Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost? | Revista Portuguesa de Cardiologia (English edition)

array:24 ["pii" => "S2174204915001816" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.08.001" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "648" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:575-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2800 "formatos" => array:3 [ "EPUB" => 189 "HTML" => 2015 "PDF" => 596 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255115001316" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.02.001" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "648" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:575-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3378 "formatos" => array:3 [ "EPUB" => 198 "HTML" => 2626 "PDF" => 554 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "Artigo Original" "titulo" => "Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "581" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost?" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1535 "Ancho" => 1519 "Tamanyo" => 48607 ] ] "descripcion" => array:1 [ "pt" => "Sobrevida dos doentes no primeiro ano após cirurgia cardíaca. Comparação do grupo A com o grupo B." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Amado, Dina Bento, Daniela Silva, Joana Chin, Nuno Marques, Paula Gago, Jorge Mimoso, Ilídio de Jesus" "autores" => array:8 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Amado" ] 1 => array:2 [ "nombre" => "Dina" "apellidos" => "Bento" ] 2 => array:2 [ "nombre" => "Daniela" "apellidos" => "Silva" ] 3 => array:2 [ "nombre" => "Joana" "apellidos" => "Chin" ] 4 => array:2 [ "nombre" => "Nuno" "apellidos" => "Marques" ] 5 => array:2 [ "nombre" => "Paula" "apellidos" => "Gago" ] 6 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 7 => array:2 [ "nombre" => "Ilídio" "apellidos" => "de Jesus" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204915001816" "doi" => "10.1016/j.repce.2015.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001816?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001316?idApp=UINPBA00004E" "url" => "/08702551/0000003400000010/v1_201510211302/S0870255115001316/v1_201510211302/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204915001828" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.08.002" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "664" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Cardiol. 2015;34:583-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2445 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 1782 "PDF" => 510 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial Comment" "titulo" => "The economics and costs of patient referral protocols for cardiac surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "583" "paginaFinal" => "585" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A economia e os custos das redes de referenciação de doentes para cirurgia cardíaca" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Antunes" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Antunes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255115001778" "doi" => "10.1016/j.repc.2015.06.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001778?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001828?idApp=UINPBA00004E" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001828/v2_201703210134/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "581" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Amado, Dina Bento, Daniela Silva, Joana Chin, Nuno Marques, Paula Gago, Jorge Mimoso, Ilídio de Jesus" "autores" => array:8 [ 0 => array:4 [ "nombre" => "José" "apellidos" => "Amado" "email" => array:1 [ 0 => "pina_amado@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Dina" "apellidos" => "Bento" ] 2 => array:2 [ "nombre" => "Daniela" "apellidos" => "Silva" ] 3 => array:2 [ "nombre" => "Joana" "apellidos" => "Chin" ] 4 => array:2 [ "nombre" => "Nuno" "apellidos" => "Marques" ] 5 => array:2 [ "nombre" => "Paula" "apellidos" => "Gago" ] 6 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 7 => array:2 [ "nombre" => "Ilídio" "apellidos" => "de Jesus" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1312 "Ancho" => 1597 "Tamanyo" => 73472 ] ] "descripcion" => array:1 [ "en" => "Death-free survival of patients awaiting cardiac surgery in group A and group B." ] ] ] "textoCompleto" => "IntroductionCardiothoracic surgery departments are concentrated in a few hospitals in Portugal. In order to meet the needs of the various cardiology centers, there are referral protocols for patients requiring cardiac surgery. Following the recommendations of the Regional Health Authorities, these protocols were altered in August 2011.These changes were mainly made for economic reasons, in an attempt to reduce national health system costs. They may have affected waiting times for surgery, but there is as yet no evidence to support this. Several authors have shown that increased waiting times for coronary artery bypass grafting (CABG) are associated with a rise in mortality during the waiting period.<a class="elsevierStyleCrossRefs" href="#bib0140">1–13</a>The aim of this study was to determine whether these changes have had an impact on waiting times of patients referred for cardiac surgery and on hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery.MethodsWe performed a retrospective, descriptive and correlational study of all patients referred for cardiac surgery by our cardiology department between January 1, 2008 and September 30, 2014. Data on baseline characteristics, waiting times for surgery (defined as the interval between the date of admission to the cardiology department and the day that information on the patient was sent to the surgical center), and events (death or hospitalization) during the waiting period were taken from patients’ medical records. For the purposes of the study, cases were only considered urgent if they had been indicated as such in patients’ records, using the following criteria: for coronary patients, those admitted for myocardial infarction and severe coronary disease (left main disease, disease of the proximal anterior descending artery or three-vessel disease), and for valve patients, those admitted for heart failure requiring ventilation and refractory to medical therapy.The patients were divided into two groups: group A, those referred for surgery between January 1, 2008 and August 31, 2011); and group B, those referred between September 1, 2011 and September 30, 2014). The month of August 2011 was chosen to divide the two groups because it was then that the referral protocols were changed.Baseline characteristics, waiting times and events were compared between the groups.A telephone follow-up was conducted by a cardiologist of patients referred for cardiac surgery during the period under analysis, and events at one year were recorded.SPSS 20.00 was used for the statistical analysis. Categorical variables were compared by the chi-square test, continuous variables were compared using one-way ANOVA, and survival curves during the waiting period and during the first year of follow-up were constructed using the Kaplan-Meier method.ResultsDuring the study period 864 patients were referred for cardiac surgery, mean age 66.0±11.6 years, 268 (31%) female and 596 (69%) male. A total of 557 cardiac surgeries were requested by our department between January 1, 2008 and August 31, 2011 (group A), and 307 between September 1, 2011 and September 30, 2014 (group B).The baseline characteristics of the two groups were similar (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), both in mean logistic EuroSCORE (6.2% in group A and 5.7% in group B [p=0.36]), and in risk factors: male gender (67.6% vs. 72.2%), hypertension (68.6% vs. 70.6%) and diabetes (25.9% vs. 25.2%). Dyslipidemia was the exception (57.7% vs. 65.5%, p=0.03). There was no significant difference between the groups in the incidence of renal dysfunction. In group A, 27.1% of patients and in group B 23.4% of patients were considered urgent.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The mean waiting time for surgery was 10.6±18.5 days (median 6.0, maximum 279 and minimum 0) in group A and 55.7±79.9 days (median 18.0, maximum 476 and minimum 0) in group B (p=0.00). The difference was significant both for patients with indication for urgent surgery (2.1 days in group A and 3.0 days in group B, p=0.03) and for patients referred for elective surgery (13.8 days in group A and 72.4 days in group B, p=0.000).With regard to indications for surgery, there were also no statistically significant differences between the groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, there were differences in waiting times for the various types of surgical indication, with a mean waiting time for CABG of 8.0±8.8 days (median 6, maximum 59 and minimum 1) in group A and 57.2±76.0 days (median 20, maximum 352 and minimum 0) in group B (p=0.00). Among patients referred for aortic valve replacement, in group A the mean waiting time was 14.0±15.8 days (median 10.0, maximum 100 and minimum 0), while in group B the mean was 90.5±86.9 days (median 68.5, maximum 363 and minimum 0) (p=0.00). For mitral valve replacement, the mean in group A was 12.6±11.9 days (median 12.6, maximum 67 and minimum 0) and in group B 63.3±81.8 days (median 25.0, maximum 338 and minimum 0) (p=0.00). Patients in group A scheduled for combined surgery waited a mean of 14.5±30.1 days (median 8.0, maximum 279 and minimum 0) and those in group B waited a mean of 59.3±97.2 days (median 20.0, maximum 476 and minimum 0) (p=0.00)<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the percentages of patients operated within the times recommended in international guidelines.<a class="elsevierStyleCrossRefs" href="#bib0235">20,21</a> The differences observed are statistically significant for the different types of surgery.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0.00). There were no deaths during the waiting period in group A but seven in group B (0% vs. 2.3%, p=0.00). The patients who died had waited for a mean of 72.6 days (median 47, minimum 13 and maximum 195); one of them was indicated for urgent surgery. Surgical indications in the patients who died were CABG in one, aortic valve replacement in three, mitral valve replacement in one and combined valve and coronary surgery in one. Kaplan-Meier survival curves for event-free survival (death or hospitalization) and for death-free survival during the waiting period in group A and group B are shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>, respectively.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Of the 755 patients referred between January 1, 2008 and October 31, 2013 for whom one-year follow-up was possible, this was achieved in 641 (85%). During this period, 12.8% of these patients, 16% of those in group A and 12.9% of those in group B (p=0.2), were hospitalized for cardiovascular causes. Cardiovascular mortality during follow-up was 4.8%, 4.7% in group A and 5.1% in group B (p=0.49). <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a> show Kaplan-Meier curves for event-free survival (death or hospitalization) and death-free survival at one year of follow-up, respectively.<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionThis is the first study in Portugal analyzing the impact of waiting times for cardiac surgery on mortality, need for hospitalization before surgery and early and one-year outcomes.The study shows that the changes in referral protocols for patients with indication for cardiac surgery at Hospital de Faro that took effect in August 2011 significantly increased waiting times and mortality during the waiting period. This increase was seen for all types of cardiac surgery, and was statistically significant for CABG, aortic and mitral valve replacement, and combined surgery.The importance of waiting times for cardiac surgery has been the subject of considerable debate. In 1995, Carroll et al. reported large differences between certain European countries and the USA, with most CABG being performed within 72 hours in the USA, while in the UK most patients waited more than three months.<a class="elsevierStyleCrossRef" href="#bib0205">14</a> There has also been disagreement concerning the definition of surgical wait times. According to the Organisation for Economic Co-operation and Development, the wait time should include the time the patient actually waits for surgery, including the time waiting for the first consultation, for diagnostic exams, and, finally, for the procedure itself.<a class="elsevierStyleCrossRefs" href="#bib0210">15,16</a> Various studies have suggested that all of these waiting time intervals need to be addressed in order to reduce total waiting time and improve the health care provided to patients.<a class="elsevierStyleCrossRef" href="#bib0210">15</a>In Canada, where this issue has been studied most, the Ontario score<a class="elsevierStyleCrossRef" href="#bib0220">17</a> was created to develop guidelines for ranking the urgency with which patients with angiographically proven coronary disease need revascularization procedures.<a class="elsevierStyleCrossRef" href="#bib0225">18</a> This score classifies patients as emergency (immediate revascularization), extremely urgent (within 24 hours), urgent (24–72 hours), semi-urgent (72 hours–14 days), short list (2–6 weeks), delayed (6 weeks–3 months), and/or marked delay (3–6 months).The Wait Time Alliance is a Canadian organization formed by various medical societies, dedicated to reducing waiting times for medical care in Canada. Its benchmarks for waiting time for CABG are 24 hours for emergency cases, seven or 14 days for urgent cases, and six weeks for elective surgery.