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León-González R, Ortolá R, Carballo-Casla A, Sotos-Prieto M, Buño-Soto A, Rodríguez-Sánchez I, Pastor-Barriuso R, Rodríguez-Artalejo F, García-Esquinas E. Growth Differentiation Factor 15 as a Biomarker of Cardiovascular Risk in Chronic Musculoskeletal Pain. J Gerontol A Biol Sci Med Sci 2024; 79:glae163. [PMID: 38975684 DOI: 10.1093/gerona/glae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND It is unknown whether growth differentiation factor 15 (GDF-15) is associated with chronic musculoskeletal pain (CMP) and whether or not its association with incident cardiovascular disease (CVD) changes according to CMP status. METHODS In total, 1 957 randomly selected adults aged ≥65 years without prior CVD were followed up between 2015 and 2023. CMP was classified according to its intensity, frequency, and interference with daily activities. The association between GDF-15 levels and CMP was assessed using linear models with progressive inclusion of potential confounders, whereas the association between GDF-15 and CVD risk was evaluated with Cox proportional hazard models with similar adjustment and interaction terms between GDF-15 and CMP. The incremental predictive performance of GDF-15 over standard predictors was evaluated using discrimination and risk reclassification metrics. RESULTS GDF-15 concentrations were 6.90% (95% confidence interval [CI]: 2.56; 11.25) higher in individuals with CMP, and up to 8.89% (4.07; 15.71) and 15.79% (8.43; 23.16) higher in those with ≥3 CMP locations and interfering pain. These increased levels were influenced by a higher prevalence of cardiometabolic risk factors, functional impairments, depressive symptoms, and greater levels of inflammation in individuals with CMP. In fully adjusted models, a twofold increase in GDF-15 was associated with a 1.49 increased risk (95% CI: 1.08; 2.05) of a CVD event in individuals with CMP, but not among those without CMP (1.02 [0.77; 1.35]); p-interaction 0.041. Adding GDF-15 to models including the Framingham Risk Score improved predictive performance among individuals with CMP. CONCLUSIONS We provide evidence that GDF-15 could serve as a biomarker to assess CMP, as well as to predict CVD incidence in individuals with CMP.
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Affiliation(s)
- Rocío León-González
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Adrián Carballo-Casla
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Neurobiology, Aging Research Center, Care Sciences and Society Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Environmental Health and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Antonio Buño-Soto
- Department of Laboratory Medicine, La Paz University Hospital-IdiPaz, Madrid, Spain
| | | | - Roberto Pastor-Barriuso
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
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Jones NR, Roalfe AK, Adoki I, Hobbs FDR, Taylor CJ. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail 2019; 21:1306-1325. [PMID: 31523902 PMCID: PMC6919428 DOI: 10.1002/ejhf.1594] [Citation(s) in RCA: 280] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Aim To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
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Affiliation(s)
- Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ibiye Adoki
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Fröhlich H, Rosenfeld N, Täger T, Goode K, Kazmi S, Hole T, Katus HA, Atar D, Cleland JGF, Agewall S, Clark AL, Frankenstein L, Grundtvig M. Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe. Heart 2019; 105:1252-1259. [PMID: 30792238 DOI: 10.1136/heartjnl-2018-314256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/22/2019] [Accepted: 02/02/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries. METHODS We identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995-2005 vs period 2: 2006-2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses. RESULTS Among 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33-105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics. CONCLUSION Ambulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.
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Affiliation(s)
- Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Niklas Rosenfeld
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Kevin Goode
- Health Technology, University of Hull, Kingston-upon-Hull, UK
| | - Syed Kazmi
- Academic Cardiology, University of Hull, Kingston-upon-Hull, UK
| | - Torstein Hole
- Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hugo A Katus
- Cardiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - John G F Cleland
- Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
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Salvadó-Hernández C, Cosculluela-Torres P, Blanes-Monllor C, Parellada-Esquius N, Méndez-Galeano C, Maroto-Villanova N, García-Cerdán RM, Núñez-Manrique MP, Barrio-Ruiz C, Salvador-González B. [Heart failure in primary care: Attitudes, knowledge and self-care]. Aten Primaria 2018; 50:213-221. [PMID: 28652033 PMCID: PMC6837070 DOI: 10.1016/j.aprim.2017.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/06/2017] [Accepted: 03/06/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DESIGN Cross-sectional and multicentre study. SETTING Primary Care. PARTICIPANTS Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. MAIN MEASUREMENTS Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. RESULTS A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). CONCLUSION Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.
