Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program

array:24 ["pii" => "S2254887415000892" "issn" => "22548874" "doi" => "10.1016/j.rceng.2015.09.003" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1181" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:8-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 238 "formatos" => array:2 [ "HTML" => 235 "PDF" => 3 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256515001976" "issn" => "00142565" "doi" => "10.1016/j.rce.2015.07.006" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1181" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:8-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 869 "formatos" => array:2 [ "HTML" => 244 "PDF" => 625 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "8" "paginaFinal" => "14" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reduction in hospitalisations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare programme" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 844 "Ancho" => 1597 "Tamanyo" => 57141 ] ] "descripcion" => array:1 [ "es" => "Frecuencia de los reingresos por insuficiencia cardiaca (IC) durante el año anterior a la inclusión en el programa UMIPIC (barras azules) y durante el año de seguimiento posterior (barras naranja)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Cerqueiro, A. González-Franco, M. Montero-Pérez-Barquero, P. Llácer, A. Conde, M.F. Dávila, M. Carrera, A. Serrado, I. Suárez, J. Pérez-Silvestre, J.A. Satué, J.C. Arévalo-Lorido, A. Rodríguez, A. Herrero, R. Jordana, L. Manzano" "autores" => array:16 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Cerqueiro" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Franco" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Montero-Pérez-Barquero" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Llácer" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Conde" ] 5 => array:2 [ "nombre" => "M.F." "apellidos" => "Dávila" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Carrera" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Serrado" ] 8 => array:2 [ "nombre" => "I." "apellidos" => "Suárez" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Pérez-Silvestre" ] 10 => array:2 [ "nombre" => "J.A." "apellidos" => "Satué" ] 11 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo-Lorido" ] 12 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez" ] 13 => array:2 [ "nombre" => "A." "apellidos" => "Herrero" ] 14 => array:2 [ "nombre" => "R." "apellidos" => "Jordana" ] 15 => array:2 [ "nombre" => "L." "apellidos" => "Manzano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887415000892" "doi" => "10.1016/j.rceng.2015.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000892?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515001976?idApp=WRCEE" "url" => "/00142565/0000021600000001/v1_201601280010/S0014256515001976/v1_201601280010/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887415000910" "issn" => "22548874" "doi" => "10.1016/j.rceng.2015.09.005" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1183" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2016;216:15-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 21 "formatos" => array:2 [ "HTML" => 19 "PDF" => 2 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Brief original" "titulo" => "Compliance with the guidelines of the European Society of Cardiology and morbidity and mortality from infectious endocarditis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "15" "paginaFinal" => "18" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cumplimiento de las guías de la Sociedad Europea de Cardiología y morbimortalidad por endocarditis infecciosa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Rodríguez Esteban, L. Carballo Arzola, S. Miranda Montero, M. Farrais Villalba, J.A. Medina García, J. Ode Febles" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez Esteban" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Carballo Arzola" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Miranda Montero" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Farrais Villalba" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Medina García" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Ode Febles" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425651500199X" "doi" => "10.1016/j.rce.2015.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651500199X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000910?idApp=WRCEE" "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415000910/v1_201601280010/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887415001149" "issn" => "22548874" "doi" => "10.1016/j.rceng.2015.09.006" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1207" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:1-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 21 "formatos" => array:2 [ "HTML" => 19 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The clinical profile of women with stable ischemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "7" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil clínico de la mujer con cardiopatía isquémica estable en España. Son necesarios más esfuerzos en prevención secundaria. Estudio SIRENA" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1021 "Ancho" => 1590 "Tamanyo" => 54145 ] ] "descripcion" => array:1 [ "en" => "Coronary arteries affected with significant lesions (≥50%). Abbreviations: DA, descending anterior; Cx, circumflex; RC, right coronary artery." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Gámez, T. Ripoll, V. Barrios, M. Anguita, M. Pedreira, I. Madariaga" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Gámez" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Ripoll" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Barrios" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Anguita" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Pedreira" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Madariaga" ] 6 => array:1 [ "colaborador" => "representing investigadores del estudio SIRENA" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256515002519" "doi" => "10.1016/j.rce.2015.09.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515002519?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415001149?idApp=WRCEE" "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415001149/v1_201601280010/en/main.assets" ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "8" "paginaFinal" => "14" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Cerqueiro, A. González-Franco, M. Montero-Pérez-Barquero, P. Llácer, A. Conde, M.F. Dávila, M. Carrera, A. Serrado, I. Suárez, J. Pérez-Silvestre, J.A. Satué, J.C. Arévalo-Lorido, A. Rodríguez, A. Herrero, R. Jordana, L. Manzano" "autores" => array:16 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Cerqueiro" "email" => array:1 [ 0 => "jmcerqueiro@lugonautas.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "González-Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Montero-Pérez-Barquero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Llácer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Conde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "M.F." "apellidos" => "Dávila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Carrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "A." "apellidos" => "Serrado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "I." "apellidos" => "Suárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "J." "apellidos" => "Pérez-Silvestre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "J.A." "apellidos" => "Satué" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "J.C." "apellidos" => "Arévalo-Lorido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 12 => array:3 [ "nombre" => "A." "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "m" "identificador" => "aff0065" ] ] ] 13 => array:3 [ "nombre" => "A." "apellidos" => "Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "n" "identificador" => "aff0070" ] ] ] 14 => array:3 [ "nombre" => "R." "apellidos" => "Jordana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "o" "identificador" => "aff0075" ] ] ] 15 => array:3 [ "nombre" => "L." "apellidos" => "Manzano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "p" "identificador" => "aff0080" ] ] ] ] "afiliaciones" => array:16 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Ntra. Señora de la Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario de Soria, Soria, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Municipal de Badalona, Badalona, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Valle del Nalón, Langreo, Asturias, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Xeral-Cies de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Nuestra Señora del Prado, Toledo, Spain" "etiqueta" => "n" "identificador" => "aff0070" ] 14 => array:3 [ "entidad" => "Servicio de Medicina Interna, Corporaciò Sanitaria Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "o" "identificador" => "aff0075" ] 15 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "p" "identificador" => "aff0080" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 818 "Ancho" => 1636 "Tamanyo" => 82286 ] ] "descripcion" => array:1 [ "en" => "Hospitalizations for heart failure (HF) and other causes during the year prior to inclusion in the UMIPIC program (blue bars) and the subsequent follow-up year (orange bars)." ] ] ] "textoCompleto" => "BackgroundHeart failure (HF) is one of the most common causes of hospitalization in developed countries, especially for elderly patients. In the population older than 65years, the annual rate of hospitalization for HF in the United States is estimated at 21 per 1000,<a class="elsevierStyleCrossRef" href="#bib0145">1</a> and constitutes the main cause of hospitalization in this age group.<a class="elsevierStyleCrossRef" href="#bib0145">1</a> A third of these hospitalizations are readmissions that occur within 90days of the hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0150">2</a>In Spain, HF generates more than 100,000 hospitalizations per year and represents approximately 2% of emergency department visits, with an annual mortality of 10%.<a class="elsevierStyleCrossRef" href="#bib0155">3</a> The costs associated with HF reach 2500 billion euros annually, which are mostly for hospitalization.<a class="elsevierStyleCrossRef" href="#bib0155">3</a> This considerably high rate of hospitalization is due to the comorbidity and advanced age of these patients, which also entails fragmented care, which limits the application of clinical practice guidelines (CPGs).<a class="elsevierStyleCrossRef" href="#bib0160">4</a> Patients with HF can therefore be considered frail and at high risk of readmission, not only for HF but also for other causes.<a class="elsevierStyleCrossRefs" href="#bib0165">5,6</a> In this context, conventional care and follow-up can be inefficient.<a class="elsevierStyleCrossRef" href="#bib0175">7</a>American and European CPGs<a class="elsevierStyleCrossRefs" href="#bib0165">5,8</a> recommend including patients with HF in special follow-up programs (recommendation IA), as an effective measure for reducing readmissions. The efficacy of this measure has been demonstrated in numerous studies and meta-analyses,<a class="elsevierStyleCrossRefs" href="#bib0185">9–11</a> although not specifically in complex chronically ill patients, due to their comorbidity. In recent years, numerous follow-up models have emerged for patients with HF. In general, the models are heterogeneous and difficult to compare because they include numerous issues, from care in a multidisciplinary consultation, home care through telephone calls, specific nursing programs, among others. The latest CPGs of the American Heart Association identify the healthcare model formed by multidisciplinary teams as the most effective for reducing the hospitalizations and mortality of patients with HF.<a class="elsevierStyleCrossRef" href="#bib0200">12</a>In our country, there are conventional HF units that have shown their efficiency.<a class="elsevierStyleCrossRef" href="#bib0205">13</a> However, the experience with more elderly patients and increased comorbidity is limited.<a class="elsevierStyleCrossRefs" href="#bib0210">14,15</a>In 2011, the HF and atrial fibrillation (AF) group of the Spanish Society of Internal Medicine (SEMI) promoted the creation of specialized healthcare units aimed at the care of patients with HF and multiple diseases, under the program name “Comprehensive Management Units for Patients with HF” (Unidades de Manejo Integral para Pacientes con IC, UMIPIC). The aim of this study was to analyze the potential clinical benefit in terms of the reduction in the number of hospitalizations and emergency department visits for patients with HF and comorbidities who were treated in the program's units.Patients and methodPatientsData were obtained from the patients included in the RICA-UMIPIC registry between November 2011 and November 2013. The RICA registry is a multicenter, prospective cohort registry, coordinated by SEMI's HF and AF group, whose characteristics have been described in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0215">15,16</a> The registry consecutively includes patients hospitalized for an episode of decompensated HF. The data are entered anonymously through the website <a id="intr0010" class="elsevierStyleInterRef" href="http://www.registrorica.org/">http://www.registrorica.org</a>. The study protocol was approved by the Ethics Committee of University Hospital Reina Sofia of Cordoba, and informed consent was obtained from all patients before their inclusion.For inclusion in the RICA registry, the patients had to be older than 50years and be hospitalized for decompensated HF according to the criteria of the European Society of Cardiology.UMIPIC programThe UMIPIC program is an initiative promoted by the SEMI's HF and AF group and offers comprehensive and continuous care for complex, chronically ill elderly patients with HF (<a id="intr0015" class="elsevierStyleInterRef" href="http://www.fesemi.org/grupos/cardiaca/umipic/programa/view">http://www.fesemi.org/grupos/cardiaca/umipic/programa/view</a>). The program integrates 23 units distributed throughout the country. For inclusion in the UMIPIC program, patients had to meet the general RICA criteria. Exclusion criteria included the need for follow-up by the Department of Cardiology (patients with ischemia who required catheterization, device implantation, eligible for prosthetic valves, in an advanced functional condition awaiting heart transplantation) and the lack of a functional and cognitive state sufficient to attend the hospital consultations and ensure correct therapeutic compliance, unless appropriate socio-family support was available.All units are equipped with nursing staff and offer follow-up according to an intensive protocolized program, based on 4 aspects: (1) comprehensive clinical approach, with care for HF and present comorbidities; (2) ongoing follow-up that includes face-to-face visits and telephone contact, as well as hospital care during hospitalization; (3) regulated teaching in self-care and support measures and the involvement of the patient and/or caregiver; and (4) flexibility and accessibility necessary to assist patients in conditions of unscheduled decompensation. The follow-up includes medical and nursing consultations.For this study, we only assessed patients who completed 1 year of follow-up. Patients who died during this period or did not complete it were excluded.Study endpointsAt the time the patients were included, their demographic variables were recorded, along with their medical history and characteristics; laboratory data; and electrocardiographic and echocardiographic parameters; and treatment parameters.