<a class="elsevierStyleCrossRef" href="#bib0230">19</a> The Access to Care Working Group of the Canadian Cardiovascular Society (CCS) has also defined waiting times for cardiac surgery, suggesting 14 days or six weeks for CABG, depending on coronary anatomy, 14 days for severe aortic stenosis and six weeks for other valve surgery.<a class="elsevierStyleCrossRef" href="#bib0235">20</a>In our study, waiting times for non-urgent CABG increased from eight to around 57 days, with some patients waiting over three months, and similar increases were seen for valve and combined surgery. Although the times referred to in the above studies reflect the situation in Canada, they are the only guidelines specifically on this subject. The 2014 ESC/EACTS Guidelines on myocardial revascularization<a class="elsevierStyleCrossRef" href="#bib0240">21</a> also present recommendations for optimal timings for intervention: revascularization (percutaneous coronary intervention or CABG) should be performed within two weeks for patients with CCS class 3 or 4 symptoms or high-risk anatomy (left main disease or equivalent, three-vessel or proximal LAD disease or depressed ventricular function), and within six weeks for all other patients with stable coronary disease.Our findings (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) show that waiting times for patients referred by our center for cardiac surgery are longer than the above recommendations.Increased wait time for CABG increases mortality during the waiting period.<a class="elsevierStyleCrossRefs" href="#bib0140">1,22</a> In our study, cardiovascular mortality in a mean waiting period of 55.7±79.9 days was 2.3% (group B), while in group A the mean waiting time was 10.6±18.5 days and there were no deaths between diagnosis and surgery. In the seven patients who died waiting for surgery, mean waiting time was 72.6 days (median 47, maximum 195 and minimum 13). These findings are also illustrated in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>.There are several studies in the literature describing mortality rates in patients waiting for cardiac surgery, the figures ranging between 0.3% and 5.8% (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Although most studies on waiting times are on CABG, Lund et al. showed that mortality in patients with symptomatic aortic stenosis awaiting valve replacement was 13.5% during a mean waiting period of 6.3 months.<a class="elsevierStyleCrossRef" href="#bib0250">23</a> More recently, Malaisrie et al. showed that mortality in patients with aortic stenosis waiting for valve replacement was 3.7% at one month and 11.6% at six months.<a class="elsevierStyleCrossRef" href="#bib0255">24</a> In another recent study, in patients with severe aortic stenosis, abrupt symptomatic deterioration from New York Heart Association (NYHA) class I to NYHA III–IV in the month preceding surgery was observed in 18% of patients, resulting in increased operative mortality (17% vs. 5% in NYHA I patients (p=0.035) and significantly worse long-term survival in patients in NYHA III–IV (56% vs. 72%; p<0.002).<a class="elsevierStyleCrossRef" href="#bib0260">25</a>It has also been shown that in patients with severe aortic stenosis who are inoperable or at high surgical risk, increased time waiting for percutaneous valve replacement is associated with higher mortality both while on the waiting list and at one year.<a class="elsevierStyleCrossRef" href="#bib0265">26</a>Although our study was not designed to establish costs, hospitalizations incur additional costs. Besides higher mortality, increased waiting times in our patients were associated with a significant rise in the number of hospitalizations (from 0.4% to 9.1%) during the waiting period. The differences between the two groups in mortality and hospitalizations can be seen in the survival curves in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. In our study population, most of these admissions were due to worsening clinical status requiring earlier surgery and hospitalization in the interim.Waiting times for cardiac surgery of over three months have also been associated with a greater number of adverse events following surgery.<a class="elsevierStyleCrossRef" href="#bib0265">26</a> No such association was seen in our study, in which the prevalence of hospitalization (12.9% vs. 16%) and mortality (4.7% vs. 5.1%) were similar in the two groups at one year, as shown in <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>.As stated above, in Canada the subject of waiting lists is the subject of considerable debate, and it has been suggested that additional financial investment can help reduce waiting times.<a class="elsevierStyleCrossRef" href="#bib0270">27</a>It can be seen from our study that longer waiting times for surgery lead to increases in hospitalizations and mortality. The available data do not allow ideal waiting times to be identified and, in any case, this was not the aim of the study. We therefore propose the establishment of a national database of patients referred for cardiac surgery, in order to quantify the adverse events that occur during the waiting period. On the basis of such objective data it will be possible to modify the referral process in order to eliminate excessive waiting times and their harmful consequences.LimitationsThe main limitations of the study stem from its retrospective and observational nature and the fact that it is based on a single referral center.A follow-up rate of 85% was achieved, which while acceptable given the number of patients, may have underestimated the event rate (hospitalization and mortality) during the follow-up period.The definition of waiting time in this study was the interval between the date of surgery and the date of referral, which may underestimate the real waiting time as experienced by the patient, and this could lead to bias.ConclusionThe changes in referral protocols for cardiac surgery, although not associated with increased one-year mortality, did result in a statistically significant increase in waiting time and hence to a rise in mortality and hospitalizations during the waiting period of 0% to 2.3% and 0.4% to 9.1%, respectively.Ethical responsibilitiesProtection of people and animalsThe authors declare that no experiments were performed on humans or animals for this study.Data confidentialityThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres817807" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec814923" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres817808" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiais e métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec814924" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-08" "fechaAceptado" => "2015-02-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec814923" "palabras" => array:4 [ 0 => "Cardiac surgical procedures" 1 => "Waiting lists" 2 => "Follow-up" 3 => "Mortality" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec814924" "palabras" => array:4 [ 0 => "Procedimentos cirúrgicos cardíacos" 1 => "Listas de espera" 2 => "Seguimento" 3 => "Mortalidade" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesThe aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery. MethodsIn this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow-up was conducted. ResultsThere were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00).During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one-year follow-up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05). ConclusionChanges to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosO objetivo deste estudo foi determinar se as alterações aos protocolos de referenciação para cirurgia cardíaca tiveram impacto nos tempos de espera, taxa de internamentos e na mortalidade durante o período de espera e durante o primeiro ano de seguimento após cirurgia. Materiais e métodosEstudo retrospetivo, com doentes referenciados para cirurgia cardíaca de 1/01/2008 a 30/09/2014. Avaliaram-se dois grupos de doentes antes e depois da mudança de referenciação: grupo A entre 1/01/2008 e 01/08/2011 e grupo B entre 01/08/2011 e 30/09/2014. Foi realizado o follow-up telefónico. ResultadosForam referenciados 864 doentes para cirurgia cardíaca, 557 no grupo A e 307 no grupo B. As características dos grupos foram semelhantes. O número médio de dias de espera para cirurgia foi de 10,6 ± 18,5 dias e de 55,7 ± 79,9 dias, respetivamente no grupo A e B (p = 0,00).Durante o período de espera foram internados dois doentes (0,4%) no grupo A e 28 (9,1%) no grupo B (p = 0,00); a taxa de mortalidade foi, respetivamente, de 0-2,3% (p = 0,00). Durante o período de follow-up de um ano foram admitidos em internamento 12,8% dos doentes do grupo A e 16% dos doentes do grupo B. A mortalidade neste período foi de cerca de 5% em ambos os grupos (p > 0,05). ConclusãoAs alterações aos protocolos de referenciação para cirurgia cardíaca tiveram impacto nos tempos de espera, no número de internamentos e na mortalidade nesse período." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiais e métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Amado J, Bento D, Silva D, Chin J, Marques N, Gago P, et al. Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos? 2015;34:575–581." ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1326 "Ancho" => 1590 "Tamanyo" => 70832 ] ] "descripcion" => array:1 [ "en" => "Event-free survival (death or hospitalization) of patients awaiting cardiac surgery in group A and group B." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1312 "Ancho" => 1597 "Tamanyo" => 73472 ] ] "descripcion" => array:1 [ "en" => "Death-free survival of patients awaiting cardiac surgery in group A and group B." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1465 "Ancho" => 1535 "Tamanyo" => 57922 ] ] "descripcion" => array:1 [ "en" => "Event-free survival (death or hospitalization) of patients at one year of follow-up in group A and group B." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1542 "Ancho" => 1521 "Tamanyo" => 53152 ] ] "descripcion" => array:1 [ "en" => "Death-free survival at one year of follow-up in group A and group B." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AoV: aortic valve; BMI: body mass index; CABG: coronary artery bypass grafting; Combined: combined valve and coronary surgery; MV: mitral valve." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.1±11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.8±11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.0±11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.2±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1±5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ejection fraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.6±12.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.2±11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.1±12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">EuroSCORE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.0±6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Renal failure stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urgent indication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Waiting time, days (total) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.6±18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.7±79.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.6±54.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urgent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Elective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8±20.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.4±85.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.1±60.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Type of surgery</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">AoV replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MV surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Combined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374634.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of patients referred for cardiac surgery." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AoV: aortic valve; CABG: coronary artery bypass grafting; Combined: combined valve and coronary surgery; MV: mitral valve." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Non-urgent CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.2±76.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">AoV replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.0±15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.5±86.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MV replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6±11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.3±81.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Combined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5±30.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.3±97.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.1±27.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.0±49.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mean waiting time for cardiac surgery in the two groups." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stable coronary disease (less than 6 weeks)<a class="elsevierStyleCrossRef" href="#bib0235">20</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Severe aortic stenosis (less than 14 days)<a class="elsevierStyleCrossRef" href="#bib0230">19</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mitral valve replacement (less than 6 weeks) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374636.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Percentages of patients undergoing cardiac surgery within recommended times.<a class="elsevierStyleCrossRefs" href="#bib0230">19,20</a>" ] ] 7 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Silber et al.<a class="elsevierStyleCrossRef" href="#bib0200">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3%<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bengtson et al.<a class="elsevierStyleCrossRef" href="#bib0145">2</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG or PCI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Morgan et al.<a class="elsevierStyleCrossRef" href="#bib0225">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Valve or CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48%<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Seddon et al.<a class="elsevierStyleCrossRef" href="#bib0155">4</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28%<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Koomen et al.<a class="elsevierStyleCrossRef" href="#bib0170">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4%<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ray et al.<a class="elsevierStyleCrossRef" href="#bib0165">6</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Valve or CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rexius et al.<a class="elsevierStyleCrossRef" href="#bib0175">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8%<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sobolev et al.<a class="elsevierStyleCrossRef" href="#bib0180">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58–0.79%<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sobolev et al.<a class="elsevierStyleCrossRef" href="#bib0245">22</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9%<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374635.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Annual mortality." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Mean waiting time of one month." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Monthly mortality." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "Weekly mortality in 1000 patient-weeks." ] ] ] "descripcion" => array:1 [ "en" => "Studies on mortality in patients awaiting cardiac surgery." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do longer delays for coronary artery bypass surgery contribute to preoperative mortality in less urgent patients?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "A.R. Levy" 2 => "L. Kuramoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mlr.0000220257.81482.67" "Revista" => array:6 [ "tituloSerie" => "Med Care" "fecha" => "2006" "volumen" => "44" "paginaInicial" => "680" "paginaFinal" => "686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16799363" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications prior to revascularization among patients waiting for coronary artery bypass grafting and percutaneous transluminal coronary angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Bengtson" 1 => "T. Karlsson" 2 => "A. Hjalmarson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "1996" "volumen" => "17" "paginaInicial" => "1846" "paginaFinal" => "1851" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8960427" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Death on the waiting list for cardiac surgery in the Netherlands in 1994 and 1995" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Plomp" 1 => "W.K. Redekop" 2 => "F.W. Dekker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "1999" "volumen" => "81" "paginaInicial" => "593" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10336916" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Waiting times and prioritisation for coronary artery bypass surgery in New Zealand" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.E. Seddon" 1 => "J.K. French" 2 => "D.J. Amos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "1999" "volumen" => "81" "paginaInicial" => "586" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10336915" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of deaths while waiting for cardiac surgery among 29,293 consecutive patients in Ontario, Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.D. Morgan" 1 => "K. Sykora" 2 => "C.D. Naylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "1998" "volumen" => "79" "paginaInicial" => "345" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9616340" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Waiting for cardiac surgery: results of a risk-stratified queuing process" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "A.A. Ray" 1 => "K.J. Buth" 2 => "J.A. Sullivan" 3 => "D.E. Johnstone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "104" "paginaInicial" => "92" "paginaFinal" => "98" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morbidity and mortality in patients waiting for coronary artery bypass surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.M. Koomen" 1 => "B.A. Huttena" 2 => "J.C. Keldera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2001" "volumen" => "19" "paginaInicial" => "260" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11251263" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality on the waiting list for coronary artery bypass grafting: incidence and risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Rexius" 1 => "G. Brandrup-Wognsen" 2 => "A. Odén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2003.05.007" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2004" "volumen" => "77" "paginaInicial" => "769" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14992868" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The risk of death associated with delayed coronary artery bypass surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "A.R. Levy" 2 => "L. Kuramoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6963-6-1" "Revista" => array:6 [ "tituloSerie" => "BMC Health Serv Res" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16403235" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "L. Kuramoto" 2 => "A.R. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiothorac Surg" "fecha" => "2006" "volumen" => "1" "paginaInicial" => "1" "paginaFinal" => "10" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "G. Fradet" 2 => "R. Hayden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6963-8-185" "Revista" => array:5 [ "tituloSerie" => "BMC Health Serv Res" "fecha" => "2008" "volumen" => "8" "paginaInicial" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18803823" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An observational study to evaluate 2 target times for elective coronary bypass surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "G. Fradet" 2 => "L. Kuramoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MLR.0b013e31824deed2" "Revista" => array:6 [ "tituloSerie" => "Med Care" "fecha" => "2012" "volumen" => "50" "paginaInicial" => "611" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22525613" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Waiting times and death on the waiting list for coronary artery bypass operation. Experiences in Munich with over 1,000 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Silber" 1 => "H. Mühling" 2 => "R. Dörr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Herz" "fecha" => "1996" "volumen" => "21" "paginaInicial" => "389" "paginaFinal" => "396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9081908" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International comparison of waiting times for selected cardiovascular procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.J. Carroll" 1 => "S.D. Horn" 2 => "B. Soderfeldt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0735-1097(94)00442-S" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1995" "volumen" => "25" "paginaInicial" => "557" "paginaFinal" => "563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7860896" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved wait times for coronary revascularization: cause to celebrate spotting the iceberg in time or time to look under the surface?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Simpson" 1 => "B.J. O’Neill" 2 => "S. Christopher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2010.12.054" "Revista" => array:7 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2011" "volumen" => "27" "numero" => "263" "paginaInicial" => "e1" "paginaFinal" => "e3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21459257" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How established wait time benchmarks significantly underestimate total wait times for cardiac surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.F. Légaré" 1 => "D. Li" 2 => "K.J. Buth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "e17" "paginaFinal" => "e21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20101361" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of priority for coronary revascularisation procedures. Revascularisation Panel and Consensus Methods Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.D. Naylor" 1 => "R.S. Baigrie" 2 => "B.S. Goldman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1990" "volumen" => "335" "paginaInicial" => "1070" "paginaFinal" => "1073" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1970377" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of deaths while waiting for cardiac surgery among 29,293 consecutive patients in Ontario, Canada. The Steering Committee of the Cardiac Care Network of Ontario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.D. Morgan" 1 => "K. Sykora" 2 => "C.D. Naylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "1998" "volumen" => "79" "paginaInicial" => "345" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9616340" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: http://www.waittimealliance.ca/benchmarks/cardiac-care" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Cardiac care wait time benchmarks for cardiovascular services and procedures" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2014" "editorial" => "Canada Wait Time Alliance" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in wait times for cardiac revascularization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.A. Southern" 1 => "M. Izadneghadar" 2 => "K.H. Humphries" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2011" "paginaInicial" => "262.e21" "paginaFinal" => "262.e27" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC/EACTS Guidelines on myocardial revascularization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Windecker" 1 => "P. Kolh" 2 => "F. Alfonso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "2544" "paginaFinal" => "2640" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The occurrence of adverse events in relation to time after registration for coronary artery bypass surgery: a population-based observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.G. Sobolev" 1 => "G. Fradet" 2 => "L. Kuramoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-8090-8-1" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Surg" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "1" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23289601" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.O. Nielsen" 1 => "K. Emmertsen" 2 => "C. Flø" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1012039" "Revista" => array:6 [ "tituloSerie" => "Thorac Cardiovasc Surg" "fecha" => "1996" "volumen" => "44" "paginaInicial" => "289" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9021905" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality while waiting for aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.C. Malaisrie" 1 => "E. McDonald" 2 => "J. Kruse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2014.06.040" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "1564" "paginaFinal" => "1571" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240781" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of preoperative symptoms on postoperative survival in severe aortic stenosis: implications for the timing of surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Piérard" 1 => "C. Meester" 2 => "S. Seldrum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "806" "paginaFinal" => "810" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of wait times on the effectiveness of transcatheter aortic valve replacement in severe aortic valve disease: a discrete event simulation model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.C. Wijeysundera" 1 => "W. Wong" 2 => "M.C. Bennell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2013.11.023" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365187" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Sampalis" 1 => "S. Boukas" 2 => "M. Liberman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2001" "volumen" => "165" "paginaInicial" => "429" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11531051" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001816/v2_201703210134/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000010/v2_201703210134/S2174204915001816/v2_201703210134/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001816?idApp=UINPBA00004E"]

