Manuel Méndez-Bailón

Background/Objectives: Acute heart failure (AHF) is the leading cause of hospitalization among patients over 65 years and is frequently associated with frailty. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) currently represent the only drug class recommended across the entire ejection fraction spectrum, although evidence regarding their effectiveness according to frailty status remains limited. Aims: To determine whether functional frailty, measured by the Short Physical Performance Battery (SPPB) test, influences the effectiveness of SGLT2i in reducing hospital readmission and mortality in elderly patients with AHF. Methods: Observational study of 794 polypathological patients admitted to Internal Medicine with AHF. An interaction analysis assessed whether SPPB, as a continuous variable, modified the association between SGLT2i and the composite outcome (hospital readmission or death), using a Cox model. The sample was further divided by SPPB test score (below 4 (N = 477) or ≥4 (N = 317)) for exploratory analyses. Descriptive and comparative analyses were performed according to SGLT2i administration, using the chi-squared test for qualitative variables and Student’s t-test for quantitative ones (Fisher’s and Mann–Whitney U test as appropriate). Survival analysis was done using Kaplan–Meier curves and Cox regression, with multivariable adjustment for confounders. Results: No significant interaction was found between SPPB score and SGLT2i (p = 0.506). When SPPB was dichotomised, SGLT2i treatment was associated with significantly lower all-cause mortality (3.7% vs. 12.0%; p = 0.018) and readmission (30.3% vs. 45.2%; p = 0.021) in SPPB ≥ 4, with mortality and readmission also numerically lower, without reaching statistical significance, in SPPB < 4 (mortality 12.9% vs. 16.9%, p = 0.410; readmission 34.5% vs. 42.0%, p = 0.220). After adjustment, SGLT2i treatment in the SPPB ≥ 4 group remained associated with a numerically lower hazard for the composite outcome (HR 0.652; 95% CI 0.418–1.018; p = 0.060). Conclusions: No evidence was found that functional frailty modifies the effectiveness of SGLT2i in elderly polypathological patients with AHF. An exploratory analysis suggested a possible gradient of greater association with SPPB ≥ 4, although this should be interpreted as hypothesis-generating.

Background: Recent proposals from the Lancet Commission redefine obesity according to obesity-related organ dysfunction rather than body size alone. Whether this complication-based framework identifies hospitalized patients at highest risk has not been evaluated. We investigated whether complication burden better predicts in-hospital mortality than obesity itself.Methods: We conducted a nationwide retrospective cohort study using the Spanish National Health System Minimum Basic Data Set, including all adult Internal Medicine hospitalizations between Jan 1, 2016, and Dec 31, 2023. Obesity was identified using ICD-10 codes, and ORDs were classified according to the Lancet Commission framework. Multilevel logistic regression models accounting for patient and hospital characteristics identified ORDs independently associated with in-hospital mortality. Risk-adjusted mortality was estimated according to the cumulative burden of prognostically relevant ORDs.Findings: Among 5.441.347 hospitalizations, 559.728 (10.9%) involved patients with obesity. Overall in-hospital mortality was 8·4%. Mortality increased progressively with the burden of obesity-related complications, from 7.0% in patients without prognostically relevant ORDs to 15.7% in those with four ORDs. Similar dose-response relationships were observed across all disease-specific cohorts. Cardiovascular and functional obesity-related diseases were the principal drivers of mortality, including atrial fibrillation (OR, 1.22; 95% CI, 1.19-1.25), obesity-related functional limitation (OR, 1.17; 95% CI, 1.11-1.24), peripheral vascular disease (OR, 1.13; 95% CI, 1.09-1.17), and secondary pulmonary hypertension (OR, 1.10; 95% CI, 1.06-1.13).Interpretation: Among hospitalized adults with obesity, prognosis was determined by the burden of obesity-related complications rather than the diagnosis of obesity itself. These findings support complication-based obesity staging as a clinically meaningful approach to hospital risk stratification and clinical decision making

