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Codina P, Vicente Gómez JÁ, Hernández Guillamet G, Ricou Ríos L, Carrete A, Vilalta V, Estrada O, Ara J, Lupón J, Bayés-Genís A, López Seguí F. Assessing the impact of haemodynamic monitoring with CardioMEMS on heart failure patients: a cost-benefit analysis. ESC Heart Fail 2024. [PMID: 38500304 DOI: 10.1002/ehf2.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS The objective of this study was to perform a cost-benefit analysis of the CardioMEMS HF System (Abbott Laboratories, Abbott Park, IL, USA) in a heart failure (HF) clinic in Spain by evaluating the real-time remote monitoring of pulmonary artery pressures, which has been shown to reduce HF-related hospitalizations and improve the quality of life for selected HF patients. Particularly, the study aimed to determine the value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower and its effectiveness remains uncertain. METHODS AND RESULTS This single-centre study enrolled all consecutive HF patients (N = 43) who had been implanted with a pulmonary artery pressure sensor (CardioMEMS HF System); 48.8% were females, aged 75.5 ± 7.0 years, with both reduced and preserved left ventricular ejection fraction; 67.4% of them were in New York Heart Association Class III. The number of HF hospitalizations in the year before and the year after the sensor implantation was compared. Quality-adjusted life years gained based on a literature review of previous studies were calculated. The rate of HF hospitalizations was significantly lower at 1 year compared with the year before CardioMEMS implantation (0.25 vs. 1.10 events/patient-year, hazard ratio 0.22, P = 0.001). At the end of the first year, the usual management outperformed the CardioMEMS HF System. By the end of the second year, the CardioMEMS system is estimated to reduce costs compared with usual management (net benefits of €346). CONCLUSIONS Based on the results, we suggest that remote monitoring of pulmonary artery pressure with the CardioMEMS HF System represents a midterm and long-term efficient strategy in a healthcare setting in Southern Europe.
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Affiliation(s)
- Pau Codina
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José Ángel Vicente Gómez
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Guillem Hernández Guillamet
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- eXiT Research Group-Control Engineering and Intelligent Systems (IIiA-UdG), Girona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Andrea Carrete
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Estrada
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Jordi Ara
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Antoni Bayés-Genís
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Francesc López Seguí
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Tafazzoli A, Reifsnider OS, Bellanca L, Ishak J, Carrasco M, Rakonczai P, Stargardter M, Linden S. A European multinational cost-effectiveness analysis of empagliflozin in heart failure with reduced ejection fraction. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1441-1454. [PMID: 36463524 PMCID: PMC10550866 DOI: 10.1007/s10198-022-01555-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This research examined the cost-effectiveness of adding empagliflozin to standard of care (SoC) compared with SoC alone for treatment of heart failure with reduced ejection fraction (HFrEF) from the perspective of healthcare payers in the United Kingdom (UK), Spain and France. METHODS A lifetime Markov cohort model was developed to simulate patients' progression through health states based on Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. The model predicted risk of death, hospitalisation for worsening heart failure (HHF), treatment-related adverse events, and treatment discontinuation each monthly cycle. Clinical inputs and utilities were derived from EMPEROR-Reduced trial data, supplemented by published literature and national costing databases. Costs (2021 pound sterling/euro) and quality-adjusted life-years (QALYs) were discounted annually for the UK (3.5%), Spain (3.0%) and France (2.5%). RESULTS In the UK, Spain and France, empagliflozin plus SoC yielded additional QALYs (0.19, 0.23 and 0.21) at higher cost (£1185, €1770 and €1183 per patient) than SoC alone, yielding incremental cost-effectiveness ratios of £6152/QALY, €7736/QALY and €5511/QALY, respectively. Reduced HHF incidence provided most cost offsets for empagliflozin plus SoC. Similar results were obtained for a range of subgroups and sensitivity analyses. Probabilistic sensitivity results indicated empagliflozin plus SoC remained cost-effective vs. SoC at willingness-to-pay thresholds of £20,000/QALY, €20,000/QALY and €30,000/QALY in 79.6%, 75.5% and 97.3% of model runs for the UK, Spain and France, respectively. CONCLUSIONS Empagliflozin added to SoC leads to health benefits for patients with HFrEF and is a cost-effective treatment option for payers in multiple European countries (UK, Spain, France).
