Characteristics and temporal pattern of readmissions of patients with atrial fibrillation hospitalized in medical departments

Iñiguez Vázquez, I.; Monte Secades, R.; Matesanz Fernández, M.; Romay Lema, E.M.; Rubal Bran, D.; Casariego Vales, E.

doi:10.1016/j.rceng.2017.03.004

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Iñiguez Vázquez, R. Monte Secades, M. Matesanz Fernández, E.M. Romay Lema, D. Rubal Bran, E. Casariego Vales" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Iñiguez Vázquez" "email" => array:1 [ 0 => "iriainhiguez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Monte Secades" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Matesanz Fernández" ] 3 => array:2 [ "nombre" => "E.M." "apellidos" => "Romay Lema" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Rubal Bran" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Casariego Vales" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Lucus Augusti, Lugo, Galicia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos" ] ] "textoCompleto" => "BackgroundAtrial fibrillation (AF) affects 1–2% of the general population,<a class="elsevierStyleCrossRef" href="#bib0180">1</a> and its prevalence is age-related, such that 70% of cases are diagnosed in those older than 65 years.<a class="elsevierStyleCrossRefs" href="#bib0185">2,3</a> Currently, up to 17.7% of patients older than 80 years have AF in the primary care setting.<a class="elsevierStyleCrossRef" href="#bib0190">3</a> AF is detected in hospitals in up to 30–35% of patients hospitalized in internal medicine departments.<a class="elsevierStyleCrossRefs" href="#bib0195">4,5</a> However, considering the gradual aging of the population and the better control and treatment of patients with multiple chronic diseases, it is conceivable that its prevalence could even double in the coming decades.<a class="elsevierStyleCrossRef" href="#bib0205">6</a>Given its frequency and the age group it affects, AF typically presents in combination with other medical problems.<a class="elsevierStyleCrossRef" href="#bib0210">7</a> Thus, these patients are characterized by high complexity: polypathology, polypharmacy and high indices of frailty, all of which reduce quality of life<a class="elsevierStyleCrossRefs" href="#bib0215">8–13</a> and increase healthcare demands, at various levels and in a manner that is difficult to schedule, due to exacerbations and the onset of interrelated diseases. Despite their clinical relevance, our understanding of the associated chronic diseases and the repercussion they have on healthcare services is limited. In fact, the study of complex chronic patients, whose conditions include AF, is poorly represented in the medical literature.<a class="elsevierStyleCrossRefs" href="#bib0240">13–15</a>The aim of this study was to determine the characteristics of patients with AF in the hospital setting and their successive hospitalizations. The results will help provide new evidence for their clinical management and will improve the care, in the clinical setting as well as in the organizational and social settings.Materials and methodsA retrospective cohort study was conducted for all hospital admissions in the departments of the medical area of University Hospital Lucus Augusti of Lugo between January 1, 2000 and December 31, 2013. This center provides health care for 240,000 inhabitants and has 879 beds. The departments that comprise the medical area are as follows: cardiology, pulmonology, neurology, nephrology, endocrinology, gastrointestinal, rheumatology, oncology, infectious diseases and internal medicine.This study had the approval of the Clinical Research Ethics Committee of Galicia (2014/409). The data source was the center's minimum basic data set. The analyzed variables were department where the patient was hospitalized, sex (male/female), date of birth, date of hospitalization and discharge, length of stay (days), destination at discharge (including death), diagnosis-related group (DRG), primary diagnosis (according to the ICD-9-CM classification) and up to 10 secondary diagnoses, with their corresponding codes (ICD-9-CM) in the order in which they appear in the hospital discharge.We reviewed the database in search of errors, verifying all cases individually and consulting the medical history when necessary. In a second step, we grouped the final diagnoses. Given that the number of diagnoses was very high and many of them were present (with differentiating nuances) in various categories of the ICD-9-CM, we grouped some of the categories into subgroups of clinically homogeneous and easily recognizable processes. For example, the diagnoses of laryngitis, tracheitis and bronchitis are grouped within a single entity known as “’lower respiratory tract infection without pneumonia”. It was therefore possible to decrease the number of diagnoses without losing the necessary clinical precision for the study. The method employed for these groupings consisted of the manual review of all diagnoses for each patient. The assignment to various groups was discussed jointly.Subsequently, for each episode of hospitalization, we calculated the burden of disease according to the Cumulative Illness Rating Scale (CIRS) criteria.<a class="elsevierStyleCrossRef" href="#bib0255">16</a> This index is a standardized clinical tool that assesses clinical and functional severity in 14 disease categories. The scale provides an accumulated score based on the comorbidity burden. We identified the hospitalizations directly related to AF (episode of heart failure, arrhythmia, systemic embolism or cerebral stroke) or its treatment (cerebral or gastrointestinal hemorrhage, secondary effect of drugs, etc.). Otherwise, we considered that the reason for hospitalization was not related to AF.At a later time, the database of hospitalization episodes was converted into a patient database. To this end, we constructed a matrix in which each row included a single patient, with their successive hospitalizations; each column had a separate variable. This matrix enabled us to calculate other secondary variables (e.g., time between hospitalizations).In the statistical analysis, we employed the chi-squared test to compare qualitative variables, with the Yates correction when necessary. For the comparison of 2 means, we employed Student's t-test after confirming the homoscedasticity. For the multiple comparison of means, we employed the analysis of variance and Duncan's test. Statistical significance was established at p<.005. We employed the SPSS statistical package version 17.0.ResultsA total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of these, 12,513 patients (18.9%) had AF. Of the total number of hospitalizations, 25,870 (17.3%) occurred for patients with AF.The patients’ clinical characteristics during the first hospitalization, based on the presence or not of AF, are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The patients with AF were significantly older and were less frequently men. Additionally, the patients with AF presented significantly more chronic diseases, a higher CIRS score and longer hospital stays than the patients without AF. There were no differences in mortality between the 2 groups.