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Kebede B, Dessie B, Getachew M, Molla Y, Bahiru B, Amha H. Clinical Characteristics, Management, and Length of Hospital Stay Between Patients with New-Onset and Acute Decompensated Chronic Heart Failure: A Prospective Cohort Study in Ethiopia. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s337047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mortalidad hospitalaria y reingresos por insuficiencia cardiaca en España. Un estudio de los episodios índice y los reingresos por causas cardiacas a los 30 días y al año. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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In-hospital Mortality and Readmissions for Heart Failure in Spain. A Study of Index Episodes and 30-Day and 1-year Cardiac Readmissions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:998-1004. [PMID: 30930253 DOI: 10.1016/j.rec.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major health care problem in Spain. Epidemiological data from hospitalized patients are scarce and the association between hospital characteristics and patient outcomes is largely unknown. The aim of this study was to identify the factors associated with in-hospital mortality and readmissions and to analyze the relationship between hospital characteristics and outcomes. METHODS A retrospective analysis of discharges with HF as the principal diagnosis at hospitals of the Spanish National Health System in 2012 was performed using the Minimum Basic Data Set. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) and in-hospital mortality at 30 days and 1 year after discharge by using a multivariate mixed model. RESULTS We included 77 652 HF patients. Mean age was 79.2±9.9 years and 55.3% were women. In-hospital mortality during the index episode was 9.2%, rising to 14.5% throughout the year of follow-up. The 1-year cardiovascular readmissions rate was 32.6%. RSMR were lower among patients discharged from high-volume hospitals (> 340 HF discharges) (in-hospital RSMR, 10.3±5.6%; 8.6±2.2%); P <.001). High-volume hospitals had higher 1-year RSRR (32.3±3.7%; 33.7±4.5%; P=.006). The availability of a cardiology department at the hospital was associated with better outcomes (in-hospital RSMR, 9.9±3.8%; 9.2±2.4%; P <.001). CONCLUSIONS High-volume hospitals and the availability of a cardiology department were associated with lower in-hospital mortality.
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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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Frankenstein L, Fröhlich H, Cleland JGF. Multidisciplinary Approach for Patients Hospitalized With Heart Failure. ACTA ACUST UNITED AC 2016; 68:885-91. [PMID: 26409892 DOI: 10.1016/j.rec.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/04/2015] [Indexed: 12/24/2022]
Abstract
Acute heart failure describes the rapid deterioration, over minutes, days or hours, of symptoms and signs of heart failure. Its management is an interdisciplinary challenge that requires the cooperation of various specialists. While emergency providers, (interventional) cardiologists, heart surgeons, and intensive care specialists collaborate in the initial stabilization of acute heart failure patients, the involvement of nurses, discharge managers, and general practitioners in the heart failure team may facilitate the transition from inpatient care to the outpatient setting and improve acute heart failure readmission rates. This review highlights the importance of a multidisciplinary approach to acute heart failure with particular focus on the chain-of-care delivered by the various services within the healthcare system.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
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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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González-García A, Montero Pérez-Barquero M, Formiga F, González-Juanatey JR, Quesada MA, Epelde F, Oropesa R, Díez-Manglano J, Cerqueiro JM, Manzano L. Has beta-blocker use increased in patients with heart failure in internal medicine settings? Prognostic implications: RICA registry. ACTA ACUST UNITED AC 2014; 67:196-202. [PMID: 24774394 DOI: 10.1016/j.rec.2013.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/25/2013] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Underuse of beta-blockers has been reported in elderly patients with heart failure. The aim of this study was to evaluate the current prescription of beta-blockers in the internal medicine setting, and its association with morbidity and mortality in heart failure patients. METHODS The information analyzed was obtained from a prospective cohort of patients hospitalized for heart failure (RICA registry] database, patients included from March 2008 to September 2011) with at least one year of follow-up. We investigated the percentage of patients prescribed beta-blockers at hospital discharge, and at 3 and 12 months, and the relationship of beta-blocker use with mortality and readmissions for heart failure. Patients with significant valve disease were excluded. RESULTS A total of 515 patients were analyzed (53.5% women), with a mean age of 77.1 (8.7) years. Beta-blockers were prescribed in 62.1% of patients at discharge. A similar percentage was found at 3 months (65.6%) and 12 months (67.9%) after discharge. All-cause mortality and the composite of all-cause mortality and readmission for heart failure were significantly lower in patients treated with beta-blockers (hazard ratio=0.59, 95% confidence interval, 0.41-0.84 vs hazard ratio=0.64, 95% confidence interval, 0.49-0.83). This decrease in mortality was maintained after adjusting by age, sex, ejection fraction, functional class, comorbidities, and concomitant treatment. CONCLUSIONS The findings of this study indicate that beta-blocker use is increasing in heart failure patients (mainly elderly) treated in the internal medicine setting, and suggest that the use of these drugs is associated with a reduction in clinical events.
