AIMS:European Systematic Coronary Risk Assessment 2 for Older Persons (SCORE2-OP) model has shown modest performance when externally validated in selected cohorts. We aim to investigate its predictive performance and clinical utility for 10-year cardiovascular (CV) risk in an unbiased and representative cohort of older people of a low CV risk country. Furthermore, we explore whether other clinical or echocardiographic features could improve its performance. METHODS AND RESULTS:A cohort of randomly selected individuals ≥65 years from a primary care population of Barcelona without established CV disease included 791 patients (63.1% female, median age 76 years, median follow-up 11.8 years). The model's performance yielded a Harrell's C-statistic of 0.706 (95% confidence interval [CI] 0.659-0.753) for the primary endpoint (myocardial infarction, stroke, and CV mortality) and 0.692 (95% CI 0.649-0.734) for the secondary endpoint (primary endpoint plus heart failure hospitalization), with better discrimination in females. SCORE2-OP underestimated the risk of primary endpoint in women [expected/observed (E/O) = 0.77], slightly overestimated in men (E/O = 1.06), and systematically underestimated the risk of the secondary endpoint (E/O = 0.52). Decision curve analysis showed net clinical benefit across a 7.5-30% risk range for primary endpoint. Valvular calcification was the only variable that significantly improved 10-year SCORE2-OP risk performance for both primary and secondary endpoints, with a change in Harrell's C of 0.028 (P = 0.017). CONCLUSION:In a low CV risk country, SCORE2-OP showed notable discrimination and excellent calibration to predict 10-year CV risk, with better performance in females. Incorporating valvular calcification in a future revised score may enhance accuracy and reduce unnecessary treatments.

This study aims to explore the walkability of three small areas (basic healthcare areas) of Barcelona city (Catalonia, Spain) for frail older adults. A mixed methods study design was conducted with 132 frail older adults in three primary care centers of Barcelona: Larrard, Barceloneta, and Vila Olímpica. A literature review was conducted to identify urban design indicators related to walkability and the aging population. These were then reflected in the surveys administered to the program participants, capturing information on their preferred routes, usual destinations, and walkability perceptions. Findings reveal significant mobility challenges for older adults, particularly the ones related to safety issues, the adequacy of sidewalk widths, greenery and urban furniture maintenance, and the presence/absence of commercial activities. This research underscores the importance of age-sensitive urban design in healthcare environments and provides a framework for enhancing walkability and accessibility for populations at greater risk of mobility-related health problems, such as frail older adults.

OBJECTIVES:To compare the effectiveness and safety of Hospital-at-Home based on Comprehensive Geriatric Assessment (CGA-HaH) for older adults with bed-based Intermediate Care Unit (BBU). DESIGN:Cohort study comparing all consecutive CGA-HaH cases managed between January 2018 and December 2023 with contemporary BBU-matched controls at the largest geriatric care provider in Barcelona. METHODS:We linked all intermediate care admissions at Parc Sanitari Pere Virgili to the Catalan health information system data to track patients' trajectories from 6 months before the index episode to June 2024. Patients admitted to CGA-HaH were matched to BBU controls using propensity score matching (PSM) based on their baseline characteristics. We used multivariable linear regression to assess the association of CGA-HaH with the percentage of days spent at home (%DSH) and Cox regression to assess the risk of death and first re-hospitalisation. RESULTS:We included 1180 consecutive CGA-HaH and 10,528 BBU episodes. CGA-HaH patients were significantly older and more functionally impaired and had better socioeconomic status. After PSM, we compared 961 CGA-HaH and 961 BBU patients, with a mean follow-up of 705 days (SD 593). CGA-HaH patients had a 7.4 higher %DSH (95% CI: 4.5-10.2, P < 0.001) with similar first re-hospitalisation [HR 1.02 (95% CI: 0.91-1.1)] and mortality risk [HR: 0.93 (95% CI: 0.81-1.06)]. CONCLUSIONS:Our results suggest that CGA-Hospital-at-Home is a viable alternative to traditional inpatient intermediate care for older adults, offering relevant advantages such as increased time spent at home without a rise in mortality.