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The patients with AF were readmitted with greater frequency over the course of the study, compared with those who did not have this arrhythmia (3.0 [SD 2.7] vs. 2.08 [SD 2.28], respectively; p<.0001). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of patients with AF in the successive hospitalizations. We observed that the mean age, number of chronic diseases, CIRS score and mortality increased significantly in each hospital readmission. As the complexity increased, there was a consistent shortening of the time elapsed between successive hospital admissions.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The hospitalization diagnoses are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. When we grouped the causes for hospitalizations, we observed that 24.7% (6390 episodes) were directly related to AF. Overall, ischemic stroke was the most common reason for hospitalization (11.5%). The primary and secondary diagnoses at admission changed in successive readmissions. Therefore, stroke was the most prevalent diagnosis in the first hospitalization, while heart failure (HF) was most prevalent in the second, third and fourth. Chronic obstructive pulmonary disease (COPD) was the most prevalent diagnosis in the fifth. The COPD cases progressively acquired a greater role as a secondary diagnosis in each readmission. The most common secondary diagnoses with which AF was associated were the following: COPD, stroke, HF, ischemic heart disease, other respiratory system diseases and arterial hypertension.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The distribution of medical services on admission for each episode of hospitalization is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. The department of internal medicine assumed 2 of every 3 hospitalizations for patients with AF, with a percentage that gradually increased with each readmission, while the rate decreased for the department of cardiology and remained stable for the department of pulmonology.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThis study shows that the profile of patients with AF who require hospitalization is that of an elderly patient with multiple associated diseases (treated mainly by the department of internal medicine) and whose hospital stay is longer than that of other patients hospitalized in the medical area. The number of hospitalizations increases over time, while the comorbidity burden and the risk of dying increases with each hospitalization.The progressive aging of the population, improvements in the quality of care and the development of increasingly effective treatments for acute processes have changed the reality of health care toward a healthcare scenario in which elderly patients with a greater comorbidity burden predominate.<a class="elsevierStyleCrossRef" href="#bib0260">17</a> The coexistence of chronic diseases in a patient increases with age,<a class="elsevierStyleCrossRef" href="#bib0265">18</a> and the causal mechanisms for these associations are not known in depth. Various chronic diseases can be grouped in one patient.<a class="elsevierStyleCrossRefs" href="#bib0270">19,20</a> The clinical behavior of the diseases within these clusters differs from that found when the disease manifests in isolation. AF is grouped with other chronic diseases in practically all cases.<a class="elsevierStyleCrossRef" href="#bib0280">21</a> Our study indicates that AF is an arrhythmia associated with numerous chronic diseases, which increases in successive hospital admissions.Several of the conditions that are associated with AF in this study are considered risk factors for the development of AF, such as arterial hypertension, HF, ischemic heart disease and advanced age.<a class="elsevierStyleCrossRef" href="#bib0280">21</a> Other conditions, such as stroke, were probably the consequence of AF itself, while COPD and various respiratory system diseases are frequently associated in patients with multiple comorbidities.<a class="elsevierStyleCrossRef" href="#bib0285">22</a> In the same context, the number of associated chronic diseases was significantly greater in the patient group with AF. However, our understanding of the different groupings of AF with other diseases is limited, as is our understanding of the measure to which the groupings change the clinical outcome. In this respect, the trials and clinical practice guidelines focus mainly on the management of a single disease,<a class="elsevierStyleCrossRef" href="#bib0290">23</a> ignoring this new healthcare reality. New studies are needed to deepen our understanding of disease clusters related to AF, their clinical presentation and their prognostic assessment in order to offer a comprehensive approach for patients.Patients with greater comorbidity and polypathology have a higher rate of readmissions.<a class="elsevierStyleCrossRef" href="#bib0295">24</a> Despite representing 30% of the population, these patients constitute 70% of healthcare expenditures.<a class="elsevierStyleCrossRef" href="#bib0295">24</a> The temporal pattern of hospital readmissions and the clinical profile of patients with AF resembles that observed in other groups of patients with multiple hospitalizations.<a class="elsevierStyleCrossRefs" href="#bib0300">25,26</a> These groups involve elderly polypathological men in which the comorbidity burden and mortality risk increases with each new hospitalization, while the time between readmissions progressively shortens.<a class="elsevierStyleCrossRefs" href="#bib0310">27–29</a> AF is associated with a 5-fold greater risk of experiencing a stroke, a 3-fold greater risk for HF<a class="elsevierStyleCrossRef" href="#bib0325">30</a> and generally greater comorbidity,<a class="elsevierStyleCrossRefs" href="#bib0330">31,32</a> which explains the greater risk of death when compared with the general population.<a class="elsevierStyleCrossRef" href="#bib0340">33</a> Our data indicate a similar tendency in terms of mortality in a selected group of patients hospitalized in medical departments with long-term follow-up.The department of internal medicine assumed the care for more than half of the patients with AF. This percentage increased as the hospitalizations occurred. This is because internists are reference specialists for the care of complex polypathological patients<a class="elsevierStyleCrossRefs" href="#bib0295">24,29,33</a> and, by extension, of patients with multiple hospitalizations.<a class="elsevierStyleCrossRef" href="#bib0310">27</a> According to our data, AF was associated with more than 4 diseases on average, which explains the higher number of readmissions. Given that internists are the hospital reference for the management of patients with AF, internists should be included in the study of related disease clusters and in the design of new healthcare plans adapted to this scenario.