<a class="elsevierStyleCrossRefs" href="#bib0220">16,17</a> As assessment endpoints, we considered hospitalizations and emergency department visits (without hospitalization) due to HF or other causes during the year prior to the index hospitalization and during the first year of follow-up.Statistical analysisWe performed a descriptive analysis of the sample using the median and interquartile range for the quantitative variables (none followed a normal distribution) and percentage for the categorical variables. For the statistical analysis, 2 consecutive time periods were considered: the year prior to and the year after the hospital discharge data for the index hospitalization, in which each patient began their follow-up by a unit integrated into the UMIPIC program. In the comparison of qualitative variables, we employed the chi-squared test. In the comparison of quantitative variables, prior to the normality study, we employed Student's t-test for paired data or the Wilcoxon test when the variables did not follow a normal distribution. The statistical package SPSS 17.0 was used for this study. The level of statistical significance was established at a value of p<.05.ResultsBaseline characteristicsDuring the study period, 460 patients were included in the UMIPIC program, 80 of whom died. A total of 258 patients completed 1 year of follow-up and were included in this analysis. The median age was 81.7years (range 77–85.9), and 51.9% were women. The majority had an ejection fraction (EF)>35% and more than half had permanent AF (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Arterial hypertension (AHT), diabetes mellitus, anemia, chronic kidney disease and chronic obstructive pulmonary disease were the most common accompanying comorbidities (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Hospitalizations and emergency department visitsThe 258 patients had 693 hospitalizations during the prefollow-up year, 613 of which were for HF and 80 were for other causes. During the follow-up year, these patients required 174 hospitalizations, 92 of which were for HF and 82 were for other causes. There was a 75% reduction in the total number of hospitalizations (p<.001), at the expense of an 85% reduction in hospitalizations for HF (p<.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no reduction in the number of hospitalizations for other causes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The same analysis was conducted excluding the index hospitalization from the calculation of hospitalizations prior to the follow-up, maintaining a significant reduction during the follow-up year of 74% (355 vs. 92 hospitalizations; p<.001).During the year prior to inclusion, there were 655 emergency department visits, not followed by hospitalization: 440 were for HF and 215 were for other causes. During the follow-up year, the patients visited the emergency department on 302 occasions; 120 for HF and 182 for other causes. This attendance rate represented a 53.9% (p<.001) reduction in emergency department visits for all causes; a 72.8% reduction for HF (p<.001) and a 15.4% reduction for other causes (p=.2) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).If we analyze the number of hospitalizations per patient due to HF in the year prior to inclusion, 57 patients (22%) had only 1 hospitalization, while the rest (201, 78%) were admitted more than once. During the first year of follow-up, only 61 patients (24%) required hospitalization, which resulted in a 76% reduction (p<.001). Of the patients who were readmitted, 41 (16%) had a single hospitalization (38.1% reduction; p=.18) and 20 (8%) had more than 1 (90% reduction; p<.001) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThese results show that the UMIPIC program units, directed by internists and specialized nursing, achieve very significant reductions in the number of hospitalizations and emergency department visits for elderly patients with HF and multiple diseases during the first year of follow-up. This reduction is achieved at the expense of reducing hospitalization for HF.The accumulated evidence on the care of complex patients with HF (such as those in this study) in specialized units is still limited.<a class="elsevierStyleCrossRefs" href="#bib0230">18,19</a> The care of complex patients is more complicated because the influence of the comorbidity can prevail, which hinders therapeutic optimization due to the numerous interactions and poorer tolerance to drugs. The results of clinical trials, obtained in younger patients who predominantly have HF with depressed EF and little comorbidity, cannot be extrapolated to the profile of typical patients in clinical practice, similar to those included in our study.<a class="elsevierStyleCrossRefs" href="#bib0240">20–22</a> Other observational studies with a similar design, conducted by cardiology units, have obtained reductions of 36–87% in the number of hospitalizations.<a class="elsevierStyleCrossRefs" href="#bib0255">23–26</a> In these studies, the treated patients were younger (mean age, 65 years), with 60% having ischemic heart disease, a mean EF of 32% and little comorbidity compared with our sample (AHT, 57%; type 2 diabetes, 37%; chronic renal failure, 4%; anemia, 27%).<a class="elsevierStyleCrossRef" href="#bib0270">26</a>The UMIPIC program units can represent a relevant advance in the medical care of patients with HF and comorbidity, by reducing hospitalization for HF by up to 85%. When we discount the index hospitalization, the results are still satisfactory, with a 74% reduction in hospitalizations for HF. Our study also achieved a marked reduction in emergency department visits, particularly for HF (73%), which constitutes a more novel aspect.As with other studies, the UMIPIC program observed no reduction in hospitalization due to causes not related to HF.<a class="elsevierStyleCrossRef" href="#bib0270">26</a> The reason for this finding might lie in the presence of difficult-to-avoid causes for hospitalization (e.g., hospitalization for surgical indications) or might simply reflect the weight of comorbidity in HF. In any case, our results suggest that comprehensive management of all comorbidities prevents HF decompensations, which are the main reason for hospitalization.It should also be noted that during the follow-up year, not only were fewer patients hospitalized for HF, but there was also a reduction in the number of patients with multiple hospitalizations. A study with a similar design as ours showed that during the follow-up year, the reduction in the number of hospitalizations was especially high among patients with a greater number of previous readmissions.<a class="elsevierStyleCrossRef" href="#bib0270">26</a> These results support the hypothesis that the more hospitalizations for HF a patient has had, the more likely that they will benefit from follow-up in a comprehensive approach unit. Consequently, it is reasonable to state that a program similar to UMIPIC will be more efficient in patients with multiple hospitalizations, while a more conventional follow-up might be sufficient for patients at low risk.<a class="elsevierStyleCrossRef" href="#bib0275">27</a> It is important to emphasize that the UMIPIC program does not require a large infrastructure, and its results are independent of the characteristics and type of hospital center.Although the financial cost analysis was not the objective of this study, considering the significant reduction in hospitalizations, we can infer that costs would very likely also decrease. In particular, if we consider the 2012 data from the Ministry of Health (<a id="intr0020" class="elsevierStyleInterRef" href="http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd.htm">http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd.htm</a>), the diagnosis-related group 544, which corresponds to most of the study patients, had a mean stay of 9.34days, with a mean cost of 4583euros per episode. Extrapolating these data to our study, the reduction of 519 hospitalizations would represent 4847 fewer stays; in other words, a savings of approximate 2,379,133euros in 1 year. This would also include reduced emergency department visits, less resulting travel and reduced care from other specialists. The implementation of these units carries a cost; however, if the financial calculation shown is reasonable, the savings that could result from the UMIPIC program are considerable.<a class="elsevierStyleCrossRef" href="#bib0175">7</a>Study limitationsThe main limitation of this study is that we do not have a rigorously randomized control group to compare the impact of the intervention on the UMIPIC program units. Moreover, it could be argued that patient selection based on a hospitalization would represent a bias. However, even ignoring the index hospitalization, the reduction in hospitalizations was significant. To avoid other biases, we excluded those patients who died during hospitalization and those who did not complete the follow-up year, given that having a having a shorter follow-up time could mean having fewer hospitalizations. It is also possible that the results might have been influenced by the work of involved specialists and specialized centers and are therefore not generalizable. Nevertheless, we believe that it is unlikely, given that the study included a wide range of centers, distributed throughout the country. Another possible criticism could be that the follow-up period of 1 year was insufficient. One year was chosen because it includes the period of greatest risk for readmission, which occurs during the first 3 months after discharge<a class="elsevierStyleCrossRef" href="#bib0150">2</a> and 1 year is typically used in most studies.<a class="elsevierStyleCrossRefs" href="#bib0185">9,10</a> The mean stay of the hospitalizations was not assessed, which other follow-up programs managed to reduce.<a class="elsevierStyleCrossRef" href="#bib0280">28</a>ConclusionThe UMIPIC program, based on comprehensive and continuous care provided by internal medicine departments, has been shown to reduce both the number of hospitalizations and emergency department visits during the first year of follow-up in elderly patients with HF and comorbidity, especially in those who experience a greater number of hospitalizations. New studies are needed to confirm these results, analyze the costs and define the profile of the patient who can benefit most from this intervention.FundingThis study received no funding.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres599585" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec613974" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres599586" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec613975" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and method" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "UMIPIC program" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Study endpoints" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Hospitalizations and emergency department visits" ] ] ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Study limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack201982" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-30" "fechaAceptado" => "2015-07-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec613974" "palabras" => array:4 [ 0 => "Heart failure" 1 => "Elderly" 2 => "Prognosis" 3 => "Follow-up programs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec613975" "palabras" => array:4 [ 0 => "Insuficiencia cardíaca" 1 => "Ancianos" 2 => "Pronóstico" 3 => "Programas de seguimiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesHeart failure (HF) is a disease with high morbidity and mortality. We evaluated the usefulness of the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral para Pacientes con IC [UMIPIC]) program. Patients and methodWe analyzed the patient data from the UMIPIC program, which was recorded in the HF registry (RICA) of the Spanish Society of Internal Medicine. We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the program against those that occurred during the subsequent follow-up year, using the chi-squared test. ResultsA total of 258 patients (mean age, 80 years; 51.9% women) was included in the study. During the previous year, there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up (75% reduction, P<.001). There were 613 hospitalisations for HF during the previous year and 92 during the follow-up (85% reduction, P<.001); 655 vs. 302 in terms of emergency department visits for any cause (53.9% reduction, P<.001); and 440 vs. 120 for emergency department visits for HF (72% reduction, P<.001). There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF. ConclusionsThe UMIPIC program based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosLa insuficiencia cardíaca (IC) es una enfermedad con una elevada morbimortalidad. Evaluamos la utilidad del programa de Unidades de Manejo Integral para Pacientes con IC (UMIPIC). Pacientes y métodoSe analizaron los datos de los pacientes incluidos en el programa UMIPIC, recogidos en el registro de IC (RICA) de la Sociedad Española de Medicina Interna. Se compararon las visitas a Urgencias y las hospitalizaciones por cualquier causa y por IC durante el año anterior a la inclusión en el programa, con las que tuvieron durante el año de seguimiento posterior, usando el test de la chi-cuadrado. ResultadosSe incluyeron 258 pacientes (edad media 80años, 51,9% mujeres). Durante el año previo hubo 693 hospitalizaciones por cualquier causa y 174 durante el seguimiento (reducción del 75%, p<0,001); 613 hospitalizaciones por IC el año antes y 92 durante el seguimiento (reducción del 85%, p<0,001); 655 vs 302 en cuanto a las visitas a Urgencias por cualquier causa (reducción del 53,9%, p<0,001); 440 vs 120 para las visitas a Urgencias por IC (reducción del 72%, p<0,001). No hubo diferencias significativas en el número de hospitalizaciones o visitas a Urgencias por otras causas diferentes a la IC. ConclusionesEl programa UMIPIC basado en la atención integral a pacientes ancianos con IC y comorbilidad reduce el porcentaje de reingresos hospitalarios y visitas a Urgencias durante el primer año de seguimiento." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y 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: Cerqueiro JM, González-Franco A, Montero-Pérez-Barquero M, Llácer P, Conde A, Dávila MF, et al. Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC. Rev Clin Esp. 2016;216:8–14." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "David García Escribá, María Esther Guisado Espartero, Gonzalo Martínez de las Cuevas, Benjamín Muñoz Calvo, Carlos Enrique Sabbagh Fajardo, Alejandro Martín Ezquerro, Manuel Lorenzo López Reboiro, Héctor Guerrero Sande, Jorge Marrero Francés, Sonia Gonzalo Pascua, María Eugenia Arkuch, Sheyla Martin Barba, María Sánchez Moruno, Purificación Durán García, David García Escrivá, María Ángeles Tur Cervantes, María Cristina Gambra Michel, Isabel Arias Miranda, Carmen Fernández Pizarro, José Manuel Gómez Sousa and Adriana Souto Peleteiro." "etiqueta" => "Appendix" "titulo" => "Collaborators" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 818 "Ancho" => 1636 "Tamanyo" => 82286 ] ] "descripcion" => array:1 [ "en" => "Hospitalizations for heart failure (HF) and other causes during the year prior to inclusion in the UMIPIC program (blue bars) and the subsequent follow-up year (orange bars)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 859 "Ancho" => 1614 "Tamanyo" => 68259 ] ] "descripcion" => array:1 [ "en" => "Emergency department visits for heart failure (HF) and other causes during the year prior to inclusion in the UMIPIC program (blue bars) and during the subsequent follow-up year (orange bars)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 844 "Ancho" => 1597 "Tamanyo" => 58776 ] ] "descripcion" => array:1 [ "en" => "Rate of readmissions for heart failure (HF) during the year prior to inclusion in the UMIPIC program (blue bars) and during the subsequent follow-up year (orange bars)." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: C1–C3, first and third quartile; COPD, chronic obstructive pulmonary disease; Me, median; n, number; %, percentage." "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="" 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">N=258 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Age and sex</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(Me, C1–C3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.7 (77–85.9) \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">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 (51.