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Affiliation(s)
- Andrés González-García
- Unidad de Insuficiencia Cardiaca y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José R González-Juanatey
- Servicio Cardiología y UCC, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Francisco Epelde
- Unidad de Soporte a Urgencias, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Roberto Oropesa
- Servicio de Medicina Interna, Hospital Can Misses, Ibiza, Balearic Islands, Spain
| | | | - José M Cerqueiro
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Luis Manzano
- Unidad de Insuficiencia Cardiaca y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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González-García A, Montero Pérez-Barquero M, Formiga F, González-Juanatey JR, Quesada MA, Epelde F, Oropesa R, Díez-Manglano J, Cerqueiro JM, Manzano L. ¿Se ha incrementado el uso de bloqueadores beta en pacientes con insuficiencia cardiaca en medicina interna? Implicaciones pronósticas: registro RICA. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pérez-Calvo JI, Montero-Pérez-Barquero M, Camafort-Babkowski M, Conthe-Gutiérrez P, Formiga F, Aramburu-Bodas O, Romero-Requena JM. Influence of admission blood pressure on mortality in patients with acute decompensated heart failure. QJM 2011; 104:325-33. [PMID: 21068084 DOI: 10.1093/qjmed/hcq202] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). BACKGROUND The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. METHODS We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. RESULTS A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. CONCLUSION Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.
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Affiliation(s)
- J I Pérez-Calvo
- Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco n° 15, 50009 Zaragoza, Spain.
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Anguita Sánchez M, Jiménez-Navarro M, Crespo M, Alonso-Pulpón L, de Teresa E, Castro-Beiras A, Roig E, Artigas R, Zapata A, López de Ulibarri I, Muñiz J. Effect of a training program for primary care physicians on the optimization of beta-blocker treatment in elderly patients with heart failure. Rev Esp Cardiol 2010; 63:677-85. [PMID: 20515625 DOI: 10.1016/s1885-5857(10)70142-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Underuse of betablockers may contribute to elevated mortality in chronic heart failure. The aim of this study was to determine whether a specific interventional training program for primary care physicians would help optimize the use of beta-blockers in elderly chronic heart failure patients. METHODS This randomized comparative study included 627 patients aged 70 years or more who were discharged consecutively from 53 Spanish hospitals with a principal diagnosis of chronic heart failure. In total, 292 health-care centers in the catchment areas of these hospitals were randomly assigned to two groups: one group of 146 centers carried out an interventional training program on beta-blocker use for primary care physicians belonging to the centers assigned to training, and 146 centers served as a control group. The main outcome variable was the percentage of patients who were receiving a beta-blocker at the maximum or maximum tolerated dose 3 months after hospital discharge. RESULTS The patients' mean age was 78+/-5 years and 42% were women. There was no difference between the groups in demographic characteristics, clinical care, or treatment at discharge. The percentage of patients who received beta-blockers at the maximum tolerated dose 3 months after discharge was greater in the training group (49% vs. 38%; P=.014). Being treated in the training group was an independent predictor of receiving a beta-blocker at the MTD (odds ratio=2.46; 95% confidence interval, 1.29-4.69; P< .001). CONCLUSIONS Implementation of an interventional training program on beta-blocker treatment for primary care physicians improved the use of these medications in elderly chronic heart failure patients.
