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Miró Ò, Martín Mojarro E, Lopez-Ayala P, Llorens P, Gil V, Alquézar-Arbé A, Bibiano C, Pavón J, Massó M, Strebel I, Espinosa B, Mínguez Masó S, Jacob J, Millán J, Andueza JA, Alonso H, Herrero-Puente P, Mueller C. Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium. Eur J Emerg Med 2024; 31:347-355. [PMID: 38985840 DOI: 10.1097/mej.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Intravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. Nonetheless, many emergency physicians are reluctant to use intravenous digoxin in patients with advanced age, impaired renal function, and potassium disturbances due to its potential capacity to increase adverse outcomes. OBJECTIVE We investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality in patients with specific age, estimated glomerular filtration rate (eGFR), and serum potassium classes. DESIGN A secondary analysis of patients included in in the Spanish EAHFE cohort, which includes patients diagnosed with AHF in the ED. SETTING 45 Spanish EDs. PARTICIPANTS Two thousand one hundred ninety-four patients with AHF and rapid atrial fibrillation (heart rate ≥100 bpm) not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED. OUTCOME The relationships between age, eGFR, and potassium with 30-day mortality were investigated using restricted cubic spline (RCS) models adjusted for relevant patient and episode variables. The impact of digoxin use on such relationships was assessed by checking interaction. MAIN RESULTS The median age of the patients was 82 years [interquartile range (IQR) = 76-87], 61.4% were women, 65.2% had previous episodes of atrial fibrillation, and the median heart rate at ED arrival was 120 bpm (IQR = 109-135). Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%, P = 0.636). Although analysis of RCS curves showed that death was associated with advanced age, worse renal function, and hypo- and hyperkalemia, use of intravenous digoxin did not interact with any of these relationships ( P = 0.156 for age, P = 0.156 for eGFR; P = 0.429 for potassium). CONCLUSION The use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- The GREAT Network, Rome, Italy
| | | | - Pedro Lopez-Ayala
- The GREAT Network, Rome, Italy
- Cardiology Department, Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospital at Home Unit, Hospital General Dr Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante
| | - Víctor Gil
- Emergency Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | | | - José Pavón
- Emergency Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria
| | - Marta Massó
- Emergency Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Ivo Strebel
- The GREAT Network, Rome, Italy
- Cardiology Department, Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospital at Home Unit, Hospital General Dr Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante
| | | | - Javier Jacob
- Emergency Department, Hospital de Bellvitge, Barcelona
| | - Javier Millán
- Emergency Department, Hospital Universitario La Fe, Valencia
| | | | - Héctor Alonso
- Emergency Department, Hospital Marqués de Valdecilla, Santander
| | - Pablo Herrero-Puente
- Emergency Department, Hospital Universitario Central de Asturias, Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Christian Mueller
- The GREAT Network, Rome, Italy
- Cardiology Department, Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, University of Basel, Basel, Switzerland
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Torres Llergo J, Carrillo Bailén M, Segura Aumente JM, Fernández Olmo MR, Puentes Chiachío M, Fernández Guerrero JC, Ruiz Ortiz M. Incidence and prediction of hospitalization for heart failure in patients with atrial fibrillation: the REFLEJA scale. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:710-719. [PMID: 38382802 DOI: 10.1016/j.rec.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Hospitalization for heart failure (HHF) is common in patients with atrial fibrillation (AF) and is associated with increased mortality. The aims of this study were to determine the incidence of HHF, identify the clinical predictors of its occurrence, and develop a new risk scale. METHODS The incidence of HHF was estimated using data from the prospective single-center REFLEJA registry of outpatients with AF (October 2017-October 2018). A multivariate Cox regression model was calculated to detect HHF predictors, and a nomogram was created for individual risk assessment. RESULTS Of the 1499 patients included (mean age 73.8±11.1 years, 48.1% women), 127 had HHF (incidence rate of 8.51 per 100 persons/y) and 319 died (rate of death from any cause of 21.1 per 100 persons/y) after a 3-year follow-up. The independent predictors of HHF were age, diabetes, chronic kidney disease, pulmonary hypertension, previous pacemaker implantation, baseline use of diuretics, and moderate-severe aortic regurgitation. The c-statistic for predicting the event was 0.762 (95%CI after boostrapping resampling, 0.753-0.791). The cumulative incidences of the main outcome for the risk scale quartiles were 1.613 (Q1), 3.815 (Q2), 8.378 (Q3), and 20.436 (Q4) cases per 100 persons/y (P <.001). CONCLUSIONS HHF was common in this AF cohort. The combination of certain clinical characteristics can identify patients with a very high risk of HHF.
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Affiliation(s)
| | | | | | | | | | | | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Gutiérrez-Carretero E, Campos AM, Giménez-Miranda L, Rezaei K, Peña A, Rossel J, Praena JM, Smani T, Ordoñez A, Medrano FJ. [Prognostic value of electrical bioimpedance measured with a portable and wireless device in acute heart failure]. Med Clin (Barc) 2024; 163:175-182. [PMID: 38821829 DOI: 10.1016/j.medcli.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION AND OBJECTIVES The current evaluation of acute heart failure (HF) does not allow an adequate prediction of its evolution. The electrical bioimpedance (BI) allows knowing the state of blood volume, until now only with fixed equipment. We have developed and validated a portable and wireless device to measure BI at the ankle (IVOL). The objective of the study is to know the long-term prognostic value of the point measurement of BI with IVOL in patients with acute HF. METHODS A prospective cohort study of unselected patients admitted for acute HF in a tertiary hospital. The association between BI and different clinical, analytical and echocardiographic variables on admission and clinical evolution were analyzed. RESULTS 76 patients were included (mean age 66.1 years, 71.1% men, 68.4% hypertensive, 34.2% diabetic, mean NT-ProBNP: 7,103 pg / ml). Of these, 52.6% with non-preserved left ventricular ejection fraction (LVEF) (<50%) and 56.6% with right ventricular (RV) dysfunction. 26.3% died during a mean follow-up of 35.8 months. Survival in patients with BI≤21,8Ω was lower, globally and in the subgroups of patients without preserved LVEF and with RV dysfunction, P<.008). In the multivariate analysis, a BI≥21.8Ω was an independent survival factor (HR: 0.242; 95% CI: 0.86-0.681; P=.007). CONCLUSIONS BI values measured with IVOL may be an independent predictor of long-term mortality in patients hospitalized for acute HF. This prognostic value is maintained in patients without preserved LVEF function and with RV dysfunction.
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Affiliation(s)
- Encarnación Gutiérrez-Carretero
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Ana María Campos
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Luis Giménez-Miranda
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Kambitz Rezaei
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Amelia Peña
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Javier Rossel
- Departamento de Ingeniería Electrónica, Universidad Politécnica de Cataluña, Barcelona, España
| | - Juan Manuel Praena
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Enfermería, Universidad de Sevilla, Sevilla, España
| | - Tarik Smani
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Antonio Ordoñez
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España; Departamento de Cirugía, Universidad de Sevilla, Sevilla, España.
