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Camafort M, Jhund P, Formiga F, Castro-Salomó A, Arévalo-Lorido J, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M, Camafort Babkowski M, Arévalo Lorido JC, Sobrino Martínez J, Manzano Espinosa L, Arias Jiménez JL, Gómez Cerezo J, Francisco J, Díez Manglano J, Aramburu Bodas O, Grau Amorós J, Montero Peréz-Barquero M, Torres Cortada G, Trullàs Vila JC, Varela Aguilar JM, Martínez de las Cuevas G, Salgado Ordóñez F, Méndez Bailón M, Ribas Pizá N. Utilidad pronóstica de las cifras ambulatorias de presión arterial en pacientes de edad avanzada con insuficiencia cardíaca. Resultados del estudio DICUMAP. Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Camafort M, Jhund PS, Formiga F, Castro-Salomó A, Arévalo-Lorido JC, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M. Prognostic value of ambulatory blood pressure values in elderly patients with heart failure. Results of the DICUMAP study. Rev Clin Esp 2021; 221:433-440. [PMID: 34130947 DOI: 10.1016/j.rceng.2020.11.010] [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: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ambulatory blood pressure monitoring (ABPM) has demonstrated value in the prognostic assessment of hypertensive patients with heart failure (HF) with or without other cardiovascular diseases. The objective of this study was to evaluate whether ABPM can identify subjects with HF with a worse prognosis. METHODS AND RESULTS Prospective multicenter study that included clinically stable outpatients with HF. All patients underwent ABPM. A total of 154 patients from 17 centers were included. Their mean age was 76.8 years (± 8.3) and 55.2% were female. In total, 23.7% had HF with a reduced ejection fraction (HFrEF), 68.2% were in NYHA functional class II, and 19.5% were in NYHA functional class III. At one year of follow up, there were 13 (8.4%) deaths, of which 10 were attributed to HF. Twenty-nine patients required hospitalization, of which 19 were due to HF. The presence of a non-dipper BP pattern was associated with an increased risk for readmission or death at one year of follow-up (25% vs. 5%; p=.024). According to a Cox regression analysis, more advanced NYHA functional class (hazard ratio 3.51; 95% CI 1.70-7.26; p=.001; for NYHA class III vs. II) and a higher proportional nocturnal reduction in diastolic BP (hazard ratio 0.961; 95%CI 0.926-0.997; p=.032 per 1% diastolic BP reduction) were independently associated with death or readmission at one year. CONCLUSION In older patients with chronic HF, a non-dipper BP pattern measured by ABPM was associated with a higher risk of hospitalization and death due to HF.
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Affiliation(s)
- M Camafort
- Unidad de Insuficiencia Cardíaca, Servicio de Medicina Interna-ICMiD, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
| | - P S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - A Castro-Salomó
- Servicio de Medicina Interna, Hospital Sant Joan, Universidad Rovira i Virgili, Reus, Spain
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Regional de Zafra, Badajoz, Spain
| | - J Sobrino-Martínez
- Servicio de Medicina Interna, Hospital l'Esperit Sant, Santa Coloma de Gramanet, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J Díez-Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
| | - Ó Aramburu
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
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Vicent L, Ayesta A, Vidán MT, Miguel-Yanes JMD, García J, Tamargo M, Gómez V, Véliz S, Fernández-Avilés F, Martínez-Sellés M. [Profile of heart failure according to the department of admission. Implications for multidisciplinary management]. Rev Esp Geriatr Gerontol 2017; 52:182-187. [PMID: 28010940 DOI: 10.1016/j.regg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. METHODS An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. RESULTS Of a total of 235 patients, 124 (52.7%) were admitted to Internal Medicine, 83 (35.3%) to Cardiology, and 28 (11.9%) to Geriatrics. Mean age was 77.0±20.2 years (Cardiology 71.5±13.5; Internal Medicine 79.2±21.1; Geriatrics 89.9±5.1; p<.001). Preserved ejection fraction was found in 121 (51.5%) patients, and this rate was higher in Internal Medicine (62.5%) and Geriatrics (70.0%) than in Cardiology (31.3%), p<.001. Comorbidity was frequent, especially atrial fibrillation (126; 53.6%), renal disease (89; 37.8%), and chronic obstructive pulmonary disease (65; 27.6%). Infections were the most common decompensating trigger in Internal Medicine (56; 45.2%), and there was often no trigger in Cardiology (45; 54.2%) and Geriatrics (14; 50.0%), p<.0001. The use of renin-angiotensin system inhibitors, beta-blockers, and spironolactone in patients with systolic dysfunction was higher in Cardiology. During the 45 days follow-up, 23 patients (9.9%) were readmitted, which was more frequent in Internal Medicine than in Cardiology (odds ratio 3.0 [95% confidence interval: 1.1 - 8.6], p=.03), with no other significant comparisons. CONCLUSIONS Patients admitted due to decompensated heart failure are elderly and often have comorbidities. There are major differences between departments as regards age and clinical profile.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Ana Ayesta
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Jorge García
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Tamargo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Víctor Gómez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Samuel Véliz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, España.
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Sánchez-Gil J, Manzano L, Flather M, Formiga F, Martel AC, Molinero AM, López RQ, Jiménez JLA, Iborra PL, Perez-Calvo JI, Montero-Pérez-Barquero M. Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry. Int J Cardiol 2017; 230:625-629. [DOI: 10.1016/j.ijcard.2016.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/07/2016] [Accepted: 12/16/2016] [Indexed: 01/29/2023]
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Cerqueiro J, González-Franco A, Montero-Pérez-Barquero M, Llácer P, Conde A, Dávila M, Carrera M, Serrado A, Suárez I, Pérez-Silvestre J, Satué J, Arévalo-Lorido J, Rodríguez A, Herrero A, Jordana R, Manzano L. Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC. Rev Clin Esp 2016; 216:8-14. [DOI: 10.1016/j.rce.2015.07.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 01/11/2023]
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Cerqueiro J, González-Franco A, Montero-Pérez-Barquero M, Llácer P, Conde A, Dávila M, Carrera M, Serrado A, Suárez I, Pérez-Silvestre J, Satué J, Arévalo-Lorido J, Rodríguez A, Herrero A, Jordana R, Manzano L. Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Crespo-Leiro MG, Segovia-Cubero J, González-Costello J, Bayes-Genis A, López-Fernández S, Roig E, Sanz-Julve M, Fernández-Vivancos C, de Mora-Martín M, García-Pinilla JM, Varela-Román A, Almenar-Bonet L, Lara-Padrón A, de la Fuente-Galán L, Delgado-Jiménez J. Adecuación en España a las recomendaciones terapéuticas de la guía de la ESC sobre insuficiencia cardiaca: ESC Heart Failure Long-term Registry. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Franco J, Formiga F, Chivite D, Manzano L, Carrera M, Arévalo-Lorido JC, Epelde F, Cerqueiro JM, Serrado A, Pérez-Barquero MM. New onset heart failure--Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study. Eur J Intern Med 2015; 26:357-62. [PMID: 25936936 DOI: 10.1016/j.ejim.2015.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/11/2015] [Accepted: 04/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart failure (HF) is a growing global epidemic. The main study aims is to evaluate the differences between new-onset and chronic-decompensated HF patients. Secondary objectives related only to new-onset HF patients include the role of left ventricular ejection fraction (LVEF) and mid-term mortality related risk factors METHODS We analyzed 2190 patients hospitalized for acute HF. We compare the 683 patients with a new-onset HF episode with the rest. Restricting the analysis to the new-onset HF patients, we also compare patients with preserved LVEF (EF>50%) with those with reduced LVEF, and analyze the factors associated with three-month mortality. RESULTS A total of 683 (31.2%) patients fulfill the criteria for "new-onset HF". These patients are older, their HF is more often related to hypertension, show higher blood pressure and heart rate values upon admission, and present with less global and disease-specific comorbidity and better baseline overall functional status. New-onset HF is more often characterized by preserved LVEF, milder baseline NYHA class and lower plasma natriuretic peptide values. After 3 months; 33 (5.2%) new-onset HF patients had died (p<0.001). Cox multivariate analysis showed a correlation between mortality and older age (hazard ratio - HR - 1.08), higher global comorbidity (HR 1.20) and lesser prescription of beta-blockers at discharge (HR 0.34). LVEF was unrelated to mortality. CONCLUSIONS New-onset HF patients show a clinical profile different to that of chronic-decompensated patients. For this subset of acute HF patients older age, higher comorbidity and beta-blocker nonprescription predict a higher risk of mid-term post-discharge mortality.
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Affiliation(s)
- Jonathan Franco
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Manzano
- Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Margarita Carrera
- Internal Medicine Service, Complejo Hospitalario de Soria, Soria, Spain
| | | | - Francisco Epelde
- Short stay Unit, Emergency Service, Hospital Universitari de Sabadell, Corporació Sanitaria Parc Tauli, Department of Medicine, UAB, Sabadell, Barcelona, Spain
| | | | - Ana Serrado
- Internal Medicine Service, Hospital Municipal de Badalona, Badalona, Barcelona, Spain
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Crespo-Leiro MG, Segovia-Cubero J, González-Costello J, Bayes-Genis A, López-Fernández S, Roig E, Sanz-Julve M, Fernández-Vivancos C, de Mora-Martín M, García-Pinilla JM, Varela-Román A, Almenar-Bonet L, Lara-Padrón A, de la Fuente-Galán L, Delgado-Jiménez J. Adherence to the ESC Heart Failure Treatment Guidelines in Spain: ESC Heart Failure Long-term Registry. ACTA ACUST UNITED AC 2015; 68:785-93. [PMID: 26003504 DOI: 10.1016/j.rec.2015.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/11/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES To estimate the percentage of heart failure patients in Spain that received the European Society of Cardiology recommended treatments, and in those that did not, to determine the reasons why. METHODS The study included 2834 consecutive ambulatory patients with heart failure from 27 Spanish hospitals. We recorded general information, the treatment indicated, and the reasons why it was not prescribed in some cases. In patients who met the criteria to receive a certain drug, true undertreatment was defined as the percentage of patients who, without justification, did not receive the drug. RESULTS In total, 92.6% of ambulatory patients with low ejection fraction received angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 93.3% beta-blockers, and 74.5% mineralocorticoid receptor antagonists. The true undertreatment rates were 3.4%, 1.8%, and 19.0%, respectively. Target doses were reached in 16.2% of patients receiving angiotensin converting enzyme inhibitors, 23.3% of those with angiotensin receptor blockers, 13.2% of those prescribed beta-blockers, and 23.5% of those with mineralocorticoid receptor antagonists. Among patients who could benefit from ivabradine, 29.1% received this drug. In total, 36% of patients met the criteria for defibrillator implantation and 90% of them had received the device or were scheduled for implantation, whereas 19.6% fulfilled the criteria for resynchronization therapy and 88.0% already had or would soon have the device. In patients who met the criteria, but did not undergo device implantation, the reasons were not cost-related. CONCLUSIONS When justified reasons for not administering heart failure drugs were taken into account, adherence to the guideline recommendations was excellent. Exclusive use of the percentage of treated patients is a poor indicator of the quality of healthcare in heart failure. Measures should be taken to improve the attainment of optimal dosing in each patient.
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Affiliation(s)
- María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante, 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.
| | - Javier Segovia-Cubero
- Unidad de Insuficiencia Cardiaca Avanzada, Trasplante e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Silvia López-Fernández
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Eulàlia Roig
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marisa Sanz-Julve
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Manuel de Mora-Martín
- Unidad de Gestión del Corazón y Enfermedades Cardiovasculares, Servicio de Cardiología, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - José Manuel García-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Área de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alfonso Varela-Román
- Servicio de Cardiología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Luis Almenar-Bonet
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Lara-Padrón
- Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Luis de la Fuente-Galán
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan Delgado-Jiménez
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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