In some contexts, like geriatric hospitals, the number of patients requiring assistance with feeding is very high and robots may be an effective tool for caregivers to provide better assistance. This article introduces NYAM, a robot designed to aid in the feeding process for individuals. Our robot is equipped with a mechanism to effectively recapture the person's attention whenever necessary. The mechanism is easily adjustable by the caregivers, allowing the straightforward customisation of the feeding service. The approach was evaluated, within a geriatric hospital, with 9 patients who used the robot for 5 consecutive days. We argue that incorporating enhanced social aspects into the robot is imperative to enhance the effectiveness and acceptance of this solution.

PURPOSE:We aimed to describe the intensity of care and its consequences on informal caregivers of stroke survivors according to the degree of care receivers' functional dependence for activities of daily living; and to identify the factors associated with caregivers' care-related quality of life. METHODS:Cross-sectional analysis of prospective data collected in a cost-utility study alongside the RACECAT trial in Catalonia (Spain). One-hundred and thirty-two care receiver-caregiver pairs were interviewed six months after stroke. Functional dependence for activities of daily living was measured with the Barthel index. We assessed caregivers care-related quality of life with the CarerQoL, which measures seven dimensions of subjective burden (CarerQoL-7D) and a happiness score (CarerQoL-VAS). We evaluated the association between characteristics of informal caregivers, characteristics of care receivers, and intensity of care, and the caregiver's care-related quality of life (subjective burden and happiness) in a hypothesized model using a structural equation model. RESULTS:Of the 132 caregivers, 74,2% were women with an average age of 59.4 ± 12.5 years. The 56.8% of them were spouses. The care intensity ranged from a mean of 24h/week for mild to 40h/week for severe dependence. Most caregivers (76.3%) were satisfied with their task, regardless of dependence, but showed increasing problems in caring for severely dependent persons. Being a woman (coeff. -0.23; 95%CI: -0.40, -0.07), spending more time in care tasks (coeff -0.37; -0.53, -0.21) and care receiver need of constant supervision (coeff 0.31; -0.47, -0.14) were associated with higher burden of care, irrespective of the degree of dependence. Caregiver burden (coeff 0.46; 0.30-0.61) and care receiver anxiety or depression (coeff -0.19; -0.34, -0.03) were associated with lower caregiver happiness. CONCLUSIONS:The findings suggest the importance of developing mainly two types of support interventions for caregivers: respite and psychosocial support. Especially for women with high caring burden and/or caring for persons with high levels of anxiety or depression.

Introduction: The aim of this study was to estimate societal costs during the first year after stroke by degree of functional disability. Patients and methods: Descriptive study of the cumulative costs incurred during 1-year follow-up of a cohort of patients with stroke in Catalonia (Spain) participating in a multicentre, population-based, cluster-randomised trial (RACECAT). Patients were recruited between September 2017 and January 2019. Costs were collected for each patient from stroke onset to 1-year follow-up through hospital accounting records, electronic healthcare records and structured telephone-based interviews at 6 and 12-months follow-up. Disability was assessed using the 90-day modified Rankin Scale (mRS). Healthcare, community care, and patient/family costs were included. We used complete data from 567 eligible participants. Cost data were analysed using generalised linear models (GLMs) with gamma distributions and log link functions. For variables with >10% zero values, two-part models were applied. We performed sensitivity analyses modifying unit costs for patient/family costs. Results: Of the 567 patients included, 53% had ischaemic large vessel oclusion (LVO) stroke, 24% intracranial haemorrhage and 23% ischaemic non-LVO stroke. Mean cost per patient during the first year after stroke was 29,673 +/- 28,632, and increased with degree of disability (mRS 0-2: 18,568 +/- 12,244; mRS 3: 38,214 +/- 28,172; mRS 4-5: 52,859 +/- 36,383). Healthcare costs represented the highest proportion of total costs (63%; 18,724/patient) across all disability levels, with index hospitalisation being the highest (12,319 +/- 17,675); however, community care and patient/family costs represented over 40% of total cost in patients with higher disability levels. Discussion and conclusion: Our results are in line with other studies; the costs during the first year after stroke are high and increase with disability. These results are valuable for calculating the cost of severe stroke cases.

Different programs promote healthy ageing through the optimization of intrinsic capacity. However, a major challenge is to assess their sustained effects over time. +AGIL Barcelona, a consolidated multidomain program, aims to optimize older adults’ intrinsic capacity through a coordinated approach among primary care, geriatrics and community resources, in agreement with the integrated care for older people (ICOPE) guidelines. We aimed to evaluate the +AGIL Barcelona longitudinal effect on older adults’ physical performance. All +AGIL Barcelona consecutive participants since 2016 were enrolled. After a comprehensive geriatric assessment, a tailored, multidisciplinary intervention aligned with the ICOPE guidelines is offered. It includes a 10-week boost multicomponent exercise program, nutritional and sleep-hygiene counselling, revision and optimization of pharmacological treatments and screening for cognitive impairment, depression and loneliness. Changes in physical performance after 3 and 6 months were assessed using mixed models including baseline frailty degree, time and all potential significant confounders. We included 194 participants in the analysis (mean age = 81.6 [standard deviation = 5.8], 68% women). An independent, clinically and statistically significant improvement in physical performance (Short Physical Performance Battery [SPPB] test, combining gait speed, strength and balance) was found at 3 months (SPPB mean change: 1.4; 95% CI: 1.1–1.6) and 6 months (SPPB mean change: 1.1; 95% CI 0.8–1.5). Equivalent results were observed for all the SPPB sub-tests. A coordinated, multidisciplinary and integrated program can benefit older adults’ intrinsic capacity. The participants’ empowerment and the connection with the available community resources are critical points for a successful intervention.

Background Infective endocarditis (IE) is a serious albeit relatively infrequent disease. Given the paucity of cases, particularly in non-referral centres, patient registries have progressively gained relevance to inform about the epidemiology, clinical presentation, and natural history of IE in the last two decades. Although they have become key to advancing knowledge of IE, registries also have shortcomings that lead to relevant consequences that are often overlooked. Objectives We aimed to discuss the strengths and limitations of registries in IE. Sources We conducted a PubMed search of relevant articles published between January 2000 and June 2022. Content The backbone of the contemporary knowledge on IE has been built upon data collected in prospective registries, which has allowed us to collect data on relatively unknown aspects of the disease, identify knowledge gaps, and generate new hypotheses, serving as platforms for further research endeavours. Well-exploited registries can provide key information on how IE is distributed across populations and how it differentially impacts patients and subgroups. However, registries face several difficulties, such as the definition of IE, which includes subjective variables and changes over time. Other limitations include difficulty achieving a comprehensive collection of cases (which depends on both project funding and information systems), over-representation of the centres that created the registry, lack of inclusion of variables to assess endpoints that are relevant to patients in terms of quality of life and prognosis, and ethical issues. Implications The review of the advantages and disadvantages of registries aims to improve the quality of the information collected, the viability of the registry itself, and the ability to answer questions that are relevant to both researchers and patients.

Different programs promote healthy ageing through the optimization of intrinsic capacity. However, a major challenge is to assess their sustained effects over time. +AGIL Barcelona, a consolidated multidomain program, aims to optimize older adults’ intrinsic capacity through a coordinated approach among primary care, geriatrics and community resources, in agreement with the integrated care for older people (ICOPE) guidelines. We aimed to evaluate the +AGIL Barcelona longitudinal effect on older adults’ physical performance.

Aims The burden of ischaemia is a risk factor for adverse outcomes in ischaemic cardiomyopathy (ICM) but is not systematically tested when deciding on revascularization. Limited data exists in patients with ICM regarding the interaction between ischaemia and early coronary revascularization (ECR). This study sought to determine if the burden of ischaemia modifies the outcomes of ECR in ICM. Methods and results Consecutive patients with ICM (left ventricular ejection fraction < 40%) with a stress-rest gated single-photon emission computed tomography (N = 747) were followed-up for ECR and major cardiovascular events (MACEs, cardiovascular death, myocardial infarction, or heart failure hospitalization). A 1:1 matched population was selected using a propensity score for ECR. The interaction between ischaemia and ECR was evaluated in the matched cohort. In the initial cohort, 131 patients underwent ECR. Of them, 109 were matched to non-ECR patients. After a median follow up of 4.1 years, 102 (46.8%) patients experienced a MACE. The effect of revascularization on MACE was dependent of the percent of ischaemia (P for the interaction at 10% ischaemia = 0.021), so that a trend towards a decreased risk of MACE was seen in patients with >10% of ischaemia [hazard ratio (HR) = 0.59 (0.30-1.18)], whereas a non-significant increase of MACE was observed in those with <10% ischaemia (HR = 1.67 [0.94-2.96]). Conclusions In a contemporary cohort of patients with ICM, the beneficial effects of ECR may be mediated by the percent of ischaemia. This study supports stress testing in ICM and an ischaemia-guided approach for ECR.