<a class="elsevierStyleCrossRefs" href="#bib0345">34,35</a>This study had a number of limitations. First, the study only describes the characteristics adult patients with AF hospitalized in the medical area. It is therefore not possible to generalize the results to patients hospitalized for surgical reasons. Second, the study design could raise doubts about the quality of the clinical information, given that the minimum basic data set is an administrative database. Nevertheless, the minimum basic data set is constructed with the discharge reports performed by the responsible physicians, and the subsequent coding is performed by experienced health professionals. Moreover, the grouping of diagnoses conducted by the researchers has not affected the AF. Several workshops were conducted among the researchers to maintain the homogeneity of the classifications. It is therefore our understanding that the essence of the data has not been modified. Lastly, the data came from a single hospital center. Since it is possible that the information could be different in hospitals from other geographical areas or of different sizes, it is advisable to reproduce this study in other healthcare areas.In summary, AF is a common arrhythmia among patients hospitalized in medical areas. AF presents in highly complex patients who are frequently hospitalized for reasons other than the AF itself. The association between AF and a high rate of readmissions, increasingly closer to each other, and its greater mortality require us to consider AF as a marker of complexity and risk. It is therefore important to development lines of research that help us to better understand the association of AF with other diseases and, as a consequence, a better understanding of its clinical presentation, evolution and repercussion on the healthcare system.Conflict of interestsThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres875304" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec863499" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres875303" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec863500" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-13" "fechaAceptado" => "2017-03-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec863499" "palabras" => array:4 [ 0 => "Atrial fibrillation" 1 => "Multimorbidity" 2 => "Polypathological" 3 => "Cluster" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec863500" "palabras" => array:4 [ 0 => "Fibrilación auricular" 1 => "Multimorbilidad" 2 => "Pluripatológico" 3 => "Clúster" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. MethodA retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. ResultsA total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; p<.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; p<.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; p<.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; p<.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; p<.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension. ConclusionsAF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoConocer las características de los pacientes con fibrilación auricular (FA) en el ámbito hospitalario y sus sucesivos ingresos. MétodoEstudio retrospectivo de cohortes con la totalidad de los ingresos hospitalarios en el área médica del hospital de Lugo entre el 1 de enero de 2000 y el 31 de diciembre de 2013. La fuente de información fue el conjunto mínimo básico de datos del centro. ResultadosSe registraron 149.271 ingresos hospitalarios correspondientes a 66.286 pacientes. Con respecto al total, el porcentaje de ingresos y pacientes con FA fue del 17,3% (25.870) y 18,9% (12.512), respectivamente. Los pacientes con FA se caracterizaron por una mayor proporción de mujeres (49,7 frente a 44,3%; p<0,0001), mayor edad (78,3 [DE 10,2] frente a 67,1 años [DE 17,9]; p<0,0001), más enfermedades crónicas (4,2 [DE 2,1] frente a 2,9 [DE 1,9]; p<0,001), estancia hospitalaria más prolongada (12,5 [DE 12,5] frente a 10,6 días [DE 19,9]; p<0,0001) y una elevada tasa de reingresos (3,0 [DE 2,75] frente a 2,1 [DE 2,28]; p<0,001), con un acortamiento progresivo del tiempo entre ingresos. El servicio de Medicina Interna asumió la atención de más de la mitad de los enfermos con FA. Los diagnósticos secundarios asociados más frecuentes fueron: enfermedad pulmonar obstructiva crónica, ictus, insuficiencia cardiaca, cardiopatía isquémica, otras enfermedades del aparato respiratorio e hipertensión arterial. ConclusionesLa FA se presenta en pacientes de alta complejidad, ingresados mayoritariamente en servicios de Medicina Interna, y se asocia a una elevada tasa de reingresos. Es preciso considerar las enfermedades asociadas a la FA que permitan un enfoque global de estos pacientes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Iñiguez Vázquez I, Monte Secades R, Matesanz Fernández M, Romay Lema EM, Rubal Bran D, Casariego Vales E. Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos. Rev Clin Esp. 2017;217:309–314." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: CIRS, Cumulative Illness Rating Scale; SD, standard deviation; NS, not significant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without AF (n=53,773) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With AF (n=12,513) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30,485 (56.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6286 (50.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.08 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.3 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. of chronic diseases (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIRS (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.2 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.0 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean stay, days (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.6 (19.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3183 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">741 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1477420.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients with and without atrial fibrillation in their first hospitalization." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: CIRS, Cumulative Illness Rating Scale; SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admissions</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st (n=12,513) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd (n=8124) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd (n=5271) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th (n=3390) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th (n=2298) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.9 (17.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.8 (15.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.4 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.1 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.3 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean stay, days (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.6 (19.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.9 (16.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7 (13.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 (13.