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a su vez&#44; se asocia a un peor pron&#243;stico en los pacientes con IC establecida<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La diabetes se asocia a una estancia hospitalaria m&#225;s prolongada y a mayores tasas de reingresos<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Adem&#225;s&#44; la diabetes confiere a los pacientes con IC mayor morbimortalidad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; el valor pron&#243;stico de la diabetes sobre la mortalidad hospitalaria y a largo plazo entre pacientes con IC sigue siendo controvertido<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; disponemos de nuevos f&#225;rmacos que han mejorado el pron&#243;stico de los pacientes con IC con fracci&#243;n de eyecci&#243;n &#40;FE&#41; reducida&#44; as&#237; como nuevos f&#225;rmacos hipoglucemiantes con beneficios cardiovasculares y en IC&#46; A pesar de estos avances&#44; el pron&#243;stico a largo plazo de los pacientes con IC y diabetes sigue siendo peor cuando lo comparamos con sus hom&#243;logos sin diabetes&#46; Sin embargo&#44; parece que este pron&#243;stico va mejorando en ambos grupos de forma progresiva<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Datos de centros espa&#241;oles tambi&#233;n revelan la estrecha relaci&#243;n entre la diabetes y las hospitalizaciones por IC en los &#250;ltimos a&#241;os&#46; Aunque la mortalidad total o los reingresos por IC aumentan en los pacientes con DM2<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#44; la mortalidad intrahospitalaria parece descender<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los objetivos de este estudio fueron evaluar cu&#225;nto sigue influyendo la DM2 en el pron&#243;stico de los pacientes hospitalizados por IC en el a&#241;o 2018 y compararlo con los resultados obtenidos en el estudio anterior &#40;2008-2011&#41;&#44; analizando c&#243;mo se ha modificado esta asociaci&#243;n a lo largo de la &#250;ltima d&#233;cada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o y fuente de los datos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio de cohortes prospectivo a partir de los pacientes del Registro Nacional de Insuficiencia Card&#237;aca &#40;RICA&#41; perteneciente al Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;&#46; Se trata de un registro multic&#233;ntrico&#44; prospectivo&#44; activo desde el a&#241;o 2008&#46; Incluye&#44; de forma &#250;nica y consecutiva&#44; a pacientes &#62;<span class="elsevierStyleHsp" style=""></span>50 a&#241;os con diagn&#243;stico de IC al alta hospitalaria tras episodio de descompensaci&#243;n o de nueva aparici&#243;n&#44; seg&#250;n las gu&#237;as europeas de cardiolog&#237;a actualmente vigentes<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo del registro se aprob&#243; inicialmente por el Comit&#233; &#201;tico del Hospital Universitario Reina Sof&#237;a de C&#243;rdoba&#46; Los datos se recogen a partir de una p&#225;gina web &#40;<a href="http://www.registrorica.org/">www&#46;registrorica&#46;org</a>&#41; que contiene la base de datos an&#243;nima y al que accede cada investigador a trav&#233;s de una clave personalizada&#46; Trat&#225;ndose de un estudio observacional de cohortes&#44; se siguieron las normas STROBE para esta metodolog&#237;a&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se estudi&#243; a todos los pacientes incluidos en el registro durante 2018&#46; Los pacientes se incluyeron en el grupo con diabetes cuando hab&#237;a un diagn&#243;stico previo&#44; tomaban hipoglucemiantes y todos los que&#44; no siendo registrados en el grupo de diabetes&#44; tuvieron una hemoglobina glucosilada &#40;HbA1c&#41; de &#8805; 6&#44;5&#37;&#46; Se excluy&#243; del an&#225;lisis de este estudio a los pacientes con hipertensi&#243;n pulmonar primaria&#44; diabetes mellitus tipo 1&#44; los que ten&#237;an una indicaci&#243;n de cirug&#237;a card&#237;aca&#44; imposibilidad de seguimiento ambulatorio y a aquellos que no dieron su consentimiento para participar&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se revis&#243; a todos los pacientes a los 12 meses y tambi&#233;n cada vez que fue necesario seg&#250;n el criterio cl&#237;nico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se evaluaron variables demogr&#225;ficas&#44; comorbilidades &#40;hipertensi&#243;n&#44; dislipidemia&#44; enfermedad renal cr&#243;nica&#44; enfermedad arterial perif&#233;rica&#44; ictus&#44; demencia&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; enfermedad coronaria&#44; anemia y fibrilaci&#243;n auricular&#41;&#44; datos cl&#237;nicos y prescripciones al alta hospitalaria&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se defini&#243; la hipertensi&#243;n arterial como la presencia de un diagn&#243;stico previo&#44; el tratamiento activo de f&#225;rmacos hipotensores o aquellos pacientes que presentaban de forma repetida determinaci&#243;n de una presi&#243;n arterial sist&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 140<span class="elsevierStyleHsp" style=""></span>mmHg o una presi&#243;n arterial diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Se consider&#243; anemia a una hemoglobina &#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dL en mujeres o &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dL en hombres&#46; Se incluy&#243; a pacientes con FE preservada y reducida&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las