| | - Francisco Javier Medrano
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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Blasco-Turrión S, Crespo-Leiro MG, Donoso Trenado V, Chi Hion PL, Díaz Molina B, Roura G, Álvarez-Osorio MP, Gómez-Bueno M, Ortiz Bautista C, Diaz JF, Garrido Bravo IP, Moreno R, Sarnago-Cebada F, Salterain González N, de la Torre Hernandez JM, García Del Blanco B, Farrero M, Ortas Nadal R, Martin P, de La Fuente L, Sanz-Sánchez J, Mirabet Pérez S, Alonso Fernández V, Gómez Hospital JA, López Granados A, Couto-Mallon D, Del Trigo Espinosa M, Rangel Sousa D, Zatarain-Nicolás E, Arzamendi Aizpurua D, López Vilella R, San Román JA, Amat-Santos IJ. Structural heart transcatheter interventions in orthotopic cardiac transplant and left ventricular assist devices recipients: A nationwide study. Int J Cardiol 2024; 413:132340. [PMID: 38992809 DOI: 10.1016/j.ijcard.2024.132340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The current incidence and outcomes of structural transcatheter procedures in heart transplant (HTx) recipients and left-ventricular assist devices (LVAD) carriers is unknown. AIMS To provide insights on structural transcatheter procedures performed across HTx and LVAD patients in Spain. METHODS Multicenter, ambispective, observational nationwide registry. RESULTS Until May/2023, 36 percutaneous structural interventions were performed (78% for HTx and 22% for LVAD) widely varying among centers (0%-1.4% and 0%-25%, respectively). Percutaneous mitral transcatheter edge-to-edge (TEER) was the most common (n = 12, 33.3%), followed by trancatheter aortic valve replacement (n = 11, 30.5%), and tricuspid procedures (n = 9, 25%). Mitral TEER resulted in mild residual mitral regurgitation in all but one case, mean gradient was <5 mmHg in 75% of them at 1-year, with no mortality and 8.3% re-admission rate. Tricuspid TEER resulted in 100% none/mild residual regurgitation with a 1-year mortality and readmission rates of 22% and 28.5%, respectively. Finally, trancatheter aortic valve replacement procedures (n = 8 in LVADs due to aortic regurgitation and n = 3 in HTx), were successful in all cases with one prosthesis degeneration leading to severe aortic regurgitation at 1-year, 18.2% mortality rate and no re-admissions. Globally, major bleeding rates were 7.9% and 12.5%, thromboembolic events 3.7% and 12.5%, readmissions 37% and 25%, and mortality 22% and 25%, in HTx and LVADs respectively. No death was related to the implanted transcatheter device. CONCLUSIONS Most centers with HTx/LVAD programs perform structural percutaneous procedures but with very inconsistent incidence. They were associated with good safety and efficacy, but larger studies are required to provide formal recommendations.
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Affiliation(s)
- Sara Blasco-Turrión
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Pedro Li Chi Hion
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Beatriz Díaz Molina
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gerard Roura
- Cardiology Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Manuel Gómez-Bueno
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Carlos Ortiz Bautista
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose F Diaz
- Cardiology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Raúl Moreno
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - Marta Farrero
- Cardiology Department, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Martin
- Cardiology Department, Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - Luis de La Fuente
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Sanz-Sánchez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Sònia Mirabet Pérez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - David Couto-Mallon
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña, Spain
| | | | - Diego Rangel Sousa
- Cardiology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Raquel López Vilella
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - J Alberto San Román
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de investigación biomédica en red, enfermedades cardiovasculares (CIBERCV), Madrid, Spain.
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Santos S, Manito N, Sánchez-Covisa J, Hernández I, Corregidor C, Escudero L, Rhodes K, Nordon C. Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00194-4. [PMID: 38936468 DOI: 10.1016/j.rec.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD). METHODS We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion). RESULTS During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82). CONCLUSIONS The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
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Affiliation(s)
- Salud Santos
- Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Kirsty Rhodes
- Real World Science & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Clementine Nordon
- Epidemiology Medical Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
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Guzmán-Carreras A, Vellisca-González AM, Molina-Puente JI, García-Alonso R, Paz-Cabezas M, Sánchez-Sauce B, Aguilar-Rodríguez F, Iguarán-Bermúdez MDR, Andrès E, Lorenzo-Villalba N, Méndez-Bailón M. Sodium-Glucose Cotransporter Type 2 Inhibitors Use in Elderly Polypathological Patients with Acute Heart Failure: PROFUND-IC Registry. J Clin Med 2024; 13:3485. [PMID: 38930015 PMCID: PMC11204832 DOI: 10.3390/jcm13123485] [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: 05/06/2024] [Revised: 06/02/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Heart failure (HF) is a highly prevalent clinical syndrome with serious morbidity and mortality. Furthermore, acute heart failure (AHF) is the main cause of hospital admission in people aged 65 years or more. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) have been shown to improve the survival and quality of life in patients with HF regardless of left ventricular ejection fraction (LVEF). Our aims were to describe the characteristics of adults with multiple pathologies admitted with acute heart failure as the main diagnosis and of the population treated with SGLT2is, as well as to evaluate if their use was associated with lower readmission and mortality rates. Methods: A prospective study of patients from the PROFUND-IC registry who were admitted with AHF as the main diagnosis was conducted. Clinical and analytical characteristics were analyzed, as well as readmissions and mortality. Descriptive and bivariate analyses of the sample between those taking SGLT2is and those who were not were performed, using the chi-square test for qualitative variables and Welch's test for quantitative measures, as well as the Fisher and Wilcoxon tests as indicated for nonparametric tests. Kaplan-Meier curves were constructed to analyze the readmission and mortality of patients at 12 months based on SGLT2i treatment. Finally, a propensity score matching was performed, guaranteeing that the observed effect of the drug was not influenced by the differences in the characteristics between the groups. Results: There were 750 patients included: 58% were women, and the mean age was 84 years. Functional class II according to the NYHA scale predominated (54%), and the mean LVEF was 51%. SGLT2 inhibitors were prescribed to only 28% of patients. Most of the patients were men (48.6% vs. 39.8%, p = 0.029), they were younger (82 vs. 84 years, p = 0.002), and their LVEF was lower (48% vs. 52%, p < 0.001). Lower mortality was observed in the group treated with SGLT2is, both during baseline admission (2.4% vs. 6.9%, p = 0.017) and at the 12-month follow-up (6.2% vs. 13%, p = 0.023); as well as a lower readmission rate (23.8% vs. 38.9%, p < 0.001). After the propensity score matching, a decrease in the 12-month readmission rate continued to be observed in the group treated with SGLT2is (p = 0.03). Conclusions: SGLT2is use was associated with lower readmission rates at the 12-month follow-up in older adults with multiple pathologies admitted with acute heart failure.
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Affiliation(s)
- Alicia Guzmán-Carreras
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Andrea María Vellisca-González
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | | | - Rocío García-Alonso
- Servicio de Medicina Interna, Complejo Asistencial de Ávila, 05071 Ávila, Spain
| | - Mateo Paz-Cabezas
- Unidad de Apoyo Metodológico a la Investigación, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | | | | | - María Del Rosario Iguarán-Bermúdez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Emmanuel Andrès
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Manuel Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Yun S, Casado J, Pérez-Silvestre J, Salamanca P, Llàcer P, Quirós R, Ruiz-Hueso R, Méndez M, Manzano L, Formiga F. Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary. Rev Clin Esp 2024; 224:288-299. [PMID: 38614320 DOI: 10.1016/j.rceng.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.