Background: Older adults hospitalized with acute heart failure frequently present with multimorbidity, frailty, and reduced physiological reserve. This makes accurate prognostic assessment particularly challenging in internal medicine. Traditional heart failure risk models often fail to capture this multidimensional vulnerability. The PROFUND index, developed to estimate medium-term mortality in multimorbid patients, and serum albumin, an established biomarker of nutritional and inflammatory status, may provide complementary prognostic information. This formed the aim of the present study. This study’s objective is to evaluate the individual and combined prognostic value of the PROFUND index and serum albumin for one-year mortality in patients admitted with AHF. Methods: We conducted a prospective, multicenter cohort study within the PROFUNDIC registry. We included consecutive adults hospitalized with AHF or decompensated chronic heart failure who met European Society of Cardiology diagnostic criteria and had NT-proBNP levels > 1500 pg/mL. PROFUND scores were obtained at admission, and hypoalbuminaemia was dichotomized as ≤3.5 g/dL. The primary outcome was one-year mortality, analyzed using Kaplan–Meier survival estimates, Cox proportional hazards models, and time-dependent ROC curves. Results: Among 544 included patients (mean age 85 years; 60% women), high PROFUND scores (>7) were present in 39% and hypoalbuminaemia in 55%. Both variables independently predicted one-year mortality, with the highest risk observed in patients presenting both high PROFUND scores (HR 2.26; 95% CI 1.66–3.09; p < 0.001) and hypoalbuminaemia (HR 1.70; 95% CI 1.18–2.46; p = 0.0046). The combined use of these markers modestly improved discriminatory performance compared with the PROFUND index alone (HR 2.83; 95% CI 1.72–4.64; p < 0.000). Conclusions: These findings suggest that integrating clinical complexity, assessed by the PROFUND index, with serum albumin provides a simple and clinically meaningful approach to early risk stratification in very elderly multimorbid patients treated in internal medicine wards.

Background/Objectives: Heart failure (HF) is a leading cause of hospitalization in older adults, with significant sex differences in presentation, treatment, and outcomes. Transitional care models may benefit women more, yet they often receive less follow-up. This study assessed whether the clinical impact of the UMIPIC multidisciplinary HF management program differs by sex. Methods: This prospective, multicenter, observational cohort study included HF patients enrolled in the UMIPIC program or followed through conventional care in the RICA registry. Outcomes (30-day and one-year mortality and readmissions) were compared between groups, stratified by sex. Multivariate Cox models adjusted for age, HF phenotype, comorbidities, and baseline therapy. Results: A total of 5644 HF patients were included, with 2034 (36%) managed in UMIPIC and 3610 (64%) receiving conventional care. Women represented 55% of UMIPIC patients and were older, with higher prevalence of hypertension, anemia, and HF with preserved ejection fraction (HFpEF) compared to conventional care. At 30 days, women in UMIPIC had lower all-cause mortality (4.0% vs. 8.0%), cardiovascular mortality (2.0% vs. 6.0%), and readmissions (9.0% vs. 18.0%; all p < 0.01); these benefits persisted at one year. In multivariate analysis, UMIPIC enrollment remained protective (HR: 0.79; 95% CI: 0.71–0.87; p < 0.001). In men, UMIPIC patients were older with more comorbidities and higher HFpEF prevalence. They also showed lower 30-day mortality (2.0% vs. 8.0%; p < 0.05) and readmissions (8.0% vs. 18.0%; p < 0.01), with benefits maintained at one year. UMIPIC enrollment remained independently associated with reduced one-year mortality in men (HR: 0.79; 95% CI: 0.71–0.88; p < 0.001). Conclusions: The UMIPIC multidisciplinary care model reduced one-year mortality and readmissions in both women and men with HF, supporting integrated care strategies to improve outcomes in this high-risk population.

Drug-induced and idiosyncratic cytopenias, including anemia, neutropenia, and thrombocytopenia, present significant challenges in fields like immunohematology and internal medicine. These conditions are often unpredictable, multifactorial, and can arise from a complex interplay of drug reactions, immune abnormalities, and other poorly understood mechanisms. In many cases, the precise triggers and underlying factors remain unclear, making diagnosis and management difficult. However, advancements in artificial intelligence (AI) are offering new opportunities to address these challenges. With its ability to process vast amounts of clinical, genomic, and pharmacovigilance data, AI can identify patterns and risk factors that may be missed by traditional methods. Machine learning algorithms can refine predictive models, enabling earlier detection and more accurate risk assessments. Additionally, AI’s role in enhancing patient engagement—through tailored monitoring and personalized treatment strategies—ensures more effective follow-up and improved clinical outcomes for patients at risk of these potentially life-threatening conditions. Through these innovations, AI is paving the way for a more proactive and personalized approach to managing drug-induced cytopenias.

Food cobalamin malabsorption (FCM) represents a prevalent, often underdiagnosed, etiology of vitamin B12 deficiency, particularly within an aging population. Unlike pernicious anemia, an autoimmune disorder targeting intrinsic factor, FCM stems from the impaired release of cobalamin from food proteins, primarily due to age-related gastric changes, medication-induced gastric hypochlorhydria, metformin, or non-immune atrophic gastritis. The clinical presentation of FCM mirrors that of general cobalamin deficiency, encompassing a spectrum of neurological (peripheral neuropathy, cognitive decline), hematological (megaloblastic anemia), and gastrointestinal (glossitis, anorexia) manifestations. Given the potential for irreversible neurological sequelae, early detection and intervention are paramount. High-dose oral cobalamin (125–250 mcg daily) has demonstrated efficacy, offering a convenient and cost-effective alternative to parenteral administration.

Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09–1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year.