Background: Poor clinical control in Chronic Obstructive Pulmonary Disease (COPD) is prevalent, yet the interplay of disease severity, modifiable factors, and clinician perception remains poorly understood. This study aimed to determine the frequency of poor control, identify its independent determinants, and characterize the heterogeneity of the poorly controlled population receiving maintenance inhaled therapy with various devices in primary care. Methods: In a multicenter, cross-sectional analysis of 988 patients from the Study SIMPLIFY, clinical control of COPD was classified using the objective RADAR score. We used multivariable logistic regression and Machine Learning (Random Forest with SHAP analysis) to identify determinants of poor control (RADAR ≥ 4) and k-medoids cluster analysis to characterize the poorly controlled subgroup (n = 452). Results: Nearly half the cohort (45.7%, n = 452) had poor clinical control. Agreement between physician-assessed control (five categories) and RADAR classification was 49.3%, with overestimation in 34.0% and underestimation in 16.7% of cases (Cohen’s κ = −0.081; weighted κ = −0.037). The strongest independent determinants were the exacerbator phenotypes (eosinophilic aOR 6.85; non-eosinophilic aOR 4.91). Key modifiable factors included active smoking (aOR 1.92), lower TAI-12 adherence score (per point; aOR 0.96), high dosing frequency (≥4 inhalations/day; aOR 1.54) and high inhaler burden (≥3 devices; aOR 1.84). Machine learning analysis identified clinical phenotype and adherence behavior as the top two scale-independent predictors of poor control. Cluster analysis of the poorly controlled group revealed five reproducible and clinically meaningful phenotypes (C0–C4), primarily separated by treatment complexity, comorbidities, and adherence. Conclusions: Poor clinical control is common and critically under-recognized in primary care patients with COPD on maintenance inhaled therapy. This is driven by a profound clinician perception gap and a failure to address key modifiable determinants, such as high dosing frequency, regimen complexity, and poor adherence, which likely drives therapeutic inertia. Our findings underscore the need to integrate objective tools to unmask poor control and highlight the importance of treatment simplification. The identification of distinct clinical phenotypes provides a roadmap toward a more personalized, evidence-based standard of care.

Background: Although single-inhaler triple therapy (SITT) improves COPD control, the specific structural and behavioral predictors of short-term clinical response following therapeutic simplification remain incompletely characterized. Methods: This prospective, multicenter observational study (N = 684) evaluated patients switching from triple therapy regimens involving multiple inhalers to SITT. A clinically meaningful response was defined as an intra-individual reduction of ≥2 points in the validated RADAR score at three months. Results: Therapeutic simplification reduced regimens requiring ≥4 inhalations/day from 46.1% to 14.3%, and poor behavioral adherence from 45.2% to 16.6%. Multivariable models identified an observed responder profile: higher baseline RADAR burden was the strongest predictor of improvement (aOR 2.00), whereas severe airflow limitation (FEV₁ < 50%) attenuated the response. Exploratory mediation analysis indicated that 88.6% of the observed clinical stabilization was not explained by measured adherence changes, and may therefore also encompass unmeasured behavioral, educational or device-related factors. Patients burdened with both high complexity and poor adherence showed the highest rate of combined structural–behavioral improvement (25.0% vs. 4.7% overall). Conclusions: Switching from MITT to SITT was associated with reduced treatment complexity, improved adherence profiles, and short-term improvement in RADAR-defined clinical control. Patients with greater baseline RADAR burden and regimen complexity showed larger observed improvements.

El Shock Cardiogénico (SC) supone una complicación grave y en muchas ocasiones mortal que se produce dentro del ámbito de las patologías cardíacas, especialmente en aquellas de origen isquémico, que provocan un deterioro de la función del miocardio. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académico, PubMed, entre otros, apoyándose para ello en el uso de descriptores en ciencias de la salud o terminología MESH. La información aquí obtenida será revisada para su posterior análisis. En líneas generales el manejo que se le dé al paciente que presenta esta patología es clave para su recuperación ya sea extrahospitalario o intrahospitalario. Su clasificación la comprende 5 etapas (en riesgo, comienzo del shock, shock clásico, deterioro y extremo) y el diagnostico comprende examen físico, cateterismo cardiaco y derecho, y ecocardiografía. El manejo farmacológico consiste en vasopresores y agentes inotrópicos, pero estos no reducen la mortalidad, la revascularización coronaria precoz se recomienda para pacientes con síndrome coronario agudo y dispositivos de asistencia mecánica circulatoria. La metodología utilizada para el presente trabajo de investigación, se enmarca dentro de una revisión bibliográfica de tipo documental.