Revista clinica espanola最新文献

{"title":"Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y anemia: programa UMIPIC","authors":"J.M. Cerqueiro González ,&nbsp;Á. González Franco ,&nbsp;M. Méndez Bailón ,&nbsp;P. Llácer Iborra ,&nbsp;A. Conde Martel ,&nbsp;J. Pérez Silvestre ,&nbsp;M. Montero Pérez-Barquero ,&nbsp;L. Manzano Espinosa","doi":"10.1016/j.rce.2026.502538","DOIUrl":"10.1016/j.rce.2026.502538","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the prognostic benefit of the UMIPIC care program in patients with heart failure (HF) and anemia.</div></div><div><h3>Methods</h3><div>Data from 3,152 patients with HF and anemia from the RICA registry were analyzed. They were divided into 2<!--> <!-->groups and selected by matched match: one receiving UMIPIC follow-up (UMIPIC group, N: 621) and the other receiving conventional care (non-UMIPIC group, N: 524). Admissions and mortality were assessed during 12 months of follow-up.</div></div><div><h3>Results</h3><div>The UMIPIC group had a lower rate of admissions for HF (19.3 vs. 29.8%; <em>P</em> <!-->&lt;<!--> <!-->0.001) and a reduction in overall mortality (24.8 vs. 36.6%; <em>P</em> <!--> <!-->&lt;<!--> <!-->0.001). Patients in the UMIPIC group with associated iron deficiency also had a lower rate of admissions for HF (19.1 vs. 32.5%; <em>P</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>Implementation of the UMIPIC program in patients with HF and anemia reduces admissions and overall mortality at one year. Additional studies are needed to explore the impact of specif iron deficiency treatment within these care program.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502538"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distrés emocional y bienestar subjetivo en adultos con diabetes tipo 1. Estudio transversal utilizando el PAID-5 y WHO-5","authors":"C. Delicado-Hernández ,&nbsp;M. Gallach-Martínez ,&nbsp;N. García-Corrales ,&nbsp;P.J. Pinés-Corrales","doi":"10.1016/j.rce.2026.502539","DOIUrl":"10.1016/j.rce.2026.502539","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502539"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordancia entre un algoritmo y el diagnóstico clínico en la gravedad de descompensación de enfermedades crónicas de pacientes en un programa de telemonitorización","authors":"J. Fernández-Rivera ,&nbsp;Y. Marín-Fernández ,&nbsp;M. Gómez-Hernández ,&nbsp;J. Ortíz-Romero ,&nbsp;A. Fernández-Moyano","doi":"10.1016/j.rce.2026.502517","DOIUrl":"10.1016/j.rce.2026.502517","url":null,"abstract":"<div><h3>Background</h3><div>Telemonitoring of biological variables can facilitate the early detection of decompensation in chronic disease. Data processing through digital tools enables the delivery of care via automated decision-support systems, such as diagnostic algorithms or alerts in high-rink situations. These tools may improve health outcomes and optimize healthcare management.</div></div><div><h3>Methods</h3><div>A diagnostic accuracy study with a retrospective cross-sectional design was conducted. Agreement in classifying the severity of decompensation in patients with chronic diseases was compared between the algorithm used in the Tele-COMPARTE program and the consensus of three observers, which was considered the reference standard. The weighted Kappa index was used to assess agreement.</div></div><div><h3>Results</h3><div>The final version of our algorithm achieved a Kappa index (95% CI) of 0,76 (0,7-0.82). By subgroups, the values were 0,84 (0,74-0,94) for alerts in patients with heart failure, 0,71 (0,57-0,85) in COPD, and 0,69 (0,6-0,79) in alerts involving both conditions, all with p &lt;<!--> <!-->0,001. The positive likelihood ratios were 6,3 in <em>low-level</em> and <em>moderate</em> alerts, 10 for <em>high-level</em> alerts, and 186,3 for <em>critical alerts</em>. Predictive values exceeded 75% in all categories.</div></div><div><h3>Conclusions</h3><div>The level of agreement between the Tele-COMPARTE algorithm and clinical consensus in stratifying the severity of decompensation in chronic disease was “good<em>”</em>, reaching a “very good<em>”</em> level in patients with heart failure. The application of the algorithm is a valid and safe procedure that supports its use within our remote monitoring program.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502517"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fiabilidad clínica de un monitor ambulatorio de presión arterial oscilométrico de muñeca: una evaluación independiente de concordancia","authors":"Ó. Seoane-Casqueiro ,&nbsp;N. Vázquez-Agra ,&nbsp;A. Cruces-Sande ,&nbsp;E. López-Prado ,&nbsp;J.E. López-Paz ,&nbsp;M. Camafort ,&nbsp;E. Casariego-Vales ,&nbsp;Á. Hermida-Ameijeiras ,&nbsp;A. Pose-Reino","doi":"10.1016/j.rce.2026.502523","DOIUrl":"10.1016/j.rce.2026.502523","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the concordance between a novel wrist-worn oscillometric device and a validated ambulatory blood pressure monitor (ABPM) for blood pressure (BP) and heart rate (HR) assessment under real 24-hour ABPM conditions.