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Efecto de un programa de formación en atención primaria sobre la optimización del tratamiento con bloqueadores beta en pacientes ancianos con insuficiencia cardiaca. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70160-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Montero Pérez-Barquero M, Conthe Gutiérrez P, Román Sánchez P, García Alegría J, Forteza-Rey J. Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna. Rev Clin Esp 2010; 210:149-58. [DOI: 10.1016/j.rce.2009.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 09/16/2009] [Accepted: 09/27/2009] [Indexed: 11/26/2022]
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[Registrolesaf. Features of patients with systemic lupus erythematosus and antiphospholipid syndrome registered by rheumatologists and internists]. ACTA ACUST UNITED AC 2008; 2:131-6. [PMID: 21794316 DOI: 10.1016/s1699-258x(06)73034-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 01/12/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Registrolesaf (Spanish Registry of Systemic Lupus Erythematosus and Primary Antiphospholipid Syndrome through Internet) enables little known aspects of systemic lupus erythematosus and antiphospholipid syndrome to be studied simply. The aim of this study was to analyze the features of patients included in Registrolesaf by rheumatologists and internists. PATIENTS AND METHOD Among other data, Registrolesaf collects data on the specialty of physicians using the registry and patients' initials, date of birth, diagnosis, sex, vital status and, optionally, the ACR criteria on lupus and consensus statement criteria on antiphospholipid syndrome. RESULTS From May 2003 to November 2004, 1421 patients were included in the registry (1269 with lupus and 152 with antiphospholipid syndrome). Rheumatologists included 462 (47.8%) lupus patients and 24 (16.7%) with antiphospholipid syndrome, while internists included 490 patients (50.7%) with lupus and 119 (82.6%) with antiphospholipid syndrome. Logistic regression analysis, controlled for age at diagnosis, disease duration and sex, showed that lupus patients included by internists had a higher frequency of malar rash (OR 1.6; 95% CI 1.2-2.2), oral ulcers (OR 1.2; 95% CI 1.4-2.7), neuro-psychiatric manifestations (OR 2.2; 95% CI 1.3- 3.8), kidney disease (OR 1.5; 95% CI 1-2) andantinuclear antibodies (OR 2.1; 95% CI 0.97-4.7), while the frequency of antiphospholipid antibodies (OR 0.6; 95% CI 0.4-0.9) and the number of lupus criteria (P=.002) were lower. CONCLUSIONS Rheumatologists and internists have a similar approach to patients with lupus and antiphospholipid syndrome, although internists could include more seriously ill patients.
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Conthe P. Medicación y educación para los pacientes con insuficiencia cardíaca: 20 años de evidencias. Med Clin (Barc) 2008; 131:460-2. [DOI: 10.1157/13126955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tribouilloy C, Rusinaru D, Mahjoub H, Goissen T, Lévy F, Peltier M. Impact of echocardiography in patients hospitalized for heart failure: A prospective observational study. Arch Cardiovasc Dis 2008; 101:465-73. [DOI: 10.1016/j.acvd.2008.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 05/24/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Formiga F, Chivite D, Manito N, Mestre AR, Llopis F, Pujol R. Admission characteristics predicting longer length of stay among elderly patients hospitalized for decompensated heart failure. Eur J Intern Med 2008; 19:198-202. [PMID: 18395164 DOI: 10.1016/j.ejim.2007.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 07/29/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acutely decompensated heart failure (HF) has become the leading cause of hospitalization for people aged 65 or older. Hospital length of stay (LOS) is a key determinant of higher hospitals costs. The aim of our study is to identify the admission characteristics that predict a longer LOS for elderly patients admitted for an acute exacerbation of HF. METHODS We prospectively evaluated 324 patients (65 years of age or older), who were consecutively admitted for decompensated HF to a tertiary teaching hospital. Variables present at the time of emergency room evaluation that could predict a longer hospital LOS were determined by comparing the characteristics of patients hospitalized for less than 4 days with those of patients needing a longer stay. RESULTS There were 191 women (59%) and 133 men in the study, with an average age of 78.6 years and a mean LOS of 7.1 days. Multivariate regression models identified two independent predictors of a hospital stay longer than four days: female gender (p=0.03, OR 1.645, 95% CI 1.047-2.584) and poorer NYHA functional class (p<0.01, OR 1.699, 95% CI 1.135-2.542). CONCLUSION In elderly patients admitted for decompensated HF, the female gender and a worse functional class at the time of admission were associated with a longer subsequent LOS.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat 08907, Barcelona, Spain.