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Affiliation(s)
- Cristina Salvadó-Hernández
- ABS Viladecans 1, SAP Delta de Llobregat, DAP Costa de Ponent, Institut Català de la Salut, Viladecans, Barcelona, España; Grupo de investigación MACAP (Malaltia Cardiovascular en Atenció Primària), Costa de Ponent Institut Català de la Salut - Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España
| | - Pilar Cosculluela-Torres
- ABS Sant Boi 4 Vinyets, SAP Baix Llobregat Centre, DAP Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España
| | - Carmen Blanes-Monllor
- ABS Sant Boi 4 Vinyets, SAP Baix Llobregat Centre, DAP Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España
| | - Neus Parellada-Esquius
- DAP Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Carmen Méndez-Galeano
- ABS Gavà 1, SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Gavà, Barcelona, España
| | - Neus Maroto-Villanova
- ABS Ramona Via, SAP Delta de Llobregat, DAP Costa de Ponent, Institut Català de la Salut, El Prat de Llobregat, Barcelona, España
| | - Rosa Maria García-Cerdán
- ABS Sant Boi 3 Camps Blancs, SAP Baix Llobregat Centre, DAP Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España
| | - M Pilar Núñez-Manrique
- ABS Florida Sud, UGE l'Hospitalet Nord, SAP Delta de Llobregat, DAP Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Carmen Barrio-Ruiz
- Grupo de investigación MACAP (Malaltia Cardiovascular en Atenció Primària), Costa de Ponent Institut Català de la Salut - Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; ABS Sant Boi 3 Camps Blancs, SAP Baix Llobregat Centre, DAP Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España
| | - Betlem Salvador-González
- Grupo de investigación MACAP (Malaltia Cardiovascular en Atenció Primària), Costa de Ponent Institut Català de la Salut - Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; ABS Florida Sud, UGE l'Hospitalet Nord, SAP Delta de Llobregat, DAP Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España; Filiación actual: Grupo de Epidemiologia y Genética Cardiovascular, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, España.
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5
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Dauriz M, Mantovani A, Bonapace S, Verlato G, Zoppini G, Bonora E, Targher G. Prognostic Impact of Diabetes on Long-term Survival Outcomes in Patients With Heart Failure: A Meta-analysis. Diabetes Care 2017; 40:1597-1605. [PMID: 29061587 DOI: 10.2337/dc17-0697] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/28/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Several studies have explored the impact of diabetes on mortality in patients with heart failure (HF). However, the extent to which diabetes may confer risk of mortality and hospitalization in this patient population remains imperfectly known. Here we examine the independent prognostic impact of diabetes on the long-term risk of mortality and hospitalization in patients with HF. RESEARCH DESIGN AND METHODS PubMed, Scopus, and Web of Science from January 1990 to October 2016 were the data sources used. We included large (n ≥1,000) observational registries and randomized controlled trials with a follow-up duration of at least 1 year. Eligible studies were selected according to predefined keywords and clinical outcomes. Data from selected studies were extracted, and meta-analysis was performed using random-effects modeling. RESULTS A total of 31 registries and 12 clinical trials with 381,725 patients with acute and chronic HF and 102,036 all-cause deaths over a median follow-up of 3 years were included in the final analysis. Diabetes was associated with a higher risk of all-cause death (random-effects hazard ratio [HR] 1.28 [95% CI 1.21, 1.35]), cardiovascular death (1.34 [1.20, 1.49]), hospitalization (1.35 [1.20, 1.50]), and the combined end point of all-cause death or hospitalization (1.41 [1.29, 1.53]). The impact of diabetes on mortality and hospitalization was greater in patients with chronic HF than in those with acute HF. Limitations included high heterogeneity and varying degrees of confounder adjustment across individual studies. CONCLUSIONS This updated meta-analysis shows that the presence of diabetes per se adversely affects long-term survival and risk of hospitalization in patients with acute and chronic HF.