</div></div><div><h3>Material and methods</h3><div>We conducted an observational concordance study in consecutive hypertensive outpatients requiring 24-hour ABPM between May and October 2025. Participants simultaneously wore a validated reference device (SunTech Oscar 2) and the wrist-worn monitor (Huawei Watch D2). Mean BP and HR values for the 24-hour, daytime, and nighttime periods were compared. Agreement was assessed using Bland–Altman analysis, intraclass correlation coefficients [ICC(A,1)], and the proportion of readings within<!--> <!-->±<!--> <!-->5,<!--> <!-->±<!--> <!-->10, and<!--> <!-->±<!--> <!-->15<!--> <!-->mmHg according to the AAMI/ESH/ISO criteria.</div></div><div><h3>Results</h3><div>Forty-one patients were included (63% women; median age: 47 years). The wrist-worn device systematically underestimated systolic BP (SBP) during the 24-hour and daytime periods and exhibited reduced variability compared with the reference device. Bland–Altman analysis showed a mean bias of –6.8<!--> <!-->mmHg for SBP with wide limits of agreement. ICC values indicated poor concordance for SBP (0.38) and moderate concordance for DBP (0.54), while HR agreement was excellent (ICC 0.87). Only 47% of systolic and 61% of DBP readings fell within<!--> <!-->±<!--> <!-->10<!--> <!-->mmHg of the reference values, below the AAMI/ESH/ISO acceptability threshold.</div></div><div><h3>Conclusions</h3><div>The wrist-worn device did not demonstrate sufficient concordance for ambulatory BP monitoring, although HR performance was reliable. These findings support the need for independent evaluations before considering such devices for clinical BP assessment.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502523"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Déficit motor persistente en paciente con Chiari tipo I, siringomielia y mielopatía cervical degenerativa","authors":"M.A. Cuervo Pinna","doi":"10.1016/j.rce.2026.502541","DOIUrl":"10.1016/j.rce.2026.502541","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502541"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La proyección lateral todavía importa: masa mediastínica anterior no detectada por un algoritmo de radiografía de tórax basado en inteligencia artificial","authors":"L. Gorospe,&nbsp;A.M. Ayala-Carbonero,&nbsp;A. González-Huete","doi":"10.1016/j.rce.2026.502540","DOIUrl":"10.1016/j.rce.2026.502540","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502540"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resumen ejecutivo del documento de consenso para las recomendaciones sobre el diagnóstico de la enfermedad tromboembólica venosa en el embarazo: recomendaciones desde la Sociedad Española de Medicina Interna, la Sociedad Española de Radiología Médica, la Sociedad Española de Radiología Vascular e Intervencionista y la Sociedad Española de Ginecología y Obstetricia 2025","authors":"Sergio Moragón-Ledesma ,&nbsp;María Ortiz-Rodríguez ,&nbsp;M. Ángeles Fidalgo-Fernández ,&nbsp;Sara Lojo-Lendoiro ,&nbsp;Pablo Demelo-Rodriguez ,&nbsp;Mikel Grau-García ,&nbsp;Miguel Martín-Asenjo ,&nbsp;Berta Serrano-Sánchez ,&nbsp;Nuria Martínez-Sánchez ,&nbsp;Olga Madridano-Cobo ,&nbsp;Esther Gálvez-González ,&nbsp;Francisco Galeano-Valle","doi":"10.1016/j.rce.2026.502522","DOIUrl":"10.1016/j.rce.2026.502522","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy and the postpartum period increase the risk of venous thromboembolism (VTE). In pregnant women, diagnosing VTE is challenging due to the similarity between normal pregnancy symptoms and those of VTE, the physiological elevation of D-dimer levels, and the altered validity of diagnostic scoring systems. In 2019, Pregnancy-Adapted YEARS Algorithm for diagnosis of suspected pulmonary embolism was published, providing evidence on the safety and effectiveness of this diagnostic algorithm.</div></div><div><h3>Methods and results</h3><div>This consensus document, developed by the Spanish Societies of Internal Medicine, Medical Radiology, Vascular and Interventional Radiology, and Obstetrics and Gynecology, presents a comprehensive review of the most recent evidence and updates the recommendations for the diagnosis of VTE in pregnancy.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502522"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finerenona en la insuficiencia cardíaca con fracción de eyección ≥ 40%: estado del arte y perspectivas futuras","authors":"P. Llàcer ,&nbsp;M. Cobo Marcos ,&nbsp;J. Nuñez ,&nbsp;L.M. Perez-Belmonte ,&nbsp;J. Pérez Silvestre ,&nbsp;M. Sanchez Marteles ,&nbsp;J. Comin-Colet","doi":"10.1016/j.rce.2026.502520","DOIUrl":"10.1016/j.rce.2026.502520","url":null,"abstract":"<div><div>Heart failure with ejection fraction ≥40% is associated with high mortality and risk of decompensation, as well as poorer quality of life. SGLT2 inhibitors are currently considered the standard therapy for these patients. However, despite treatment with these drugs, patients continue to have a high risk of adverse events. Overactivation of the mineralocorticoid receptor promotes the release of inflammatory and profibrotic factors, which contribute to the development and progression of this entity. However, not all mineralocorticoid receptor antagonists have demonstrated clinical benefit in these patients. The FINEARTS-HF study demonstrated that finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly reduces the risk of cardiovascular death or heart failure decompensation, with consistent results across all patient subgroups analyzed. Consequently, in the treatment of these patients the combination of SGLT2 inhibitors and finerenone should be considered.