(2017-06-28) Álvarez-Sala Walther, Jose Luis; Ortega Molina, Paloma; García Seoane, Jorge; López Gallardo, Meritxell; Delgado Losada, Mª Luisa; Ramos Sánchez, Mabel; Fernández Galaz, Carmen; Calvo Manuel, Elpidio; Martinez Hernandez, David; Calle Puron, Mª Elisa; Alfaro Ramos, Mª José; Villena Garrido, Mª Victoria; Tejedor Jorge, Alberto; Gomez Garcia, Mª Victoria; Fuertes Dominguez, Mª Anuncia; Plata Muñoz, Mª Jesús; Fernandez Lopez, Mª Josefa; Serrano Ruiz-Calderon, Rocio; Martin Villa, Jose Manuel; Perez Vizcaino, Francisco; Bombin Martin, Asier; Orte Cano, Carmen; Bermejo de las Heras, Sara; Calle de la Rosa, Lucia de la; Gonzalez de la Rocha, Mª EugeniaLa garantía de calidad en el ámbito universitario puede considerarse como la atención sistemática, estructurada y continua a las titulaciones ofertadas. La garantía de calidad se compromete a poner en marcha los medios que aseguren y demuestren la calidad de los programas formativos que se desarrollan en cada una de las titulaciones ofrecidas por la Universidad y así cumplir con la obligación que tiene con la sociedad. El presente proyecto nace como fruto de la responsabilidad adquirida para el cumplimiento de las funciones encomendadas y, con el objetivo de seguir adoptando una estrategia de mejora continua de la calidad de la docencia y satisfacción de los colectivos implicados en el proceso de enseñanza-aprendizaje (Profesorado, Estudiantes y PAS). PublicationEvaluación del profesorado de Medicina en Práctica Clínica(2016-01-28) Álvarez-Sala Walther, Jose Luis; Álvarez-Sala Walther, Luis Antonio; Calvo Manuel, Elpidio; Fernández Galaz, Carmen; García Seoane, Jorge; López Gallardo, Meritxell; Cuadrado Pérez, María Luz; Martínez Hernández, David; Millán Núñez Cortés, Jesús; Ortega Molina, Paloma; Pérez de Oteiza, Carlos Antonio; Tejedor Jorge, Alberto; Villena Garrido, María Victoria PublicationClinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine(MPDI, 2021-04-09) Martín Sánchez, Rubén Ángel; Lorenzo Villalba, Noel; Calvo Elías, Alberto Elpidio; Dubón Peralta, Ester Emilia; Chocrón Benbunan, Cynthia Elisa; Cano de Luque, Carmen María; López García, Lidia; Rivas Molinero, María; Outón González, Cristina; Marco Martínez, Javier; Calvo Manuel, Elpidio; Andrès, Emmanuel; Méndez Bailón, ManuelBackground and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission. PublicationHeart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis(MPDI, 2021-04-16) Marco Martínez, Javier; Elola Somoza, Francisco Javier; Fernández Pérez, Cristina; Bernal Sobrino, José Luis; Azaña Gómez, Francisco Javier; García Klepizg, José Luis; Andrès, Emmanuel; Zapatero Gaviria, Antonio; Barba Martín, Raquel; Calvo Manuel, Elpidio; Canora Lebrato, Jesus; Lorenzo Villalba, Noel; Méndez Bailón, ManuelBackground: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).