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Ignacio Pérez Calvo J, Amores Arriaga B, Torralba Cabeza M. Prescripción de betabloqueantes en la insuficiencia cardíaca. Rev Clin Esp 2008; 208:111-2; author reply 112-3. [DOI: 10.1157/13115214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Escaned Barbosa J, Roig Minguell E, Chorro Gascó FJ, de Teresa Galván E, Jiménez Mena M, López de Sá y Areses E, Alfonso Manterola F, Gómez Esmorís L, Martin Burrieza F, Salvador Taboada MJ, Alonso-Pulpón Rivera LA. Ámbito de actuación de la cardiología en los nuevos escenarios clínicos. Rev Esp Cardiol 2008. [DOI: 10.1157/13116204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Montero Pérez-Barquero M, Martínez Fernández R, de Los Mártires Almingol I, Michán Doña A, Conthe Gutiérrez P. [Prognostic factors in patients admitted with type 2 diabetes in Internal Medicine Services: hospital mortality and readmission in one year (DICAMI study)]. Rev Clin Esp 2007; 207:322-30. [PMID: 17662196 DOI: 10.1157/13107943] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Type II diabetes mellitus (T2DM) is a prevalent Public Health Care problem that causes an increase in morbidity, mortality and number of hospital admissions as well as increased costs in care services in this population group. The clinical indicator that determine readmission and/or death are analyzed in a 12 month follow-up period. METHODS All T2DM patients admitted in Spanish Internal Medicine Services between two different periods (june 1-15, 2003 and november 1-15) were enrolled in a prospective cohort study. Primary endpoint were readmission and/or death in the year following the first admission. RESULTS Population of the study (n = 482) was distributed in 229 males (47.5%) and 253 females (52.5%). Mean age was 73.48 +/- 8.86 years. A total of 210 (43.6%) were not readmitted to the hospital and/or died in the follow-up and 272 (56.4%) were readmitted and/or died. The latter 272 patients had a significantly greater percentage of heart failure (odds ratio [OR] 1.760; 1.073-2.886), atrial fibrillation (OR 1.747; 1.010- 3.022) and previous history of systolic blood pressure (OR 0.400; 0.241-0.666). They also showed increased levels of plasma glucose (OR 1.004; 1.001-1.007), and lower concentration of plasma hemoglobin (OR 0.756; 0.677-0.845) and creatinine clearance (OR 0.985; 0.976-0.994). CONCLUSIONS T2DM patients who are admitted to the Internal Medicine Services in Spain are elderly patients with elevated indices of readmission and death in a short follow-up period (one year). The coexistence of heart failure, atrial fibrillation, renal dysfunction deterioration and decrease in hemoglobin levels may predict this worse outcome.
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Guglin M, Awad KE, Polavaram L, Vankayala H. Aldosterone antagonists: the most underutilized class of heart failure medications. Am J Cardiovasc Drugs 2007; 7:75-9. [PMID: 17355168 DOI: 10.2165/00129784-200707010-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Aldosterone antagonists have been proven to be beneficial in severe heart failure (HF) as a result of systolic dysfunction. We sought to determine if there is a disparity in their utilization compared with ACE inhibitors and beta-adrenoceptor antagonists (beta-blockers). METHODS In the first part of the study, we asked physicians to answer a questionnaire presenting a hypothetical HF patient. In the second part, we reviewed hospital charts of patients with HF exacerbation. RESULTS Spironolactone was used less frequently than other drugs. At home, 75.0% of patients were receiving ACE inhibitors, 66.7% received beta-blockers, and 38.2% received spironolactone (p < 0.001). During the admission, 93.1% of patients received ACE inhibitors and 58.3% received spironolactone (p < 0.001). CONCLUSIONS Despite good evidence, underutilization of aldosterone antagonists in patients matching the population of the RALES (Randomized Aldactone Evaluation Study) trial persists in both outpatient and inpatient settings. The difference between the usage of ACE inhibitors and spironolactone is significant in patients with systolic dysfunction equally qualifying for both medications.
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Affiliation(s)
- Maya Guglin
- Wayne State University, Detroit, Michigan 48201, USA.
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Formiga F, Chivite D, Manito N, Casas S, Riera A, Pujol R. Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure. Cardiology 2006; 108:73-8. [PMID: 17003545 DOI: 10.1159/000095885] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 07/02/2006] [Indexed: 02/02/2023]
Abstract
Chronic heart failure (HF) is associated with a poor prognosis and causes considerable mortality. The aim of this study was to identify the admission characteristics useful to predict in-hospital mortality in patients admitted because of decompensation of HF. We evaluated 414 patients (age 76.2 years, 57% women). The hospital mortality rate was 11.1%. We identified 4 independent predictors of mortality: low Barthel index (odds ratio 1.03; 95% confidence interval 1.01-1.04), creatinine level >200 mumol/l (odds ratio 3.40; 95% confidence interval 1.51-7.66), peripheral oedema (odds ratio 3.12; 95% confidence interval 1.28-7.58) and the protective effect of the new onset of the disease (odds ratio 0.2; 95% confidence interval 0.08-0.77). In conclusion, the mortality of patients admitted to the hospital with an exacerbation of HF can be predicted if either poor functional capacity, renal insufficiency, peripheral oedema or previous diagnoses of HF are present. This clinical finding may help clinicians in their decision making in HF in the emergency room.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Urrutia A, Lupón J, Altimir S, González B, Herreros J, Díez C, Coll R, Valle V, Rey-Joly C. [Use of betablockers in elderly patients with congestive heart failure]. Med Clin (Barc) 2006; 126:206-10. [PMID: 16510092 DOI: 10.1157/13084869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Few studies of betablockers (BB) have been performed specifically in older patients with congestive heart failure (CHF). We evaluated the characteristics of elderly patients with CHF treated with BB. Moreover, we assessed whether BB are associated with a better outcome in them. PATIENTS AND METHOD We evaluated clinical and functional characteristics of patients aged > or = 75 years with CHF treated with or without BB, with special interest being paid in the mortality. RESULTS 47 out of 107 patients were treated with BB. Only in 3 it was necessary to withdraw BB. Patients treated with no BB were older, with a higher New York Heart Association (NYHA) class, more prevalent chronic obstructive pulmonary disease (COPD) and in poorer functional situation. In patients treated with BB, ischemic heart disease was more prevalent. Reasons for "no treatment with BB" were severe aortic stenosis (n = 2), severe mitral regurgitation (n = 9), asthma-COPD (n = 28), arterial disease (n = 16) and fragility (n = 9). 25% of the patients on BB reached the target dose. One-year mortality (5.7% vs 27.6%) and 2-year mortality (20.68% vs 60%) were both significantly lower (p = 0.01 and p = 0.002, respectively) in patients on BB. CONCLUSIONS 44% of our elderly patients with CHF received BB with good tolerance. Patients treated with BB were younger, with more ischemic heart disease, better NYHA class, less functional deterioration and without COPD. One-year and two-year mortality in patients who can receive BB were lower.
