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Díez-Villanueva P, Jimenez-Mendez C, Pérez Á, Esteban-Fernández A, Datino T, Martínez-Sellés M, Ayesta A. Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events? Cardiology 2023; 148:195-206. [PMID: 37040727 DOI: 10.1159/000530424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. SUMMARY The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. KEY MESSAGES In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment.
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Affiliation(s)
| | | | - Ángel Pérez
- Cardiology Department, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | - Tomás Datino
- Cardiology Department, Hospital Universitario Quirón and Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea, Madrid, Spain
| | - Ana Ayesta
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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López-Azor JC, Vicent L, Valero-Masa MJ, Esteban-Fernández A, Gómez-Bueno M, Pérez Á, Díez-Villanueva P, De-Juan J, Manuel-Iniesta Á, Bover R, Del Prado S, Martínez-Sellés M. Safety of sacubitril/valsartan initiated during hospitalization: data from a non-selected cohort. ESC Heart Fail 2019; 6:1161-1166. [PMID: 31701680 PMCID: PMC6989298 DOI: 10.1002/ehf2.12527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/25/2019] [Accepted: 09/06/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Sacubitril/valsartan is safe when initiated during hospitalization in a clinical trial setting. Its safety in real‐life population is not stablished. We compared the initiation of sacubitril/valsartan during hospitalization in a non‐selected population, in the PIONEER‐HF trial, and in non‐selected outpatients. Methods and results Multicentre registry included 527 patients: 100 were started on sacubitril/valsartan during hospitalization (19.0%) and 427 as outpatients (81.0%). Compared with those in the pivotal trial, inpatients in our cohort were older (71 ± 12 vs. 61 ± 14 years; P < 0.001); had more frequently Functional Class II (41 [41.0%] vs. 100 [22.7%]; P < 0.001), higher levels of N‐terminal pro‐B type natriuretic peptide (4044 [1630–8680] vs. 2013 [1002–4132] pg/mL; P < 0.001), better glomerular filtration rate (63.5 [51.0–80.0] vs. 58.4 [47.5–71.5] mL/min; P = 0.01), and higher systolic blood pressure (121 [110–136] vs. 118 [110–133] mmHg; P = 0.03); and received angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers more frequently (92 [92.0%] vs. 208 [52.7%]; P < 0.001). Compared with non‐selected outpatients, inpatients were older (71 ± 12 vs. 68 ± 12 years, P = 0.02), had more frequent Functional Class III–IV (58 [58.0%] vs. 129 [30.3%], P < 0.001), had higher levels of N‐terminal pro‐B type natriuretic peptide (4044 [1630–8680] vs. 2182 [1134–4172]; P < 0.001), and were receiving angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers target dose less frequently (55 [55.0%] vs. 335 [78.5%]; P < 0.001). They also started sacubitril/valsartan with a low dose (50 mg/12 h) more frequently (80 [80.0%] vs. 209 [48.8%], P < 0.001). The initiation of sacubitril/valsartan in outpatients was an independent predictor of high‐dose use (OR 3.1; 95% confidence interval 1.7–5.6, P < 0.001). The follow‐up time in both cohorts, including all patients enrolled, was similar (7.0 ± 0.1 vs. 7.2 ± 2.6 months, P = 0.72). All‐cause admissions during follow‐up were more frequent in inpatients (30 [30.0%] vs. 68 outpatients [15.9%], P = 0.001), with no relevant differences in all‐cause mortality. There was no significant difference in sacubitril/valsartan withdrawal rate (17 inpatients [17.0%] vs. 49 outpatients [11.5%], P = 0.13). The incidence of adverse effects was also similar: hypotension (16 inpatients [16.0%] vs. 71 outpatients [16.7%], P = 0.88), worsening renal function (7 inpatients [7.0%] vs. 29 outpatients [6.8%], P = 0.94), and hyperkalaemia (1 inpatient [1.0%] vs. 21 outpatients [4.9%], P = 0.09). We did not register any case of angioedema. Conclusions It is safe to initiate sacubitril/valsartan during hospitalization in daily clinical practice. Inpatients have a higher risk profile and receive low starting doses more frequently than outpatients.
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Affiliation(s)
- Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Jesús Valero-Masa
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | | | - Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | - Ángel Pérez
- Servicio de Cardiología, Hospital de Burgos, Burgos, Spain
| | | | - Javier De-Juan
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Ramón Bover
- Servicio de Cardiología, Hospital Universitario Clínico de San Carlos. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Susana Del Prado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Servicio de Cardiología, Universidad Complutense, Universidad Europea, Madrid, Spain
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de Haro JC, López-Pedrajas D, Pérez Á, Rodríguez JF, Carmona M. Synthesis of rigid polyurethane foams from phosphorylated biopolyols. Environ Sci Pollut Res Int 2019; 26:3174-3183. [PMID: 28822032 DOI: 10.1007/s11356-017-9765-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Renewable resources are playing a key role on the synthesis of biodegradable polyols. Moreover, the incorporation of covalently linked additives is increasing in importance in the polyurethane (PU) market. In this work, previously epoxidized grape seed oil and methyl oleate were transformed into phosphorylated biopolyols through an acid-catalyzed ring-opening hydrolysis in the presence of H3PO4. The formation of phosphate polyesters was confirmed by FT-IR and 31P-NMR. However, the synthesis of a high-quality PU rigid foam was not possible using exclusively these polyols attending to their low hydroxyl value. In that way, different rigid PU foams were prepared from the phosphorylated biopolyols and the commercial polyol Alcupol R4520. It was observed that phosphorylated biopolyols can be incorporated up to a 57 wt.% in the PU synthesis without significant structural changes with respect to the commercial foam. Finally, thermogravimetric and EDAX analyses revealed an improvement of thermal stability by the formation of a protective phosphorocarbonaceous char layer.