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. of chronic diseases (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIRS (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.2 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.0 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3183 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">700 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">543 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">372 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">267 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time between hospitalizations, days (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">716.7 (913.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">455.9 (667.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">340.3 (537.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">275.7 (450) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1477421.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients with atrial fibrillation according to the order of hospitalization." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: AF, atrial fibrillation; AHT, arterial hypertension; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; HF, heart failure; IHD, ischemic heart disease; ORSD, other respiratory system diseases." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Diagnostic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admission</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st (n=12,513) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd (n=8124) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd (n=5271) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th (n=3390) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th (n=2298) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke 1440 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CHF 728 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CHF 483 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CHF 354 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">COPD 226 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 1, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF 1298 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke 601 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">COPD 432 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">COPD 320 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CHF 211 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HF 1008 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">COPD 599 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke 305 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AHT 193 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AHT 152 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 3, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">COPD 744 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF 520 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF 277 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ORSD 187 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ORSD 126 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 4, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IHD 720 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ORSD 390 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AHT 272 (5.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke 142 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke 88 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1477419.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Primary and secondary diagnoses associated with atrial fibrillation depending on the order of hospitalization." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Medical service \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admission</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st (n=12,513) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd (n=8124) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd (n=5271) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th (n=3390) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th (n=2298) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal Medicine, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6308 (50.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4600 (56.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3216 (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2053 (60.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1470 (63.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2740 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1328 (6.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">742 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">383 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">240 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1224 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">818 (9.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">535 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">383 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">285 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">557 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">205 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">472 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">290 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1477418.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of medical departments at admission for patients with atrial fibrillation according to the order of hospitalization." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:35 [ 0 => array:3 [ "identificador" => "bib0180" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused update of the ESC Guidelines for the management of auricular fibrillation: an update of the 2010 ESC guidelines for the management of auricular fibrillation developed with the special contribution of the European Hearth Rhythm Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. 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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; affects 1&#8211;2&#37; of the general population&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">1</span></a> and its prevalence is age-related&#44; such that 70&#37; of cases are diagnosed in those older than 65 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;3</span></a> Currently&#44; up to 17&#46;7&#37; of patients older than 80 years have AF in the primary care setting&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">3</span></a> AF is detected in hospitals in up to 30&#8211;35&#37; of patients hospitalized in internal medicine departments&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; considering the gradual aging of the population and the better control and treatment of patients with multiple chronic diseases&#44; it is conceivable that its prevalence could even double in the coming decades&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given its frequency and the age group it affects&#44; AF typically presents in combination with other medical problems&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a> Thus&#44; these patients are characterized by high complexity&#58; polypathology&#44; polypharmacy and high indices of frailty&#44; all of which reduce quality of life<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#8211;13</span></a> and