variables de laboratorio se tomaron de una muestra en ayunas en las primeras 24 h del ingreso&#46; Las determinaciones realizadas fueron las habituales&#58; creatinina&#44; urea&#44; filtrado glomerular &#40;FG&#41; por la ecuaci&#243;n de MDRD &#40;the Modification of Diet in Renal Disease&#41;&#44; hemoglobina&#44; l&#237;pidos&#44; glucosa&#44; sodio y la porci&#243;n N-terminal del prop&#233;ptido natriur&#233;tico tipo B &#40;NT-proBNP&#41;&#46; Se defini&#243; hiponatremia por un sodio &#60;<span class="elsevierStyleHsp" style=""></span>135 mEq&#47;L&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La variable dependiente &#40;resultado&#41; primaria fue la combinaci&#243;n de mortalidad total o reingreso por IC durante un seguimiento de 12 meses&#46; Las decisiones terap&#233;uticas fueron a criterio del investigador&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis de los datos</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las variables cuantitativas continuas se resumen por media &#40;desviaci&#243;n est&#225;ndar&#41; y las variables continuas discretas y las nominales categ&#243;ricas se resumen con n&#250;meros &#40;&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se compararon mediante el test de la chi al cuadrado&#46; Para valorar si una variable continua segu&#237;a una distribuci&#243;n normal se aplic&#243; el test de Kolmogorov-Smirnov y para comparar medias se utiliz&#243; la t de Student&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para evaluar la fuerza de asociaci&#243;n&#44; hazard ratio &#40;HR&#41;&#44; de la diabetes sobre la mortalidad total o los reingresos&#44; se realiz&#243; a una regresi&#243;n de Cox por pasos multivariante&#46; Todas las variables con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 fueron incluidas en el modelo&#46; Se evalu&#243; la relaci&#243;n del tratamiento antidiab&#233;tico al alta sobre la variable dependiente mediante la prueba de la chi al cuadrado&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de los pacientes con diabetes en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se presentan las caracter&#237;sticas basales y los eventos&#44; utiliz&#225;ndose en su comparaci&#243;n los test correspondientes dependiendo del tipo de variables&#46; As&#237; mismo&#44; se evalu&#243; la relaci&#243;n independiente sobre la mortalidad total o los reingresos en la cohorte actual respecto a la inicial mediante una curva de supervivencia de Kaplan-Meier &#40;log-rank&#41;&#46; Por &#250;ltimo&#44; una regresi&#243;n de Cox por pasos multivariante evalu&#243; las variables que influyeron de forma independiente en la mortalidad&#47;reingresos entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se analizaron todos los an&#225;lisis estad&#237;sticos mediante SPSS 26&#46;0 &#40;SPSS&#44; version 26&#46;0&#44; IBM&#44; Chicago&#44; IL&#41;&#46; La significaci&#243;n estad&#237;stica se estableci&#243; en p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados de la cohorte del 2018</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte del 2018&#44; de los cuales 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de los pacientes con diabetes comparados con los pacientes sin diabetes est&#225;n resumidas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Los pacientes con diabetes eran m&#225;s j&#243;venes&#44; pero con mayor n&#250;mero de comorbilidades&#46; Respecto al tratamiento modulador de la IC&#44; la proporci&#243;n de pacientes tratados con betabloqueantes y antialdoster&#243;nicos fue mayor entre los pacientes con diabetes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un total de 309 &#40;33&#37;&#41; pacientes desarrollaron el evento combinado de muerte por cualquier causa o reingreso hospitalario por IC&#46; Las diferencias entre pacientes con&#47;sin diabetes no alcanzaron significaci&#243;n estad&#237;stica&#58; 162 &#40;36&#37;&#41; pacientes con diabetes frente a 147 &#40;30&#37;&#41; pacientes sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#44; fallecieron o reingresaron por IC en el a&#241;o de seguimiento &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; 1&#44;25&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;0-1&#44;57&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los eventos de forma independiente&#44; 202 &#40;22&#37;&#41; pacientes fallecieron&#44; 101 &#40;23&#37;&#41; con diabetes y 101 &#40;21&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;475&#41;&#44; HR 1&#44;11 &#40;IC95&#37; 0&#44;84-1&#44;46&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;478&#41;&#46; Por otro lado&#44; 178 &#40;19&#37;&#41; pacientes requirieron una nueva hospitalizaci&#243;n&#44; 98 &#40;22&#37;&#41; con diabetes y 80 &#40;16&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#44; HR 1&#44;40 &#40;IC95&#37; 1&#44;04-1&#44;88&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Aunque en el an&#225;lisis basal la diabetes se relacion&#243; con la mortalidad total o los reingresos hospitalarios como se ha comentado anteriormente&#44; tras el an&#225;lisis multivariante no alcanz&#243; la significaci&#243;n estad&#237;stica&#46; Las variables asociadas de forma independiente a un evento combinado fueron&#58; la edad &#40;HR 1&#44;02&#59; IC95&#37; 1&#44;00-1&#44;03&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41;&#44; la fibrilaci&#243;n auricular &#40;HR 1&#44;53&#59; IC95&#37; 