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Domingo M, Conangla L, Lupón J, de Antonio M, Moliner P, Santiago-Vacas E, Codina P, Zamora E, Cediel G, González B, Díaz V, Rivas C, Velayos P, Santesmases J, Pulido A, Crespo E, Bayés-Genís A. Valor pronóstico de la ecografía de pulmón en pacientes ambulatorios con insuficiencia cardiaca crónica estable. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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2
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Grau Amorós J, García García JÁ, Mira Escartí JA, Serrado Iglesias A, Moreno García MC, Manzano L, Quesada Simón MA, Dávila Ramos MF, Casado Cerrada J, González Franco Á, Montero-Pérez-Barquero M. Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study). Med Clin (Barc) 2021; 158:167-172. [PMID: 33962767 DOI: 10.1016/j.medcli.2021.01.016] [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: 10/22/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. PATIENTS AND METHOD Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. RESULTS 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF. CONCLUSIONS Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.
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Affiliation(s)
| | | | | | | | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, España
| | | | | | | | - Álvaro González Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Lau K, Malik A, Foroutan F, Buchan TA, Daza JF, Sekercioglu N, Orchanian-Cheff A, Alba AC. Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis. J Card Fail 2020; 27:349-363. [PMID: 33171294 DOI: 10.1016/j.cardfail.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Resting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect. METHODS AND RESULTS We systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72-76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08-1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate. CONCLUSIONS High-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age.
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Affiliation(s)
- Kimberley Lau
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- McMaster University, Hamilton, Ontario, Canada; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Tayler A Buchan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | | | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ana C Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada.
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4
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Domingo M, Conangla L, Lupón J, de Antonio M, Moliner P, Santiago-Vacas E, Codina P, Zamora E, Cediel G, González B, Díaz V, Rivas C, Velayos P, Santesmases J, Pulido A, Crespo E, Bayés-Genís A. Prognostic value of lung ultrasound in chronic stable ambulatory heart failure patients. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 74:862-869. [PMID: 32861606 DOI: 10.1016/j.rec.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES The role of lung ultrasound (LUS) in acute heart failure (HF) has been widely studied, but little is known about its usefulness in chronic HF. This study assessed the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients. METHODS We included consecutive outpatients who attended a scheduled follow-up visit in a HF clinic. LUS was performed in situ. The operators were blinded to clinical data and examined 8 thoracic areas. The sum of B-lines across all lung zones and the quartiles of this addition were used for the analyses. Linear regression and Cox regression analyses were performed. The main clinical outcomes were a composite of all-cause death or hospitalization for HF and mortality from any cause. RESULTS A total of 577 individuals were included (72% men; 69± 12 years). The mean number of B-lines was 5±6. During a mean follow-up of 31±7 months, 157 patients experienced the main clinical outcome and 111 died. Having ≥ 8 B-lines (Q4) doubled the risk of experiencing the composite primary event (P <.001) and increased the risk of death from any cause by 2.6-fold (P <.001). On multivariate analysis, the total sum of B-lines remained independent predictive factor of the composite endpoint (HR, 1.04; 95%CI, 1.02-1.06; P=.002) and of all-cause death (HR, 1.04; 95%CI, 1.02-1.07; P=.001), independently of whether or not N-terminal pro-B-type natriuretic peptide (NT-proBNP) was included in the model (P=.01 and P=.008, respectively), with a 3% to 4% increased risk for each 1-line addition. CONCLUSIONS LUS identified patients with stable chronic HF at high risk of death or HF hospitalization.
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Affiliation(s)
- Mar Domingo
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Conangla
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta de Antonio
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Moliner
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pau Codina
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Beatriz González
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Violeta Díaz
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carmen Rivas
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Patricia Velayos
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Santesmases
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ana Pulido
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eva Crespo
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servei de Cardiologia, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
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Vergaro G, Emdin M, Lupón J. How a large registry can explain pathophysiology: The case of anemia in the heart failure syndromes. Int J Cardiol 2020; 298:72-73. [PMID: 31611082 DOI: 10.1016/j.ijcard.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Heart Failure Clinic, Health Sciences Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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Gastelurrutia P, Lupón J, Moliner P, Yang X, Cediel G, de Antonio M, Domingo M, Altimir S, González B, Rodríguez M, Rivas C, Díaz V, Fung E, Zamora E, Santesmases J, Núñez J, Woo J, Bayes-Genis A. Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction. Mayo Clin Proc Innov Qual Outcomes 2018; 2:176-185. [PMID: 30225447 PMCID: PMC6124320 DOI: 10.1016/j.mayocpiqo.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Results Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF. Conclusion Comorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.
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Key Words
- GDS, Geriatric Depression Scale
- HF, heart failure
- HFmrEF, heart failure and mildly reduced ejection fraction
- HFpEF, heart failure and preserved left ventricular ejection fraction
- HFrEF, heart failure and reduced left ventricular ejection fraction
- LVEF, left ventricular ejection fraction
- MLHFQ, Minnesota Living with Heart Failure Questionnaire
- NYHA, New York Heart Association
- OARS, Older Americans Resources and Services
- QOL, quality of life
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Affiliation(s)
- Paloma Gastelurrutia
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Pedro Moliner
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Xiaobo Yang
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - German Cediel
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marta de Antonio
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Salvador Altimir
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Beatriz González
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Margarita Rodríguez
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carmen Rivas
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Violeta Díaz
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Erik Fung
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Elisabet Zamora
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Javier Santesmases
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain.,Clinic University Hospital, INCLIVA, Department of Medicine, University of València, València, Spain
| | - Jean Woo
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
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Cases Amenós A, Ojeda López R, Portolés Pérez JM. Insuficiencia cardíaca en la enfermedad renal y déficit de hierro: importancia de la ferroterapia. Nefrologia 2017; 37:587-591. [DOI: 10.1016/j.nefro.2017.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/01/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
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¿Cuál debe ser el objetivo en la insuficiencia cardiaca: la hemoglobina o el hierro? Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Hawwa N, Tang WHW. What Should We Target in Heart Failure: Hemoglobin or Iron? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:811-812. [PMID: 27402492 DOI: 10.1016/j.rec.2016.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Nael Hawwa
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States.
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