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Affiliation(s)
- Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, ''Sacro Cuore'' Hospital, Negrar, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Blaya-Nováková V, Prado-Galbarro FJ, Sarría-Santamera A. Effects of annual influenza vaccination on mortality in patients with heart failure. Eur J Public Health 2016; 26:890-892. [PMID: 27615735 DOI: 10.1093/eurpub/ckw141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The objective was to evaluate the effect of influenza vaccine on all-cause mortality in a cohort of patients with heart failure followed up in primary care centres of the Community of Madrid, Spain, during the period 2006-10. Results of the Cox proportional-hazard model were adjusted for age and sex and, after 1:1 nearest neighbour matching, for propensity score. The analysis was further stratified by season. Having received annual influenza vaccine was associated with a decreased risk of death during the influenza season (hazard ratio = 0.59, 95% CI = 0.41-0.84), but no protective effect was observed before or after the influenza season.
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Affiliation(s)
| | | | - Antonio Sarría-Santamera
- Agency for Health Technology Assessment, Institute of Health Carlos III, Madrid, Spain.,Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Spain.,Health Services Research on Chronic Patients Network REDISSEC, Madrid, Spain
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7
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Calidad de vida relacionada con la salud de los pacientes con insuficiencia cardiaca crónica sistólica en España: resultados del estudio VIDA-IC. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.07.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Comín-Colet J, Anguita M, Formiga F, Almenar L, Crespo-Leiro MG, Manzano L, Muñiz J, Chaves J, de Frutos T, Enjuanes C. Health-related Quality of Life of Patients With Chronic Systolic Heart Failure in Spain: Results of the VIDA-IC Study. ACTA ACUST UNITED AC 2015; 69:256-71. [PMID: 26725973 DOI: 10.1016/j.rec.2015.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/16/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Although heart failure negatively affects the health-related quality of life of Spanish patients there is little information on the clinical factors associated with this issue. METHODS Cross-sectional multicenter study of health-related quality of life. A specific questionnaire (Kansas City Cardiomyopathy Questionnaire) and a generic questionnaire (EuroQoL-5D) were administered to 1037 consecutive outpatients with systolic heart failure. RESULTS Most patients with poor quality of life had a worse prognosis and increased severity of heart failure. Mobility was more limited and rates of pain/discomfort and anxiety/depression were higher in the study patients than in the general population and patients with other chronic conditions. The scores on both questionnaires were very highly correlated (Pearson r =0.815; P < .001). Multivariable linear regression showed that being older (standardized β=-0.2; P=.03), female (standardized β=-10.3; P < .001), having worse functional class (standardized β=-20.4; P < .001), a higher Charlson comorbidity index (standardized β=-1.2; P=.005), and recent hospitalization for heart failure (standardized β=6.28; P=.006) were independent predictors of worse health-related quality of life. CONCLUSIONS Patients with heart failure have worse quality of life than the general Spanish population and patients with other chronic diseases. Female sex, being older, comorbidity, advanced symptoms, and recent hospitalization are determinant factors in health-related quality of life in these patients.
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Affiliation(s)
- Josep Comín-Colet
- Programa de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Manuel Anguita
- Programa de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Almenar
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | - Luis Manzano
- Unidad de Insuficiencia Cardiaca y Riesgo Vascular en el Anciano, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - José Chaves
- Departamento Médico de Pfizer S.L.U., Madrid, Spain
| | | | - Cristina Enjuanes
- Programa de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Kaldara E, Sanoudou D, Adamopoulos S, Nanas JN. Outpatient management of chronic heart failure. Expert Opin Pharmacother 2014; 16:17-41. [PMID: 25480690 DOI: 10.1517/14656566.2015.978286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Heart failure (HF) treatment attracts a share of intensive research because of its poor HF prognosis. In the past decades, the prognosis of HF has improved considerably, mainly as a consequence of the progress that has been made in the pharmacological management of HF. AREAS COVERED This article reviews the outpatient pharmacological management of chronic HF due to left ventricular systolic dysfunction and offers recommendations on the use of various drugs. In addition, the present article attempts to provide practical therapeutic algorithms based on current clinical strategies. EXPERT OPINION Continued research directed toward identifying factors associated with high pharmacotherapy guideline adherence and understanding of variants that influence response to drugs will hopefully halt or reverse the major pathophysiological mechanisms involved in this syndrome.