increase healthcare demands&#44; at various levels and in a manner that is difficult to schedule&#44; due to exacerbations and the onset of interrelated diseases&#46; Despite their clinical relevance&#44; our understanding of the associated chronic diseases and the repercussion they have on healthcare services is limited&#46; In fact&#44; the study of complex chronic patients&#44; whose conditions include AF&#44; is poorly represented in the medical literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the characteristics of patients with AF in the hospital setting and their successive hospitalizations&#46; The results will help provide new evidence for their clinical management and will improve the care&#44; in the clinical setting as well as in the organizational and social settings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective cohort study was conducted for all hospital admissions in the departments of the medical area of University Hospital <span class="elsevierStyleItalic">Lucus Augusti</span> of Lugo between January 1&#44; 2000 and December 31&#44; 2013&#46; This center provides health care for 240&#44;000 inhabitants and has 879 beds&#46; The departments that comprise the medical area are as follows&#58; cardiology&#44; pulmonology&#44; neurology&#44; nephrology&#44; endocrinology&#44; gastrointestinal&#44; rheumatology&#44; oncology&#44; infectious diseases and internal medicine&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This study had the approval of the Clinical Research Ethics Committee of Galicia &#40;2014&#47;409&#41;&#46; The data source was the center&#39;s minimum basic data set&#46; The analyzed variables were department where the patient was hospitalized&#44; sex &#40;male&#47;female&#41;&#44; date of birth&#44; date of hospitalization and discharge&#44; length of stay &#40;days&#41;&#44; destination at discharge &#40;including death&#41;&#44; diagnosis-related group &#40;DRG&#41;&#44; primary diagnosis &#40;according to the ICD-9-CM classification&#41; and up to 10 secondary diagnoses&#44; with their corresponding codes &#40;ICD-9-CM&#41; in the order in which they appear in the hospital discharge&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We reviewed the database in search of errors&#44; verifying all cases individually and consulting the medical history when necessary&#46; In a second step&#44; we grouped the final diagnoses&#46; Given that the number of diagnoses was very high and many of them were present &#40;with differentiating nuances&#41; in various categories of the ICD-9-CM&#44; we grouped some of the categories into subgroups of clinically homogeneous and easily recognizable processes&#46; For example&#44; the diagnoses of laryngitis&#44; tracheitis and bronchitis are grouped within a single entity known as &#8220;&#8217;lower respiratory tract infection without pneumonia&#8221;&#46; It was therefore possible to decrease the number of diagnoses without losing the necessary clinical precision for the study&#46; The method employed for these groupings consisted of the manual review of all diagnoses for each patient&#46; The assignment to various groups was discussed jointly&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Subsequently&#44; for each episode of hospitalization&#44; we calculated the burden of disease according to the Cumulative Illness Rating Scale &#40;CIRS&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> This index is a standardized clinical tool that assesses clinical and functional severity in 14 disease categories&#46; The scale provides an accumulated score based on the comorbidity burden&#46; We identified the hospitalizations directly related to AF &#40;episode of heart failure&#44; arrhythmia&#44; systemic embolism or cerebral stroke&#41; or its treatment &#40;cerebral or gastrointestinal hemorrhage&#44; secondary effect of drugs&#44; etc&#46;&#41;&#46; Otherwise&#44; we considered that the reason for hospitalization was not related to AF&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At a later time&#44; the database of hospitalization episodes was converted into a patient database&#46; To this end&#44; we constructed a matrix in which each row included a single patient&#44; with their successive hospitalizations&#59; each column had a separate variable&#46; This matrix enabled us to calculate other secondary variables &#40;e&#46;g&#46;&#44; time between hospitalizations&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the statistical analysis&#44; we employed the chi-squared test to compare qualitative variables&#44; with the Yates correction when necessary&#46; For the comparison of 2 means&#44; we employed Student&#39;s <span class="elsevierStyleItalic">t</span>-test after confirming the homoscedasticity&#46; For the multiple comparison of means&#44; we employed the analysis of variance and Duncan&#39;s test&#46; Statistical significance was established at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;005&#46; We employed the SPSS statistical package version 17&#46;0&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 149&#44;271 hospital admissions corresponding to 66&#44;286 patients were recorded&#46; Of these&#44; 12&#44;513 patients &#40;18&#46;9&#37;&#41; had AF&#46; Of the total number of hospitalizations&#44; 25&#44;870 &#40;17&#46;3&#37;&#41; occurred for patients with AF&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patients&#8217; clinical characteristics during the first hospitalization&#44; based on the presence or not of AF&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The patients with AF were significantly older and were less frequently men&#46; Additionally&#44; the patients with AF presented significantly more chronic diseases&#44; a higher CIRS score and longer hospital stays than the patients without AF&#46; There were no differences in mortality between the 2 groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The patients with AF were readmitted with greater frequency over the course of the study&#44; compared with those who did not have this arrhythmia &#40;3&#46;0 &#91;SD 2&#46;7&#93; vs&#46; 2&#46;08 &#91;SD 2&#46;28&#93;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of patients with AF in the successive hospitalizations&#46; We observed that the mean age&#44; number of chronic diseases&#44; CIRS score and mortality increased significantly in each hospital readmission&#46; As the complexity increased&#44; there was a consistent shortening of the time elapsed between successive hospital admissions&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The hospitalization diagnoses are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; When we grouped the causes for hospitalizations&#44; we observed that 24&#46;7&#37; &#40;6390 episodes&#41; were directly related to AF&#46; Overall&#44; ischemic stroke was the most common reason for hospitalization &#40;11&#46;5&#37;&#41;&#46; The primary and secondary diagnoses at admission changed in successive readmissions&#46; Therefore&#44; stroke was the most prevalent diagnosis in the first hospitalization&#44; while heart failure &#40;HF&#41; was most prevalent in the second&#44; third and