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Affiliation(s)
- Agustín Urrutia
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
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Abstract
Guidelines have existed in medicine for many centuries. Galen's doctrine of laudable pus sent many to an early grave, but variance in treatment put the practitioner in a difficult position, especially if all did not go well. Currently, guidelines proliferate, allegedly based upon careful evaluation of evidence culled from a variety of sources. However, obedience to guidelines is variable internationally and nationally, thus raising questions about their enforceability. They are, of course, not legally enforceable, but courts may be influenced by them, and variation must be evidence-based. Guidelines cannot logically be regarded as being set in stone; if that were the case, then there could be no innovation and medicine would not advance.
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Gil P, Justo S, Castilla MA, Criado C, Caramelo C. Cardio-renal insufficiency: the search for management strategies. Curr Opin Nephrol Hypertens 2005; 14:442-7. [PMID: 16046902 DOI: 10.1097/01.mnh.0000170753.41279.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the pathophysiology and treatment of an increasingly common entity, cardio-renal insufficiency. Cardio-renal insufficiency is more than a simultaneous cardiac and renal disease. Patients with this condition live within a fragile equilibrium challenged by the interaction of profibrogenic, atherosclerotic, neurohumoral, and other less known factors. Regarding therapy, the avoidance of oscillations between overfilled-decompensated and emptied-overtreated states becomes of critical importance. Particular focus should be paid to personalized treatment, adjusted according to heart and kidney reserve, the predictable complications of therapy, prevention of decompensations, simple measures-based follow-up and alternative procedures. RECENT FINDINGS Recent studies have established the important repercussions of unbalanced renal function on cardiovascular prognosis. In the heart failure setting, trials involving extensive cohorts of ageing or comorbidity-affected patients are presently under way. Special attention should be paid to recognize the presence of renal failure coexisting with heart failure, especially in patients with deceivingly near-normal plasma creatinine. Formulae to predict creatinine clearance are being increasingly incorporated into daily clinical practice. Disturbed renal function is an underappreciated prognostic factor in heart failure, and renal failure is frequently viewed as a relative contraindication to some proven efficacious therapies. SUMMARY Cardio-renal insufficiency is an emerging entity, with affected individuals surviving with extreme degrees of simultaneous heart failure and renal failure. Management of the condition is an intellectually demanding process. Crucial to this management is extensive medical expertise and an in-depth understanding of the particular renal, haemodynamic and internal milieu equilibrium of the patients.
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Affiliation(s)
- Paloma Gil
- Nephrology and Medicine Departments, Jiménez Díaz Foundation, University Autónoma, Queen Sofia Institue of Nephrology Research, Reyes Católicos 2, 28040 Madrid, Spain
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McMurray J, Cohen-Solal A, Dietz R, Eichhorn E, Erhardt L, Hobbs FDR, Krum H, Maggioni A, McKelvie RS, Piña IL, Soler-Soler J, Swedberg K. Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice. Eur J Heart Fail 2005; 7:710-21. [PMID: 16087129 DOI: 10.1016/j.ejheart.2005.07.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 07/05/2005] [Accepted: 07/06/2005] [Indexed: 11/23/2022] Open
Abstract
Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well-being and prolong life. This may be due to unfamiliarity with the evidence-base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta-blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non-specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.
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Affiliation(s)
- John McMurray
- Department of Cardiology, Western Infirmary, Glasgow, G12 8QQ, UK.
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