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Heart disease</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertensive heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104 (40.3%) \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">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (22.1%) \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">Ejection fraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(Me, C1–C3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (40–62) \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">Ejection fraction <35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (13.4%) \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">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 (60.5%) \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">Previous heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">172 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">226 (87.6%) \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">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (44%) \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">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (50%) \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">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (28%) \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">Cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (14.3%) \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">Renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (41.5%) \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">Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 (55%) \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">Peripheral artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (8.9%) \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">Cerebrovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (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">Liver disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (4.3%) \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">Dementia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (3.1%) \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">Charlson index >3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (30.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Cognitive and functional state and social support</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pfeiffer index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(Me, C1–C3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \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">Barthel index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(Me, C1–C3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (80–100) \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">Institutionalized \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (7.6%) \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">Family support \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">252 (97.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab980922.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Population characteristics assessed at the time of inclusion in the UMIPIC program units." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in cardiovascular hospitalization and comorbidity of heart failure in the United States: findings from the National Hospital Discharge Surveys 1980–2006" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2009.11.037" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2011" "volumen" => "149" "paginaInicial" => "39" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20060181" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rehospitalatizations among patients in the Medicare fee-for-service program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.F. Jencks" 1 => "M.V. William" 2 => "E.A. Coleman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa0803563" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "1418" "paginaFinal" => "1428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología de la insuficiencia cardiaca aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Montes-Santiago" 1 => "J.C. Arévalo" 2 => "J.M. Cerqueiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2014" "volumen" => "142" "numero" => "Suppl 1" "paginaInicial" => "3" "paginaFinal" => "8" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in comorbidity, disability and polypharmacy in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.Y. Wong" 1 => "S.I. Chaudhry" 2 => "M.M. Desai" 3 => "H.M. Krumholz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2010.08.017" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2011" "volumen" => "124" "paginaInicial" => "136" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21295193" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HFSA 2010 Comprehensive Heart Failure Practice Guideline Heart Failure Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Lindenfeld" 1 => "N.M. Albert" 2 => "J.P. Boehmer" 3 => "S.P. Collins" 4 => "J.A. Ezekowitz" 5 => "M.M. Givertz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2009.12.001" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "1" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20123311" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Dharmarajan" 1 => "A.F. Hsieh" 2 => "Z. Lin" 3 => "H. Bueno" 4 => "J.S. Ross" 5 => "L.I. Horwitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.216476" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "309" "paginaInicial" => "355" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23340637" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Programas de intervención en la IC: análisis crítico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Anguita Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol Supl" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "45" "paginaFinal" => "56" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J.V. McMurray" 1 => "S. Adamopoulos" 2 => "S.D. Anker" 3 => "A. Auricchio" 4 => "M. Böhm" 5 => "K. Dickstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehs104" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "1787" "paginaFinal" => "1847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22611136" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical service organisation for heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Takeda" 1 => "S.J. Taylor" 2 => "R.S. Taylor" 3 => "F. Khan" 4 => "H. Krum" 5 => "M. Underwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "9" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidisciplinary strategies for the management of heart failure patients at high risk for admission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.A. McAlister" 1 => "S. Stewart" 2 => "S. Ferrua" 3 => "J.J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2004.05.055" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "44" "paginaInicial" => "810" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15312864" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transitional care interventions to prevent readmissions for persons with heart failure. A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Felther" 1 => "C.D. Jones" 2 => "W.C. Cené" 3 => "Z.J. Zheng" 4 => "C.A. Sueta" 5 => "E.J. Coker-Schwimmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M14-0083" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2014" "volumen" => "160" "paginaInicial" => "774" "paginaFinal" => "784" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862840" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.W. Yancy" 1 => "M. Jessup" 2 => "B. Bozkurt" 3 => "J. Butler" 4 => "D.E. Casey Jr." 5 => "M.H. Drazner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31829e8776" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "128" "paginaInicial" => "e240" "paginaFinal" => "e327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23741058" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigadores del Registro BADAPIC. Características clínicas, tratamiento y morbimortalidad a corto plazo de pacientes con insuficiencia cardiaca controlados en consultas específicas de insuficiencia cardiaca. Resultados del Registro BADAPIC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Anguita Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2004" "volumen" => "57" "paginaInicial" => "1159" "paginaFinal" => "1169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15617639" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reducción de ingresos hospitalarios tras la implantación de un programa multidisciplinario de insuficiencia cardiaca en Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Méndez Bailón" 1 => "N. Muñoz Rivas" 2 => "J. Ortiz Alonso" 3 => "L. Audibert Mena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "130" "paginaInicial" => "476" "paginaFinal" => "477" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados asistenciales de una consulta monográfica para pacientes con insuficiencia cardiaca. Estudio de cohortes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Cerqueiro González" 1 => "F. Terrón Pérez" 2 => "C. Abeledo Vázquez" 3 => "M.J. López Díaz" 4 => "M. Matesanz Fernández" 5 => "E. Casariego Vales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Galicia Clin" "fecha" => "2010" "volumen" => "71" "paginaInicial" => "103" "paginaFinal" => "110" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigadores del registro RICA. ¿Se ha incrementado el uso de bloqueadores beta en pacientes con insuficiencia cardiaca en medicina interna? Implicaciones pronósticas: registro RICA" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. González-García" 1 => "M. Montero Pérez-Barquero" 2 => "F. Formiga" 3 => "J.R. González-Juanatey" 4 => "M.A. Quesada" 5 => "F. Epelde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2013.07.012" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "196" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24774394" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal functional status three-month mortality after a heart failure hospitalization in elderly patients. The prospective RICA study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Formiga" 1 => "D. Chivite" 2 => "A. Conde" 3 => "F. Ruiz-Laiglesia" 4 => "A.G. Franco" 5 => "C.P. Bocanegra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2013.12.169" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2014" "volumen" => "172" "paginaInicial" => "127" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24452223" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multidisciplinary intervention to prevent the readmision of elderly patients with congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.V. Rich" 1 => "V. Beckham" 2 => "C. Wittenberg" 3 => "C.L. Leven" 4 => "K.E. Freedland" 5 => "R.M. Carney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199511023331806" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1995" "volumen" => "333" "paginaInicial" => "1190" "paginaFinal" => "1195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7565975" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comprehensive discharge planing for the hospitalized elderly: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Naylor" 1 => "D. Brooten" 2 => "R. Jones" 3 => "R. Lavizzo-Mourey" 4 => "M. Mezey" 5 => "M. Pauly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1994" "volumen" => "120" "paginaInicial" => "999" "paginaFinal" => "1006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8185149" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure in very old adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.E. Forman" 1 => "A. Ahmed" 2 => "J.L. Fleg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Heart Fail Resp" "fecha" => "2013" "volumen" => "10" "paginaInicial" => "387" "paginaFinal" => "400" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of frailty in patients with cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Singh" 1 => "R. Stewart" 2 => "H. White" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu197" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "1726" "paginaFinal" => "1731" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24864078" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of elderly patients with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Manzano" 1 => "C. Escobar" 2 => "J.G. Cleland" 3 => "M. Flather" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfs109" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "1097" "paginaFinal" => "1103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22771845" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comprehensive management system for heart failure improves clinical outcomes and reduces medical resources utilisation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. West" 1 => "N.H. Miller" 2 => "K.M. Parker" 3 => "D. Senneca" 4 => "G. Ghandour" 5 => "M. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1997" "volumen" => "79" "paginaInicial" => "58" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9024737" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.E. Smith" 1 => "S.A. Fabri" 2 => "R. Pai" 3 => "D. Ferry" 4 => "T. Heywood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "1997" "volumen" => "20" "paginaInicial" => "949" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9383589" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of heart failure program on hospitalization frequency and exercise tolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Hanumanthu" 1 => "J. Butker" 2 => "D. Chomsky" 3 => "S. Davis" 4 => "J.R. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1997" "volumen" => "96" "paginaInicial" => "2842" "paginaFinal" => "2848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9386147" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reducción de los ingresos por IC en el primer año de seguimiento en una unidad multidisciplinaria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Lupón" 1 => "T. Parajón" 2 => "A. Urrutia" 3 => "B. González" 4 => "J. Herreros" 5 => "S. Altimir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2005" "volumen" => "58" "paginaInicial" => "374" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15847734" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "On behalf of the NorthStar Investigators, all members of The Danish Heart Failure Clinics Network. Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (NorthStar)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Shou" 1 => "F. Gustafsson" 2 => "L. Videbaek" 3 => "C. Tuxen" 4 => "N. Keller" 5 => "J. Handberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehs235" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "432" "paginaFinal" => "442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22875412" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacto sobre la morbimortalidad de la insuficiencia cardiaca: estudio comparativo del manejo por una unidad de IC respecto al manejo convencional" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Comin-Colet" 1 => "D. Viles" 2 => "J. Martí" 3 => "R. Serrat" 4 => "L. Recasesns" 5 => "J. Vila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2002" "volumen" => "55" "numero" => "Suppl 2" "paginaInicial" => "145" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack201982" "titulo" => "Acknowledgments" "texto" => "We would like to thank the center coordinator of the RICA registry (S&H Medical Science Service) for their monitoring, logistical and administrative support. We would also like to thank the laboratory Menarini for their support in creating and maintaining the RICA registry, through an unconditional grant." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415000892/v1_201601280010/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021600000001/v1_201601280010/S2254887415000892/v1_201601280010/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000892?idApp=WRCEE"]