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Affiliation(s)
- S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Atención a la Insuficiencia Cardíaca Comunitaria, Servicios de Cardiología y Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - J Pérez-Silvestre
- Servicio de Medicina Interna, UMIPIC, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Salamanca
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - P Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - R Quirós
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain; RICAPPS, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Spain
| | - R Ruiz-Hueso
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Méndez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Lee CJ, Lee H, Yoon M, Chun KH, Kong MG, Jung MH, Kim IC, Cho JY, Kang J, Park JJ, Kim HC, Choi DJ, Lee J, Kang SM. Heart Failure Statistics 2024 Update: A Report From the Korean Society of Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:56-69. [PMID: 38694933 PMCID: PMC11058436 DOI: 10.36628/ijhf.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 05/04/2024]
Abstract
Background and Objectives The number of people with heart failure (HF) is increasing worldwide, and the social burden is increasing as HF has high mortality and morbidity. We aimed to provide updated trends on the epidemiology of HF in Korea to shape future social measures against HF. Methods We used the National Health Information Database of the National Health Insurance Service to determine the prevalence, incidence, hospitalization rate, mortality rate, comorbidities, in-hospital mortality, and healthcare cost of patients with HF from 2002 to 2020 in Korea. Results The prevalence of HF in the total Korean population rose from 0.77% in 2002 to 2.58% (1,326,886 people) in 2020. Although the age-standardized incidence of HF decreased over the past 18 years, the age-standardized prevalence increased. In 2020, the hospitalization rate for any cause in patients with HF was 1,166 per 100,000 persons, with a steady increase from 2002. In 2002, the HF mortality was 3.0 per 100,000 persons, which rose to 15.6 per 100,000 persons in 2020. While hospitalization rates and in-hospital mortality for patients with HF increased, the mortality rate for patients with HF did not (5.8% in 2020), and the one-year survival rate from the first diagnosis of HF improved. The total healthcare costs for patients with HF were approximately $2.4 billion in 2020, a 16-fold increase over the $0.15 billion in 2002. Conclusions The study's results underscore the growing socioeconomic burden of HF in Korea, driven by an aging population and increasing HF prevalence.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyeong-Hyeon Chun
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Jeehoon Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm, Co., Ltd., Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Miró Ò, Llorens P, Aguiló S, Alquézar-Arbé A, Fernández C, Burillo-Putze G, Marcos NC, Marañón AA, Oms GS, Del Castillo JG. Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study. Rev Clin Esp 2024; 224:204-216. [PMID: 38423386 DOI: 10.1016/j.rceng.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. METHODS All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. RESULTS We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. CONCLUSIONS AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain.
| | - S Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - G Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain
| | - N C Marcos
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - A A Marañón
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - G S Oms
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - J G Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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10
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Bonilla-Palomas JL, Anguita-Sánchez M, Fernández-Pérez C, Bernal-Sobrino JL, García M, Prado N, Rosillo N, Pérez-Villacastín J, Gómez-Doblas JJ, Elola-Somoza FJ. [Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study]. Med Clin (Barc) 2024; 162:213-219. [PMID: 37981482 DOI: 10.1016/j.medcli.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND PURPOSE In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models. RESULTS The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002). CONCLUSIONS In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.
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Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, La Coruña, España
| | - José Luis Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - María García
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Náyade Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
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Camino Ortega E, Baroja Gil de Gómez A, González Gamarra A, Cuevas-Budhart MA, García Klepzig JL, Gómez Del Pulgar García-Madrid M. [Education interventions in heart failure using m-Health: Systematic review]. Aten Primaria 2023; 55:102734. [PMID: 37639948 PMCID: PMC10470284 DOI: 10.1016/j.aprim.2023.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure. DESIGN Systematic review of randomized clinical trials. DATA SOURCES Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science. SELECTION OF STUDIES In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included. DATA EXTRACTION The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias. RESULTS All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application. CONCLUSION This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.
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Affiliation(s)
- Emma Camino Ortega
- Centro de Salud Goya, Servicio Madrileño de Salud (SERMAS), Madrid, España
| | | | | | - Miguel Angel Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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12
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Martín-Mojarro E, Gil V, Llorens P, Flores-Quesada S, Troiano-Ungerer OJ, Alquézar-Arbé A, Jacob J, Herrero P, Sánchez C, Miró Ò. Factors associated with unjustified chronic treatment with digoxin in patients with acute heart failure and relationship with short-term prognosis. Rev Clin Esp 2023; 223:532-541. [PMID: 37716426 DOI: 10.1016/j.rceng.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome. METHOD Patients diagnosed with AHF who were in chronic treatment with digoxin, were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge. RESULTS We analyzed 2,366 patients on chronic digoxin treatment (median age = 83 years, women = 61%), which was considered adequate in 1,373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin-angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% versus 7.6%, p = 0.05; and 12.6% versus 9.1%, p < 0.001, respectively). No differences were recorded in prolonged stay (35.7% versus 33.8%) or post-discharge adverse events (32.9% versus 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95%CI = 0.85-2.03) for in-hospital mortality; 1.29 (0.74-2.25) for 30-day mortality; 1.07 (0.82-1.40) for prolonged stay; and 0.88 (0.65-1.19) for post-discharge adverse event. CONCLUSION There is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.
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Affiliation(s)
- E Martín-Mojarro
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - S Flores-Quesada
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - O J Troiano-Ungerer
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - C Sánchez
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain.
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13
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Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, Anguita-Gámez M, Rosillo N, Del Prado N, Bernal JL, Fernández-Pérez C, Fernández-Rozas I, Gómez-Doblas JJ, Pérez-Villacastin J, Elola FJ. One-year readmissions for circulatory diseases and in-hospital mortality after an index episode of heart failure in elderly patients. A nationwide data from public hospitals in Spain between 2016 and 2018. Clin Res Cardiol 2023:10.1007/s00392-023-02202-7. [PMID: 37041378 DOI: 10.1007/s00392-023-02202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of hospitalization and death in elderly patients. However, there is limited evidence on readmission and mortality 1-year after discharge for HF. METHODS Retrospective analysis of the Minimum Basic Data Set, including HF episodes, discharged from Spanish hospitals between 2016 and 2018 in ≥ 75 years. We calculated: (a) the rate of readmissions due to circulatory system diseases (CSD) 365 days after index episode; (b) in-hospital mortality in readmissions; and (c) predictors of mortality and readmission. RESULTS We included 178,523 patients (59.2% women) aged 85.1 ± 5.5 years. The most frequent comorbidities were arrhythmias (56.0%) and renal failure (39.5%). During the follow-up, 48,932 patients (27.4%) had at least one readmission for CSD and a crude rate of 40.2%, the most frequent one HF (52.8%). The median between the date of readmission and discharge from the last admission was 70 days [IQI 24; 171] for the first readmission. The most relevant predictors of the number of readmissions were valvular heart disease and myocardial ischemia. During the readmissions, 26,757 patients (79.1%) died, representing a cumulative in-hospital mortality of 47,945 (26.9%). The factors in the index episode predictors of mortality during readmissions were cardio-respiratory failure and stroke. The number of readmissions was a risk factor for in-hospital mortality (OR 1.13; 95% CI 1.11-1.14). CONCLUSIONS The readmission rate for CSD 1-year after the index episode of HF in patients ≥ 75 years was 28.4%. The cumulative in-hospital mortality rate during the readmissions was 26.9%, and the number of rehospitalizations was identified as one of the main predictors of mortality.
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Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain.
| | - Manuel Anguita-Sánchez
- Cardiology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Nicolás Rosillo
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - Náyade Del Prado
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - José Luis Bernal
- Management Control Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Preventive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
- Preventive Medicine Department, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
| | - Inmaculada Fernández-Rozas
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain
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14
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Bravo Candela I, Moya González N, Salamanca Bautista P, Pérez Silvestre J, Conde Martel A, Carrascosa García S, Sánchez Marteles M, Cerqueiro González JM, Casado Cerrada J, Montero-Pérez-Barquero M. Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry. Rev Clin Esp 2023; 223:231-239. [PMID: 36934810 DOI: 10.1016/j.rceng.2023.01.006] [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: 11/22/2022] [Accepted: 01/31/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND AND AIMS The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. MATERIAL AND METHODS This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50 mmHg. All-cause mortality was assessed at 1 year after admission. RESULTS A total of 2291 patients were included, with mean age 80.1 ± 7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP < 50 mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21-2.05, p = 0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, haemoglobin and sodium levels. CONCLUSIONS Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients.