Statistics

Original Article

Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost?

Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos?

José Amado

Corresponding author

pina_amado@hotmail.com

Corresponding author.

, Dina Bento, Daniela Silva, Joana Chin, Nuno Marques, Paula Gago, Jorge Mimoso, Ilídio de Jesus

Serviço de Cardiologia, Centro Hospitalar do Algarve, Faro, Portugal

Read

5368

Times
was read the article

1721

Total PDF

3647

Total HTML

Share statistics

 array:24 [
  "pii" => "S2174204915001816"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "648"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2015;34:575-81"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2800
    "formatos" => array:3 [
      "EPUB" => 189
      "HTML" => 2015
      "PDF" => 596
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255115001316"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2015.02.001"
      "estado" => "S300"
      "fechaPublicacion" => "2015-10-01"
      "aid" => "648"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2015;34:575-81"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3378
        "formatos" => array:3 [
          "EPUB" => 198
          "HTML" => 2626
          "PDF" => 554
        ]
      ]
      "pt" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
        "titulo" => "Altera&#231;&#227;o nas redes de referencia&#231;&#227;o de doentes para cirurgia cardiotor&#225;cica&#58; as raz&#245;es econ&#243;micas ser&#227;o destitu&#237;das de custos&#63;"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "pt"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "575"
            "paginaFinal" => "581"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Changes in referral protocols for cardiac surgery&#58; Do financial considerations come at a cost&#63;"
          ]
        ]
        "contieneResumen" => array:2 [
          "pt" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0020"
            "etiqueta" => "Figura 4"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr4.jpeg"
                "Alto" => 1535
                "Ancho" => 1519
                "Tamanyo" => 48607
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sobrevida dos doentes no primeiro ano ap&#243;s cirurgia card&#237;aca&#46; Compara&#231;&#227;o do grupo A com o grupo B&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Amado, Dina Bento, Daniela Silva, Joana Chin, Nuno Marques, Paula Gago, Jorge Mimoso, Il&#237;dio de Jesus"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Jos&#233;"
                "apellidos" => "Amado"
              ]
              1 => array:2 [
                "nombre" => "Dina"
                "apellidos" => "Bento"
              ]
              2 => array:2 [
                "nombre" => "Daniela"
                "apellidos" => "Silva"
              ]
              3 => array:2 [
                "nombre" => "Joana"
                "apellidos" => "Chin"
              ]
              4 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Marques"
              ]
              5 => array:2 [
                "nombre" => "Paula"
                "apellidos" => "Gago"
              ]
              6 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Mimoso"
              ]
              7 => array:2 [
                "nombre" => "Il&#237;dio"
                "apellidos" => "de Jesus"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204915001816"
          "doi" => "10.1016/j.repce.2015.08.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001816?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001316?idApp=UINPBA00004E"
      "url" => "/08702551/0000003400000010/v1_201510211302/S0870255115001316/v1_201510211302/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204915001828"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.08.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "664"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Cardiol. 2015;34:583-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2445
      "formatos" => array:3 [
        "EPUB" => 153
        "HTML" => 1782
        "PDF" => 510
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial Comment</span>"
      "titulo" => "The economics and costs of patient referral protocols for cardiac surgery"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "583"
          "paginaFinal" => "585"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A economia e os custos das redes de referencia&#231;&#227;o de doentes para cirurgia card&#237;aca"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Manuel Antunes"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Antunes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115001778"
        "doi" => "10.1016/j.repc.2015.06.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001778?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001828?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001828/v2_201703210134/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Changes in referral protocols for cardiac surgery&#58; Do financial considerations come at a cost&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "575"
        "paginaFinal" => "581"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jos&#233; Amado, Dina Bento, Daniela Silva, Joana Chin, Nuno Marques, Paula Gago, Jorge Mimoso, Il&#237;dio de Jesus"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Amado"
            "email" => array:1 [
              0 => "pina&#95;amado&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Dina"
            "apellidos" => "Bento"
          ]
          2 => array:2 [
            "nombre" => "Daniela"
            "apellidos" => "Silva"
          ]
          3 => array:2 [
            "nombre" => "Joana"
            "apellidos" => "Chin"
          ]
          4 => array:2 [
            "nombre" => "Nuno"
            "apellidos" => "Marques"
          ]
          5 => array:2 [
            "nombre" => "Paula"
            "apellidos" => "Gago"
          ]
          6 => array:2 [
            "nombre" => "Jorge"
            "apellidos" => "Mimoso"
          ]
          7 => array:2 [
            "nombre" => "Il&#237;dio"
            "apellidos" => "de Jesus"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Centro Hospitalar do Algarve&#44; Faro&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Altera&#231;&#227;o nas redes de referencia&#231;&#227;o de doentes para cirurgia cardiotor&#225;cica&#58; as raz&#245;es econ&#243;micas ser&#227;o destitu&#237;das de custos&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1312
            "Ancho" => 1597
            "Tamanyo" => 73472
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Death-free survival of patients awaiting cardiac surgery in group A and group B&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiothoracic surgery departments are concentrated in a few hospitals in Portugal&#46; In order to meet the needs of the various cardiology centers&#44; there are referral protocols for patients requiring cardiac surgery&#46; Following the recommendations of the Regional Health Authorities&#44; these protocols were altered in August 2011&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">These changes were mainly made for economic reasons&#44; in an attempt to reduce national health system costs&#46; They may have affected waiting times for surgery&#44; but there is as yet no evidence to support this&#46; Several authors have shown that increased waiting times for coronary artery bypass grafting &#40;CABG&#41; are associated with a rise in mortality during the waiting period&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#8211;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to determine whether these changes have had an impact on waiting times of patients referred for cardiac surgery and on hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a retrospective&#44; descriptive and correlational study of all patients referred for cardiac surgery by our cardiology department between January 1&#44; 2008 and September 30&#44; 2014&#46; Data on baseline characteristics&#44; waiting times for surgery &#40;defined as the interval between the date of admission to the cardiology department and the day that information on the patient was sent to the surgical center&#41;&#44; and events &#40;death or hospitalization&#41; during the waiting period were taken from patients&#8217; medical records&#46; For the purposes of the study&#44; cases were only considered urgent if they had been indicated as such in patients&#8217; records&#44; using the following criteria&#58; for coronary patients&#44; those admitted for myocardial infarction and severe coronary disease &#40;left main disease&#44; disease of the proximal anterior descending artery or three-vessel disease&#41;&#44; and for valve patients&#44; those admitted for heart failure requiring ventilation and refractory to medical therapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patients were divided into two groups&#58; group A&#44; those referred for surgery between January 1&#44; 2008 and August 31&#44; 2011&#41;&#59; and group B&#44; those referred between September 1&#44; 2011 and September 30&#44; 2014&#41;&#46; The month of August 2011 was chosen to divide the two groups because it was then that the referral protocols were changed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Baseline characteristics&#44; waiting times and events were compared between the groups&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A telephone follow-up was conducted by a cardiologist of patients referred for cardiac surgery during the period under analysis&#44; and events at one year were recorded&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">SPSS 20&#46;00 was used for the statistical analysis&#46; Categorical variables were compared by the chi-square test&#44; continuous variables were compared using one-way ANOVA&#44; and survival curves during the waiting period and during the first year of follow-up were constructed using the Kaplan-Meier method&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">During the study period 864 patients were referred for cardiac surgery&#44; mean age 66&#46;0&#177;11&#46;6 years&#44; 268 &#40;31&#37;&#41; female and 596 &#40;69&#37;&#41; male&#46; A total of 557 cardiac surgeries were requested by our department between January 1&#44; 2008 and August 31&#44; 2011 &#40;group A&#41;&#44; and 307 between September 1&#44; 2011 and September 30&#44; 2014 &#40;group B&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The baseline characteristics of the two groups were similar &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; both in mean logistic EuroSCORE &#40;6&#46;2&#37; in group A and 5&#46;7&#37; in group B &#91;p&#61;0&#46;36&#93;&#41;&#44; and in risk factors&#58; male gender &#40;67&#46;6&#37; vs&#46; 72&#46;2&#37;&#41;&#44; hypertension &#40;68&#46;6&#37; vs&#46; 70&#46;6&#37;&#41; and diabetes &#40;25&#46;9&#37; vs&#46; 25&#46;2&#37;&#41;&#46; Dyslipidemia was the exception &#40;57&#46;7&#37; vs&#46; 65&#46;5&#37;&#44; p&#61;0&#46;03&#41;&#46; There was no significant difference between the groups in the incidence of renal dysfunction&#46; In group A&#44; 27&#46;1&#37; of patients and in group B 23&#46;4&#37; of patients were considered urgent&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The mean waiting time for surgery was 10&#46;6&#177;18&#46;5 days &#40;median 6&#46;0&#44; maximum 279 and minimum 0&#41; in group A and 55&#46;7&#177;79&#46;9 days &#40;median 18&#46;0&#44; maximum 476 and minimum 0&#41; in group B &#40;p&#61;0&#46;00&#41;&#46; The difference was significant both for patients with indication for urgent surgery &#40;2&#46;1 days in group A and 3&#46;0 days in group B&#44; p&#61;0&#46;03&#41; and for patients referred for elective surgery &#40;13&#46;8 days in group A and 72&#46;4 days in group B&#44; p&#61;0&#46;000&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to indications for surgery&#44; there were also no statistically significant differences between the groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; there were differences in waiting times for the various types of surgical indication&#44; with a mean waiting time for CABG of 8&#46;0&#177;8&#46;8 days &#40;median 6&#44; maximum 59 and minimum 1&#41; in group A and 57&#46;2&#177;76&#46;0 days &#40;median 20&#44; maximum 352 and minimum 0&#41; in group B &#40;p&#61;0&#46;00&#41;&#46; Among patients referred for aortic valve replacement&#44; in group A the mean waiting time was 14&#46;0&#177;15&#46;8 days &#40;median 10&#46;0&#44; maximum 100 and minimum 0&#41;&#44; while in group B the mean was 90&#46;5&#177;86&#46;9 days &#40;median 68&#46;5&#44; maximum 363 and minimum 0&#41; &#40;p&#61;0&#46;00&#41;&#46; For mitral valve replacement&#44; the mean in group A was 12&#46;6&#177;11&#46;9 days &#40;median 12&#46;6&#44; maximum 67 and minimum 0&#41; and in group B 63&#46;3&#177;81&#46;8 days &#40;median 25&#46;0&#44; maximum 338 and minimum 0&#41; &#40;p&#61;0&#46;00&#41;&#46; Patients in group A scheduled for combined surgery waited a mean of 14&#46;5&#177;30&#46;1 days &#40;median 8&#46;0&#44; maximum 279 and minimum 0&#41; and those in group B waited a mean of 59&#46;3&#177;97&#46;2 days &#40;median 20&#46;0&#44; maximum 476 and minimum 0&#41; &#40;p&#61;0&#46;00&#41;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the percentages of patients operated within the times recommended in international guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">20&#44;21</span></a> The differences observed are statistically significant for the different types of surgery&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">During the waiting period two patients &#40;0&#46;4&#37;&#41; were hospitalized in group A and 28 &#40;9&#46;1&#37;&#41; in group B &#40;p&#61;0&#46;00&#41;&#46; There were no deaths during the waiting period in group A but seven in group B &#40;0&#37; vs&#46; 2&#46;3&#37;&#44; p&#61;0&#46;00&#41;&#46; The patients who died had waited for a mean of 72&#46;6 days &#40;median 47&#44; minimum 13 and maximum 195&#41;&#59; one of them was indicated for urgent surgery&#46; Surgical indications in the patients who died were CABG in one&#44; aortic valve replacement in three&#44; mitral valve replacement in one and combined valve and coronary surgery in one&#46; Kaplan-Meier survival curves for event-free survival &#40;death or hospitalization&#41; and for death-free survival during the waiting period in group A and group B are shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>&#44; respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Of the 755 patients referred between January 1&#44; 2008 and October 31&#44; 2013 for whom one-year follow-up was possible&#44; this was achieved in 641 &#40;85&#37;&#41;&#46; During this period&#44; 12&#46;8&#37; of these patients&#44; 16&#37; of those in group A and 12&#46;9&#37; of those in group B &#40;p&#61;0&#46;2&#41;&#44; were hospitalized for cardiovascular causes&#46; Cardiovascular mortality during follow-up was 4&#46;8&#37;&#44; 4&#46;7&#37; in group A and 5&#46;1&#37; in group B &#40;p&#61;0&#46;49&#41;&#46; <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a> show Kaplan-Meier curves for event-free survival &#40;death or hospitalization&#41; and death-free survival at one year of follow-up&#44; respectively&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">This is the first study in Portugal analyzing the impact of waiting times for cardiac surgery on mortality&#44; need for hospitalization before surgery and early and one-year outcomes&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study shows that the changes in referral protocols for patients with indication for cardiac surgery at Hospital de Faro that took effect in August 2011 significantly increased waiting times and mortality during the waiting period&#46; This increase was seen for all types of cardiac surgery&#44; and was statistically significant for CABG&#44; aortic and mitral valve replacement&#44; and combined surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The importance of waiting times for cardiac surgery has been the subject of considerable debate&#46; In 1995&#44; Carroll et al&#46; reported large differences between certain European countries and the USA&#44; with most CABG being performed within 72 hours in the USA&#44; while in the UK most patients waited more than three months&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> There has also been disagreement concerning the definition of surgical wait times&#46; According to the Organisation for Economic Co-operation and Development&#44; the wait time should include the time the patient actually waits for surgery&#44; including the time waiting for the first consultation&#44; for diagnostic exams&#44; and&#44; finally&#44; for the procedure itself&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15&#44;16</span></a> Various studies have suggested that all of these waiting time intervals need to be addressed in order to reduce total waiting time and improve the health care provided to patients&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In Canada&#44; where this issue has been studied most&#44; the Ontario score<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> was created to develop guidelines for ranking the urgency with which patients with angiographically proven coronary disease need revascularization procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> This score classifies patients as emergency &#40;immediate revascularization&#41;&#44; extremely urgent &#40;within 24 hours&#41;&#44; urgent &#40;24&#8211;72 hours&#41;&#44; semi-urgent &#40;72 hours&#8211;14 days&#41;&#44; short list &#40;2&#8211;6 weeks&#41;&#44; delayed &#40;6 weeks&#8211;3 months&#41;&#44; and&#47;or marked delay &#40;3&#8211;6 months&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The Wait Time Alliance is a Canadian organization formed by various medical societies&#44; dedicated to reducing waiting times for medical care in Canada&#46; Its benchmarks for waiting time for CABG are 24 hours for emergency cases&#44; seven or 14 days for urgent cases&#44; and six weeks for elective surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> The Access to Care Working Group of the Canadian Cardiovascular Society &#40;CCS&#41; has also defined waiting times for cardiac surgery&#44; suggesting 14 days or six weeks for CABG&#44; depending on coronary anatomy&#44; 14 days for severe aortic stenosis and six weeks for other valve surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our study&#44; waiting times for non-urgent CABG increased from eight to around 57 days&#44; with some patients waiting over three months&#44; and similar increases were seen for valve and combined surgery&#46; Although the times referred to in the above studies reflect the situation in Canada&#44; they are the only guidelines specifically on this subject&#46; The 2014 ESC&#47;EACTS Guidelines on myocardial revascularization<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> also present recommendations for optimal timings for intervention&#58; revascularization &#40;percutaneous coronary intervention or CABG&#41; should be performed within two weeks for patients with CCS class 3 or 4 symptoms or high-risk anatomy &#40;left main disease or equivalent&#44; three-vessel or proximal LAD disease or depressed ventricular function&#41;&#44; and within six weeks for all other patients with stable coronary disease&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our findings &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; show that waiting times for patients referred by our center for cardiac surgery are longer than the above recommendations&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Increased wait time for CABG increases mortality during the waiting period&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;22</span></a> In our study&#44; cardiovascular mortality in a mean waiting period of 55&#46;7&#177;79&#46;9 days was 2&#46;3&#37; &#40;group B&#41;&#44; while in group A the mean waiting time was 10&#46;6&#177;18&#46;5 days and there were no deaths between diagnosis and surgery&#46; In the seven patients who died waiting for surgery&#44; mean waiting time was 72&#46;6 days &#40;median 47&#44; maximum 195 and minimum 13&#41;&#46; These findings are also illustrated in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There are several studies in the literature describing mortality rates in patients waiting for cardiac surgery&#44; the figures ranging between 0&#46;3&#37; and 5&#46;8&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Although most studies on waiting times are on CABG&#44; Lund et al&#46; showed that mortality in patients with symptomatic aortic stenosis awaiting valve replacement was 13&#46;5&#37; during a mean waiting period of 6&#46;3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> More recently&#44; Malaisrie et al&#46; showed that mortality in patients with aortic stenosis waiting for valve replacement was 3&#46;7&#37; at one month and 11&#46;6&#37; at six