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502520"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147756971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto clínico y económico de la Unidad del Paciente Pluripatológico","authors":"F. Martínez García ,&nbsp;L.M. Cantero Nieto ,&nbsp;T. Bruno Pérez ,&nbsp;A.J. Trujillo Santos","doi":"10.1016/j.rce.2026.502521","DOIUrl":"10.1016/j.rce.2026.502521","url":null,"abstract":"<div><h3>Introduction</h3><div>Managing patients with a high burden of chronic conditions and multiple pathologies poses a challenge to the sustainability of the healthcare system. We evaluated the impact of establishing a Multimorbidity Patient Unit (MUP) on reducing emergency department visits and hospital admissions.</div></div><div><h3>Methods</h3><div>This was a pre-post observational study that included patients enrolled in the MUP between November 2022 and December 2023. Demographic and clinical variables were analyzed, as well as the number of emergency department visits and hospital admissions before and after enrollment. The savings resulting from the implementation of the unit were estimated.</div></div><div><h3>Results</h3><div>Eighty-six patients were included (mean age 81.2 years; 52.3% male), with the most prevalent diagnoses being heart failure (97.7%), hypertension (95.3%), and chronic kidney disease (91.9%). Avoidable emergency room visits decreased by 64.18% and avoidable hospital admissions decreased by 64.47%. The estimated savings during the study period was €541,723.20.</div></div><div><h3>Conclusions</h3><div>The MUP proved to be a highly cost-effective intervention, significantly reducing avoidable healthcare utilization and improving continuity of care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502521"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploración de los patrones espaciales de la mortalidad por sarcoidosis en España entre 2009 y 2023","authors":"L. Cayuela ,&nbsp;A.M. Gaeta ,&nbsp;V. Achaval Rodríguez ,&nbsp;J. Librero ,&nbsp;A. Cayuela","doi":"10.1016/j.rce.2026.502516","DOIUrl":"10.1016/j.rce.2026.502516","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe temporal trends and spatial distribution of sarcoidosis-related mortality in mainland Spain between 2009 and 2023, with a focus on sex-specific differences and high-risk clusters.</div></div><div><h3>Methods</h3><div>An ecological study was conducted using mortality data from the Spanish National Statistics Institute (INE) for deaths coded as ICD-10 D86. Age-adjusted mortality rates were calculated using direct standardization to the European Standard Population 2013. Temporal trends were assessed with joinpoint regression, and spatial patterns were analyzed at the provincial level using standardized mortality ratios (SMRs), Bayesian-smoothed relative risks (RRs), and posterior probabilities via the Besag–York–Mollié model. Global and local clustering was evaluated with spatial scan statistics, Moran's I, and Local Indicators of Spatial Association (LISA).</div></div><div><h3>Results</h3><div>Between 2009 and 2023, 709 sarcoidosis-related deaths were recorded (417 women, 292 men). Mortality increased significantly in men (average annual percentage change (AAPC) 4.5%, 95% CI 1.6–7.4%) but not in women (AAPC 1.0%, 95% CI –1.3–3.5%). Geographic analysis revealed persistent high-risk clusters in northwestern provinces, particularly Galicia and Castilla y León, whereas central and Mediterranean provinces exhibited lower-than-expected mortality. Sex-specific clustering patterns were evident, with women showing more widespread high-risk regions. Bayesian-smoothed relative risks and posterior probabilities corroborated these findings, indicating true excess risk rather than random variation.</div></div><div><h3>Conclusions</h3><div>Sarcoidosis mortality in mainland Spain demonstrates marked geographic heterogeneity and sex-specific patterns, with persistent high-risk clusters in the northwest. These results are suggestive of the interplay of genetic, environmental, and healthcare-related factors, providing a foundation for targeted surveillance, preventive strategies, and resource allocation.</div><div>.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502516"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}