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Affiliation(s)
- I Bravo Candela
- Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - N Moya González
- Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - P Salamanca Bautista
- Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Universidad de Sevilla, Sevilla, Spain.
| | - J Pérez Silvestre
- Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Conde Martel
- Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S Carrascosa García
- Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Sánchez Marteles
- Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - J Casado Cerrada
- Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain
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15
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Bravo Candela I, Moya González N, Salamanca Bautista P, Pérez Silvestre J, Conde Martel A, Carrascosa García S, Sánchez Marteles M, Cerqueiro González J, Casado Cerrada J, Montero-Pérez-Barquero M. Utilidad pronóstica de la presión de pulso en pacientes con insuficiencia cardiaca con fracción de eyección preservada: Registro RICA. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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16
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 671] [Impact Index Per Article: 671.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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Melero-Muñoz FJ, Bueno-Delgado MV, Martínez-Carreras R, Maestre-Ferriz R, Beteta-Medina MÁ, Puebla-Martínez T, Bleda-Tomás AL, Sánchez-Nanclares G, Pérez-de-Zabala R, Álvarez-Leon M. Design and Development of a Heterogeneous Active Assisted Living Solution for Monitoring and Following Up with Chronic Heart Failure Patients in Spain. SENSORS (BASEL, SWITZERLAND) 2022; 22:8961. [PMID: 36433557 PMCID: PMC9695743 DOI: 10.3390/s22228961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Heart failure is the most common disease among elderly people, and the risk increases with age. The use of smart Internet of Things (IoT) systems for monitoring patients with chronic heart failure (CHF) in a non-intrusive manner can result in better control of the disease, improving proactive healthcare through real-time and historical patient's data, promoting self-care in patients, reducing unneeded interaction between patients and doctors, reducing the number of hospitalizations and saving healthcare costs. This work presents an active assisted living (AAL) solution based on the IoT to provide a tele-assistance platform for CHF patients from the public health service of the region of Murcia in Spain, with formal and informal caregivers and health professionals also as key actors. In this article, we have detailed the methodology, results, and conclusions of the prevalidation phase for the set of IoT technologies to be integrated in the AAL platform, the first mandatory step before the deployment of a large-scale pilot that will lead to improving the innovation of the system from its current technology readiness level to the market. The work presented, in the framework of the H2020 Pharaon project, aims to serve as inspiration to the R&D community for the design, development, and deployment of AAL solutions based on heterogeneous IoT technologies, or similar approaches, for smart healthcare solutions in real healthcare institutions.
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Affiliation(s)
- Francisco José Melero-Muñoz
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
| | - María Victoria Bueno-Delgado
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
- E-Lighthouse Network Solutions S.L, C/Angel s/n, 30202 Cartagena, Spain
| | - Ramón Martínez-Carreras
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
| | - Rafael Maestre-Ferriz
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
| | | | - Tomás Puebla-Martínez
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
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Sánchez-Marcos C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez F, Herrera S, Castillero-Díaz L, Herrero P, Gil V, Miró Ò. Análisis de la efectividad y seguridad de las unidades de estancia corta en la hospitalización de pacientes con insuficiencia cardíaca aguda. Propensity Score UCE-EAHFE. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tratamiento a distancia de la insuficiencia cardiaca mediante el algoritmo HeartLogic. Registro RE-HEART. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [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: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
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Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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21
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Gonzalez-Loyola FE, Muñoz MA, Navas E, Real J, Vinyoles E, Verdú-Rotellar JM. Burden of heart failure in primary healthcare. Aten Primaria 2022; 54:102413. [PMID: 35777242 PMCID: PMC9251565 DOI: 10.1016/j.aprim.2022.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. Design Retrospective observational cohort study. Setting Study was carried out in primary care setting. Participants and interventions Patients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measures Information came from electronic medical records. Results A total of 64 441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16 305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. Conclusion Heart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.
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Affiliation(s)
- Felipe-Estuardo Gonzalez-Loyola
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Departament de Pediatría, Obstetricia i Ginecología i Medicina Preventiva, Programa de Doctorat en Metodología de la Recerca BIomèdica, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miguel-Angel Muñoz
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Elena Navas
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ernest Vinyoles
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - José-Maria Verdú-Rotellar
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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22
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Salinas-Botrán A, Sanz-Cánovas J, Pérez-Somarriba J, Pérez-Belmonte LM, Cobos-Palacios L, Rubio-Rivas M, de-Cossío-Tejido S, Ramos-Rincón JM, Méndez-Bailón M, Gómez-Huelgas R. Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain. Rev Clin Esp 2022; 222:255-265. [PMID: 34629304 PMCID: PMC8497960 DOI: 10.1016/j.rceng.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. METHODS We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission factors associated with in-hospital mortality. RESULTS A total of 1718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n = 819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p < 0.001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p = 0.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p = 0.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p < 0.001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p < 0.001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p < 0.001). CONCLUSIONS Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.
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Affiliation(s)
- A Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - J Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - J Pérez-Somarriba
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain.
| | - L Cobos-Palacios
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - M Rubio-Rivas
- Servicio de Medicina Interna, Hospital Universitario Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S de-Cossío-Tejido
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - M Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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23
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Salinas-Botrán A, Sanz-Cánovas J, Pérez-Somarriba J, Pérez-Belmonte LM, Cobos-Palacios L, Rubio-Rivas M, de-Cossío-Tejido S, Ramos-Rincón JM, Méndez-Bailón M, Gómez-Huelgas R. [Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain]. Rev Clin Esp 2022; 222:255-265. [PMID: 34305156 PMCID: PMC8285252 DOI: 10.1016/j.rce.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 01/12/2023]
Abstract
Background There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission risk factors associated with in-hospital mortality. Results A total of 1,718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n=819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p< .001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p=.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p=.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p< .001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p< .001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p< .001). Conclusions Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.
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Affiliation(s)
- A Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - J Pérez-Somarriba
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - L Cobos-Palacios
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - M Rubio-Rivas
- Servicio de Medicina Interna, Hospital Universitario Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - S de-Cossío-Tejido
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Alicante, España
| | - M Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
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24
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Antonio-Oriola R, Vellone E, Durante A, De Maria M, Di Nitto M, Gea-Caballero V, Santolalla-Arnedo I, Czapla M, Benavent-Cervera JV, Sánchez-González JL, Juárez-Vela R. Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI): A Psychometric Evaluation. J Pers Med 2022; 12:625. [PMID: 35455741 PMCID: PMC9028340 DOI: 10.3390/jpm12040625] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients' self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. PURPOSE To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. METHOD CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. RESULTS Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors"), two in the self-care monitoring subscale ("illness behaviors" and "prevention behaviors") and one factor for the self-efficacy subscale. The Pearson's rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension.
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Affiliation(s)
- Rosa Antonio-Oriola
- Doctorate Program in Clinical and Community Nursing, University of Valencia, 46001 Valencia, Spain;
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Angela Durante
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Marco Di Nitto
- Centro per l’Eccellenza Clinica, la Qualità e la Sicurezza Delle Cure (CNEC), Istituto Superiore di Sanità, 00162 Rome, Italy;
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, Valencia International University, 46002 Valencia, Spain; (V.G.-C.); (J.V.B.-C.)
| | - Iván Santolalla-Arnedo
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Michał Czapla
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | | | | | - Raúl Juárez-Vela
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
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25
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Características clínicas, manejo y riesgo de complicaciones a un año en pacientes con insuficiencia cardíaca con y sin diabetes tipo 2 en España. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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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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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Varela L, Delgado JF. Epidemiología y tratamiento de la insuficiencia cardiaca en España: estudio PATHWAYS-HF. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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[SEMERGEN positioning on approaching chronic heart failure in primary care]. Semergen 2021; 48:106-123. [PMID: 34924298 DOI: 10.1016/j.semerg.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a public health problem that generates a large healthcare burden both in hospitals and in Primary Care (PC). The publication of numerous studies about HF in recent years has led to a paradigm shift in the approach to this syndrome, in which the work of PC teams is gaining greater prominence. The recent guidelines published by the European Society of Cardiology have fundamentally introduced changes in the management of patients with HF. The new proposed strategy, with drugs that reduce hospitalizations and slow the progression of the disease, should now be a priority for all professionals involved. This position document analyzes a proposal for an approach based on multidisciplinary teams with the leadership of family doctors, key to providing quality care throughout the entire process of the disease, from its prevention to the end of the life.
