Introduction: Heart failure (HF) is a high prevalence disease worldwide, with a negative impact on the patients' quality of life. Atrial fibrillation (AF) is the most common arrhythmia in older adults with a prevalence around 9% in adults aged 80 years or older. In patients with HF the prevalence of AF is higher than in the general population. In 2011, our Department created an outpatient clinic (oPC), aiming to evaluate the patients with HF after hospitalisation episodes, trying to optimise both the disease stratification and treatment goals as well as encouraging lifestyle changes. Objective: The aim of this study is to characterize patients seen in the oPC, based on a division in two groups: those with and those without AF. The authors intend to determine if the presence of AF has an influence in some clinical outcomes of each group, such as the New York Heart Association (NYHA) classification, the prevalence of systolic dysfunction and mortality rate. Methods: This prospective study included the 319 patients reevaluated in the oPC after hospitalisation episodes, during the years of 2011 and 2012. Demographic and clinical data were collected in appropriate forms and the population was divided in two groups, regarding the existence or absence of AF. Clinical outcomes of both groups were compared and statistical analysis was made using SPSS 19.0. Results: The prevalence of AF in this population was 50.5%, corresponding to 161 patients. From these 62.7% were women. The median age in both groups was similar (with AF, 80 ± 9.2 years; without AF, 79 ± 10.7 years). Around 30% of the AF group was stratified as III–IV NYHA class of HF, comparing to 20.5% in the non-AF group. The prevalence of moderate-to-severe systolic dysfunction was higher in the non-AF (35.8% vs 21%) but there is around 20% of missing in both sides, corresponding to a lack of structural evaluation (echocardiogram). Moderate-to-severe valvular disease (VD) was present in 22.5% of the non-AF group and in 31% of the AF group and ischemic heart disease (IHD) in 33.8% and 22.4%, respectively. The prescription of B-blockers was slightly higher in the AF group (73.9% vs 70.2%). The creatinine clearance rate was around 56 ml/min in both groups. The 6 month readmission and mortality rate (not yet fully available) will also be analysed. Conclusions: AF has a high prevalence in our population, mostly in women but, unlike other series, the AF patients are not older. However, the clinical severity of the disease (class III–IV NYHA) was higher in the AF group. There is a high number of patients without a quantitative systolic function evaluation, which may represent a bias. According to the data of our study, the existence of AF does not lead to worst clinical outcomes and the relation with the usual risk factors for its presence (e.g. IHD) was not confirmed.

Introduction: Medical records (MR) are the most important source of information and means of communication in medical care. Also, they have increasing legal importance in the defence of both the heath provider and the patient. Since 2011, (MR) have been considered by our department as Quality Indicators (QI) and efforts have been made in order to improve patient care. Objective: To evaluate medical records quality in a Department of Internal Medicine. Material and Methods: We randomly choose 25 patients' files per month, from January to June 2013, making a total of 150 files. A protocol with a list of QI was created in 2011 and in 2013 we use a new index, the "AVD-DezIS" score, as a QI for medical records. It consists of 4 items on daily living basic activities (QI 1), 5 items on daily living instrumental activities (QI 2) and 11 items on social and functional profiles (QI 3). In January and February 2013, records were filled on paper and since March 2013, filling is made electronically and is mandatory before the discharge. The others QIs included are the list of medical problems at the day preceding the discharge (QI 4) and information about prognosis at the day of the discharge (QI 5). The statistic analysis was made using the Microsoft Office Excel 2007 and SPSS 20.0. Results: Preliminary global results of the 3 first months were considered satisfactory for QI1 (78%), QI2 (76%) and QI3 (73%). From January to March, we found significant improvement for QI1 (from 64% to 96%), for QI2 (from 64% to 88%), and for QI3 (from 56% to 88%). No such difference was found for QI4 and QI5. The list of medical problems (QI4) was considered adequate in 77%, a significant improvement from 2010 (65%). The predicted prognosis was adequate in 54%, and higher than in 2010 (16%). The overall rate of compliance to the protocol was 72%. Discussion and conclusions: Results show an improvement in the overall quality of medical records after the establishment of the mandatory filling of the AVD-DezIs score before the discharge. When comparing with the 2010 results, the list of medical problems showed significant improvement but the prognosis maintains low compliance. This protocol seems to have helped us to improve the quality of medical practice and stressed the importance of accurate medical records. This improvement can be reached through the education of health providers which should emphasise the importance of medical and social data in the health care management and can be included in a continuous quality improvement program. We will also analyse other important outcomes like mortality, readmission rates and length of stay. We also compare medical records for different destinations at discharge.

Screening tools are particularly helpful, not only in anticipating performance ability and potential fr caregiver stress, but also the allocation of equipment and support services.