Introducción y objetivosEl desfibrilador automático implantable (DAI) es una alternativa coste-efectiva para la prevención secundaria de la muerte súbita cardiaca, pero sigue habiendo dudas sobre su eficiencia en prevención primaria, sobre todo en pacientes con cardiopatía no isquémica.MétodosAnálisis de coste-utilidad del DAI más tratamiento médico convencional frente a tratamiento médico convencional para la prevención primaria de arritmias cardiacas desde la perspectiva del Sistema Nacional de Salud. Se simuló el curso de la enfermedad mediante modelos de Markov en pacientes con y sin cardiopatía isquémica. Los parámetros del modelo se basaron en los resultados obtenidos mediante metanálisis de los ensayos clínicos publicados entre 1996 y 2018 en los que se comparaba el DAI con el tratamiento médico convencional, los resultados de seguridad del ensayo DANISH y el análisis de la práctica clínica habitual en un hospital terciario.ResultadosSe estimó un beneficio del DAI sobre la muerte por cualquier causa con HR = 0,70 (IC95%, 0,58-0,85) en cardiopatía isquémica y HR = 0,79 (IC95%, 0,66-0,96) en no isquémica. La razón de coste-efectividad incremental estimada mediante análisis probabilístico fue de 19.171 euros/año de vida ajustado por calidad (AVAC) en pacientes con cardiopatía isquémica, 31.084 euros/AVAC en pacientes con miocardiopatía dilatada no isquémica y 23.230 euros/AVAC en los menores de 68 años.ConclusionesLa eficiencia del DAI monocameral ha mejorado en la última década y este resulta coste-efectivo para los pacientes con disfunción ventricular izquierda de origen isquémico o no isquémico menores de 68 años considerando una disposición a pagar 25.000 euros/AVAC. En pacientes no isquémicos mayores, la razón de coste-efectividad incremental estimada se sitúa alrededor de los 30.000 euros/AVAC.

Introduction and objective: Implantable cardioverter-defibrillators (ICD) are a cost-effective alternative for secondary prevention of sudden cardiac death, but their efficiency in primary prevention, especially among patients with nonischemic heart disease, is still uncertain. Methods: We performed a cost-effectiveness analysis of ICD plus conventional medical treatment (CMT) vs CMT for primary prevention of cardiac arrhythmias from the perspective of the national health service. We simulated the course of the disease by using Markov models in patients with ischemic and nonischemic heart disease. The parameters of the model were based on the results obtained from a meta-analysis of clinical trials published between 1996 and 2018 comparing ICD plus CMT vs CMT, the safety results of the DANISH trial, and analysis of real-world clinical practice in a tertiary hospital. Results: We estimated that ICD reduced the likelihood of all-cause death in patients with ischemic heart disease (HR, 0.70; 95%CI, 0.58-0.85) and in those with nonischemic heart disease (HR, 0.79; 95%CI, 0.66-0.96). The incremental cost-effectiveness ratio (ICER) estimated with probabilistic analysis was euro 19 171/quality adjusted life year (QALY) in patients with ischemic heart disease and euro 31 084/QALY in those with nonischemic dilated myocardiopathy overall and euro 23 230/QALY in patients younger than 68 years. Conclusions: The efficiency of single-lead ICD systems has improved in the last decade, and these devices are cost-effective in patients with ischemic and nonischemic left ventricular dysfunction younger than 68 years, assuming willingness to pay as euro 25 000/QALY. For older nonischemic patients, the ICER was around euro 30 000/QALY. (c) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

ABSTRACTBackgroundThe effect of renin–angiotensin system (RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between RAS blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension (HTN).MethodsThis is a cohort study using regional health records. We identified all individuals aged 18–95 years from 87 healthcare reference areas of the main health provider in Catalonia (Spain), with a history of HTN from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the 3 months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAS blockade, ACEi or ARB) we estimated associations in age-, sex-, healthcare area- and propensity score-matched samples.ResultsFrom a cohort of 1 365 215 inhabitants we identified 305 972 patients with HTN history. Recent use of ACEi/ARBs in patients with HTN was associated with a lower 6-month cumulative incidence of COVID-19 diagnosis {3.78% [95% confidence interval (CI) 3.69–3.86%] versus 4.53% (95% CI 4.40–4.65%); P < 0.001}. In the 12 344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death [OR = 0.91 (0.71–1.15); P = 0.426].ConclusionsRAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.