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Remote heart failure management using the HeartLogic algorithm. RE-HEART Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 75:709-716. [PMID: 34896031 DOI: 10.1016/j.rec.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). CONCLUSIONS The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
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López-Vilella R, Marqués-Sulé E, Sánchez-Lázaro I, Laymito Quispe R, Martínez Dolz L, Almenar Bonet L. Creatinine and NT-ProBNP levels could predict the length of hospital stay of patients with decompensated heart failure. Acta Cardiol 2021; 76:1100-1107. [PMID: 33480331 DOI: 10.1080/00015385.2020.1871264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome that causes high morbidity and mortality with a high number of admissions and sometimes prolonged admissions. This study aimed at assessing whether parameters detected during the first 24 h of admission may predict a prolonged hospital stay in patients admitted to hospital for decompensated HF. METHODS From January 2016 to December 2019, 2359 admissions of decompensated HF were recorded. In-hospital transfers, de novo HF, deaths and scheduled admissions were discarded to homogenise the sample. Finally, 1196 patients were included. The sample was divided into two groups: (a) non-prolonged admission (n = 643, admission ≤7 days) or (b) prolonged admission (n = 553, admission >7 days). Clinical, analytical, electrocardiographic and echocardiographic variables obtained during the first 24 h of admission were analysed. RESULTS Univariate differences were found at admission in NT-ProBNP, creatinine, history of cardiac surgery, smoking and alcoholism, left and right ventricular ejection fraction, systolic blood pressure and heart rate. The ROC analysis showed significant areas under the curve for the NT-ProBNP (AUC: 0.63, 95% CI: 0.60-0.67; p < 0.001) and creatinine (AUC: 0.69, 95% CI: 0.66-0.72; p < 0.0001). The variables associated with prolonged hospital admission were NT-ProBNP (OR: 1, 95% CI: 1-1; p < 0.001), creatinine (OR: 2.2, 95% CI: 1.8-2.7; p < 0.0001) and previous smoking (OR: 1.5, 95% CI: 0.4-1; p < 0.02). CONCLUSIONS Variables such as creatinine and NT-ProBNP at hospital admission may define a subgroup of patients who will probably have a long hospital stay. Therefore, the planning of hospital care and transition to discharge may be enhanced.
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Affiliation(s)
- Raquel López-Vilella
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Ignacio Sánchez-Lázaro
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Rocío Laymito Quispe
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
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Bonilla-Palomas JL, Anguita-Sánchez MP, Elola-Somoza FJ, Bernal-Sobrino JL, Fernández-Pérez C, Ruiz-Ortíz M, Jiménez-Navarro M, Bueno-Zamora H, Cequier-Fillat Á, Marín-Ortuño F. Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain. Eur J Clin Invest 2021; 51:e13606. [PMID: 34076253 DOI: 10.1111/eci.13606] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model. RESULTS A total of 1 254 830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P < .001)], although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P < .001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P < .001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P = .32). CONCLUSIONS From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.
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Affiliation(s)
| | | | | | - José L Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Servicio de Control de Gestión, University Hospital 12 de Octubre, Madrid, Spain
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain. Rev Clin Esp 2021; 222:195-204. [PMID: 34511336 DOI: 10.1016/j.rceng.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline. METHODS This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged ≥ 18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed. RESULTS We identified 21,851 patients with HF (age 78.0 ± 11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9 ± 72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population. CONCLUSIONS In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF.
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Affiliation(s)
- C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - L Varela
- Departamento médico, AstraZeneca Spain
| | | | - M Capel
- Departamento médico, AstraZeneca Spain
| | - A Sicras-Mainar
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Sicras-Navarro
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Hormigo
- Centro de Salud de Atención Primaria Puerta Blanca, Málaga, Spain
| | - R Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - N Manito
- Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M Botana
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Llisterri-Caro JL, Cinza-Sanjurjo S, Martín-Sánchez V, Rodríguez-Roca GC, Micó-Pérez RM, Segura-Fragoso A, Velilla-Zancada S, Polo-García J, Barquilla-García A, Rodríguez Padial L, Prieto-Díaz MA. Prevalence of Chronic Heart Failure, Associated Factors, and Therapeutic Management in Primary Care Patients in Spain, IBERICAN Study. J Clin Med 2021; 10:4036. [PMID: 34575146 PMCID: PMC8471153 DOI: 10.3390/jcm10184036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of chronic heart failure (CHF) in patients assisted in primary care is not well known. We investigated the prevalence of CHF, its associated factors, and its therapeutic management. METHODS AND FINDINGS This was a cross-sectional, multicenter study conducted in primary care (PC) in baseline patients of the IBERICAN study (Identification of the Spanish Population at Cardiovascular and Renal Risk). CHF was defined as the presence of this condition in the medical history, classifying patients according to the type of ventricular dysfunction in CHF with preserved ejection fraction (pEF), or CHF with reduced ejection fraction (rEF). Clinical characteristics, relationship between CHF and main cardiovascular risk factors (CVRF), and drug treatments used according to ejection fraction (EF) were analyzed. RESULTS A total of 8066 patients were included (54.5% women), average age (SD) was 57.9 (14.8) years, of which 3.1% (95% CI: 2.3-3.7) presented CHF, without differences between men and women. CHF with pEF (61.8%; 95% CI: 55.5-67.6) was more frequent in women, and CHF with rEF (38.1%; 95% CI: 33.2-45.5) (p = 0.028) was similar in both genders (65.9%; 95% CI: 57.1-73.4 vs. 57.3%; 95% CI: 47.7-65.8) (p = 0.188). A progressive increase of the prevalence with age (15.2% in ≥80 years) and with the aggregation of CVRF was observed. The most prescribed treatments were beta-blockers (54.7%) followed by angiotensin converting enzyme inhibitors (42.8%) and angiotensin II receptor antagonists (41.3%), without differences between pEF and rEF. The variables that are most associated with the probability of suffering CHF were a personal history of left ventricular hypertrophy (OR: 5.968; p < 0.001), of atrial fibrillation (OR: 3.494; p < 0.001), and of peripheral vascular disease (OR: 2.029; p < 0.001). CONCLUSIONS Three in every 100 patients included in the IBERICAN study presented CHF, of which two thirds had pEF. The condition increased exponentially with age and aggregation of CVRF. We did not find any differences in drug treatment according to the type of ventricular dysfunction. The treatment of HF with rEF has much room for improvement.