months&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> In another recent study&#44; in patients with severe aortic stenosis&#44; abrupt symptomatic deterioration from New York Heart Association &#40;NYHA&#41; class I to NYHA III&#8211;IV in the month preceding surgery was observed in 18&#37; of patients&#44; resulting in increased operative mortality &#40;17&#37; vs&#46; 5&#37; in NYHA I patients &#40;p&#61;0&#46;035&#41; and significantly worse long-term survival in patients in NYHA III&#8211;IV &#40;56&#37; vs&#46; 72&#37;&#59; p&#60;0&#46;002&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">It has also been shown that in patients with severe aortic stenosis who are inoperable or at high surgical risk&#44; increased time waiting for percutaneous valve replacement is associated with higher mortality both while on the waiting list and at one year&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Although our study was not designed to establish costs&#44; hospitalizations incur additional costs&#46; Besides higher mortality&#44; increased waiting times in our patients were associated with a significant rise in the number of hospitalizations &#40;from 0&#46;4&#37; to 9&#46;1&#37;&#41; during the waiting period&#46; The differences between the two groups in mortality and hospitalizations can be seen in the survival curves in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; In our study population&#44; most of these admissions were due to worsening clinical status requiring earlier surgery and hospitalization in the interim&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Waiting times for cardiac surgery of over three months have also been associated with a greater number of adverse events following surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> No such association was seen in our study&#44; in which the prevalence of hospitalization &#40;12&#46;9&#37; vs&#46; 16&#37;&#41; and mortality &#40;4&#46;7&#37; vs&#46; 5&#46;1&#37;&#41; were similar in the two groups at one year&#44; as shown in <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As stated above&#44; in Canada the subject of waiting lists is the subject of considerable debate&#44; and it has been suggested that additional financial investment can help reduce waiting times&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">It can be seen from our study that longer waiting times for surgery lead to increases in hospitalizations and mortality&#46; The available data do not allow ideal waiting times to be identified and&#44; in any case&#44; this was not the aim of the study&#46; We therefore propose the establishment of a national database of patients referred for cardiac surgery&#44; in order to quantify the adverse events that occur during the waiting period&#46; On the basis of such objective data it will be possible to modify the referral process in order to eliminate excessive waiting times and their harmful consequences&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">The main limitations of the study stem from its retrospective and observational nature and the fact that it is based on a single referral center&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A follow-up rate of 85&#37; was achieved&#44; which while acceptable given the number of patients&#44; may have underestimated the event rate &#40;hospitalization and mortality&#41; during the follow-up period&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The definition of waiting time in this study was the interval between the date of surgery and the date of referral&#44; which may underestimate the real waiting time as experienced by the patient&#44; and this could lead to bias&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The changes in referral protocols for cardiac surgery&#44; although not associated with increased one-year mortality&#44; did result in a statistically significant increase in waiting time and hence to a rise in mortality and hospitalizations during the waiting period of 0&#37; to 2&#46;3&#37; and 0&#46;4&#37; to 9&#46;1&#37;&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of people and animals</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data confidentiality</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres817807"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec814923"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres817808"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o e objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Materiais e m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec814924"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        10 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-12-08"
    "fechaAceptado" => "2015-02-23"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec814923"
          "palabras" => array:4 [
            0 => "Cardiac surgical procedures"
            1 => "Waiting lists"
            2 => "Follow-up"
            3 => "Mortality"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec814924"
          "palabras" => array:4 [
            0 => "Procedimentos cir&#250;rgicos card&#237;acos"
            1 => "Listas de espera"
            2 => "Seguimento"
            3 => "Mortalidade"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times&#44; hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective study of patients referred for cardiac surgery between January 1&#44; 2008 and September 30&#44; 2014&#44; the study population was divided into two groups&#58; those referred before &#40;group A&#44; January 1&#44; 2008 to August 31&#44; 2011&#41; and after &#40;group B&#44; September 1&#44; 2011 to September 30&#44; 2014&#41; the change in referral protocols&#46; A telephone follow-up was conducted&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 864 patients referred for cardiac surgery&#44; 557 in group A and 307 in group B&#46; Patient characteristics were similar between groups&#46; The mean waiting time for surgery was 10&#46;6&#177;18&#46;5 days and 55&#46;7&#177;79&#46;9 days in groups A and B&#44; respectively &#40;p&#61;0&#46;00&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">During the waiting period two patients &#40;0&#46;4&#37;&#41; were hospitalized in group A and 28 &#40;9&#46;1&#37;&#41; in group B &#40;p&#61;0&#58;00&#41;&#59; mortality was&#44; respectively&#44; 0&#37; and 2&#46;3&#37; &#40;p&#61;0&#46;00&#41;&#46; During one-year follow-up 12&#46;8&#37; of group A patients and 16&#37; of group B patients were hospitalized&#46; Cardiovascular mortality in this period was around 5&#37; in both groups &#40;p&#62;0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Changes to referral protocols for cardiac surgery had an impact on waiting times&#44; on the number of hospitalizations and on mortality in this period&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste estudo foi determinar se as altera&#231;&#245;es aos protocolos de referencia&#231;&#227;o para cirurgia card&#237;aca tiveram impacto nos tempos de espera&#44; taxa de internamentos e na mortalidade durante o per&#237;odo de espera e durante o primeiro ano de seguimento ap&#243;s cirurgia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiais e m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo&#44; com doentes referenciados para cirurgia card&#237;aca de 1&#47;01&#47;2008 a 30&#47;09&#47;2014&#46; Avaliaram-se dois grupos de doentes antes e depois da mudan&#231;a de referencia&#231;&#227;o&#58; grupo A entre 1&#47;01&#47;2008 e 01&#47;08&#47;2011 e grupo B entre 01&#47;08&#47;2011 e 30&#47;09&#47;2014&#46; Foi realizado o <span class="elsevierStyleItalic">follow-up</span> telef&#243;nico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foram referenciados 864 doentes para cirurgia card&#237;aca&#44; 557 no grupo A e 307 no grupo B&#46; As caracter&#237;sticas dos grupos foram semelhantes&#46; O n&#250;mero m&#233;dio de dias de espera para cirurgia foi de 10&#44;6 &#177; 18&#44;5 dias e de 55&#44;7 &#177; 79&#44;9 dias&#44; respetivamente no grupo A e B &#40;p &#61; 0&#44;00&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Durante o per&#237;odo de espera foram internados dois doentes &#40;0&#44;4&#37;&#41; no grupo A e 28 &#40;9&#44;1&#37;&#41; no grupo B &#40;p &#61; 0&#44;00&#41;&#59; a taxa de mortalidade foi&#44; respetivamente&#44; de 0-2&#44;3&#37; &#40;p &#61; 0&#44;00&#41;&#46; Durante o per&#237;odo de <span class="elsevierStyleItalic">follow-up</span> de um ano foram admitidos em internamento 12&#44;8&#37; dos doentes do grupo A e 16&#37; dos doentes do grupo B&#46; A mortalidade neste per&#237;odo foi de cerca de 5&#37; em ambos os grupos &#40;p &#62; 0&#44;05&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">As altera&#231;&#245;es aos protocolos de referencia&#231;&#227;o para cirurgia card&#237;aca tiveram impacto nos tempos de espera&#44; no n&#250;mero de internamentos e na mortalidade nesse per&#237;odo&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiais e m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Amado J&#44; Bento D&#44; Silva D&#44; Chin J&#44; Marques N&#44; Gago P&#44; et al&#46; Altera&#231;&#227;o nas redes de referencia&#231;&#227;o de doentes para cirurgia cardiotor&#225;cica&#58; as raz&#245;es econ&#243;micas ser&#227;o destitu&#237;das de custos&#63; 2015&#59;34&#58;575&#8211;581&#46;</p>"
      ]
    ]
    "multimedia" => array:8 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1326
            "Ancho" => 1590
            "Tamanyo" => 70832
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Event-free survival &#40;death or hospitalization&#41; of patients awaiting cardiac surgery in group A and group B&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1312
            "Ancho" => 1597
            "Tamanyo" => 73472
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Death-free survival of patients awaiting cardiac surgery in group A and group B&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1465
            "Ancho" => 1535
            "Tamanyo" => 57922
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Event-free survival &#40;death or hospitalization&#41; of patients at one year of follow-up in group A and group B&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1542
            "Ancho" => 1521
