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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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Garay A, Tapia J, Anguita M, Formiga F, Almenar L, Crespo-Leiro MG, Manzano L, Muñiz J, Chaves J, De Frutos T, Moliner P, Corbella X, Enjuanes-Grau C, Comín-Colet J. Gender Differences in Health-Related Quality of Life in Patients with Systolic Heart Failure: Results of the VIDA Multicenter Study. J Clin Med 2020; 9:jcm9092825. [PMID: 32878281 PMCID: PMC7563299 DOI: 10.3390/jcm9092825] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Previous studies have shown that heart failure is associated with worse health-related quality of life (HRQoL). The existence of differences according to gender remains controversial. We studied 1028 consecutive outpatients with heart failure and reduced ejection fraction (HFrEF) from a multicentre cross-sectional descriptive study across Spain that assessed HRQoL using two questionnaires (KCCQ, Kansas City Cardiomyopathy Questionnaire; and EQ-5D, EuroQoL 5 dimensions). The primary objective of the study was to describe differences in HRQoL between men and women in global scores and domains of health status of patients and explore gender differences and its interactions with heart failure related factors. In adjusted analysis women had lower scores in KCCQ overall summary scores when compared to men denoting worse HRQoL (54.7 ± 1.3 vs. 62.7 ± 0.8, p < 0.0001), and specifically got lower score in domains of symptom frequency, symptoms burden, physical limitation, quality of life and social limitation. No differences were found in domains of symptom stability and self-efficacy. Women also had lower scores on all items of EQ-5D (EQ-5D index 0.58 ± 0.01 vs. 0.67 ± 0.01, p < 0.0001). Finally, we analyzed interaction between gender and different clinical determinants regarding the presence of limitations in the 5Q-5D and overall summary score of KCCQ. Interestingly, there was no statistical significance for interaction for any variable. In conclusion, women with HFrEF have worse HRQoL compared to men. These differences do not appear to be mediated by clinical or biological factors classically associated with HRQoL nor with heart failure severity.
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Affiliation(s)
- Alberto Garay
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Javier Tapia
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Departamento de Ciencias Clínicas, Universidad de Barcelona, 08907 Barcelona, Spain
| | - Manuel Anguita
- Unidad de Insuficiencia Cardíaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba 14004, Argentina;
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, 46009 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), 15006 A Coruña, Spain;
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, 28034 Madrid, Spain;
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 La Coruña, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 15705 Santiago de Compostela, Spain
| | - José Chaves
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Trinidad De Frutos
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Pedro Moliner
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
- Cátedra HESTIA en Atención Integrada Social y Sanitaria, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08017 Barcelona, Spain
| | - Cristina Enjuanes-Grau
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Servicio de Cardiologia, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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The treatment gap in patients with chronic systolic heart failure: a systematic review of evidence-based prescribing in practice. Heart Fail Rev 2018; 21:675-697. [PMID: 27465132 DOI: 10.1007/s10741-016-9575-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The extent and impact of under-prescribing of evidence-based pharmacological therapies among heart failure patients with reduced ejection fraction (HFREF) in contemporary practice is unclear. We sought to examine the prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs), and to quantify the estimated 'treatment gap' among HFREF patients in the 'real-world' setting. The MEDLINE, PubMed, EMBASE, CINAHL and CENTRAL databases were searched for registry- or survey-based studies which examined the prescribing rates of ACE inhibitors, ARBs, BBs and MRAs among HFREF patients. Searches were limited to those published in the years 2000-2015. A total of 23 reports, including 83,605 patients, were evaluated. Overall, ACE inhibitors/ARBs, BBs and MRAs were prescribed to 79.8, 81.4 and 36.4 % of patients, respectively. The estimated treatment gaps in the overall population were 13.1 % for ACE inhibitors/ARBs, 3.9 % for BBs and 16.8 % for MRAs. The proportion of patients who received ≥50 % of the guideline-recommended target doses was 72 % for ACE inhibitors, 51 % for ARBs, 49 % for BBs, 53 % for the combination of ACE inhibitors/ARBs and BBs and 83 % for MRAs. Prescribing these drugs according to contemporary guidelines was associated with lower mortality risk. Patients who were elderly, female and with comorbidities were less likely to receive optimal treatment as recommended by the guidelines. ACE inhibitors, ARBs, BBs and MRAs are under-prescribed in eligible HFREF patients. Efforts should be made to improve approaches to closing the treatment gap at both systems of care and individual levels.
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Escoda R, Miró Ò, Martín-Sánchez F, Jacob J, Herrero P, Gil V, Garrido J, Pérez-Durá M, Fuentes M, Llorens P. Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Evolución del perfil clínico de los pacientes con insuficiencia cardiaca aguda atendidos en servicios de urgencias españoles. Rev Clin Esp 2017; 217:127-135. [DOI: 10.1016/j.rce.2016.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/11/2016] [Accepted: 10/23/2016] [Indexed: 11/23/2022]
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Enjuanes C, Bruguera J, Grau M, Cladellas M, Gonzalez G, Meroño O, Moliner-Borja P, Verdú JM, Farré N, Comín-Colet J. Estado del hierro en la insuficiencia cardiaca crónica: impacto en síntomas, clase funcional y capacidad de ejercicio submáxima. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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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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Iron Status in Chronic Heart Failure: Impact on Symptoms, Functional Class and Submaximal Exercise Capacity. ACTA ACUST UNITED AC 2015; 69:247-55. [PMID: 26684058 DOI: 10.1016/j.rec.2015.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/14/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the effect of iron deficiency and anemia on submaximal exercise capacity in patients with chronic heart failure. METHODS We undertook a single-center cross-sectional study in a group of stable patients with chronic heart failure. At recruitment, patients provided baseline information and completed a 6-minute walk test to evaluate submaximal exercise capacity and exercise-induced symptoms. At the same time, blood samples were taken for serological evaluation. Iron deficiency was defined as ferritin < 100 ng/mL or transferrin saturation < 20% when ferritin is < 800 ng/mL. Additional markers of iron status were also measured. RESULTS A total of 538 heart failure patients were eligible for inclusion, with an average age of 71 years and 33% were in New York Heart Association class III/IV. The mean distance walked in the test was 285 ± 101 meters among those with impaired iron status, vs 322 ± 113 meters (P=.002). Symptoms during the test were more frequent in iron deficiency patients (35% vs 27%; P=.028) and the most common symptom reported was fatigue. Multivariate logistic regression analyses showed that increased levels of soluble transferrin receptor indicating abnormal iron status were independently associated with advanced New York Heart Association class (P < .05). Multivariable analysis using generalized additive models, soluble transferrin receptor and ferritin index, both biomarkers measuring iron status, showed a significant, independent and linear association with submaximal exercise capacity (P=.03 for both). In contrast, hemoglobin levels were not significantly associated with 6-minute walk test distance in the multivariable analysis. CONCLUSIONS In patients with chronic heart failure, iron deficiency but not anemia was associated with impaired submaximal exercise capacity and symptomatic functional limitation.
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Micropartículas de pequeño tamaño como indicadores del estado agudo en la insuficiencia cardiaca sistólica. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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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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Beygui F, Anguita M, Tebbe U, Comin-Colet J, Galinier M, Bramlage P, Turgonyi E, Lins K, Imekraz L, de Frutos T, Böhm M. A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms. Heart Fail Rev 2015; 20:545-52. [DOI: 10.1007/s10741-015-9496-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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. 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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14
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Montoro-García S, Shantsila E, Wrigley BJ, Tapp LD, Abellán Alemán J, Lip GYH. Small-size Microparticles as Indicators of Acute Decompensated State in Ischemic Heart Failure. ACTA ACUST UNITED AC 2015; 68:951-8. [PMID: 25819989 DOI: 10.1016/j.rec.2014.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/14/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES Microparticles are markers for cell activation and apoptosis and could provide valuable information that is not available from clinical data. This study assesses the clinical and biological relationship of small-sized microparticles in different forms of ischemic systolic heart failure and their relation to markers of inflammation and repair. METHODS We compared 49 patients with acute heart failure, 39 with stable heart failure and 25 patients with stable coronary artery disease. Small-size microparticles counts were determined by high-resolution flow cytometry. Moreover, 3 different monocyte subpopulations and their expression of inflammatory and adhesive scavenger receptors were analyzed using a conventional flow cytometer. RESULTS Endothelial CD144+ microparticle counts were decreased in heart failure groups (P=.008). Annexin V-binding microparticle counts were found increased in heart failure (P=.024) and in patients with lower functional class (P=.013). Platelet CD42b+ microparticle counts positively correlated with left ventricular ejection fraction (P=.006), and annexin V-binding microparticle counts with interleukin-6 levels in stable heart failure (P=.034). Annexin V-binding microparticle counts in the acute status strongly correlated with toll-like receptor-4 expression on all monocyte subsets (all P<.01). Three months after admission with acute heart failure, annexin V-binding microparticle counts were positively correlated with receptors for interleukin-6, CD163 and CD204 (all P<.05). CONCLUSIONS Annexin V-binding microparticle counts constitute valuable hallmarks of acute decompensated state in systolic heart failure. The observed relationship between small-size annexin V-binding microparticles and scavenger receptors supports their involvement in the progression of the acute response to injury, and thus their contribution to the pathogenesis of acute decompensated heart failure.
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Affiliation(s)
- Silvia Montoro-García
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Departamento de Riesgo Cardiovascular, Facultad de Ciencias de la Salud, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, Murcia, Spain
| | - Eduard Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Benjamin J Wrigley
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Luke D Tapp
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - José Abellán Alemán
- Departamento de Riesgo Cardiovascular, Facultad de Ciencias de la Salud, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, Murcia, Spain
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
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