1&#44;18-1&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y la enfermedad arterial perif&#233;rica &#40;HR 1&#44;58&#59; IC95&#37; 1&#44;08-2&#44;31&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Respecto a las variables de laboratorio&#44; fueron la hemoglobina &#40;HR 0&#44;92&#59; IC95&#37; 0&#44;87-0&#44;98&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; y el FG &#40;HR 0&#44;992&#59; IC95&#37; 0&#44;991-0&#44;993&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El tratamiento con betabloqueantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; y antialdoster&#243;nicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; consigui&#243; una reducci&#243;n de eventos a lo largo del seguimiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">La metformina fue el f&#225;rmaco m&#225;s utilizado &#40;35&#37;&#41;&#46; El uso de iSGLT2 &#40;2&#44;69&#37;&#41; y arGLP1 &#40;1&#44;12&#37;&#41; fue a&#250;n muy reducido&#46; Se objetiva una tendencia no significativa en la reducci&#243;n de eventos en pacientes tratados con iSGL2 &#40;0&#44;62&#37; vs&#46; 3&#44;9&#37; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>B&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados de la cohorte de 2008-2011</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados de la variable principal previamente publicados demostraron un exceso de mortalidad y reingresos por IC en los pacientes con diabetes&#46; Un total de 233 &#40;47&#44;5&#37;&#41; pacientes con diabetes fallecieron o reingresaron por IC &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; De estos&#44; 151 &#40;31&#44;3&#37;&#41; pacientes con diabetes fallecieron frente a 136 &#40;23&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; HR 1&#44;54 &#40;IC95&#37; 1&#44;20-1&#44;97&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y 197 &#40;40&#44;9&#37;&#41; pacientes con diabetes reingresaron respecto a 186 &#40;31&#44;4&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; HR 1&#44;46 &#40;IC95&#37; 1&#44;18-1&#44;80&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparaci&#243;n de las 2<span class="elsevierStyleHsp" style=""></span>cohortes</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes de la cohorte de 2018 son mayores&#44; hab&#237;a m&#225;s varones&#44; mayor prevalencia de hiperlipidemia y un FG superior&#46; Como era esperable se objetiva un aumento significativo del uso de betabloqueantes&#44; antialdoster&#243;nicos y ARNI &#40;inhibidor dual receptor angiotensina y neprilisina&#41;&#44; manteni&#233;ndose el uso de IECA&#47;ARA-2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tras comparar a los pacientes con diabetes de la cohorte 2018 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&#41; con la de 2008-2011 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&#41; se observa una disminuci&#243;n significativa de eventos combinados &#40;36&#37; vs&#46; 47&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis independiente&#44; tanto la mortalidad total &#40;30&#44;8&#37; vs&#46; 23&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; como las hospitalizaciones &#40;22&#37; vs&#46; 40&#44;2&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; disminuyeron de forma significativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante revel&#243; un exceso significativo de eventos combinados en la cohorte de 2008-2011 &#40;HR 1&#44;48&#59; IC95&#37; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; respecto a la cohorte de 2018&#46; Los eventos de la cohorte inicial se relacionaron de forma proporcional con la edad&#44; las comorbilidades medidas por el &#237;ndice de Charlson y la FE del ventr&#237;culo izquierdo&#46; Los betabloqueantes fueron protectores de eventos &#40;con mayor uso en la cohorte de 2018&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>A-C se muestra el an&#225;lisis de supervivencia mediante curvas de Kaplan-Meier que compara mortalidad o ingreso hospitalario&#44; mortalidad total o ingresos hospitalarios a un a&#241;o de seguimiento entre las cohortes 2018 y 2008-2011&#46; Los pacientes con diabetes de la cohorte 2018 mostraron reducciones significativas en los 3<span class="elsevierStyleHsp" style=""></span>desenlaces con respecto a la cohorte 2008-2011&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">El presente estudio concluye que el pron&#243;stico de los pacientes con DM2 hospitalizados por IC ha mejorado en los &#250;ltimos a&#241;os&#44; con una reducci&#243;n significativa de la mortalidad total y de los reingresos por IC&#46; El objetivo principal del presente estudio fue comparar el pron&#243;stico de los pacientes con diabetes en ambos per&#237;odos&#44; observ&#225;ndose que la prevalencia de DM2 experimentaba un ligero aumento no significativo en los &#250;ltimos a&#241;os&#46; Nuestros resultados confirman tambi&#233;n la reducci&#243;n significativa de la mortalidad de los pacientes con DM2 hospitalizados por IC y de los reingresos por IC&#46; Los pacientes con diabetes de la cohorte de 2008-2011 ten&#237;an 1&#44;5 veces m&#225;s riesgo de mortalidad o reingreso comparado con los pacientes con diabetes de 2018&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados proceden de una cohorte de pacientes con IC cr&#243;nica descompensada en condiciones de vida real&#44; comprob&#225;ndose una prevalencia de diabetes de casi un 50&#37;&#44; siendo similar a otros registros que muestran un incremento progresivo de la relaci&#243;n entre diabetes e IC en los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;9&#44;10&#44;14</span></a>&#46; En Espa&#241;a&#44; la situaci&#243;n es bastante similar con un aumento de la incidencia de hospitalizaciones en pacientes con IC y DM2<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; La diabetes suele estar infraestimada cuando se utilizan altas hospitalarias donde ocasionalmente se omite el t&#233;rmino diabetes como diagn&#243;stico secundario<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La diabetes no se relaciona con una mortalidad mayor en la cohorte del 2018<span class="elsevierStyleItalic">&#44;</span> pero s&#237; con los reingresos hospitalarios&#46; En los pacientes de este mismo registro reclutados entre 2008 y 2011 se observ&#243; una asociaci&#243;n significativa de la diabetes con la mortalidad por cualquier causa o las hospitalizaciones por IC<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; En esta l&#237;nea&#44; los pacientes ingresados en unidades coronarias por IC desde 1985 hasta 2008 presentaron m&#225;s eventos adversos&#44; incluida mortalidad y hospitalizaciones en la poblaci&#243;n diab&#233;tica&#44; tendencia que mejoraba a lo largo del tiempo en ambos grupos<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46; En contraste&#44; Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> reportaron que la mortalidad intrahospitalaria en pacientes con DM2 fue menor comparada con los pacientes sin diabetes en el per&#237;odo 2001-2015&#46; Respecto a las hospitalizaciones por IC&#44; los pacientes con diabetes ten&#237;an mayor probabilidad de reingreso respecto a los pacientes sin diabetes&#44; pero esta observaci&#243;n se amortiguaba en el per&#237;odo 2008-2015&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Todo indica que algo est&#225; cambiando en el abordaje de los pacientes con IC y DM2&#44; pero lo que no est&#225; claro es c&#243;mo explicar esta tendencia&#46; La reducci&#243;n de la mortalidad se puede deber a un mejor control gluc&#233;mico de los pacientes con diabetes durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> o al impacto de los programas de abordaje espec&#237;fico de la IC en unidades multidisciplinarias como el programa Unidades de Manejo Integral para Pacientes con Insuficiencia Card&#237;aca &#40;UMIPIC&#41;&#46; Los programas de UMIPIC han demostrado que reducen las hospitalizaciones y visitas a Urgencias&#44; pero no la mortalidad<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Otras explicaciones pueden ser los avances en el tratamiento de la IC con FE reducida con la incorporaci&#243;n de los ARNI y un mayor uso de f&#225;rmacos moduladores del pron&#243;stico&#44; y la incorporaci&#243;n de nuevos f&#225;rmacos hipoglucemiantes con mejor perfil metab&#243;lico y beneficios adicionales sobre la mortalidad&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Las hospitalizaciones por IC siguen siendo m&#225;s frecuentes en los pacientes con diabetes&#44; aunque la diferencia entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se ha reducido considerablemente&#46; En el per&#237;odo de 2008-2011 un aumento relativo del 10&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y para el 2018 fue solo del 6&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#46; Estos hallazgos podr&#237;an tambi&#233;n explicarse por el impacto progresivo de los programas de UMIPIC o simplemente consultas monogr&#225;ficas de IC y por la introducci&#243;n de los iSGLT2 en el tratamiento de la DM2&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Estos datos concuerdan con lo publicados por Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#44; estabilizaci&#243;n de hospitalizaciones por IC entre los pacientes con diabetes y una tendencia a la disminuci&#243;n de la mortalidad a lo largo del per&#237;odo estudiado &#40;2001-2015&#41;&#46; Nuestros resultados ampl&#237;an esta observaci&#243;n con datos del 2018&#46; La mortalidad intrahospitalaria de los pacientes con diabetes e IC parece estar reduci&#233;ndose desde la pasada d&#233;cada a pesar del incremento de la prevalencia de la diabetes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes contin&#250;an teniendo mayor n&#250;mero de comorbilidades que los pacientes sin diabetes&#44; siendo esto un hallazgo com&#250;n en todos los estudios publicados<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; Las variables independientes asociadas a las variables finales de mortalidad por cualquier causa o reingreso por IC son las esperables en una cohorte de pacientes con elevada validez externa por representar la situaci&#243;n real de nuestras plantas de hospitalizaci&#243;n&#46; La edad avanzada&#44; la presencia de comorbilidades como la fibrilaci&#243;n auricular&#44; la enfermedad renal cr&#243;nica&#44; la enfermedad arterial perif&#233;rica y la anemia son variables asociadas cl&#225;sicamente al mal pron&#243;stico de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Como se ha mencionado&#44; la aparici&#243;n de nuevos f&#225;rmacos para el tratamiento de la IC podr&#237;a ayudar a explicar los cambios observados&#46; Sin embargo&#44; la utilizaci&#243;n de los ARNI no estaba suficientemente extendida en 2018&#44; por lo que no ha podido influir de forma sustancial en nuestros resultados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; El aumento del uso de betabloqueantes y los antagonistas de los receptores de aldosterona se asoci&#243; a una reducci&#243;n de eventos a pesar que la mayor&#237;a de los pacientes ten&#237;an FE preservada&#59; este hecho tiene dif&#237;cil explicaci&#243;n&#44; pero podr&#237;a estar en relaci&#243;n con una mejora en la optimizaci&#243;n terap&#233;utica de los pacientes&#46; Respecto al tratamiento de la DM2&#44; el uso de iSGLT2 fue bastante bajo en 2018&#44; solo 12 pacientes &#40;2&#44;7&#37;&#41; del total de la cohorte de pacientes con diabetes&#46; Sin embargo&#44; solo uno de los pacientes reingres&#243; frente a los 11 pacientes que no &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;067&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#46; Aunque este hecho no es suficiente para explicar la reducci&#243;n de hospitalizaciones por IC en nuestra cohorte&#44; s&#237; que est&#225; en la l&#237;nea de las observaciones de estudios similares con iSGLT2<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As&#237; pues&#44; nuestro estudio observacional demuestra la tendencia en la reducci&#243;n en la mortalidad total y en las hospitalizaciones por IC&#44; pero no puede explicar su causa&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Hay que interpretar estos resultados teniendo en cuenta sus limitaciones&#46; Primero&#44; adem&#225;s de nuevo diagn&#243;stico&#44; la definici&#243;n de DM2 se basa en las historias cl&#237;nicas y en el registro de f&#225;rmacos antidiab&#233;ticos&#46; Segundo&#44; la determinaci&#243;n de HbA1c no se realiz&#243; de forma sistem&#225;ticamente&#46; Tercero&#44; los resultados solo pueden extrapolarse a pacientes con IC cr&#243;nica tras una agudizaci&#243;n&#46; Cuarto&#44; el uso de los f&#225;rmacos con beneficios sobre la evoluci&#243;n de la IC y de la DM2 era a&#250;n muy anecd&#243;tica&#46; Por &#250;ltimo&#44; aunque el an&#225;lisis ha sido ajustado con diferentes covariables cl&#237;nicamente relevantes&#44; no se pueden excluir variables no medidas que podr&#237;an modificar los resultados&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0200" class="elsevierStylePara elsevierViewall">La diabetes sigue relacion&#225;ndose con una mayor tasa de reingresos por IC&#44; pero la mortalidad tiende a igualarse si se compara con pacientes sin diabetes&#46; La mortalidad total y las hospitalizaciones en pacientes con diabetes e IC cr&#243;nica se han reducido significativamente en la &#250;ltima d&#233;cada&#46; La explicaci&#243;n de este hallazgo probablemente sea multifactorial&#44; precis&#225;ndose estudios espec&#237;ficos que esclarezcan este hecho&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">El registro RICA pertenece a la Sociedad Espa&#241;ola de Medicina Interna y est&#225; liderado por el Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular&#46; Este estudio no ha recibido ninguna subvenci&#243;n de organismos p&#250;blicos ni privados&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Dise&#241;o y fuente de los datos"
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              "titulo" => "Resultados de la cohorte del 2018"
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              "titulo" => "Resultados de la cohorte de 2008-2011"
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              "titulo" => "Comparaci&#243;n de las 2 cohortes"
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          "titulo" => "Discusi&#243;n"
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    "fechaRecibido" => "2020-12-05"
    "fechaAceptado" => "2021-04-29"
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            0 => "Diabetes mellitus"
            1 => "Insuficiencia card&#237;aca"
            2 => "Mortalidad"
            3 => "Hospitalizaci&#243;n"
            4 => "Reingresos"
            5 => "Pron&#243;stico"
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            0 => "Diabetes mellitus"
            1 => "Heart failure"
            2 => "Mortality"
            3 => "Hospitalization"
            4 => "Readmissions"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La insuficiencia card&#237;aca &#40;IC&#41; y la diabetes son 2<span class="elsevierStyleHsp" style=""></span>procesos fuertemente asociados&#46; El objetivo principal fue analizar la evoluci&#243;n del pron&#243;stico de los pacientes con diabetes que ingresan por IC a lo largo de 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo para comparar el pron&#243;stico a un a&#241;o de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018&#46; Los pacientes proceden del Registro Nacional de Insuficiencia Card&#237;aca &#40;RICA&#41; de la Sociedad Espa&#241;ola de Medicina Interna&#46; El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses&#46; Se utiliz&#243; una regresi&#243;n multivariante de Cox para evaluar la fuerza de asociaci&#243;n &#40;hazard ratio &#91;HR&#93;&#41; de la diabetes y los desenlaces entre ambos per&#237;odos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte de 2018&#44; de los que 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de la poblaci&#243;n de los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos fueron similares&#46; En los pacientes con diabetes se observ&#243; el desenlace combinado en 233 &#40;47&#44;5&#37;&#41; en la cohorte de 2008-2011 y 162 &#40;36&#37;&#41; en la cohorte de 2018 &#40;HR 1&#44;48&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La proporci&#243;n de ingresos &#40;HR 1&#44;39&#59; IC95&#37; 1&#44;07-1&#44;80&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; y la mortalidad total &#40;HR 1&#44;60&#59; IC95&#37; 1&#44;20-2&#44;14&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; tambi&#233;n fueron significativamente mayores en los pacientes con diabetes de la cohorte de 2008-2011 con respecto a la del 2018&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En 2018 se observa una mejor&#237;a del pron&#243;stico de la mortalidad total y los reingresos durante un a&#241;o de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al per&#237;odo de 2008-2011&#46;</p></span>"
        "secciones" => array:4 [
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          1 => array:2 [
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            "titulo" => "M&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Heart failure &#40;HF&#41; and diabetes are 2<span class="elsevierStyleHsp" style=""></span>strongly associated diseases&#46; The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2<span class="elsevierStyleHsp" style=""></span>time periods&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018&#46; The patients are from the Spanish Society of Internal Medicine&#39;s National Heart Failure Registry &#40;RICA&#44; for its initials in Spanish&#41;&#46; The primary endpoint was to analyze the composite outcome of total mortality and&#47;or readmission due to HF in 12 months&#46; A multivariate Cox regression model was used to evaluate the strength of association &#40;hazard ratio &#91;HR&#93;&#41; between diabetes and the outcomes between both periods&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 936 patients were included in the 2018 cohort&#44; of which 446 &#40;48&#37;&#41; had diabetes&#46; The baseline characteristics of the populations from the 2<span class="elsevierStyleHsp" style=""></span>periods were similar&#46; In patients with diabetes&#44; the composite outcome was observed in 233 &#40;47&#46;5&#37;&#41; in the 2008-2011 cohort and 162 &#40;36&#37;&#41; in the 2018 cohort &#91;HR 1&#46;48&#59; 95&#37; confidence interval &#40;95&#37;CI&#41; 1&#46;18-1&#46;85&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#93;&#46; The proportion of readmissions &#40;HR 1&#46;39&#59; 95&#37;CI 1&#46;07-1&#46;80&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;015&#41; and total mortality &#40;HR 1&#46;60&#59; 95&#37;CI 1&#46;20-2&#46;14&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41; were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In 2018&#44; an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Los nombres de los componentes del Registro RICA est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0075">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0220" class="elsevierStylePara elsevierViewall">&#193;lvarez Rocha&#44; P&#46;&#59; Anarte&#44; L&#46;&#59; Aramburu-Bodas&#44; O&#46;&#59; Ar&#233;valo-Lorido&#44; J&#46;C&#46;&#59; Arias Jim&#233;nez&#44; J&#46;L&#46;&#59; Carrasco S&#225;nchez&#44; F&#46;J&#46;&#59; Carrascosa&#44; S&#46;&#59; Cepeda&#44; J&#46;M&#46;&#59; Cerqueiro&#44; J&#46;M&#46;&#59; Conde-Martel&#44; A&#46;&#59; D&#225;vila Ramos&#44; M&#46;F&#46;&#59; Epelde&#44; F&#46;&#59; Garc&#237;a Campos&#44; A&#46;&#59; Gonz&#225;lez Franco&#44; A&#46;&#59; Le&#243;n Acu&#241;a&#44; A&#46;&#59; L&#243;pez Castellanos&#44; G&#46;&#59; Lorente Furi&#243;&#44; O&#46;&#59; Manzano&#44; L&#46;&#59; Montero-P&#233;rez-Barquero&#44; M&#46;&#59; Moreno Garc&#237;a&#44; M&#46;C&#46;&#59; Ormaechea Gorricho&#44; G&#46;&#59; Quesada Sim&#243;n&#44; M&#46;A&#46;&#59; R&#225;bago Lorite&#44; I&#46;<span class="elsevierStyleSmallCaps">&#59;</span> Ruiz Ortega&#44; R&#46;&#59; Salamanca Bautista&#44; M&#46;P&#46;&#59; Silvera&#44; G&#46;&#59; Soler Rangel&#44; L&#46;&#44; y Trull&#224;s&#44; J&#46;C&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Miembros del Registro RICA&#58;"
            "identificador" => "sec0075"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM &#40;2018&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No DM &#40;2018&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>488&#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM&#40;2008-2011&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muerte o reingreso por IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">233 &#40;47&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;25 &#40;1&#44;00-1&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortalidad total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;475&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;30&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;11 &#40;0&#44;84-1&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reingreso por IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;40&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;40 &#40;1&#44;04-1&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2822002.png"
              ]
            ]
            1 => 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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Mortalidad total y&#47;o reingresos atendiendo al tratamiento antidiab&#233;tico al alta de la cohorte del 2018</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TotalN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NoN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metformina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sulfonilureas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;5&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Variables de laboratorio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ARNI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariante</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariante</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;03 &#40;1&#44;01-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;03 &#40;1&#44;02-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;hombre&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;02 &#40;0&#44;84-1&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;860&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;95-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia m&#233;dica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13 &#40;0&#44;75-1&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;560&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;90 &#40;0&#44;74-1&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;55 &#40;1&#44;27-1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;34 &#40;1&#44;04-1&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;18 &#40;0&#44;96-1&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;31 &#40;1&#44;01-1&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Demencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;48 &#40;1&#44;00-2&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;17 &#40;0&#44;94-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09 &#40;0&#44;75-1&#44;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a hipertensiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Variables de laboratorio</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>creatinina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Filtrado glomerular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HbA1c&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento de la insuficiencia card&#237;aca al alta</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diur&#233;ticos tiaz&#237;dicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antialdoster&#243;nicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96 &#40;0&#44;77-1&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;683&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IECA&#47;ARA-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;841&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Predictores independientes de mortalidad o reingresos hospitalarios a los 12 meses de seguimiento en pacientes con diabetes atendiendo a la inclusi&#243;n en 2008-2011 frente a 2018&#46; An&#225;lisis multivariante mediante regresi&#243;n de Cox</p>"
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                          "etal" => false
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                      "titulo" => "Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients&#58; Findings from the RICA registry"
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                      "titulo" => "In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure&#58; Results from the ESC-HFA Heart Failure Long-Term Registry"
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Vol. 222. Núm. 2.
Páginas 63-72 (febrero 2022)
ORIGINAL
Evolución de la asociación de diabetes y eventos posalta en pacientes con insuficiencia cardíaca crónica descompensada: hallazgos del registro RICA
Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry
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F.J. Carrasco-Sáncheza,
Autor para correspondencia
, M.I. Páez-Rubioa, J.C. Arévalo-Loridob, J. Carretero-Gómezb, A. Conde-Martelc, F. Epelded, P. Álvarez-Rochae, M.P. Salamanca-Bautistaf, J.M. Cepeda-Rodrigog, M. Montero-Pérez-Barqueroh, en representación del Registro RICA
a Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, España
b Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
c Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
d Unidad de Estancia Corta, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
e Unidad Multidisciplinaria de Insuficiencia Cardíaca, Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
f Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
g Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España
h Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, España
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Tablas (4)
Tabla 1. Características basales de la población de la cohorte del 2018 atendiendo a la condición de diabetes y comparación de los pacientes con diabetes con la cohorte de 2008-2011
Tabla 2. Proporción de eventos atendiendo a la condición de diabetes, cohorte temporal y tratamiento hipoglucemiante. Eventos durante el seguimiento entre los pacientes con diabetes de la cohorte de 2018 y 2008-2011 (A). Mortalidad total o reingresos atendiendo al tratamiento antidiabético al alta de la cohorte de 2018 (B)
Tabla 3. Predictores independientes de mortalidad o reingresos hospitalarios a los 12 meses de seguimiento de la cohorte de 2018. Análisis univariante y multivariante mediante regresión de Cox
Tabla 4. Predictores independientes de mortalidad o reingresos hospitalarios a los 12 meses de seguimiento en pacientes con diabetes atendiendo a la inclusión en 2008-2011 frente a 2018. Análisis multivariante mediante regresión de Cox
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Resumen
Objetivos

La insuficiencia cardíaca (IC) y la diabetes son 2procesos fuertemente asociados. El objetivo principal fue analizar la evolución del pronóstico de los pacientes con diabetes que ingresan por IC a lo largo de 2períodos.

Métodos

Estudio prospectivo para comparar el pronóstico a un año de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018. Los pacientes proceden del Registro Nacional de Insuficiencia Cardíaca (RICA) de la Sociedad Española de Medicina Interna. El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses. Se utilizó una regresión multivariante de Cox para evaluar la fuerza de asociación (hazard ratio [HR]) de la diabetes y los desenlaces entre ambos períodos.

Resultados

Se incluyó a un total de 936 pacientes en la cohorte de 2018, de los que 446 (48%) tenían diabetes. Las características basales de la población de los 2períodos fueron similares. En los pacientes con diabetes se observó el desenlace combinado en 233 (47,5%) en la cohorte de 2008-2011 y 162 (36%) en la cohorte de 2018 (HR 1,48; intervalo de confianza del 95% [IC95%] 1,18-1,85; p <0,001). La proporción de ingresos (HR 1,39; IC95% 1,07-1,80; p=0,015) y la mortalidad total (HR 1,60; IC95% 1,20-2,14; p <0,001) también fueron significativamente mayores en los pacientes con diabetes de la cohorte de 2008-2011 con respecto a la del 2018.

Conclusiones

En 2018 se observa una mejoría del pronóstico de la mortalidad total y los reingresos durante un año de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al período de 2008-2011.

Palabras clave:
Diabetes mellitus
Insuficiencia cardíaca
Mortalidad
Hospitalización
Reingresos
Pronóstico
Abstract
Aims

Heart failure (HF) and diabetes are 2strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2time periods.

Methods

This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods.

Results

A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p<.001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p=.015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p<.001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort.

Conclusions

In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.

Keywords:
Diabetes mellitus
Heart failure
Mortality
Hospitalization
Readmissions
Prognosis

Artículo

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