            "Tamanyo" => 53152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Death-free survival at one year of follow-up in group A and group B&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AoV&#58; aortic valve&#59; BMI&#58; body mass index&#59; CABG&#58; coronary artery bypass grafting&#59; Combined&#58; combined valve and coronary surgery&#59; MV&#58; mitral valve&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;1&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;8&#177;11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;0&#177;11&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;2&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#177;5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dyslipidemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Smoking</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ejection fraction</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;6&#177;12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;2&#177;11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;1&#177;12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">EuroSCORE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&#177;5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&#177;6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Renal failure stage</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Urgent indication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Waiting time&#44; days &#40;total&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6&#177;18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;7&#177;79&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;6&#177;54&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urgent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0&#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&#177;2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;8&#177;20&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;4&#177;85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;1&#177;60&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Type of surgery</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AoV replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MV surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Combined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374634.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients referred for cardiac surgery&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AoV&#58; aortic valve&#59; CABG&#58; coronary artery bypass grafting&#59; Combined&#58; combined valve and coronary surgery&#59; MV&#58; mitral valve&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Non-urgent CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&#177;8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;2&#177;76&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AoV replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;0&#177;15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;5&#177;86&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MV replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;6&#177;11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;3&#177;81&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Combined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5&#177;30&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;3&#177;97&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;1&#177;27&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;0&#177;49&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374637.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Mean waiting time for cardiac surgery in the two groups&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stable coronary disease &#40;less than 6 weeks&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Severe aortic stenosis &#40;less than 14 days&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mitral valve replacement &#40;less than 6 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374636.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Percentages of patients undergoing cardiac surgery within recommended times&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;20</span></a></p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CABG&#58; coronary artery bypass grafting&#59; PCI&#58; percutaneous coronary intervention&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Silber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bengtson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG or PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Morgan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valve or CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Seddon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28&#37;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Koomen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ray et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valve or CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Rexius et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sobolev et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58&#8211;0&#46;79&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sobolev et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374635.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Annual mortality&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Mean waiting time of one month&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Monthly mortality&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Weekly mortality in 1000 patient-weeks&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Studies on mortality in patients awaiting cardiac surgery&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do longer delays for coronary artery bypass surgery contribute to preoperative mortality in less urgent patients&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "A&#46;R&#46; Levy"
                            2 => "L&#46; Kuramoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.mlr.0000220257.81482.67"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "2006"
                        "volumen" => "44"
                        "paginaInicial" => "680"
                        "paginaFinal" => "686"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16799363"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications prior to revascularization among patients waiting for coronary artery bypass grafting and percutaneous transluminal coronary angioplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Bengtson"
                            1 => "T&#46; Karlsson"
                            2 => "A&#46; Hjalmarson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "1996"
                        "volumen" => "17"
                        "paginaInicial" => "1846"
                        "paginaFinal" => "1851"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8960427"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Death on the waiting list for cardiac surgery in the Netherlands in 1994 and 1995"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Plomp"
                            1 => "W&#46;K&#46; Redekop"
                            2 => "F&#46;W&#46; Dekker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "593"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10336916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Waiting times and prioritisation for coronary artery bypass surgery in New Zealand"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;E&#46; Seddon"
                            1 => "J&#46;K&#46; French"
                            2 => "D&#46;J&#46; Amos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "586"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10336915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of deaths while waiting for cardiac surgery among 29&#44;293 consecutive patients in Ontario&#44; Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;D&#46; Morgan"
                            1 => "K&#46; Sykora"
                            2 => "C&#46;D&#46; Naylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "1998"
                        "volumen" => "79"
                        "paginaInicial" => "345"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9616340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Waiting for cardiac surgery&#58; results of a risk-stratified queuing process"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:4 [
                            0 => "A&#46;A&#46; Ray"
                            1 => "K&#46;J&#46; Buth"
                            2 => "J&#46;A&#46; Sullivan"
                            3 => "D&#46;E&#46; Johnstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2001"
                        "volumen" => "104"
                        "paginaInicial" => "92"
                        "paginaFinal" => "98"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morbidity and mortality in patients waiting for coronary artery bypass surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;M&#46; Koomen"
                            1 => "B&#46;A&#46; Huttena"
                            2 => "J&#46;C&#46; Keldera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "260"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11251263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality on the waiting list for coronary artery bypass grafting&#58; incidence and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Rexius"
                            1 => "G&#46; Brandrup-Wognsen"
                            2 => "A&#46; Od&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2003.05.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2004"
                        "volumen" => "77"
                        "paginaInicial" => "769"
                        "paginaFinal" => "775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14992868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of death associated with delayed coronary artery bypass surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "A&#46;R&#46; Levy"
                            2 => "L&#46; Kuramoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6963-6-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16403235"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "L&#46; Kuramoto"
                            2 => "A&#46;R&#46; Levy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "G&#46; Fradet"
                            2 => "R&#46; Hayden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6963-8-185"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2008"
                        "volumen" => "8"
                        "paginaInicial" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18803823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An observational study to evaluate 2 target times for elective coronary bypass surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "G&#46; Fradet"