A pesar del aumento de la supervivencia, el ictus representa una carga en salud y socioeconómica creciente. Mediante el uso de bases de datos poblacionales describimos las características principales de los pacientes con ictus isquémico y comparamos el uso de recursos y el gasto asociado un año antes y 3 años después del evento. Se identificaron en los sistemas de Información del Servicio Catalán de la Salud todos los pacientes con ictus isquémico entre los años 2012 y 2016. Se relacionaron todos los contactos con el sistema sanitario desde un año antes del episodio índice hasta 3 años después. Se describió el uso de recursos y el gasto sanitario mensual y anual por paciente en los distintos recursos. Se identificaron 36.044 pacientes con ictus isquémico, edad media (DE) de 74,7 (13,3) años. La supervivencia a los 3 años fue del 63%. El gasto medio por paciente en el año previo fue de 3.230€, de 11.060€ el primer año desde el ictus, de 4.104€ el segundo y 3.878€ el tercero. Los mayores determinantes de gasto en el primer año fueron las hospitalizaciones (incluyendo la hospitalización inicial), representando el 45% de la diferencia con respecto al año previo al ictus, y en segundo lugar el gasto en convalecencia y rehabilitación (un 33%). Después del primer año, los mayores determinantes del incremento en el gasto respecto al año previo fueron las nuevas hospitalizaciones y el tratamiento farmacológico. Después de un ictus isquémico, el gasto en atención sanitaria aumenta principalmente por las necesidades iniciales de hospitalización y después del primer año se reduce, aunque manteniéndose por encima de los valores previos al ictus. La información derivada de bases de datos poblacionales es útil para mejorar la organización de los servicios de atención al ictus. Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. We identified 36,044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.

Introduction: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. Methods: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. Results: We identified 36,044 patients with ischaemic stroke (mean age, 74.7 +/- 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was euro 3,230 the year before stroke, euro 11,060 for year one after stroke, euro 4,104 for year 2, and euro 3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. Conclusion: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services. (C) 2019 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.

Purpose To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design/methodology/approach The RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings The study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group. Originality/value The authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.

Background The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose. Methods A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed. Results After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care. Conclusions There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.

Aims This study aimed to evaluate the decline in urgent cardiovascular hospital admissions and in-hospital mortality during the COVID pandemic in two successive waves, and to evaluate differences by sex, age, and deprivation index subgroups. Methods and Results We obtained acute cardiovascular hospital episodes during the years 2019–2020 from region-wide data on public healthcare usage for the population of Catalonia (North-East Spain). We fitted time models to estimate the incidence rate ratios (IRRs) of the acute coronary syndrome (ACS) and acute heart failure (HF) admissions during the first pandemic wave, the between-waves period, and the second wave compared with the corresponding pre-COVID-19 periods and to test for the interaction with sex, age, and area-based socioeconomic level. We evaluated the effect of COVID-19 period on in-hospital mortality. ACS (n = 8,636) and HF (n = 27,566) episodes were defined using primary diagnostic ICD-10 codes. ACS and HF admissions decreased during the first wave (IRR = 0.66, 95%CI: 0.58–0.76 and IRR = 0.61, 95% CI: 0.55–0.68, respectively) and during the second wave (IRR = 0.80, 95%CI: 0.72–0.88 and IRR = 0.76, 95%CI: 0.69–0.84, respectively); acute HF admissions also decreased in the period between waves (IRR: 0.81, 95%CI: 0.74–0.89). The impact was similar in all sex and socioeconomic subgroups and was higher in older patients with ACS. In-hospital mortality was higher than expected only during the first wave. Conclusion During the first wave of the COVID-19 pandemic, there was a marked decline in urgent cardiovascular hospital admissions that were attenuated during the second wave. Both the decline and the attenuation of the effect have been similar in all subgroups regardless of age, sex, or socioeconomic status. In-hospital mortality for ACS and HF episodes increased during the first wave, but not during the second wave.