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Affiliation(s)
- Ali Tafazzoli
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | | | - Leana Bellanca
- Boehringer Ingelheim Ltd., Ellesfield Avenue, Bracknell, Berkshire, RG12 8YS UK
| | - Jack Ishak
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | - Marc Carrasco
- Boehringer Ingelheim España S.A, Prat de la Riba 50, 08204 Sant Cugat del Vallès, Spain
| | - Pal Rakonczai
- Evidera, Dorottya Udvar, Bocskai út 134-146-E épület 2. Emelet, Magyarország, 1113 Budapest, Hungary
| | | | - Stephan Linden
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
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Méndez Fernández AB, Vergara Arana A, Olivella San Emeterio A, Azancot Rivero MA, Soriano Colome T, Soler Romeo MJ. Cardiorenal syndrome and diabetes: an evil pairing. Front Cardiovasc Med 2023; 10:1185707. [PMID: 37234376 PMCID: PMC10206318 DOI: 10.3389/fcvm.2023.1185707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Cardiorenal syndrome (CRS) is a pathology where the heart and kidney are involved, and the deterioration of one of them leads to the malfunction of the other. Diabetes mellitus (DM) carries a higher risk of HF and a worse prognosis. Furthermore, almost half of people with DM will have chronic kidney disease (CKD), which means that DM is the main cause of kidney failure. The triad of cardiorenal syndrome and diabetes is known to be associated with increased risk of hospitalization and mortality. Cardiorenal units, with a multidisciplinary team (cardiologist, nephrologist, nursing), multiple tools for diagnosis, as well as new treatments that help to better control cardio-renal-metabolic patients, offer holistic management of patients with CRS. In recent years, the appearance of drugs such as sodium-glucose cotransporter type 2 inhibitors, have shown cardiovascular benefits, initially in patients with type 2 DM and later in CKD and heart failure with and without DM2, offering a new therapeutic opportunity, especially for cardiorenal patients. In addition, glucagon-like peptide-1 receptor agonists have shown CV benefits in patients with DM and CV disease in addition to a reduced risk of CKD progression.
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Affiliation(s)
| | - Ander Vergara Arana
- Department of Nephrology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | | | | | - Toni Soriano Colome
- Department of Cardiology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
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Sánchez MA, Marín F, Masjuan J, Cosín-Sales J, Rodríguez JMV, Barrios V, Barón-Esquivias G, Lekuona I, Pérez-Cabeza AI, Freixa-Pamias R, Jimenez FJP, Khatib MMK, Priu CR, Fernández MS. Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study. Cardiol J 2022; 29:936-947. [PMID: 36200548 PMCID: PMC9788750 DOI: 10.5603/cj.a2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. METHODS Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. RESULTS Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6-7.3; p = 0.002) but not for thromboembolic events or major bleeding. CONCLUSIONS Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding.
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Affiliation(s)
- Manuel Anguita Sánchez
- Department of Cardiology, Hospital Reina Sofía Córdoba, IMIBIC, University of Cordoba, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Jaime Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, IRYCIS, Departamento de Medicina, Universidad de Alcalá. Red INVICTUS, Madrid, Spain
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Alcalá University, Madrid, Spain
| | - Gonzalo Barón-Esquivias
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain,Unidad Cardiovascular, Instituto de Biotecnología de Sevilla, Centro de Investigación en Red Cardiovascular, Madrid, Spain
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med 2022; 11:jcm11175199. [PMID: 36079133 PMCID: PMC9456780 DOI: 10.3390/jcm11175199] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | - Luis Varela
- AstraZeneca Farmaceutica, 28033 Madrid, Spain
| | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
- Correspondence:
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Escobar C, Luis-Bonilla J, Crespo-Leiro MG, Esteban-Fernández A, Farré N, Garcia A, Nuñez J. Individualizing the treatment of patients with heart failure with reduced ejection fraction: a journey from hospitalization to long-term outpatient care. Expert Opin Pharmacother 2022; 23:1589-1599. [PMID: 35995759 DOI: 10.1080/14656566.2022.2116275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Despite the relevant advances achieved thanks to the traditional step-by-step therapeutic approach, heart failure with reduced ejection fraction (HFrEF) remains associated with considerable morbidity and mortality. The pathogenesis of HFrEF is complex, with the implication of various neurohormonal systems, including activation of deleterious pathways (i.e. renin-angiotensin-aldosterone, sympathetic, and sodium-glucose cotransporter-2 [SGLT2] systems) and the inhibition of protective pathways (i.e. natriuretic peptides and the guanylate cyclase system). Therefore, the burden of HF can only be reduced through a comprehensive approach that involves all evidence-based use of available HF drugs targeting the neurohormonal systems involved. AREAS COVERED : We performed a critical analysis of evidence from recent clinical trials and assessed the effects of HF therapies on hemodynamics and renal function. EXPERT OPINION : HF therapy must be adapted to the clinical profile (i.e. congestion, blood pressure, heart rate, renal function, and electrolytes). Consequently, blood pressure is reduced by beta blockers, renin-angiotensin-aldosterone system inhibitors, sacubitril/valsartan, and, minimally, by SGLT2 inhibitors and vericiguat; heart rate decreases with beta blockers and ivabradine; and renal function is impaired and potassium are levels increased with renin-angiotensin-aldosterone system inhibitors and sacubitril/valsartan. Practical recommendations on how to individualize HF therapy according to patient profile are provided.
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Affiliation(s)
- Carlos Escobar
- Cardiology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - Ana Garcia
- Hospital Clinic I Provincial De Barcelona, Barcelona, Spain
| | - Julio Nuñez
- Hospital Clinico de Valencia, Valencia, Spain
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Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis. J Clin Med 2022; 11:jcm11154591. [PMID: 35956206 PMCID: PMC9369637 DOI: 10.3390/jcm11154591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139−0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
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Obaya Rebollar JC. [New approaches in the treatment of heart failure: A change in therapeutic strategy]. Aten Primaria 2022; 54:102309. [PMID: 35240518 PMCID: PMC8891710 DOI: 10.1016/j.aprim.2022.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/26/2022] Open
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Delgado-Jiménez JF, Segovia-Cubero J, Almenar-Bonet L, de Juan-Bagudá J, Lara-Padrón A, García-Pinilla JM, Bonilla-Palomas JL, López-Fernández S, Mirabet-Pérez S, Gómez-Otero I, Castro-Fernández A, Díaz-Molina B, Goirigolzarri-Artaza J, Rincón-Díaz LM, Pascual-Figal DA, Anguita-Sánchez M, Muñiz J, Crespo-Leiro MG. Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. J Clin Med 2022; 11:jcm11051170. [PMID: 35268260 PMCID: PMC8910891 DOI: 10.3390/jcm11051170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m2, and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1−5.4 mEq/L = 13.8%, 5.5−5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment.
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Affiliation(s)
- Juan F. Delgado-Jiménez
- Instituto de Investigación y Servicio de Cardiología del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Correspondence:
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario La Fe, 46026 Valencia, Spain
| | - Javier de Juan-Bagudá
- Instituto de Investigación y Servicio de Cardiología del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
| | - Antonio Lara-Padrón
- Servicio de Cardiología, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain;
| | - José Manuel García-Pinilla
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, International Business Information Management Association, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | | | - Silvia López-Fernández
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 A Coruña, Spain
| | | | - Beatriz Díaz-Molina
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Josebe Goirigolzarri-Artaza
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Clínico de San Carlos, 28040 Madrid, Spain
| | - Luis Miguel Rincón-Díaz
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Domingo Andrés Pascual-Figal
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Javier Muñiz
- Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña (UDC), 15006 A Coruña, Spain;
| | - María G. Crespo-Leiro
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Complexo Hospitalario Universitario, 15006 A Coruña, Spain
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10
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Méndez-Bailón M, Lorenzo-Villalba N, Romero-Correa M, Guisado-Espartero E, González-Soler J, Rugeles-Niño J, Sebastián-Leza A, Ceresuela-Eito L, Romaní-Costa V, Quesada-Simón A, Soler-Rangel L, Herrero-Domingo A, Díez-García L, Alcalá-Pedrajas J, Villalonga-Comas M, Andrès E, Gudiñ-Aguirre D, Formiga F, Aramburu-Bodas O, Arias-Jiménez J, Salamanca-Bautista P. Cancer Impacts Prognosis on Mortality in Patients with Acute Heart Failure: Analysis of the EPICTER Study. J Clin Med 2022; 11:jcm11030571. [PMID: 35160023 PMCID: PMC8836514 DOI: 10.3390/jcm11030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: Heart failure (HF) and cancer are currently the leading causes of death worldwide, with an increasing incidence with age. Little is known about the treatment received and the prognosis of patients with acute HF and a prior cancer diagnosis. Objective: to determine the clinical characteristics, palliative treatment received, and prognostic impact of patients with acute HF and a history of solid tumor. Methods: The EPICTER study (“Epidemiological survey of advanced heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted for acute HF in 74 Spanish hospitals. Patients were classified into two groups according to whether they met criteria for acute HF with and without solid cancer, and the groups were subsequently compared. A multivariable logistic regression analysis was conducted, using the forward stepwise method. A Kaplan–Meier survival analysis was performed to evaluate the impact of solid tumor on prognosis in patients with acute HF. Results: A total of 3127 patients were included, of which 394 patients (13%) had a prior diagnosis of some type of solid cancer. Patients with a history of cancer presented a greater frequency of weight loss at admission: 18% vs. 12% (p = 0.030). In the cancer group, functional impairment was noted more frequently: 43% vs. 35%, p = 0.039). Patients with a history of solid cancer more frequently presented with acute HF with preserved ejection fraction (65% vs. 58%, p = 0.048) than reduced or mildly reduced. In-hospital and 6-month follow-up mortality was 31% (110/357) in patients with solid cancer vs. 26% (637/2466), p = 0.046. Conclusion: Our investigation demonstrates that in-hospital mortality and mortality during 6-month follow-up in patients with acute HF were higher in those subjects with a history of concomitant solid tumor cancer diagnosis.
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Affiliation(s)
- Manuel Méndez-Bailón
- Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria (IdISSC), 28040 Madrid, Spain;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | | | | | | | | | | | | | | | | | | | | | - Luis Díez-García
- Internal Medicine Department, Torrecárdenas Hospital, 04009 Almería, Spain;
| | - José Alcalá-Pedrajas
- Internal Medicine Department, Pozoblanco Hospital, 14400 Pozoblanco, Córdoba, Spain;
| | | | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | | | | | - Oscar Aramburu-Bodas
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (O.A.-B.); (J.A.-J.); (P.S.-B.)
| | - Jose Arias-Jiménez
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (O.A.-B.); (J.A.-J.); (P.S.-B.)
| | - Prado Salamanca-Bautista
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (O.A.-B.); (J.A.-J.); (P.S.-B.)
- Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain
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11
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Li P, Zhao H, Zhang J, Ning Y, Tu Y, Xu D, Zeng Q. Similarities and Differences Between HFmrEF and HFpEF. Front Cardiovasc Med 2021; 8:678614. [PMID: 34616777 PMCID: PMC8488158 DOI: 10.3389/fcvm.2021.678614] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022] Open
Abstract
The new guidelines classify heart failure (HF) into three subgroups based on the ejection fraction (EF): HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF). The new guidelines regarding the declaration of HFmrEF as a unique phenotype have achieved the goal of stimulating research on the basic characteristics, pathophysiology, and treatment of HF patients with a left ventricular EF of 40-49%. Patients with HFmrEF have more often been described as an intermediate population between HFrEF and HFpEF patients; however, with regard to etiology and clinical indicators, they are more similar to the HFrEF population. Concerning clinical prognosis, they are closer to HFpEF because both populations have a good prognosis and quality of life. Meanwhile, growing evidence indicates that HFmrEF and HFpEF show heterogeneity in presentation and pathophysiology, and the emergence of this heterogeneity often plays a crucial role in the prognosis and treatment of the disease. To date, the exact mechanisms and effective treatment strategies of HFmrEF and HFpEF are still poorly understood, but some of the current evidence, from observational studies and post-hoc analyses of randomized controlled trials, have shown that patients with HFmrEF may benefit more from HFrEF treatment strategies, such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan. This review summarizes available data from current clinical practice and mechanistic studies in terms of epidemiology, etiology, clinical indicators, mechanisms, and treatments to discuss the potential association between HFmrEF and HFpEF patients.
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Affiliation(s)
- Peixin Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Hengli Zhao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Jianyu Zhang
- Department of Cardiology, Foshan First People's Hospital, Foshan, Guangdong, China
| | - Yunshan Ning
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yan Tu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
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