                            2 => "L&#46; Kuramoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MLR.0b013e31824deed2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "2012"
                        "volumen" => "50"
                        "paginaInicial" => "611"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22525613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Waiting times and death on the waiting list for coronary artery bypass operation&#46; Experiences in Munich with over 1&#44;000 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Silber"
                            1 => "H&#46; M&#252;hling"
                            2 => "R&#46; D&#246;rr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Herz"
                        "fecha" => "1996"
                        "volumen" => "21"
                        "paginaInicial" => "389"
                        "paginaFinal" => "396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9081908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International comparison of waiting times for selected cardiovascular procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;J&#46; Carroll"
                            1 => "S&#46;D&#46; Horn"
                            2 => "B&#46; Soderfeldt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0735-1097(94)00442-S"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1995"
                        "volumen" => "25"
                        "paginaInicial" => "557"
                        "paginaFinal" => "563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7860896"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved wait times for coronary revascularization&#58; cause to celebrate spotting the iceberg in time or time to look under the surface&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Simpson"
                            1 => "B&#46;J&#46; O&#8217;Neill"
                            2 => "S&#46; Christopher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2010.12.054"
                      "Revista" => array:7 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "numero" => "263"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21459257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How established wait time benchmarks significantly underestimate total wait times for cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;F&#46; L&#233;gar&#233;"
                            1 => "D&#46; Li"
                            2 => "K&#46;J&#46; Buth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "e17"
                        "paginaFinal" => "e21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20101361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of priority for coronary revascularisation procedures&#46; Revascularisation Panel and Consensus Methods Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;D&#46; Naylor"
                            1 => "R&#46;S&#46; Baigrie"
                            2 => "B&#46;S&#46; Goldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1990"
                        "volumen" => "335"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1073"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1970377"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of deaths while waiting for cardiac surgery among 29&#44;293 consecutive patients in Ontario&#44; Canada&#46; The Steering Committee of the Cardiac Care Network of Ontario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;D&#46; Morgan"
                            1 => "K&#46; Sykora"
                            2 => "C&#46;D&#46; Naylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "1998"
                        "volumen" => "79"
                        "paginaInicial" => "345"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9616340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <span class="elsevierStyleInterRef" id="intr0010" href="http://www.waittimealliance.ca/benchmarks/cardiac-care">http&#58;&#47;&#47;www&#46;waittimealliance&#46;ca&#47;benchmarks&#47;cardiac-care</span>"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Cardiac care wait time benchmarks for cardiovascular services and procedures"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2014"
                        "editorial" => "Canada Wait Time Alliance"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in wait times for cardiac revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Southern"
                            1 => "M&#46; Izadneghadar"
                            2 => "K&#46;H&#46; Humphries"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2011"
                        "paginaInicial" => "262&#46;e21"
                        "paginaFinal" => "262&#46;e27"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC&#47;EACTS Guidelines on myocardial revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Windecker"
                            1 => "P&#46; Kolh"
                            2 => "F&#46; Alfonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "2014"
                        "paginaInicial" => "2544"
                        "paginaFinal" => "2640"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The occurrence of adverse events in relation to time after registration for coronary artery bypass surgery&#58; a population-based observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "G&#46; Fradet"
                            2 => "L&#46; Kuramoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1749-8090-8-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiothorac Surg"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23289601"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;O&#46; Nielsen"
                            1 => "K&#46; Emmertsen"
                            2 => "C&#46; Fl&#248;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-1012039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorac Cardiovasc Surg"
                        "fecha" => "1996"
                        "volumen" => "44"
                        "paginaInicial" => "289"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9021905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality while waiting for aortic valve replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;C&#46; Malaisrie"
                            1 => "E&#46; McDonald"
                            2 => "J&#46; Kruse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2014.06.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "98"
                        "paginaInicial" => "1564"
                        "paginaFinal" => "1571"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of preoperative symptoms on postoperative survival in severe aortic stenosis&#58; implications for the timing of surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Pi&#233;rard"
                            1 => "C&#46; Meester"
                            2 => "S&#46; Seldrum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "97"
                        "paginaInicial" => "806"
                        "paginaFinal" => "810"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of wait times on the effectiveness of transcatheter aortic valve replacement in severe aortic valve disease&#58; a discrete event simulation model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;C&#46; Wijeysundera"
                            1 => "W&#46; Wong"
                            2 => "M&#46;C&#46; Bennell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2013.11.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Sampalis"
                            1 => "S&#46; Boukas"
                            2 => "M&#46; Liberman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2001"
                        "volumen" => "165"
                        "paginaInicial" => "429"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11531051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001816/v2_201703210134/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000010/v2_201703210134/S2174204915001816/v2_201703210134/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001816?idApp=UINPBA00004E"
]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2015.08.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	3	4	7
2024 October	28	22	50
2024 September	36	17	53
2024 August	36	30	66
2024 July	41	24	65
2024 June	26	15	41
2024 May	29	20	49
2024 April	21	20	41
2024 March	28	19	47
2024 February	20	33	53
2024 January	20	31	51
2023 December	18	27	45
2023 November	25	17	42
2023 October	16	14	30
2023 September	26	19	45
2023 August	24	19	43
2023 July	28	11	39
2023 June	38	12	50
2023 May	52	22	74
2023 April	27	8	35
2023 March	44	20	64
2023 February	38	18	56
2023 January	21	10	31
2022 December	35	24	59
2022 November	35	16	51
2022 October	25	21	46
2022 September	19	22	41
2022 August	30	28	58
2022 July	28	26	54
2022 June	13	13	26
2022 May	19	22	41
2022 April	25	27	52
2022 March	27	24	51
2022 February	18	12	30
2022 January	22	23	45
2021 December	20	33	53
2021 November	36	34	70
2021 October	31	33	64
2021 September	29	27	56
2021 August	25	33	58
2021 July	19	30	49
2021 June	14	8	22
2021 May	22	39	61
2021 April	27	31	58
2021 March	49	7	56
2021 February	43	22	65
2021 January	24	13	37
2020 December	13	8	21
2020 November	35	13	48
2020 October	10	3	13
2020 September	52	24	76
2020 August	20	8	28
2020 July	45	12	57
2020 June	21	16	37
2020 May	39	13	52
2020 April	33	8	41
2020 March	56	16	72
2020 February	96	61	157
2020 January	49	6	55
2019 December	46	16	62
2019 November	27	11	38
2019 October	28	6	34
2019 September	42	9	51
2019 August	19	9	28
2019 July	35	10	45
2019 June	28	14	42
2019 May	29	8	37
2019 April	27	15	42
2019 March	17	11	28
2019 February	25	11	36
2019 January	18	7	25
2018 December	38	9	47
2018 November	94	10	104
2018 October	195	6	201
2018 September	62	18	80
2018 August	59	11	70
2018 July	86	9	95
2018 June	89	7	96
2018 May	38	10	48
2018 April	38	8	46
2018 March	48	8	56
2018 February	20	3	23
2018 January	24	6	30
2017 December	51	7	58
2017 November	59	12	71
2017 October	44	10	54
2017 September	42	11	53
2017 August	42	9	51
2017 July	24	8	32
2017 June	39	11	50
2017 May	44	10	54
2017 April	23	11	34
2017 March	29	52	81
2017 February	23	5	28
2017 January	17	3	20
2016 December	32	5	37
2016 November	14	4	18
2016 October	26	8	34
2016 September	21	2	23
2016 August	6	3	9
2016 July	18	3	21
2016 June	7	2	9
2016 May	6	2	8
2016 April	21	10	31
2016 March	16	16	32
2016 February	40	26	66
2016 January	30	28	58
2015 December	31	24	55
2015 November	61	19	80

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter