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Este documento se envió asimismo a la revista oficial de la SEMES, Emergencias, para su publicación. Consensus Document for the Management of Patients With Atrial Fibrillation in Hospital Emergency Departments Atrial fibrillation (AF) is the most prevalent arrhythmia in hospital emergency departments and is a serious disease associated with a twofold increase in morbidity and a high mortality rate. However, the management of AF in this scenario is variable and frequently inadequate. This is probably a consequence of the diverse clinical aspects and therapeutic options to consider in the management of patients with AF. Therefore, implementation of specific, coordinated management strategies by the different care providers involved is needed to improve the quality of care and optimize the use of human and material resources. This document presents the guidelines recommended by the Spanish Society of Cardiology (SEC) and the Spanish Society of Emergency Medicine (SEMES) for the management of AF in hospital emergency departments. These guidelines are based on published scientific evidence and are applicable to most emergency departments in Spain. Specific management strategies are proposed for the conversion and maintenance of sinus rhythm, heart rate control during AF, prophylaxis for thrombi and emboli, and hospital admission and discharge protocols.

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Background Correct identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients is crucial to implement therapeutic interventions that may prevent disease progression. Methods We compared the real prevalence of DKD in T2DM patients according to actual serum and urine laboratory data with the presence of a diagnosic terms “DKD” and/or “CKD” on the electronic medical records (EMR) using a natural language processing tool (Savana Manager®). All patients older than 18 years and diagnosed of T2DM were selected. DKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 or urinary albumin to creatinine ratio (UACR) >30 mg/g or urinary protein to creatinine ratio (UPCR) >0.3 g/g after excluding acute kidney injury. Results 15,304 T2DM patients identified on EMR were eligible to be enter the study. 4,526 (29.6%) T2DM patients had DKD according to lab criteria. However, the terms “CKD” or “DKD” were only present in 33.1% and 7.5%, representing a hidden prevalence of CKD and DKD of 66.9% and 92.5%, respectively. Less severe kidney disease (lower UACR or UPCR, higher eGFR values), female sex, and lack of insulin prescription were associated with the absence of “DKD” or “CKD” terms in EMR (p<0.001) Conclusions The prevalence of DKD, among T2DM defined by lab data, is significantly higher than that reported on hospital electronic medical records. This could imply underdiagnosis of DKD, especially in patients with the least severe disease who may benefit the most from optimized therapy.