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Affiliation(s)
- Elisabeth Kaldara
- University of Athens, Medical School, 3rd Cardiology Department , Mikras Asias 67, 11527 Attiki, Athens , Greece +30 2108236877 ; +30 2107789901 ;
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Sarría-Santamera A, Prado-Galbarro FJ, Martín-Martínez MA, Carmona R, Gamiño Arroyo AE, Sánchez-Piedra C, Garrido Elustondo S, del Cura González I. [Survival of patients with heart failure in primary care]. Aten Primaria 2014; 47:438-45. [PMID: 25487462 PMCID: PMC6983774 DOI: 10.1016/j.aprim.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/11/2014] [Accepted: 03/26/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe survival of patients with chronic heart failure (HF) followed up in primary care (PC) and analyse the effect of sex, age, clinical and health services factors, and income levels on survival. DESIGN Longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records. SETTING PC Area 7 of the Community of Madrid. PARTICIPANTS Patients 24 year and older with at least one visit to PC in 2006. PRINCIPAL MEASUREMENT Incident cases of HF followed up from 2006 to 2010 or until death. Survival analysis with Kaplan-Meier and Cox proportional hazard multivariate regression. RESULTS A total of 3,061 cases were identified in a cohort of 227,984 patients. The survival rate was 65% at 5 years, with 519 patients dying with a median survival of 49 months. Factors associated with increased risk of mortality were, age (HR=1.04, 1.03-1.05), and having a diagnosis of ischemic heart disease (HR=1.45, 1.15- 1.78), or diabetes (HR=1.52, 1.17-1.95). Factors with a significant protective effect were: female sex (HR=0.72, 0.59-0.86), non-pensioner (HR=0.43, 0.23-0.84), having received the influenza vaccine annually (HR=0.01, 0.00-0.06), prescribed lipid-lowering drugs (HR=0.78, 0.61-0.99) or ACE inhibitors (HR=0.73, 0.60-0.88), and blood tests having been requested (HR=0.97, 0.95-1.00), X-rays (HR=0.81, 0.74-0.88), or electrocardiograms (HR=0.90, 0.81-0.99) in PC. CONCLUSIONS Data from patients with HF followed up in PC indicate that their survival is better than that obtained in other countries, supporting the argument of a better evolution of HF in Mediterranean countries.
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Affiliation(s)
- Antonio Sarría-Santamera
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España; Unidad Docente de Ciencias Sanitarias y Médico Sociales, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España.
| | | | | | - Rocío Carmona
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España
| | | | | | - Sofía Garrido Elustondo
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España; Unidad de Investigación de Atención Primaria de Madrid, Madrid, España
| | - Isabel del Cura González
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), España; Unidad de Investigación de Atención Primaria de Madrid, Madrid, España; Departamento de Medicina Preventiva, Universidad Rey Juan Carlos, Madrid, España
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Comín-Colet J, Verdú-Rotellar JM, Vela E, Clèries M, Bustins M, Mendoza L, Badosa N, Cladellas M, Ferré S, Bruguera J. Eficacia de un programa integrado hospital-atención primaria para la insuficiencia cardiaca: análisis poblacional sobre 56.742 pacientes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comín-Colet J, Verdú-Rotellar JM, Vela E, Clèries M, Bustins M, Mendoza L, Badosa N, Cladellas M, Ferré S, Bruguera J. Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients. ACTA ACUST UNITED AC 2014; 67:283-93. [PMID: 24774591 DOI: 10.1016/j.rec.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309,345. METHODS For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service). RESULTS We included 56,742 patients in the study. There were 181,204 hospital admissions and 30,712 deaths during the study period. In the adjusted analyses, when compared to the 54,659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established. CONCLUSIONS The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.
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Affiliation(s)
- Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - José María Verdú-Rotellar
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain
| | - Emili Vela
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Montse Clèries
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Montserrat Bustins
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Lola Mendoza
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Centro de Atención Primaria Poble Nou, Institut Català de la Salut, Barcelona, Spain
| | - Neus Badosa
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Mercè Cladellas
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sofía Ferré
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain
| | - Jordi Bruguera
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
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Levy WC. Should heart failure patients move to Catalonia? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:526-528. [PMID: 24776199 DOI: 10.1016/j.rec.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, Washington, United States.
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Levy WC. ¿Deben mudarse a Cataluña los pacientes con insuficiencia cardiaca? Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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