Statistics

Original article

Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program

Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC

J.M. Cerqueiroa,

Corresponding author

jmcerqueiro@lugonautas.com

Corresponding author.

, A. González-Francob, M. Montero-Pérez-Barqueroc, P. Llácerd, A. Condee, M.F. Dávilaf, M. Carrerag, A. Serradoh, I. Suárezi, J. Pérez-Silvestrej, J.A. Satuék, J.C. Arévalo-Loridol, A. Rodríguezm, A. Herreron, R. Jordanao, L. Manzanop

a Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain

b Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

c Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain

d Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, Spain

e Servicio de Medicina Interna, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain

f Servicio de Medicina Interna, Hospital Universitario Ntra. Señora de la Candelaria, Santa Cruz de Tenerife, Spain

g Servicio de Medicina Interna, Complejo Hospitalario de Soria, Soria, Spain

h Servicio de Medicina Interna, Hospital Municipal de Badalona, Badalona, Barcelona, Spain

i Servicio de Medicina Interna, Hospital Valle del Nalón, Langreo, Asturias, Spain

j Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain

k Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain

l Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain

m Servicio de Medicina Interna, Hospital Universitario Xeral-Cies de Vigo, Vigo, Pontevedra, Spain

n Servicio de Medicina Interna, Hospital Nuestra Señora del Prado, Toledo, Spain

o Servicio de Medicina Interna, Corporaciò Sanitaria Parc Taulí, Sabadell, Barcelona, Spain

p Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain

Read

249

Times
was read the article

Total PDF

242

Total HTML

Share statistics

 array:24 [
  "pii" => "S2254887415000892"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2015.09.003"
  "estado" => "S300"
  "fechaPublicacion" => "2016-01-01"
  "aid" => "1181"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Clin Esp. 2016;216:8-14"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 238
    "formatos" => array:2 [
      "HTML" => 235
      "PDF" => 3
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256515001976"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2015.07.006"
      "estado" => "S300"
      "fechaPublicacion" => "2016-01-01"
      "aid" => "1181"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Clin Esp. 2016;216:8-14"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 869
        "formatos" => array:2 [
          "HTML" => 244
          "PDF" => 625
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Reducci&#243;n de ingresos y visitas a Urgencias en pacientes fr&#225;giles con insuficiencia card&#237;aca&#58; resultados del programa asistencial UMIPIC"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "8"
            "paginaFinal" => "14"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Reduction in hospitalisations and emergency department visits for frail patients with heart failure&#58; Results of the UMIPIC healthcare programme"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 844
                "Ancho" => 1597
                "Tamanyo" => 57141
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Frecuencia de los reingresos por insuficiencia cardiaca &#40;IC&#41; durante el a&#241;o anterior a la inclusi&#243;n en el programa UMIPIC &#40;barras azules&#41; y durante el a&#241;o de seguimiento posterior &#40;barras naranja&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46;M&#46; Cerqueiro, A&#46; Gonz&#225;lez-Franco, M&#46; Montero-P&#233;rez-Barquero, P&#46; Ll&#225;cer, A&#46; Conde, M&#46;F&#46; D&#225;vila, M&#46; Carrera, A&#46; Serrado, I&#46; Su&#225;rez, J&#46; P&#233;rez-Silvestre, J&#46;A&#46; Satu&#233;, J&#46;C&#46; Ar&#233;valo-Lorido, A&#46; Rodr&#237;guez, A&#46; Herrero, R&#46; Jordana, L&#46; Manzano"
            "autores" => array:16 [
              0 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Cerqueiro"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Gonz&#225;lez-Franco"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Montero-P&#233;rez-Barquero"
              ]
              3 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Ll&#225;cer"
              ]
              4 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Conde"
              ]
              5 => array:2 [
                "nombre" => "M&#46;F&#46;"
                "apellidos" => "D&#225;vila"
              ]
              6 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Carrera"
              ]
              7 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Serrado"
              ]
              8 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Su&#225;rez"
              ]
              9 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "P&#233;rez-Silvestre"
              ]
              10 => array:2 [
                "nombre" => "J&#46;A&#46;"
                "apellidos" => "Satu&#233;"
              ]
              11 => array:2 [
                "nombre" => "J&#46;C&#46;"
                "apellidos" => "Ar&#233;valo-Lorido"
              ]
              12 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Rodr&#237;guez"
              ]
              13 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Herrero"
              ]
              14 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Jordana"
              ]
              15 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Manzano"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887415000892"
          "doi" => "10.1016/j.rceng.2015.09.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000892?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515001976?idApp=WRCEE"
      "url" => "/00142565/0000021600000001/v1_201601280010/S0014256515001976/v1_201601280010/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887415000910"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2015.09.005"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "1183"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Rev Clin Esp. 2016;216:15-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 21
      "formatos" => array:2 [
        "HTML" => 19
        "PDF" => 2
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Brief original</span>"
      "titulo" => "Compliance with the guidelines of the European Society of Cardiology and morbidity and mortality from infectious endocarditis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "15"
          "paginaFinal" => "18"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Cumplimiento de las gu&#237;as de la Sociedad Europea de Cardiolog&#237;a y morbimortalidad por endocarditis infecciosa"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Rodr&#237;guez Esteban, L&#46; Carballo Arzola, S&#46; Miranda Montero, M&#46; Farrais Villalba, J&#46;A&#46; Medina Garc&#237;a, J&#46; Ode Febles"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Rodr&#237;guez Esteban"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Carballo Arzola"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Miranda Montero"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Farrais Villalba"
            ]
            4 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Medina Garc&#237;a"
            ]
            5 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ode Febles"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S001425651500199X"
        "doi" => "10.1016/j.rce.2015.07.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651500199X?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000910?idApp=WRCEE"
    "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415000910/v1_201601280010/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887415001149"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2015.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "1207"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2016;216:1-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 21
      "formatos" => array:2 [
        "HTML" => 19
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "The clinical profile of women with stable ischemic heart disease in Spain&#46; More effort is needed in secondary prevention&#46; SIRENA study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "7"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Perfil cl&#237;nico de la mujer con cardiopat&#237;a isqu&#233;mica estable en Espa&#241;a&#46; Son necesarios m&#225;s esfuerzos en prevenci&#243;n secundaria&#46; Estudio SIRENA"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1021
              "Ancho" => 1590
              "Tamanyo" => 54145
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Coronary arteries affected with significant lesions &#40;&#8805;50&#37;&#41;&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; DA&#44; descending anterior&#59; Cx&#44; circumflex&#59; RC&#44; right coronary artery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;M&#46; G&#225;mez, T&#46; Ripoll, V&#46; Barrios, M&#46; Anguita, M&#46; Pedreira, I&#46; Madariaga"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "G&#225;mez"
            ]
            1 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Ripoll"
            ]
            2 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Barrios"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Anguita"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Pedreira"
            ]
            5 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Madariaga"
            ]
            6 => array:1 [
              "colaborador" => "representing investigadores del estudio SIRENA"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256515002519"
        "doi" => "10.1016/j.rce.2015.09.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515002519?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415001149?idApp=WRCEE"
    "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415001149/v1_201601280010/en/main.assets"
  ]
  "en" => array:22 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Reduction in hospitalizations and emergency department visits for frail patients with heart failure&#58; Results of the UMIPIC healthcare program"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "8"
        "paginaFinal" => "14"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46;M&#46; Cerqueiro, A&#46; Gonz&#225;lez-Franco, M&#46; Montero-P&#233;rez-Barquero, P&#46; Ll&#225;cer, A&#46; Conde, M&#46;F&#46; D&#225;vila, M&#46; Carrera, A&#46; Serrado, I&#46; Su&#225;rez, J&#46; P&#233;rez-Silvestre, J&#46;A&#46; Satu&#233;, J&#46;C&#46; Ar&#233;valo-Lorido, A&#46; Rodr&#237;guez, A&#46; Herrero, R&#46; Jordana, L&#46; Manzano"
        "autores" => array:16 [
          0 => array:4 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Cerqueiro"
            "email" => array:1 [
              0 => "jmcerqueiro&#64;lugonautas&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Gonz&#225;lez-Franco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Montero-P&#233;rez-Barquero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Ll&#225;cer"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Conde"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46;F&#46;"
            "apellidos" => "D&#225;vila"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Carrera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Serrado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Su&#225;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "P&#233;rez-Silvestre"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "J&#46;A&#46;"
            "apellidos" => "Satu&#233;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Ar&#233;valo-Lorido"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">m</span>"
                "identificador" => "aff0065"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Herrero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">n</span>"
                "identificador" => "aff0070"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Jordana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">o</span>"
                "identificador" => "aff0075"
              ]
            ]
          ]
          15 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Manzano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">p</span>"
                "identificador" => "aff0080"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:16 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Lucus Augusti&#44; Lugo&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#44; Asturias&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; IMIBIC&#47;Hospital Universitario Reina Sof&#237;a&#44; Universidad de C&#243;rdoba&#44; C&#243;rdoba&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital de Manises&#44; Manises&#44; Valencia&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Dr&#46; Negr&#237;n&#44; Las Palmas de Gran Canaria&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Ntra&#46; Se&#241;ora de la Candelaria&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Complejo Hospitalario de Soria&#44; Soria&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Municipal de Badalona&#44; Badalona&#44; Barcelona&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Valle del Nal&#243;n&#44; Langreo&#44; Asturias&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Consorcio Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario de Fuenlabrada&#44; Fuenlabrada&#44; Madrid&#44; Spain"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Comarcal de Zafra&#44; Zafra&#44; Badajoz&#44; Spain"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
          12 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Xeral-Cies de Vigo&#44; Vigo&#44; Pontevedra&#44; Spain"
            "etiqueta" => "m"
            "identificador" => "aff0065"
          ]
          13 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Nuestra Se&#241;ora del Prado&#44; Toledo&#44; Spain"
            "etiqueta" => "n"
            "identificador" => "aff0070"
          ]
          14 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Corporaci&#242; Sanitaria Parc Taul&#237;&#44; Sabadell&#44; Barcelona&#44; Spain"
            "etiqueta" => "o"
            "identificador" => "aff0075"
          ]
          15 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "p"
            "identificador" => "aff0080"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Reducci&#243;n de ingresos y visitas a Urgencias en pacientes fr&#225;giles con insuficiencia card&#237;aca&#58; resultados del programa asistencial UMIPIC"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 818
            "Ancho" => 1636
            "Tamanyo" => 82286
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for heart failure &#40;HF&#41; and other causes during the year prior to inclusion in the UMIPIC program &#40;blue bars&#41; and the subsequent follow-up year &#40;orange bars&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; is one of the most common causes of hospitalization in developed countries&#44; especially for elderly patients&#46; In the population older than 65<span class="elsevierStyleHsp" style=""></span>years&#44; the annual rate of hospitalization for HF in the United States is estimated at 21 per 1000&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> and constitutes the main cause of hospitalization in this age group&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> A third of these hospitalizations are readmissions that occur within 90<span class="elsevierStyleHsp" style=""></span>days of the hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Spain&#44; HF generates more than 100&#44;000 hospitalizations per year and represents approximately 2&#37; of emergency department visits&#44; with an annual mortality of 10&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> The costs associated with HF reach 2500 billion euros annually&#44; which are mostly for hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> This considerably high rate of hospitalization is due to the comorbidity and advanced age of these patients&#44; which also entails fragmented care&#44; which limits the application of clinical practice guidelines &#40;CPGs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> Patients with HF can therefore be considered frail and at high risk of readmission&#44; not only for HF but also for other causes&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;6</span></a> In this context&#44; conventional care and follow-up can be inefficient&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">American and European CPGs<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;8</span></a> recommend including patients with HF in special follow-up programs &#40;recommendation IA&#41;&#44; as an effective measure for reducing readmissions&#46; The efficacy of this measure has been demonstrated in numerous studies and meta-analyses&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9&#8211;11</span></a> although not specifically in complex chronically ill patients&#44; due to their comorbidity&#46; In recent years&#44; numerous follow-up models have emerged for patients with HF&#46; In general&#44; the models are heterogeneous and difficult to compare because they include numerous