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Affiliation(s)
- Jose L. Llisterri-Caro
- Spanish Society of Primary Care Physicians (SEMERGEN)’s Foundation, 28009 Madrid, Spain;
| | - Sergio Cinza-Sanjurjo
- Porto do Son Health Center, Health Area of Santiago de Compostela, 15970 Santiago de Compostela, Spain
| | - Vicente Martín-Sánchez
- Institute of Biomedicine (IBIOMED), University of León, 24004 León, Spain;
- Epidemiology and Public Health Networking Biomedical Research Center (CIBERESP), 24004 León, Spain
| | | | - Rafael M. Micó-Pérez
- Fontanars dels Alforins Health Center, Xàtiva–Ontinyent Department of Health, 46635 Valencia, Spain;
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Formiga F, García-Pavía P, Martín Sánchez FJ, Navarro-Ruiz A, Rubio-Terrés C, Peral C, Tarilonte P, López-Ibáñez de Aldecoa A, Rubio-Rodríguez D. Health and economic impact of the correct diagnosis of transthyretin cardiac amyloidosis in Spain. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1127-1133. [PMID: 34047214 DOI: 10.1080/14737167.2021.1933948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To estimate the health and economic impact of the reduction in mortality and cardiovascular hospitalizations, associated with correct diagnosis of cardiac transthyretin amyloidosis (ATTR-CM), from the Spanish National Health System (NHS) perspective.Methods: A costs and effects analysis were performed (probabilistic Markov model) with time horizons between 1 and 15 years, comparing the correct diagnosis of ATTR-CM versus the non-diagnosis. Transition probabilities were obtained from the ATTR-ACT study (placebo arm) and from the literature. Costs and healthcare resources were obtained from Spanish sources (€ 2019) and from a panel of Spanish clinical experts.Results: After 1, 5, 10 and 15 years, the diagnosis of ATTR-CM would generate a gain of 0.031 (95%CI 0.025; 0.038); 0.387 (95%CI 0.329; 0.435); 0.754 (95%CI 0.678; 0.781) and 0.944 (95%CI 0.905; 0.983) life years per patient, respectively, with savings of € 212 (95%CI € -632; 633), € 2,289 (95%CI € 2,250; 2,517), € 2,859 (95%CI € 2,584; 3,149) and € 2,906 (95%CI € 2,669; 3,450) per patient, respectively, versus the non-diagnosis.Conclusions: Just by correctly diagnosing ATTR-CM, years of life would be gained, cardiovascular hospitalizations would be avoided, and savings would be generated for the NHS, compared to the non-diagnosis of the disease.
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Affiliation(s)
- Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Pablo García-Pavía
- Heart Failure and Family Heart Disease Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | | | - Andrés Navarro-Ruiz
- Pharmacy Department, Hospital General Universitario de Elche , Alicante, Spain
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Jorge-Samitier P, Fernández-Rodrigo MT, Juárez-Vela R, Antón-Solanas I, Gea-Caballero V. Management of Hypnotics in Patients with Insomnia and Heart Failure during Hospitalization: A Systematic Review. NURSING REPORTS 2021; 11:373-381. [PMID: 34968214 PMCID: PMC8608124 DOI: 10.3390/nursrep11020036] [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: 03/18/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Heart failure is a chronic, progressive syndrome of signs and symptoms, which has been associated to a range of comorbidities including insomnia. Acute decompensation of heart failure frequently leads to hospital admission. During hospital admission, long-term pharmacological treatments such as hypnotics can be modified or stopped. AIM To synthesize the scientific evidence available about the effect of withdrawing hypnotic drugs during hospital admission in patients with decompensated heart failure and insomnia. METHOD A systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was carried out in the following scientific databases: PubMed, Scopus, Dialnet and Cochrane. INCLUSION CRITERIA studies including a population of adults with heart failure and sleep disorders in treatment with hypnotics and admitted to hospital, studies written in English or Spanish and published until June 2020. EXCLUSION CRITERIA studies involving children, patients admitted to intensive care and patients diagnosed with sleep apnea. RESULTS We identified a total of 265 documents; only nine papers met the selection criteria. The most frequently used drugs for the treatment of insomnia in patients with heart failure were benzodiazepines and benzodiazepine agonists; their secondary effects can alter perceived quality of life and increase the risk of adverse effects. Withdrawal of these drugs during hospital admission could increase the risk of delirium. Future research in this area should evaluate the management of hypnotics during hospital admission in patients with decompensated heart failure. In addition, safe and efficient non-pharmacological alternatives for the treatment of insomnia in this population should be tested and implemented.
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Affiliation(s)
- Pablo Jorge-Samitier
- Hospital Clínico Lozano Blesa, Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain;
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - María Teresa Fernández-Rodrigo
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Raúl Juárez-Vela
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X El Sabio SN, 37008 Salamanca, Spain;
| | - Isabel Antón-Solanas
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
- Research Group GENIAPA (GIIS094), Institute of Research of Aragon, Avenida San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe, Adscript Center of the University of Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain;
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Eng SH, Waldréus N, González B, Ehrlin J, Díaz V, Rivas C, Velayos P, Puertas M, Ros A, Martín P, Lupón J, Bayes-Genis A, Jaarsma T. Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain. ESC Heart Fail 2021; 8:2492-2501. [PMID: 33942551 PMCID: PMC8318476 DOI: 10.1002/ehf2.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
Aims This study aimed to evaluate psychometric properties of the Spanish version of the Thirst Distress Scale for patients with Heart Failure (TDS‐HF) and to describe thirst distress‐associated factors in outpatients at a heart failure (HF) clinic in Spain. Thirst is common in patients with HF, but thirst distress has rarely been addressed and may significantly decrease quality of life. Methods and results A cross‐sectional study was performed assessing perceived thirst distress by patients with HF during the preceding 3 days, with the TDS‐HF (scores 8 to 40). Univariable and multivariable linear regression analyses were performed to identify variables independently associated with thirst distress. Three‐hundred two HF outpatients were included (age 67 ± 12 years, 74% male, HF duration 82 ± 75 months, left ventricular ejection fraction 42 ± 14%). Most patients were on treatment with fluid restriction (99%), sodium restriction (99%), and diuretics (70%). The psychometric evaluation of the Spanish version of the TDS‐HF showed satisfactory item‐total and inter‐item correlations (range from 0.77 to 0.85 and 0.60 to 0.84, respectively), and internal consistency was 0.95 (Cronbach's alpha). The majority perceived mild to moderate thirst distress, and 18% perceived it as high or severe. The mean score obtained was 16.2 ± 9.3 (median 13, Q1–Q3 8–20). Higher serum urea {beta coefficient 1.6 [95% confidence interval (CI) 0.267 to 2.92], P = 0.019} and lower potassium [beta coefficient −3.63 (85% CI −6.32 to −0.93), P = 0.009] remained significantly associated with thirst distress in the multivariable analysis, together with the dose of diuretics [beta coefficient 2.98 (95% CI 1.37 to 4.59), P < 0.001]. Treatment with angiotensin receptor blocker showed an independent protective effect [beta coefficient −3.62 (95% CI −6.89 to −0.345), P = 0.03]. Conclusions The psychometric evaluation of the Spanish version of the TDS‐HF showed good psychometric properties. One in five patients experienced severe distress by thirst, but the majority had mild to moderate thirst distress. The dose of diuretics and angiotensin receptor blocker treatment influence thirst distress and could be clinically important targets to relieve thirst distress in patients with HF.
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Affiliation(s)
- Sanna Hagelberg Eng
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Beatriz González
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Jenny Ehrlin
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Violeta Díaz
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Carmen Rivas
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Patricia Velayos
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - María Puertas
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Alba Ros
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Paula Martín
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitary Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Tiny Jaarsma
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry. Med Clin (Barc) 2021; 158:13-19. [PMID: 33485617 DOI: 10.1016/j.medcli.2020.10.022] [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: 07/18/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There are few data in the Spanish population about the causes of death in patients admitted to internal medicine departments for heart failure. Their study according to left ventricular ejection fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis. METHODS Prospective multicentre cohort study of 4144 patients admitted with heart failure to internal medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥ 50%), mEF (40%-49%) and rEF (<40%). Patients were followed-up for a median of one year. RESULTS There were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly heart failure (50%) and sudden cardiac death (7.5%). Non-cardiovascular (NoCV) causes were responsible for 365 deaths (30.5%). The most common NoCV causes were infections (13%). The most frequent and early cause in all groups was heart failure. Patients with pEF, compared to the other groups, had lower risk of sudden cardiac death and higher risk of infections (P <.05). The causes of death in patients with mrEF were closer to those with pEF. CONCLUSIONS The causes of death in patients with heart failure were different depending on ejection fraction strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by internal medicine.
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Transcultural Adaptation and Theoretical Models of Validation of the Spanish Version of the Self-Care of Heart Failure Index Version 6.2 (SCHFI v.6.2). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020569. [PMID: 33445459 PMCID: PMC7827763 DOI: 10.3390/ijerph18020569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heart failure (HF) is a major and growing public health problem worldwide. Across the world, heart failure is associated with high mortality, high hospitalization rates, and poor quality of life. Self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability, the response to symptoms when they occur, and the ability to follow the treatment regimen and control symptoms. One instrument used to measure self-care is the Self Care of Heart Failure Index. AIM The purpose of this study was to test the psychometric properties of the Spanish version of the Self Care of Heart Failure Index v.6.2 (SCHFI v.6.2). METHODOLOGY Before testing its psychometric properties, the SCHFI v.6.2 was translated and adapted from its original English version into Spanish. Subsequently, we tested the instrument's psychometric properties on a sample of 203 participants with HF. Descriptive statistics were used to analyze the sociodemographic and clinical variables, and to describe item responses. We tested the factorial validity of the SCHFI v.6.2 using confirmatory and exploratory factor analysis. RESULTS Confirmatory factor analysis (CFA) was performed using the our pre-existing models which resulted with poor fit indices. Thus, we performed exploratory factor analysis (EFA) on each of the SCHFI v.6.2 scales. CONCLUSION The Spanish version of the SCHFI v.6.2. has good characteristics of factorial validity and can be used in clinical practice and research to measure self-care in patients with HF.
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Guideline-directed medical therapy in real-world heart failure patients with low blood pressure and renal dysfunction. Clin Res Cardiol 2021; 110:1051-1062. [DOI: 10.1007/s00392-020-01790-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 01/14/2023]
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Epidemiology and treatment of heart failure in Spain: the HF-PATHWAYS study. ACTA ACUST UNITED AC 2020; 75:31-38. [PMID: 33380382 DOI: 10.1016/j.rec.2020.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES To describe the epidemiology and treatment of a large contemporary cohort of patients with heart failure (HF). METHODS Observational, retrospective, population-based study using the BIG-PAC database, which includes people aged ≥ 18 years seeking care for HF between 2017 and 2019. The main variables were the prevalence/annual incidence rate, comorbidities, clinical variables, and medication administered. RESULTS We identified 19 762 patients with HF from a total of 1 189 003 persons seeking medical attention from 2017 to 2019 (2019: mean age, 78.3 years; 53.0% men). Distribution by type of left ventricular ejection fraction (LVEF) was as follows: 51.7% reduced, 40.2% preserved, and 8.1% mid-range. In 2019, the prevalence was 1.89% (95%CI, 1.70-2.08), with an incidence rate of 2.78 new cases per 1000 persons/y. No statistically significant differences were observed in prevalence and/or incidence from 2017 to 2019. Among patients with HF with reduced ejection fraction (HFrEF), 64% received beta-blockers, 80.5% angiotensin-converting enzyme inhibitor/angiotensin receptor blockers or sacubitril-valsartan, and 29.8% an aldosterone antagonist. In addition, from the diagnosis (baseline) to 24 months of follow-up, there was discreet treatment optimization, which was notable in the first 3 to 6 months. CONCLUSIONS Epidemiological data on HF remained stable during the study period, with a lower prevalence than that reported in non-population-based studies. There is wide room for improvement in the optimization of medical treatment of HFrEF.
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Delgado JF, Oliva J, González-Franco Á, Cepeda JM, García-García JÁ, González-Domínguez A, Garcia-Casanovas A, Jiménez Merino S, Comín-Colet J. Budget impact of ferric carboxymaltose treatment in patients with chronic heart failure and iron deficiency in Spain. J Med Econ 2020; 23:1418-1424. [PMID: 33073660 DOI: 10.1080/13696998.2020.1838872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The treatment of iron deficiency (ID) with ferric carboxymaltose (FCM) improves the functional class and quality of life of chronic heart failure (CHF) patients with reduced left ventricular ejection fraction (LVEF), and reduces the rate of hospitalization due to worsening CHF. This study aims to evaluate the budget impact for the Spanish National Health System (SNHS) of treating ID in reduced LVEF CHF with FCM compared to non-iron treatment. METHODS We simulated a hypothetical cohort of 1000 CHF patients with ID and reduced LVEF based on the Spanish population characteristics. A decision-analytic model was also built using the data from the largest FCM clinical trial (CONFIRM-HF) that lasted for a year. We considered the use of healthcare resources from a national prospective study. A deterministic sensitivity analysis was carried out varying the corresponding baseline data by ±25%. RESULTS The cost of treating the simulated population with FCM was €2,570,914, while that of the non-iron treatment was €3,105,711, which corresponds to a cost saving of €534,797 per 1,000 patients in one year. Cost savings were mainly due to a decrease in the number of hospitalizations. All sensitivity analysis showed cost savings for the SNHS. CONCLUSIONS FCM results in an annual cost saving of €534.80 per patient, and would thus be expected to reduce the economic burden of CHF in Spain.
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Affiliation(s)
- Juan F Delgado
- Cardiology Service, Hospital Universitario 12 de Octubre, Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
| | - Álvaro González-Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Asturias, Spain
- Heart Failure and Atrial Fibrillation Group, Spanish Society of Internal Medicine (SEMI)
| | - Jose María Cepeda
- Department of Internal Medicine, Hospital Vega Baja de Orihuela, Alicante, Spain
| | | | | | | | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Torralba-Morón Á, Guerra-Vales JM, Medrano-Ortega FJ, Navarro-Puerto MA, Lora-Pablos D, Marín-León I, Calderón-Sandubete E, Gómez-de la Cámara A. Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. Rev Clin Esp 2020; 220:537-547. [PMID: 31776005 DOI: 10.1016/j.rce.2019.10.003] [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: 05/10/2019] [Revised: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.
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Affiliation(s)
- Á Torralba-Morón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J M Guerra-Vales
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España
| | - F J Medrano-Ortega
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - M A Navarro-Puerto
- Servicio de Medicina Interna, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
| | - D Lora-Pablos
- Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Investigación Clínica, Hospital Universitario 12 de Octubre, Madrid, España
| | - I Marín-León
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - E Calderón-Sandubete
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - A Gómez-de la Cámara
- Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Investigación Clínica, Hospital Universitario 12 de Octubre, Madrid, España
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Torralba-Morón Á, Guerra-Vales J, Medrano-Ortega F, Navarro-Puerto M, Lora-Pablos D, Marín-León I, Calderón-Sandubete E, Gómez-de la Cámara A. Renal function at admission as a prognostic marker for patients hospitalized for a first episode of heart failure. Results of the PREDICE study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Adeliño Recasens R, Villuendas Sabaté R. Pulmonary vein isolation: A promising strategy for the treatment of atrial fibrillation in patients with heart failure. Med Clin (Barc) 2020; 155:445-447. [PMID: 33092853 DOI: 10.1016/j.medcli.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Raquel Adeliño Recasens
- Unidad de Arritmias, Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Roger Villuendas Sabaté
- Unidad de Arritmias, Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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Prevalence of advanced heart failure and use of palliative care in admitted patients: Findings from the EPICTER study. Int J Cardiol 2020; 327:125-131. [PMID: 33171167 DOI: 10.1016/j.ijcard.2020.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/01/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND AIM Palliative care in patients with advanced heart failure is strongly recommended by Clinical Practice Guidelines. We aimed to calculate the prevalence of advanced heart failure in admitted patients, to describe their management, and to analyse the factors that influence their referral to specialised palliative care. PATIENTS AND METHODS Cross-sectional, multicentre study that consecutively included patients admitted for heart failure in 74 Spanish hospitals. If they met criteria for advanced heart failure, their treatment, complications and procedures were recorded. RESULTS A total of 3153 patients were included. Of them, 739 (23%) met criteria for advanced heart failure. They were more likely to be women, older and to have a history of anaemia, chronic kidney disease and cognitive impairment. For their management, furosemide infusions (30%) and vasodilators (21%) were used. Refractory symptoms were treated with opioids (47%) and benzodiazepines (44%). Palliative care was only provided in the last hours of life in 48% of them. A multidisciplinary approach, involving palliative care specialists was sought in 15% of these patients. Treatment with furosemide infusions, an advanced New York Heart Association functional class, to meet advanced HF criteria and the presence of cancer were associated with the referral to specialised palliative care. CONCLUSIONS Almost one in four patients admitted with HF met criteria of advanced disease. They were older and had more comorbidities. Specialist palliative care services were involved in only a minority of patients, mainly those who were highly symptomatic or had cancer.
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Carmona-Pírez J, Poblador-Plou B, Díez-Manglano J, Morillo-Jiménez MJ, Marín Trigo JM, Ioakeim-Skoufa I, Gimeno-Miguel A, Prados-Torres A. Multimorbidity networks of chronic obstructive pulmonary disease and heart failure in men and women: Evidence from the EpiChron Cohort. Mech Ageing Dev 2020; 193:111392. [PMID: 33129797 DOI: 10.1016/j.mad.2020.111392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
Patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) constitute a complex population with different phenotypes based on pathophysiology, comorbidity, sex and age. We aimed to compare the multimorbidity patterns of HF and COPD in men and women using network analysis. Individuals aged 40 years or older on 2015 of the EpiChron Cohort (Aragon, Spain) were stratified by sex and as having COPD (n = 28,608), HF (n = 13,414), or COPD and HF (n = 3952). We constructed one network per group by obtaining age-adjusted phi correlations between comorbidities. For each sex, networks differed between the three study groups; between sexes, similarities were found for the two HF groups. We detected some specific diseases highly connected in all networks (e.g., cardio-metabolic, respiratory diseases, and chronic kidney failure), and some others that were group-specific that would require further study. We identified common clusters (i.e., cardio-metabolic, cardiovascular, cancer, and neuro-psychiatric) and others specific and clinically relevant in COPD patients (e.g., behavioral risk disorders were systematically associated with psychiatric diseases in women and cancer in men). Network analysis represents a powerful tool to analyze, visualize, and compare the multimorbidity patterns of COPD and HF, also facilitated by developing an ad hoc website.
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Affiliation(s)
- Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain; Aragon Health Service (SALUD). Department III of Zaragoza, Zaragoza, Spain.
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain.
| | - Jesús Díez-Manglano
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain; Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain.
| | - Manuel Jesús Morillo-Jiménez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain.
| | | | | | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain.
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC. Miguel Servet University Hospital, 50009, Zaragoza, Spain.
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48
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Jorge-Samitier P, Durante A, Gea-Caballero V, Antón-Solanas I, Fernández-Rodrigo MT, Juárez-Vela R. Sleep Quality in Patients with Heart Failure in the Spanish Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7772. [PMID: 33114209 PMCID: PMC7660645 DOI: 10.3390/ijerph17217772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/19/2023]
Abstract
Background: Heart failure is a major problem in western societies. Sleep Disorders maintain a bidirectional relationship with heart failure, as shown by studies conducted in other countries. This study aims to describe the quality of sleep in Spanish patients with heart failure. Materials and methods: We carried out a cross-sectional study to analyze the quality of sleep in a sample of 203 patients with a diagnosis of heart failure admitted to an Internal Medicine Service. The Pittsburg Sleep Quality Index (PSQI) was used to evaluate sleep quality in our sample over a one-month period. Results: 75% of the sample presented sleep disorders. The most common problems included the interruption of sleep (73.5% nocturia and 30% breathing difficulties); 35% had poor sleep efficiency; 33% showed a decrease in daytime performance; 84% had used hypnotics at some point to induce sleep and 35% used them regularly. Conclusions: This is the first study to report on the perceived sleep quality of patients with heart failure in Spain. Self-perception of sleep quality differed from that estimated by the PSQI. The prevalence of the use of sleep-inducing medication was very high. The diurnal dysfunction generated by sleep disorders in a heart failure environment can contribute to the development of self-care and cognitive deterioration problems.
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Affiliation(s)
- Pablo Jorge-Samitier
- Department of Physiatry and Nursing, University of Zaragoza, Hospital Clínico Lozano Blesa, Avda. San Juan Bosco, 15, 50009 Zaragoza, Spain;
| | - Angela Durante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy;
| | - Vicente Gea-Caballero
- Nursing School La Fe, Adscript Center of University of Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain
| | - Isabel Antón-Solanas
- Department of Physiatry and Nursing, University of Zaragoza, Research Group GENIAPA, Calle Domingo Miral s/n, 50009-Zaragoza, Spain;
| | | | - Raúl Juárez-Vela
- School of Nursing, University of La Rioja, Research Group GRUPAC and Research Institute IDI-Paz, C/Duquesa de la Victoria 88, 26004 Logroño, La Rioja, Spain;
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Sánchez B, Guijarro C, Velasco M, Vicente MJ, Galán M, Herreros B. Evaluating the efficacy of an Advanced Care Planning Program for Health Decisions in patients with advanced heart failure: protocol for a Randomized Clinical Trial. BMC Cardiovasc Disord 2020; 20:456. [PMID: 33087061 PMCID: PMC7579909 DOI: 10.1186/s12872-020-01738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background An Advanced Care Planning (ACP) program of health decisions is the result of a process of reflection and relationship-building between the patient, their relatives and health professionals. It is based on respect for patients’ autonomy, involving them in making decisions about their disease in a way that is shared between the medical team, the patient and their relatives. Up until now, the efficacy of an ACP has not been measured in the existing literature, and therefore it is unknown if these programs reach their goal. The main objective of our study is to evaluate the efficacy of an ACP program for decision-making in patients with advanced heart failure (HF) in comparison to usual follow up and care. This objective will be evaluated by the Patient Activation Measure test, which measures the participation and self-management of the patient in decision-making. Secondary objectives: to evaluate the effect of the program on quality of life, to know if the patients wishes expressed through the ACP program are fulfilled, to measure the impact of the program on patients’ caregivers, to determine the satisfaction of patients included in the program and to evaluate the effect on quality of death. Methods Randomized multicentre clinical trial at four hospitals in Madrid. Once they are included in the study, patients’ allocation to groups (control vs intervention) will be made by alternative sampling. ACP will be applied to the intervention group, whereas in the Control Group usual follow-up will be carried out in HF units. All patients will fulfil questionnaires and tests related to the objectives of the study again after a 12-month follow-up period in order to gauge the effect of ACP in patients with advanced HF. Discussion The characteristics of patients with advanced HF make them a model for designing ACP programs, given the high prevalence of this disease, the progressive increase in its incidence and it’s clinical characteristics. Until now, the efficacy of this type of program has not been measured, so this Clinical Trial can provide relevant data for future ACP projects. Trial registration ClinicalTrials.gov Identifier: NCT04424680. Registered 9 June 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04424680?term=NCT04424680&draw=2&rank=1.
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Affiliation(s)
- Beatriz Sánchez
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - María Velasco
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - María Jesús Vicente
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Miguel Galán
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Benjamín Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain. .,Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, Spain.
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50
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Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res 2020; 20:964. [PMID: 33081776 PMCID: PMC7576860 DOI: 10.1186/s12913-020-05828-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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