fourth&#46; Chronic obstructive pulmonary disease &#40;COPD&#41; was the most prevalent diagnosis in the fifth&#46; The COPD cases progressively acquired a greater role as a secondary diagnosis in each readmission&#46; The most common secondary diagnoses with which AF was associated were the following&#58; COPD&#44; stroke&#44; HF&#44; ischemic heart disease&#44; other respiratory system diseases and arterial hypertension&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The distribution of medical services on admission for each episode of hospitalization is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; The department of internal medicine assumed 2 of every 3 hospitalizations for patients with AF&#44; with a percentage that gradually increased with each readmission&#44; while the rate decreased for the department of cardiology and remained stable for the department of pulmonology&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">This study shows that the profile of patients with AF who require hospitalization is that of an elderly patient with multiple associated diseases &#40;treated mainly by the department of internal medicine&#41; and whose hospital stay is longer than that of other patients hospitalized in the medical area&#46; The number of hospitalizations increases over time&#44; while the comorbidity burden and the risk of dying increases with each hospitalization&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The progressive aging of the population&#44; improvements in the quality of care and the development of increasingly effective treatments for acute processes have changed the reality of health care toward a healthcare scenario in which elderly patients with a greater comorbidity burden predominate&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a> The coexistence of chronic diseases in a patient increases with age&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a> and the causal mechanisms for these associations are not known in depth&#46; Various chronic diseases can be grouped in one patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">19&#44;20</span></a> The clinical behavior of the diseases within these clusters differs from that found when the disease manifests in isolation&#46; AF is grouped with other chronic diseases in practically all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">21</span></a> Our study indicates that AF is an arrhythmia associated with numerous chronic diseases&#44; which increases in successive hospital admissions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Several of the conditions that are associated with AF in this study are considered risk factors for the development of AF&#44; such as arterial hypertension&#44; HF&#44; ischemic heart disease and advanced age&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">21</span></a> Other conditions&#44; such as stroke&#44; were probably the consequence of AF itself&#44; while COPD and various respiratory system diseases are frequently associated in patients with multiple comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a> In the same context&#44; the number of associated chronic diseases was significantly greater in the patient group with AF&#46; However&#44; our understanding of the different groupings of AF with other diseases is limited&#44; as is our understanding of the measure to which the groupings change the clinical outcome&#46; In this respect&#44; the trials and clinical practice guidelines focus mainly on the management of a single disease&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">23</span></a> ignoring this new healthcare reality&#46; New studies are needed to deepen our understanding of disease clusters related to AF&#44; their clinical presentation and their prognostic assessment in order to offer a comprehensive approach for patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Patients with greater comorbidity and polypathology have a higher rate of readmissions&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> Despite representing 30&#37; of the population&#44; these patients constitute 70&#37; of healthcare expenditures&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> The temporal pattern of hospital readmissions and the clinical profile of patients with AF resembles that observed in other groups of patients with multiple hospitalizations&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">25&#44;26</span></a> These groups involve elderly polypathological men in which the comorbidity burden and mortality risk increases with each new hospitalization&#44; while the time between readmissions progressively shortens&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">27&#8211;29</span></a> AF is associated with a 5-fold greater risk of experiencing a stroke&#44; a 3-fold greater risk for HF<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">30</span></a> and generally greater comorbidity&#44;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">31&#44;32</span></a> which explains the greater risk of death when compared with the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> Our data indicate a similar tendency in terms of mortality in a selected group of patients hospitalized in medical departments with long-term follow-up&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The department of internal medicine assumed the care for more than half of the patients with AF&#46; This percentage increased as the hospitalizations occurred&#46; This is because internists are reference specialists for the care of complex polypathological patients<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">24&#44;29&#44;33</span></a> and&#44; by extension&#44; of patients with multiple hospitalizations&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a> According to our data&#44; AF was associated with more than 4 diseases on average&#44; which explains the higher number of readmissions&#46; Given that internists are the hospital reference for the management of patients with AF&#44; internists should be included in the study of related disease clusters and in the design of new healthcare plans adapted to this scenario&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">34&#44;35</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">This study had a number of limitations&#46; First&#44; the study only describes the characteristics adult patients with AF hospitalized in the medical area&#46; It is therefore not possible to generalize the results to patients hospitalized for surgical reasons&#46; Second&#44; the study design could raise doubts about the quality of the clinical information&#44; given that the minimum basic data set is an administrative database&#46; Nevertheless&#44; the minimum basic data set is constructed with the discharge reports performed by the responsible physicians&#44; and the subsequent coding is performed by experienced health professionals&#46; Moreover&#44; the grouping of diagnoses conducted by the researchers has not affected the AF&#46; Several workshops were conducted among the researchers to maintain the homogeneity of the classifications&#46; It is therefore our understanding