issues&#44; from care in a multidisciplinary consultation&#44; home care through telephone calls&#44; specific nursing programs&#44; among others&#46; The latest CPGs of the American Heart Association identify the healthcare model formed by multidisciplinary teams as the most effective for reducing the hospitalizations and mortality of patients with HF&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our country&#44; there are conventional HF units that have shown their efficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> However&#44; the experience with more elderly patients and increased comorbidity is limited&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2011&#44; the HF and atrial fibrillation &#40;AF&#41; group of the Spanish Society of Internal Medicine &#40;SEMI&#41; promoted the creation of specialized healthcare units aimed at the care of patients with HF and multiple diseases&#44; under the program name &#8220;Comprehensive Management Units for Patients with HF&#8221; &#40;<span class="elsevierStyleItalic">Unidades de Manejo Integral para Pacientes con IC</span>&#44; UMIPIC&#41;&#46; The aim of this study was to analyze the potential clinical benefit in terms of the reduction in the number of hospitalizations and emergency department visits for patients with HF and comorbidities who were treated in the program&#39;s units&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Data were obtained from the patients included in the RICA-UMIPIC registry between November 2011 and November 2013&#46; The RICA registry is a multicenter&#44; prospective cohort registry&#44; coordinated by SEMI&#39;s HF and AF group&#44; whose characteristics have been described in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">15&#44;16</span></a> The registry consecutively includes patients hospitalized for an episode of decompensated HF&#46; The data are entered anonymously through the website <a id="intr0010" class="elsevierStyleInterRef" href="http://www.registrorica.org/">http&#58;&#47;&#47;www&#46;registrorica&#46;org</a>&#46; The study protocol was approved by the Ethics Committee of University Hospital Reina Sofia of Cordoba&#44; and informed consent was obtained from all patients before their inclusion&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For inclusion in the RICA registry&#44; the patients had to be older than 50<span class="elsevierStyleHsp" style=""></span>years and be hospitalized for decompensated HF according to the criteria of the European Society of Cardiology&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">UMIPIC program</span><p id="par0040" class="elsevierStylePara elsevierViewall">The UMIPIC program is an initiative promoted by the SEMI&#39;s HF and AF group and offers comprehensive and continuous care for complex&#44; chronically ill elderly patients with HF &#40;<a id="intr0015" class="elsevierStyleInterRef" href="http://www.fesemi.org/grupos/cardiaca/umipic/programa/view">http&#58;&#47;&#47;www&#46;fesemi&#46;org&#47;grupos&#47;cardiaca&#47;umipic&#47;programa&#47;view</a>&#41;&#46; The program integrates 23 units distributed throughout the country&#46; For inclusion in the UMIPIC program&#44; patients had to meet the general RICA criteria&#46; Exclusion criteria included the need for follow-up by the Department of Cardiology &#40;patients with ischemia who required catheterization&#44; device implantation&#44; eligible for prosthetic valves&#44; in an advanced functional condition awaiting heart transplantation&#41; and the lack of a functional and cognitive state sufficient to attend the hospital consultations and ensure correct therapeutic compliance&#44; unless appropriate socio-family support was available&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All units are equipped with nursing staff and offer follow-up according to an intensive protocolized program&#44; based on 4 aspects&#58; &#40;1&#41; comprehensive clinical approach&#44; with care for HF and present comorbidities&#59; &#40;2&#41; ongoing follow-up that includes face-to-face visits and telephone contact&#44; as well as hospital care during hospitalization&#59; &#40;3&#41; regulated teaching in self-care and support measures and the involvement of the patient and&#47;or caregiver&#59; and &#40;4&#41; flexibility and accessibility necessary to assist patients in conditions of unscheduled decompensation&#46; The follow-up includes medical and nursing consultations&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For this study&#44; we only assessed patients who completed 1 year of follow-up&#46; Patients who died during this period or did not complete it were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study endpoints</span><p id="par0055" class="elsevierStylePara elsevierViewall">At the time the patients were included&#44; their demographic variables were recorded&#44; along with their medical history and characteristics&#59; laboratory data&#59; and electrocardiographic and echocardiographic parameters&#59; and treatment parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">16&#44;17</span></a> As assessment endpoints&#44; we considered hospitalizations and emergency department visits &#40;without hospitalization&#41; due to HF or other causes during the year prior to the index hospitalization and during the first year of follow-up&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the sample using the median and interquartile range for the quantitative variables &#40;none followed a normal distribution&#41; and percentage for the categorical variables&#46; For the statistical analysis&#44; 2 consecutive time periods were considered&#58; the year prior to and the year after the hospital discharge data for the index hospitalization&#44; in which each patient began their follow-up by a unit integrated into the UMIPIC program&#46; In the comparison of qualitative variables&#44; we employed the chi-squared test&#46; In the comparison of quantitative variables&#44; prior to the normality study&#44; we employed Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired data or the Wilcoxon test when the variables did not follow a normal distribution&#46; The statistical package SPSS 17&#46;0 was used for this study&#46; The level of statistical significance was established at a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Baseline characteristics</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the study period&#44; 460 patients were included in the UMIPIC program&#44; 80 of whom died&#46; A total of 258 patients completed 1 year of follow-up and were included in this analysis&#46; The median age was 81&#46;7<span class="elsevierStyleHsp" style=""></span>years &#40;range 77&#8211;85&#46;9&#41;&#44; and 51&#46;9&#37; were women&#46; The majority had an ejection fraction &#40;EF&#41;<span class="elsevierStyleHsp" style=""></span>&#62;35&#37; and more than half had permanent AF &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Arterial hypertension &#40;AHT&#41;&#44; diabetes mellitus&#44; anemia&#44; chronic kidney disease and chronic obstructive pulmonary disease were the most common accompanying comorbidities &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Hospitalizations and emergency department visits</span><p id="par0070" class="elsevierStylePara elsevierViewall">The 258 patients had 693 hospitalizations during the prefollow-up year&#44; 613 of which were for HF and 80 were for other causes&#46; During the follow-up year&#44; these patients required 174 hospitalizations&#44; 92 of which were for HF and 82 were for other causes&#46; There was a 75&#37; reduction in the total number of hospitalizations &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; at the expense of an 85&#37; reduction in hospitalizations for HF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There was no reduction in the number of hospitalizations for other causes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The same analysis was conducted excluding the index hospitalization from the calculation of hospitalizations prior to the follow-up&#44; maintaining a significant reduction during the follow-up year of 74&#37; &#40;355 vs&#46; 92 hospitalizations&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">During the year prior to inclusion&#44; there were 655 emergency department visits&#44; not followed by hospitalization&#58; 440 were for HF and 215 were for other causes&#46; During the follow-up year&#44; the patients visited the emergency department on 302 occasions&#59; 120 for HF and 182 for other causes&#46; This attendance rate represented a 53&#46;9&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; reduction in emergency department visits for all causes&#59; a 72&#46;8&#37; reduction for HF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and a 15&#46;4&#37; reduction for other causes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;2&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">If we analyze the number of hospitalizations per patient due to HF in the year prior to inclusion&#44; 57 patients &#40;22&#37;&#41; had only 1 hospitalization&#44; while the rest &#40;201&#44; 78&#37;&#41; were admitted more than once&#46; During the first year of follow-up&#44; only 61 patients &#40;24&#37;&#41; required hospitalization&#44; which resulted in a 76&#37; reduction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Of the patients who were readmitted&#44; 41 &#40;16&#37;&#41; had a single hospitalization &#40;38&#46;1&#37; reduction&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;18&#41; and 20 &#40;8&#37;&#41; had more than 1 &#40;90&#37; reduction&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">These results show that the UMIPIC program units&#44; directed by internists and specialized nursing&#44; achieve very significant reductions in the number of hospitalizations and emergency department visits for elderly patients with HF and multiple diseases during the first year of follow-up&#46; This reduction is achieved at the expense of reducing hospitalization for HF&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The accumulated evidence on the care of complex patients with HF &#40;such as those in this study&#41; in specialized units is still limited&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18&#44;19</span></a> The care of complex patients is more complicated because the influence of the comorbidity can prevail&#44; which hinders therapeutic optimization due to the numerous interactions and poorer tolerance to drugs&#46; The results of clinical trials&#44; obtained in younger patients who predominantly have HF with depressed EF and little comorbidity&#44; cannot be extrapolated to the profile of typical patients in clinical practice&#44; similar to those included in our study&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">20&#8211;22</span></a> Other observational studies with a similar design&#44; conducted by cardiology units&#44; have obtained reductions of 36&#8211;87&#37; in the number of hospitalizations&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">23&#8211;26</span></a> In these studies&#44; the treated patients were younger &#40;mean age&#44; 65 years&#41;&#44; with 60&#37; having ischemic heart disease&#44; a mean EF of 32&#37; and little comorbidity compared with our sample &#40;AHT&#44; 57&#37;&#59; type 2 diabetes&#44; 37&#37;&#59; chronic renal failure&#44; 4&#37;&#59; anemia&#44; 27&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The UMIPIC program units can represent a relevant advance in the medical care of patients with HF and comorbidity&#44; by reducing hospitalization for HF by up to 85&#37;&#46; When we discount the index hospitalization&#44; the results are still satisfactory&#44; with a 74&#37; reduction in hospitalizations for HF&#46; Our study also achieved a marked reduction in emergency department visits&#44; particularly for HF &#40;73&#37;&#41;&#44; which constitutes a more novel aspect&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As with other studies&#44; the UMIPIC program observed no reduction in hospitalization due to causes not related to HF&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> The reason for this finding might lie in the presence of difficult-to-avoid causes for hospitalization &#40;e&#46;g&#46;&#44; hospitalization for surgical indications&#41; or might simply reflect the weight of comorbidity in HF&#46; In any case&#44; our results suggest that comprehensive management of all comorbidities prevents HF decompensations&#44; which are the main reason for hospitalization&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">It should also be noted that during the follow-up year&#44; not only were fewer patients hospitalized for HF&#44; but there was also a reduction in the number of patients with multiple hospitalizations&#46; A study with a similar design as ours showed that during the follow-up year&#44; the reduction in the number of hospitalizations was especially high among patients with a greater number of previous readmissions&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> These results support the hypothesis that the more hospitalizations for HF a patient has had&#44; the more likely that they will benefit from follow-up in a comprehensive approach unit&#46; Consequently&#44; it is reasonable to state that a program similar to UMIPIC will be more efficient in patients with multiple hospitalizations&#44; while a more conventional follow-up might be sufficient for patients at low risk&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> It is important to emphasize that the UMIPIC program does not require a large infrastructure&#44; and its results are independent of the characteristics and type of hospital center&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although the financial cost analysis was not the objective of this study&#44; considering the significant reduction in hospitalizations&#44; we can infer that costs would very likely also decrease&#46; In particular&#44; if we consider the 2012 data from the Ministry of Health &#40;<a id="intr0020" class="elsevierStyleInterRef" href="http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd.htm">http&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;estadEstudios&#47;estadisticas&#47;cmbd&#46;htm</a>&#41;&#44; the diagnosis-related group 544&#44; which corresponds to most of the study patients&#44; had a mean stay of 9&#46;34<span class="elsevierStyleHsp" style=""></span>days&#44; with a mean cost of 4583<span class="elsevierStyleHsp" style=""></span>euros per episode&#46; Extrapolating these data to our study&#44; the reduction of 519 hospitalizations would represent 4847 fewer stays&#59; in other words&#44; a savings of approximate 2&#44;379&#44;133<span class="elsevierStyleHsp" style=""></span>euros in 1 year&#46; This would also include reduced emergency department visits&#44; less resulting travel and reduced care from other specialists&#46; The implementation of these units carries a cost&#59; however&#44; if the financial calculation shown is reasonable&#44; the savings that could result from the UMIPIC program are considerable&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study limitations</span><p id="par0120" class="elsevierStylePara elsevierViewall">The main limitation of this study is that we do not have a rigorously randomized control group to compare the impact of the intervention on the UMIPIC program units&#46; Moreover&#44; it could be argued that patient selection based on a hospitalization would represent a bias&#46; However&#44; even ignoring the index hospitalization&#44; the reduction in hospitalizations was significant&#46; To avoid other biases&#44; we excluded those patients who died during hospitalization and those who did not complete the follow-up year&#44; given that having a having a shorter follow-up time could mean having fewer hospitalizations&#46; It is also possible that the results might have been influenced by the work of involved specialists and specialized centers and are therefore not generalizable&#46; Nevertheless&#44; we believe that it is unlikely&#44; given that the study included a wide range of centers&#44; distributed throughout the country&#46; Another possible criticism could be that the follow-up period of 1 year was insufficient&#46; One year was chosen because it includes the period of greatest risk for readmission&#44; which occurs during the first 3 months after discharge<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> and 1 year is typically used in most studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9&#44;10</span></a> The mean stay of the hospitalizations was not assessed&#44; which other follow-up programs managed to reduce&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The UMIPIC program&#44; based on comprehensive and continuous care provided by internal medicine departments&#44; has been shown to reduce both the number of hospitalizations and emergency department visits during the first year of follow-up in elderly patients with HF and comorbidity&#44; especially in those who experience a greater number of hospitalizations&#46; New studies are needed to confirm these results&#44; analyze the costs and define the profile of the patient who can benefit most from this intervention&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study received no funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres599585"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Patients and method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec613974"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres599586"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Pacientes y m&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec613975"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and method"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "UMIPIC program"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Study endpoints"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Baseline characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Hospitalizations and emergency department visits"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Study limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "xack201982"
          "titulo" => "Acknowledgments"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-03-30"
    "fechaAceptado" => "2015-07-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec613974"
          "palabras" => array:4 [
            0 => "Heart failure"
            1 => "Elderly"
            2 => "Prognosis"
            3 => "Follow-up programs"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec613975"
          "palabras" => array:4 [
            0 => "Insuficiencia card&#237;aca"
            1 => "Ancianos"
            2 => "Pron&#243;stico"
            3 => "Programas de seguimiento"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Heart failure &#40;HF&#41; is a disease with high morbidity and mortality&#46; We evaluated the usefulness of the Comprehensive Management Units for Patients with HF &#40;<span class="elsevierStyleItalic">Unidades de Manejo Integral para Pacientes con IC</span> &#91;UMIPIC&#93;&#41; program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We analyzed the patient data from the UMIPIC program&#44; which was recorded in the HF registry &#40;RICA&#41; of the Spanish Society of Internal Medicine&#46; We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the program against those that occurred during the subsequent follow-up year&#44; using the chi-squared test&#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 258 patients &#40;mean age&#44; 80 years&#59; 51&#46;9&#37; women&#41; was included in the study&#46; During the previous year&#44; there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up &#40;75&#37; reduction&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; There were 613 hospitalisations for HF during the previous year and 92 during the follow-up &#40;85&#37; reduction&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; 655 vs&#46; 302 in terms of emergency department visits for any cause &#40;53&#46;9&#37; reduction&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; and 440 vs&#46; 120 for emergency department visits for HF &#40;72&#37; reduction&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The UMIPIC program based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La insuficiencia card&#237;aca &#40;IC&#41; es una enfermedad con una elevada morbimortalidad&#46; Evaluamos la utilidad del programa de Unidades de Manejo Integral para Pacientes con IC &#40;UMIPIC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron los datos de los pacientes incluidos en el programa UMIPIC&#44; recogidos en el registro de IC &#40;RICA&#41; de la Sociedad Espa&#241;ola de Medicina Interna&#46; Se compararon las visitas a Urgencias y las hospitalizaciones por cualquier causa y por IC durante el a&#241;o anterior a la inclusi&#243;n en el programa&#44; con las que tuvieron durante el a&#241;o de seguimiento posterior&#44; usando el test de la chi-cuadrado&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 258 pacientes &#40;edad media 80<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 51&#44;9&#37; mujeres&#41;&#46; Durante el a&#241;o previo hubo 693 hospitalizaciones por cualquier causa y 174 durante el seguimiento &#40;reducci&#243;n del 75&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; 613 hospitalizaciones por IC el a&#241;o antes y 92 durante el seguimiento &#40;reducci&#243;n del 85&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; 655 vs 302 en cuanto a las visitas a Urgencias por cualquier causa &#40;reducci&#243;n del 53&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; 440 vs 120 para las visitas a Urgencias por IC &#40;reducci&#243;n del 72&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No hubo diferencias significativas en el n&#250;mero de hospitalizaciones o visitas a Urgencias por otras causas diferentes a la IC&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El programa UMIPIC basado en la atenci&#243;n integral a pacientes ancianos con IC y comorbilidad reduce el porcentaje de reingresos hospitalarios y visitas a Urgencias durante el primer a&#241;o de seguimiento&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todo"
          ]
          2 => array:2 [
            "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; Cerqueiro JM&#44; Gonz&#225;lez-Franco A&#44; Montero-P&#233;rez-Barquero M&#44; Ll&#225;cer P&#44; Conde A&#44; D&#225;vila MF&#44; et al&#46; Reducci&#243;n de ingresos y visitas a Urgencias en pacientes fr&#225;giles con insuficiencia card&#237;aca&#58; resultados del programa asistencial UMIPIC&#46; Rev Clin Esp&#46; 2016&#59;216&#58;8&#8211;14&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall">David Garc&#237;a Escrib&#225;&#44; Mar&#237;a Esther Guisado Espartero&#44; Gonzalo Mart&#237;nez de las Cuevas&#44; Benjam&#237;n Mu&#241;oz Calvo&#44; Carlos Enrique Sabbagh Fajardo&#44; Alejandro Mart&#237;n Ezquerro&#44; Manuel Lorenzo L&#243;pez Reboiro&#44; H&#233;ctor Guerrero Sande&#44; Jorge Marrero Franc&#233;s&#44; Sonia Gonzalo Pascua&#44; Mar&#237;a Eugenia Arkuch&#44; Sheyla Martin Barba&#44; Mar&#237;a S&#225;nchez Moruno&#44; Purificaci&#243;n Dur&#225;n Garc&#237;a&#44; David Garc&#237;a Escriv&#225;&#44; Mar&#237;a &#193;ngeles Tur Cervantes&#44; Mar&#237;a Cristina Gambra Michel&#44; Isabel Arias Miranda&#44; Carmen Fern&#225;ndez Pizarro&#44; Jos&#233; Manuel G&#243;mez Sousa and Adriana Souto Peleteiro&#46;</p>"
            "etiqueta" => "Appendix"
            "titulo" => "<span class="elsevierStyleBold">Collaborators</span>"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 818
            "Ancho" => 1636
            "Tamanyo" => 82286
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for heart failure &#40;HF&#41; and other causes during the year prior to inclusion in the UMIPIC program &#40;blue bars&#41; and the subsequent follow-up year &#40;orange bars&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 859
            "Ancho" => 1614
            "Tamanyo" => 68259
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Emergency department visits for heart failure &#40;HF&#41; and other causes during the year prior to inclusion in the UMIPIC program &#40;blue bars&#41; and during the subsequent follow-up year &#40;orange bars&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 844
            "Ancho" => 1597
            "Tamanyo" => 58776
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Rate of readmissions for heart failure &#40;HF&#41; during the year prior to inclusion in the UMIPIC program &#40;blue bars&#41; and during the subsequent follow-up year &#40;orange bars&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; C1&#8211;C3&#44; first and third quartile&#59; COPD&#44; chronic obstructive pulmonary disease&#59; Me&#44; median&#59; <span class="elsevierStyleItalic">n</span>&#44; number&#59; &#37;&#44; percentage&#46;</p>"
          "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">&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><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>258&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" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age and sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;Me&#44; C1&#8211;C3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;7 &#40;77&#8211;85&#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"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">134 &#40;51&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Heart disease</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertensive heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">104 &#40;40&#46;3&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">57 &#40;22&#46;1&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Ejection fraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;Me&#44; C1&#8211;C3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;40&#8211;62&#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"><span class="elsevierStyleHsp" style=""></span>Ejection fraction &#60;35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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 &#40;13&#46;4&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">156 &#40;60&#46;5&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Previous heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">172 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">226 &#40;87&#46;6&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">115 &#40;44&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">129 &#40;50&#37;&#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"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">64 &#40;28&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">37 &#40;14&#46;3&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">107 &#40;41&#46;5&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">142 &#40;55&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Peripheral artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">23 &#40;8&#46;9&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Cerebrovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">32 &#40;12&#46;4&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Liver disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">11 &#40;4&#46;3&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">8 &#40;3&#46;1&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Charlson index &#62;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">78 &#40;30&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Cognitive and functional state and social support</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pfeiffer index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;Me&#44; C1&#8211;C3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;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"><span class="elsevierStyleHsp" style=""></span>Barthel index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;Me&#44; C1&#8211;C3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;80&#8211;100&#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"><span class="elsevierStyleHsp" style=""></span>Institutionalized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">17 &#40;7&#46;6&#37;&#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"><span class="elsevierStyleHsp" style=""></span>Family support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">n</span>&#44; &#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">252 &#40;97&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab980922.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Population characteristics assessed at the time of inclusion in the UMIPIC program units&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in cardiovascular hospitalization and comorbidity of heart failure in the United States&#58; findings from the National Hospital Discharge Surveys 1980&#8211;2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2009.11.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "149"
                        "paginaInicial" => "39"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20060181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehospitalatizations among patients in the Medicare fee-for-service program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Jencks"
                            1 => "M&#46;V&#46; William"
                            2 => "E&#46;A&#46; Coleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0803563"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "1418"
                        "paginaFinal" => "1428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiolog&#237;a de la insuficiencia cardiaca aguda"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Montes-Santiago"
                            1 => "J&#46;C&#46; Ar&#233;valo"
                            2 => "J&#46;M&#46; Cerqueiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2014"
                        "volumen" => "142"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in comorbidity&#44; disability and polypharmacy in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;Y&#46; Wong"
                            1 => "S&#46;I&#46; Chaudhry"
                            2 => "M&#46;M&#46; Desai"
                            3 => "H&#46;M&#46; Krumholz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2010.08.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "136"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21295193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HFSA 2010 Comprehensive Heart Failure Practice Guideline Heart Failure Society of America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Lindenfeld"
                            1 => "N&#46;M&#46; Albert"
                            2 => "J&#46;P&#46; Boehmer"
                            3 => "S&#46;P&#46; Collins"
                            4 => "J&#46;A&#46; Ezekowitz"
                            5 => "M&#46;M&#46; Givertz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2009.12.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "1"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20123311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnoses and timing of 30-day readmissions after hospitalization for heart failure&#44; acute myocardial infarction&#44; or pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Dharmarajan"