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Affiliation(s)
- Juan Carlos de Haro
- Department of Chemical Engineering, Institute of Chemical and Environmental Technology, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain
| | - Daniel López-Pedrajas
- Department of Chemical Engineering, Institute of Chemical and Environmental Technology, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain
| | - Ángel Pérez
- Department of Chemical Engineering, Institute of Chemical and Environmental Technology, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain
| | - Juan Francisco Rodríguez
- Department of Chemical Engineering, Institute of Chemical and Environmental Technology, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain
| | - Manuel Carmona
- Department of Chemical Engineering, Institute of Chemical and Environmental Technology, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain.
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Abstract
Two different approaches on a directed (and possibly weighted) network G are considered in order to define the PageRank of each edge of G with the focus on its applications. It is shown that both approaches are equivalent, even though it is clear that one approach has clear computational advantages over the other. The usefulness of this concept in the context of applications is illustrated by means of some examples within the area of cybersecurity and some simulations and examples within the scope of subway networks.
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Affiliation(s)
- Regino Criado
- Department of Applied Mathematics, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Santiago Moral
- Department of Applied Mathematics, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ángel Pérez
- Department of Applied Mathematics, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Miguel Romance
- Department of Applied Mathematics, Rey Juan Carlos University, 28933 Madrid, Spain
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Affiliation(s)
- Abraham Casas
- Department of Chemical Engineering
Institute for Chemical and Environmental Technology (ITQUIMA), University of Castilla-La Mancha, Avd. Camilo José Cela 1A, 13005 Ciudad Real, Spain
| | - Ángel Pérez
- Department of Chemical Engineering
Institute for Chemical and Environmental Technology (ITQUIMA), University of Castilla-La Mancha, Avd. Camilo José Cela 1A, 13005 Ciudad Real, Spain
| | - María Jesús Ramos
- Department of Chemical Engineering
Institute for Chemical and Environmental Technology (ITQUIMA), University of Castilla-La Mancha, Avd. Camilo José Cela 1A, 13005 Ciudad Real, Spain
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Lucas-Torres C, Pérez Á, Cabañas B, Moreno A. Study by 31P NMR spectroscopy of the triacylglycerol degradation processes in olive oil with different heat-transfer mechanisms. Food Chem 2014; 165:21-8. [DOI: 10.1016/j.foodchem.2014.05.092] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/29/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
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Casas A, Ramos MJ, Pérez Á. Product Separation after Chemical Interesterification of Vegetable Oils with Methyl Acetate. Part II: Liquid–Liquid Equilibrium. Ind Eng Chem Res 2012. [DOI: 10.1021/ie300791g] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abraham Casas
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla—La Mancha, Avenida Camilo
José Cela s/n 13071, Ciudad Real, Spain
| | - Maria Jesús Ramos
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla—La Mancha, Avenida Camilo
José Cela s/n 13071, Ciudad Real, Spain
| | - Ángel Pérez
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla—La Mancha, Avenida Camilo
José Cela s/n 13071, Ciudad Real, Spain
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Casas A, Ramos MJ, Pérez Á. Product Separation after Chemical Interesterification of Vegetable Oils with Methyl Acetate. Part I: Vapor–Liquid Equilibrium. Ind Eng Chem Res 2012. [DOI: 10.1021/ie3007903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Abraham Casas
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla-La
Mancha, Avenida Camilo José Cela s/n, 13071 Ciudad Real, Spain
| | - Maria Jesús Ramos
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla-La
Mancha, Avenida Camilo José Cela s/n, 13071 Ciudad Real, Spain
| | - Ángel Pérez
- Department
of Chemical Engineering, Institute for Chemical
and Environmental Technology (ITQUIMA), University of Castilla-La
Mancha, Avenida Camilo José Cela s/n, 13071 Ciudad Real, Spain
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Llanos J, Camarillo R, Pérez Á, Cañizares P. Polymer supported ultrafiltration as a technique for selective heavy metal separation and complex formation constants prediction. Sep Purif Technol 2010. [DOI: 10.1016/j.seppur.2010.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Llanos J, Pérez Á, Cañizares P. Water-soluble polymer ultrafiltration process at pilot scale: Study of hydrodynamics and factors limiting flux. J Memb Sci 2009. [DOI: 10.1016/j.memsci.2009.05.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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