that the essence of the data has not been modified&#46; Lastly&#44; the data came from a single hospital center&#46; Since it is possible that the information could be different in hospitals from other geographical areas or of different sizes&#44; it is advisable to reproduce this study in other healthcare areas&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In summary&#44; AF is a common arrhythmia among patients hospitalized in medical areas&#46; AF presents in highly complex patients who are frequently hospitalized for reasons other than the AF itself&#46; The association between AF and a high rate of readmissions&#44; increasingly closer to each other&#44; and its greater mortality require us to consider AF as a marker of complexity and risk&#46; It is therefore important to development lines of research that help us to better understand the association of AF with other diseases and&#44; as a consequence&#44; a better understanding of its clinical presentation&#44; evolution and repercussion on the healthcare system&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Resultados"
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              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
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        ]
        3 => array:2 [
          "identificador" => "xpalclavsec863500"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of interests"
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        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-12-13"
    "fechaAceptado" => "2017-03-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec863499"
          "palabras" => array:4 [
            0 => "Atrial fibrillation"
            1 => "Multimorbidity"
            2 => "Polypathological"
            3 => "Cluster"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec863500"
          "palabras" => array:4 [
            0 => "Fibrilaci&#243;n auricular"
            1 => "Multimorbilidad"
            2 => "Pluripatol&#243;gico"
            3 => "Cl&#250;ster"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the characteristics of patients with auricular fibrillation &#40;AF&#41; in the hospital setting and their successive hospitalisations&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1&#44; 2000 and December 31&#44; 2013&#46; The data source was the centre&#39;s minimum basic data set&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 149&#44;271 hospital admissions corresponding to 66&#44;286 patients were recorded&#46; Of the total&#44; the percentage of admissions and patients with AF was 17&#46;3&#37; &#40;25&#44;870&#41; and 18&#46;9&#37; &#40;12&#44;512&#41;&#44; respectively&#46; The patients with AF were characterized by a larger proportion of women &#40;49&#46;7 vs&#46; 44&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#44; advanced age &#40;78&#46;3 &#91;DE 10&#46;2&#93; vs&#46; 67&#46;1 years &#91;DE 17&#46;9&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#44; more chronic diseases &#40;4&#46;2 &#91;DE 2&#46;1&#93; vs&#46; 2&#46;9 &#91;DE 1&#46;9&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; longer hospital stays &#40;12&#46;5 &#91;DE 12&#46;5&#93; vs&#46; 10&#46;6 &#91;DE 19&#46;9&#93; days&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; and a high rate of readmissions &#40;3&#46;0 &#91;DE 2&#46;75&#93; vs&#46; 2&#46;1 &#91;DE 2&#46;28&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; with a progressive shortening of the time between hospitalisations&#46; The department of internal medicine was responsible for the care of more than half of the patients with AF&#46; The most common associated secondary diagnoses were chronic obstructive pulmonary disease&#44; stroke&#44; heart failure&#44; ischemic heart disease&#44; other respiratory system diseases and arterial hypertension&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AF occurs in highly complex patients&#44; who are mostly hospitalized in internal medicine departments&#44; and is associated with a high rate of readmissions&#46; We need to consider the diseases associated with AF for an overall approach to these patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer las caracter&#237;sticas de los pacientes con fibrilaci&#243;n auricular &#40;FA&#41; en el &#225;mbito hospitalario y sus sucesivos ingresos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de cohortes con la totalidad de los ingresos hospitalarios en el &#225;rea m&#233;dica del hospital de Lugo entre el 1 de enero de 2000 y el 31 de diciembre de 2013&#46; La fuente de informaci&#243;n fue el conjunto m&#237;nimo b&#225;sico de datos del centro&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se registraron 149&#46;271 ingresos hospitalarios correspondientes a 66&#46;286 pacientes&#46; Con respecto al total&#44; el porcentaje de ingresos y pacientes con FA fue del 17&#44;3&#37; &#40;25&#46;870&#41; y 18&#44;9&#37; &#40;12&#46;512&#41;&#44; respectivamente&#46; Los pacientes con FA se caracterizaron por una mayor proporci&#243;n de mujeres &#40;49&#44;7 frente a 44&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; mayor edad &#40;78&#44;3 &#91;DE 10&#44;2&#93; frente a 67&#44;1 a&#241;os &#91;DE 17&#44;9&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; m&#225;s enfermedades cr&#243;nicas &#40;4&#44;2 &#91;DE 2&#44;1&#93; frente a 2&#44;9 &#91;DE 1&#44;9&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; estancia hospitalaria m&#225;s prolongada &#40;12&#44;5 &#91;DE 12&#44;5&#93; frente a 10&#44;6 d&#237;as &#91;DE 19&#44;9&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y una elevada tasa de reingresos &#40;3&#44;0 &#91;DE 2&#44;75&#93; frente a 2&#44;1 &#91;DE 2&#44;28&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con un acortamiento progresivo del tiempo entre ingresos&#46; El servicio de Medicina Interna asumi&#243; la atenci&#243;n de m&#225;s de la mitad de los enfermos con FA&#46; Los diagn&#243;sticos secundarios asociados m&#225;s frecuentes fueron&#58; enfermedad pulmonar obstructiva cr&#243;nica&#44; ictus&#44; insuficiencia cardiaca&#44; cardiopat&#237;a isqu&#233;mica&#44; otras enfermedades del aparato respiratorio e hipertensi&#243;n arterial&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La FA se presenta en pacientes de alta complejidad&#44; ingresados mayoritariamente en servicios de Medicina Interna&#44; y se asocia a una elevada tasa de reingresos&#46; Es preciso considerar las enfermedades asociadas a la FA que permitan un enfoque global de estos pacientes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; I&#241;iguez V&#225;zquez I&#44; Monte Secades R&#44; Matesanz Fern&#225;ndez M&#44; Romay Lema EM&#44; Rubal Bran D&#44; Casariego Vales E&#46; Caracter&#237;sticas y patr&#243;n temporal de reingresos de los pacientes con fibrilaci&#243;n auricular hospitalizados en servicios m&#233;dicos&#46; Rev Clin Esp&#46; 2017&#59;217&#58;309&#8211;314&#46;</p>"
      ]
    ]
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CIRS&#44; Cumulative Illness Rating Scale&#59; SD&#44; standard deviation&#59; NS&#44; not significant&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without AF &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#44;773&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With AF &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;513&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#44;485 &#40;56&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6286 &#40;50&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; years &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;08 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;3 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; of chronic diseases &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIRS &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;0 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean stay&#44; days &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3183 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">741 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients with and without atrial fibrillation in their first hospitalization&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CIRS&#44; Cumulative Illness Rating Scale&#59; SD&#44; standard deviation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admissions</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;513&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5271&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3390&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2298&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; years &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;9 &#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;8 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;4 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;1 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;3 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean stay&#44; days &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;3 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; of chronic diseases &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;4 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIRS &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;0 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3183 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">700 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">543 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">372 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">267 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time between hospitalizations&#44; days &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">716&#46;7 &#40;913&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">455&#46;9 &#40;667&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">340&#46;3 &#40;537&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">275&#46;7 &#40;450&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; AF&#44; atrial fibrillation&#59; AHT&#44; arterial hypertension&#59; CHF&#44; congestive heart failure&#59; COPD&#44; chronic obstructive pulmonary disease&#59; HF&#44; heart failure&#59; IHD&#44; ischemic heart disease&#59; ORSD&#44; other respiratory system diseases&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Diagnostic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admission</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;513&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5271&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3390&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2298&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke 1440 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CHF 728 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CHF 483 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CHF 354 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">COPD 226 &#40;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 1&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF 1298 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke 601 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">COPD 432 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">COPD 320 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CHF 211 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 2&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HF 1008 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">COPD 599 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke 305 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AHT 193 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AHT 152 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 3&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">COPD 744 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF 520 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF 277 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ORSD 187 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ORSD 126 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary 4&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IHD 720 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ORSD 390 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AHT 272 &#40;5&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke 142 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke 88 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Primary and secondary diagnoses associated with atrial fibrillation depending on the order of hospitalization&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Medical service&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Admission</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;513&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3rd<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5271&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3390&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5th<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2298&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal Medicine&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6308 &#40;50&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4600 &#40;56&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3216 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2053 &#40;60&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1470 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiology&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2740 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1328 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">742 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">383 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonology&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1224 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">818 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">535 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">383 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">285 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurology&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">557 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">205 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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