                            1 => "A&#46;F&#46; Hsieh"
                            2 => "Z&#46; Lin"
                            3 => "H&#46; Bueno"
                            4 => "J&#46;S&#46; Ross"
                            5 => "L&#46;I&#46; Horwitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.216476"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2013"
                        "volumen" => "309"
                        "paginaInicial" => "355"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23340637"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Programas de intervenci&#243;n en la IC&#58; an&#225;lisis cr&#237;tico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Anguita S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol Supl"
                        "fecha" => "2007"
                        "volumen" => "7"
                        "paginaInicial" => "45"
                        "paginaFinal" => "56"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46;V&#46; McMurray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                            3 => "A&#46; Auricchio"
                            4 => "M&#46; B&#246;hm"
                            5 => "K&#46; Dickstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs104"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "1787"
                        "paginaFinal" => "1847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22611136"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical service organisation for heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Takeda"
                            1 => "S&#46;J&#46; Taylor"
                            2 => "R&#46;S&#46; Taylor"
                            3 => "F&#46; Khan"
                            4 => "H&#46; Krum"
                            5 => "M&#46; Underwood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multidisciplinary strategies for the management of heart failure patients at high risk for admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;A&#46; McAlister"
                            1 => "S&#46; Stewart"
                            2 => "S&#46; Ferrua"
                            3 => "J&#46;J&#46; McMurray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2004.05.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2004"
                        "volumen" => "44"
                        "paginaInicial" => "810"
                        "paginaFinal" => "819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15312864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transitional care interventions to prevent readmissions for persons with heart failure&#46; A systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Felther"
                            1 => "C&#46;D&#46; Jones"
                            2 => "W&#46;C&#46; Cen&#233;"
                            3 => "Z&#46;J&#46; Zheng"
                            4 => "C&#46;A&#46; Sueta"
                            5 => "E&#46;J&#46; Coker-Schwimmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/M14-0083"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2014"
                        "volumen" => "160"
                        "paginaInicial" => "774"
                        "paginaFinal" => "784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862840"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of heart failure&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on practice guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;W&#46; Yancy"
                            1 => "M&#46; Jessup"
                            2 => "B&#46; Bozkurt"
                            3 => "J&#46; Butler"
                            4 => "D&#46;E&#46; Casey Jr&#46;"
                            5 => "M&#46;H&#46; Drazner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31829e8776"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "128"
                        "paginaInicial" => "e240"
                        "paginaFinal" => "e327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23741058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Investigadores del Registro BADAPIC&#46; Caracter&#237;sticas cl&#237;nicas&#44; tratamiento y morbimortalidad a corto plazo de pacientes con insuficiencia cardiaca controlados en consultas espec&#237;ficas de insuficiencia cardiaca&#46; Resultados del Registro BADAPIC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Anguita S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2004"
                        "volumen" => "57"
                        "paginaInicial" => "1159"
                        "paginaFinal" => "1169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15617639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reducci&#243;n de ingresos hospitalarios tras la implantaci&#243;n de un programa multidisciplinario de insuficiencia cardiaca en Medicina Interna"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; M&#233;ndez Bail&#243;n"
                            1 => "N&#46; Mu&#241;oz Rivas"
                            2 => "J&#46; Ortiz Alonso"
                            3 => "L&#46; Audibert Mena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2008"
                        "volumen" => "130"
                        "paginaInicial" => "476"
                        "paginaFinal" => "477"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados asistenciales de una consulta monogr&#225;fica para pacientes con insuficiencia cardiaca&#46; Estudio de cohortes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Cerqueiro Gonz&#225;lez"
                            1 => "F&#46; Terr&#243;n P&#233;rez"
                            2 => "C&#46; Abeledo V&#225;zquez"
                            3 => "M&#46;J&#46; L&#243;pez D&#237;az"
                            4 => "M&#46; Matesanz Fern&#225;ndez"
                            5 => "E&#46; Casariego Vales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Galicia Clin"
                        "fecha" => "2010"
                        "volumen" => "71"
                        "paginaInicial" => "103"
                        "paginaFinal" => "110"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Investigadores del registro RICA&#46; &#191;Se ha incrementado el uso de bloqueadores beta en pacientes con insuficiencia cardiaca en medicina interna&#63; Implicaciones pron&#243;sticas&#58; registro RICA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Gonz&#225;lez-Garc&#237;a"
                            1 => "M&#46; Montero P&#233;rez-Barquero"
                            2 => "F&#46; Formiga"
                            3 => "J&#46;R&#46; Gonz&#225;lez-Juanatey"
                            4 => "M&#46;A&#46; Quesada"
                            5 => "F&#46; Epelde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2013.07.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "196"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24774394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal functional status three-month mortality after a heart failure hospitalization in elderly patients&#46; The prospective RICA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Formiga"
                            1 => "D&#46; Chivite"
                            2 => "A&#46; Conde"
                            3 => "F&#46; Ruiz-Laiglesia"
                            4 => "A&#46;G&#46; Franco"
                            5 => "C&#46;P&#46; Bocanegra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2013.12.169"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "172"
                        "paginaInicial" => "127"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24452223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A multidisciplinary intervention to prevent the readmision of elderly patients with congestive heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;V&#46; Rich"
                            1 => "V&#46; Beckham"
                            2 => "C&#46; Wittenberg"
                            3 => "C&#46;L&#46; Leven"
                            4 => "K&#46;E&#46; Freedland"
                            5 => "R&#46;M&#46; Carney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199511023331806"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1995"
                        "volumen" => "333"
                        "paginaInicial" => "1190"
                        "paginaFinal" => "1195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7565975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comprehensive discharge planing for the hospitalized elderly&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Naylor"
                            1 => "D&#46; Brooten"
                            2 => "R&#46; Jones"
                            3 => "R&#46; Lavizzo-Mourey"
                            4 => "M&#46; Mezey"
                            5 => "M&#46; Pauly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1994"
                        "volumen" => "120"
                        "paginaInicial" => "999"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8185149"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart failure in very old adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;E&#46; Forman"
                            1 => "A&#46; Ahmed"
                            2 => "J&#46;L&#46; Fleg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Heart Fail Resp"
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "387"
                        "paginaFinal" => "400"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Importance of frailty in patients with cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Singh"
                            1 => "R&#46; Stewart"
                            2 => "H&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu197"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "1726"
                        "paginaFinal" => "1731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24864078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of elderly patients with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Manzano"
                            1 => "C&#46; Escobar"
                            2 => "J&#46;G&#46; Cleland"
                            3 => "M&#46; Flather"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfs109"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "1097"
                        "paginaFinal" => "1103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22771845"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comprehensive management system for heart failure improves clinical outcomes and reduces medical resources utilisation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; West"
                            1 => "N&#46;H&#46; Miller"
                            2 => "K&#46;M&#46; Parker"
                            3 => "D&#46; Senneca"
                            4 => "G&#46; Ghandour"
                            5 => "M&#46; Clark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1997"
                        "volumen" => "79"
                        "paginaInicial" => "58"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9024737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46;E&#46; Smith"
                            1 => "S&#46;A&#46; Fabri"
                            2 => "R&#46; Pai"
                            3 => "D&#46; Ferry"
                            4 => "T&#46; Heywood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Cardiol"
                        "fecha" => "1997"
                        "volumen" => "20"
                        "paginaInicial" => "949"
                        "paginaFinal" => "954"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9383589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of heart failure program on hospitalization frequency and exercise tolerance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Hanumanthu"
                            1 => "J&#46; Butker"
                            2 => "D&#46; Chomsky"
                            3 => "S&#46; Davis"
                            4 => "J&#46;R&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1997"
                        "volumen" => "96"
                        "paginaInicial" => "2842"
                        "paginaFinal" => "2848"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9386147"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reducci&#243;n de los ingresos por IC en el primer a&#241;o de seguimiento en una unidad multidisciplinaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Lup&#243;n"
                            1 => "T&#46; Paraj&#243;n"
                            2 => "A&#46; Urrutia"
                            3 => "B&#46; Gonz&#225;lez"
                            4 => "J&#46; Herreros"
                            5 => "S&#46; Altimir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "374"
                        "paginaFinal" => "380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15847734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "On behalf of the NorthStar Investigators&#44; all members of The Danish Heart Failure Clinics Network&#46; Extended heart failure clinic follow-up in low-risk patients&#58; a randomized clinical trial &#40;NorthStar&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Shou"
                            1 => "F&#46; Gustafsson"
                            2 => "L&#46; Videbaek"
                            3 => "C&#46; Tuxen"
                            4 => "N&#46; Keller"
                            5 => "J&#46; Handberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs235"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "432"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22875412"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impacto sobre la morbimortalidad de la insuficiencia cardiaca&#58; estudio comparativo del manejo por una unidad de IC respecto al manejo convencional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Comin-Colet"
                            1 => "D&#46; Viles"
                            2 => "J&#46; Mart&#237;"
                            3 => "R&#46; Serrat"
                            4 => "L&#46; Recasesns"
                            5 => "J&#46; Vila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2002"
                        "volumen" => "55"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "145"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack201982"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0140" class="elsevierStylePara elsevierViewall">We would like to thank the center coordinator of the RICA registry &#40;S&#38;H Medical Science Service&#41; for their monitoring&#44; logistical and administrative support&#46; We would also like to thank the laboratory Menarini for their support in creating and maintaining the RICA registry&#44; through an unconditional grant&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021600000001/v1_201601280010/S2254887415000892/v1_201601280010/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1901"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021600000001/v1_201601280010/S2254887415000892/v1_201601280010/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887415000892?idApp=WRCEE"
]

Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2015.09.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2023 March	7	4	11
2018 February	113	0	113
2018 January	122	0	122
2016 January	0	1	1
2015 December	0	1	1
2015 November	0	1	1

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter