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Palau P, Calvo B, Sastre C, Domínguez E, Marín P, Flor C, Núñez J, López L. Unravelling the Mechanisms Behind Exercise Intolerance and Recovery in Long COVID. Am J Med 2024:S0002-9343(24)00235-3. [PMID: 38648998 DOI: 10.1016/j.amjmed.2024.04.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Patients suffering from long COVID may exhibit autonomic dysregulation. However, the association between autonomic dysregulation and exercise intolerance and the impact of therapeutic interventions on its modulation remain unclear. This study investigated the relationship between heart rate recovery at the first minute (HRR1), a proxy for autonomic imbalance, and exercise intolerance in patients with long COVID. Additionally, the study aimed to assess the effects of a 12-week home-based inspiratory muscle training program on autonomic modulation in this patient population. METHODS This study is a post hoc subanalysis of a randomized trial in which 26 patients with long COVID were randomly assigned to receive either a 12-week inspiratory muscle training program or usual care alone (NCT05279430). The data were analyzed using Pearson's correlation and linear mixed regression analysis. RESULTS The mean age was 50.4±12.2 years, and 11 (42.3%) were women. Baseline HRR1 was significantly correlated with maximal functional capacity (peakVO2) (r=0.402, p=0.041). Patients with lower baseline HRR1 (≤ 22 bpm) exhibited higher resting heart rates and lower peakVO2. Inspiratory muscle training led to a more substantial increase in peakVO2 in patients with lower HRR1 at baseline (p=0.019). Additionally, a significant improvement in HRR1 was observed in the IMT group compared to the usual care group after 12-week (Δ +9.39, 95% CI=2.4-16.4, p=0.010). CONCLUSION Lower baseline HRR1 is associated with exercise intolerance in long COVID patients and may serve as a valuable criterion for identifying individuals likely to benefit more from a home-based inspiratory muscle training program.
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Affiliation(s)
- Patricia Palau
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain.
| | - Beatriz Calvo
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain
| | | | - Eloy Domínguez
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain; Universitat Jaume I, Castellón, Spain
| | - Paloma Marín
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain; Facultad de Enfermería, Universitat de València. Valencia, Spain
| | - Cristina Flor
- Facultad de Fisioterapia. Universitat de València. Valencia, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular
| | - Laura López
- Cardiology Department. Hospital Clínico Universitario, INCLIVA. Universitat de València. Valencia, Spain; Facultad de Fisioterapia. Universitat de València. Valencia, Spain
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García-Blas S, Pernias V, González D'gregorio J, Fernández-Cisnal A, Bonanad C, Sastre C, Valero E, Miñana G, Zaharia G, Núñez J, Sanchis J. Carbohydrate antigen 125-guided pre-TAVI medical optimization: impact on quality of life and clinical outcomes. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00037-9. [PMID: 38311024 DOI: 10.1016/j.rec.2024.01.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION AND OBJECTIVES Carbohydrate antigen 125 (CA125), a biomarker associated with fluid overload, has proven useful in managing diuretic therapy in heart failure. We aimed to evaluate the impact of diuretic optimization guided by CA125 before transcatheter aortic valve implantation (TAVI) on outcomes. METHODS This prospective interventional study enrolled patients scheduled for TAVI, in whom baseline CA125 was measured 2 weeks before TAVI. Patients with CA125 ≥ 20 U/mL underwent diuretic up-titration before TAVI. Three groups were included: group I) baseline CA125 <20 U/mL; IIa) CA125 ≥ 20 U/mL that decreased after treatment, and IIb) CA125 ≥ 20 U/mL that did not decrease. The primary outcome was changes in the Kansas City Cardiomyopathy Questionnaire at 3 and 12 months. The secondary endpoint was clinical events. RESULTS The study included 184 patients (115 group I, 46 IIa, and 23 IIb). Groups I and IIa exhibited early and sustained improvements in the Kansas City Cardiomyopathy Questionnaire (group I: 18.9 points [95%CI, 15.7-22.1; P <.001] at 90 days, and 18.1 [95%CI, 14.9-21.4, P <.001] at 1 year; group IIa: 21.1 points [95%CI, 15.4-26.7; P <.001] and 19.5 [95%CI, 13.9-25.1; P <.001] respectively). In contrast, in group IIb there was no significant improvement at 90 days (P=.12), with improvement being significant only at 1 year (17.8 points, 95%CI, 5.9-29.6; P=.003). Over a median follow-up of 20.7 months, there were 63 (27.83%) deaths or heart failure admissions. Multivariate analysis showed a lower risk of events in group I vs IIb (HR, 0.28; 95%CI, 0.14-0.58; P <.001), and IIa vs IIb (HR, 0.24; 95%CI, 0.11-0.55; P <.001). CONCLUSIONS Patients with persistently high CA125 despite diuretic therapy pre-TAVI showed slower functional recovery and poorer clinical outcomes after TAVI.
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Affiliation(s)
- Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Vicente Pernias
- Servicio de Cardiología, Hospital General de Castellón, Castellón, Spain
| | | | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Georgiana Zaharia
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Valencia, Valencia, Spain
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Palau P, Domínguez E, Gonzalez C, Bondía E, Albiach C, Sastre C, Martínez ML, Núñez J, López L. Effect of a home-based inspiratory muscle training programme on functional capacity in postdischarged patients with long COVID: the InsCOVID trial. BMJ Open Respir Res 2022; 9:9/1/e001439. [PMID: 36549786 PMCID: PMC9791108 DOI: 10.1136/bmjresp-2022-001439] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue and exercise intolerance are the most common symptoms in patients with long COVID. AIMS This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity in patients' long COVID after a previous admission due to SARS-CoV-2 pneumonia. METHODS This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week IMT or usual care alone (NCT05279430). The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention.The primary endpoint was the change in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints. RESULTS The mean age of the sample and time to first visit after discharge were 50.4±12.2 years and 362±105 days, respectively. A total of 11 (42.3%) were female. At baseline, the mean of peakVO2, ventilatory efficiency and CIx were 18.9±5 mL/kg/min, 29.4±5.2 and 0.64±0.19, respectively. The IMT arm improved their peakVO2 significantly compared with usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p<0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency. CONCLUSION In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL. TRIAL REGISTRATION NUMBER NCT05279430.
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eloy Domínguez
- Cardiology Department. Hospital Clínico Universitario de Valencia, Universitat Jaume I, Castellón, Spain
| | - Cruz Gonzalez
- Pneumology Department, Hospital Clínico Universitario de Valencia, Hospital Clinico Universitario, Valencia, Spain
| | - Elvira Bondía
- Pneumology Department, Hospital Clínico Universitario de Valencia, Hospital Clinico Universitario, Valencia, Spain
| | - Cristina Albiach
- Cardiology Department, Hospital Clínico Universitario de Valencia, Hospital Clínico Universitario, Valencia, Spain
| | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia. Universitat de València, INCLIVA, Valencia, Spain
| | - Maria Luz Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Hospital Clínico Universitario, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Laura López
- Physiotherapy Department, Universitat de Valencia, Valencia, Spain
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Mollar A, Bonanad C, Diez-Villanueva P, Segarra D, Civera J, Sastre C, Conesa A, Villaescusa A, Fernández J, Miñana G, Navarro J, Sanchis J, Núñez J. Frailty and Hospitalization Burden in Patients With Chronic Heart Failure. Am J Cardiol 2022; 183:48-54. [PMID: 36153181 DOI: 10.1016/j.amjcard.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
Frailty is associated with increased mortality and hospitalizations in patients with heart failure (HF). However, there is little evidence regarding the burden of morbidity. In this study, we aimed to assess the association between frailty and recurrent all-cause HF hospitalizations in patients with stable chronic HF. This was an observational and prospective study that enrolled HF outpatients followed in a specialized HF unit of a single tertiary care center from 2017 to 2019. Frailty was assessed by Fried criteria. Robustness, prefrailty, and frailty were defined as 0, 1 to 2, and ≥3, respectively. The independent association between frailty status and recurrent hospitalizations was assessed through Famoye's bivariate Poisson regression model, and risk estimates were expressed as incidence rate ratios (IRR). A total of 277 patients were included. The mean age was 74 ± 10 years, 118 were women (42.6%), and 131 patients (47.3%) had left ventricular ejection fraction ≥50. According to Fried's score 61 patients (22%) were robust, 95 patients (34%) were prefrail, and 121 patients (44%) were frail. After a median follow-up of 2.21 (1.6 to 2.8) years, 52 patients (19%) died. We registered 348 all-cause hospitalizations in 144 patients (52%) and 178 HF hospitalizations in 108 patients (39%). Compared with robust patients, frailty was associated with a higher risk of all-cause and HF recurrent hospitalizations in multivariable analysis (IRR 2.01, 95% confidence interval 1.14 to 3.57, p = 0.017 and IRR 2.25, 95% confidence interval 1.16-4.36, p = 0.016, respectively). In conclusion, in patients with chronic HF, frailty identifies patients with an increased risk of total and recurrent all-cause and HF hospitalizations.
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Affiliation(s)
- Anna Mollar
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | | | - Daniel Segarra
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Jose Civera
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Julio Fernández
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Jorge Navarro
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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Palau P, Domínguez E, Seller J, Sastre C, Sanchis J, López L, Bodí V, Llàcer P, Miñana G, Espriella RDELA, Bayés-Genís A, Núñez J. Chronotropic index and long-term outcomes in heart failure with preserved ejection fraction. Rev Esp Cardiol (Engl Ed) 2022:S1885-5857(22)00211-0. [PMID: 36038124 DOI: 10.1016/j.rec.2022.08.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the usefulness of heart rate (HR) response to exercise for risk stratification in heart failure with preserved ejection fraction (HFpEF). Therefore, this study aimed to assess the association between HR response to exercise and the risk of total episodes of worsening heart failure (WHF) in symptomatic stable patients with HFpEF. METHODS This single-center study included 133 patients with HFpEF (NYHA II-III) who performed maximal cardiopulmonary exercise testing. HR response to exercise was evaluated using the chronotropic index (CIx) formula. A negative binomial regression method was used. RESULTS The mean age of the sample was 73.2± 10.5 years; 56.4% were female, and 51.1% were in atrial fibrillation. The median for CIx was 0.4 [0.3-0.55]. At a median follow-up of 2.4 [1.6-5.3] years, a total of 146 WHF events in 58 patients and 41 (30.8%) deaths were registered. In the whole sample, CIx was not associated with adverse outcomes (death, P=.319, and WHF events, P=.573). However, we found a differential effect across electrocardiographic rhythms for WHF events (P for interaction=.002). CIx was inversely and linearly associated with the risk of WHF events in patients with sinus rhythm and was positively and linearly associated with those with atrial fibrillation. CONCLUSIONS In patients with HFpEF, CIx was differentially associated with the risk of total WHF events across rhythm status. Lower CIx emerged as a risk factor for predicting higher risk in patients with sinus rhythm. In contrast, higher CIx identified a higher risk in those with atrial fibrillation.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
| | - Eloy Domínguez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Universitat Jaume I, Castellón, Spain.
| | - Julia Seller
- Servicio de Cardiología, Hospital de Denia, Denia, Alicante, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Laura López
- Facultad de Fisioterapia. Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rafael dE lA Espriella
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Civera J, Miñana G, de la Espriella R, Santas E, Sastre C, Mollar A, Conesa A, Martínez A, Núñez E, Bayés-Genís A, Núñez J. Venous Leg Compression for Tissue Decongestion in Patients With Worsening Congestive Heart Failure. Front Cardiovasc Med 2022; 9:847450. [PMID: 35872894 PMCID: PMC9304621 DOI: 10.3389/fcvm.2022.847450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
AimsVenous leg compression (VLC) with elastic bandages has been proposed as a potentially useful strategy for decreasing tissue congestion. We aimed to evaluate the effect of VLC on short-term changes on intravascular refill, assessed by inferior vena cava (IVC) diameter in patients with worsening heart failure (WHF) requiring parenteral furosemide. Additionally, we sought to evaluate whether early changes in IVC were related to short-term decongestion.MethodsThis is a prospective study in which we included 20 consecutive ambulatory patients with WHF treated with subcutaneous furosemide and VLC for at least 72 h. The endpoints were (a) short-term changes in IVC, (b) the association between decongestion and 3-h IVC changes following VLC. Changes in continuous endpoints and their longitudinal trajectories were estimated with linear mixed regression models. All analyses were adjusted for multiple comparisons.ResultsFollowing administration of subcutaneous furosemide and VLC, we found a significant increase in 3-h IVC diameter (ΔIVC = 1.6 mm, CI 95%: 0.7–2.5; p < 0.001), with a greater increase in those with baseline IVC≤21 mm (2.4 vs. 0.8 mm; p < 0.001). 3-h intravascular refill (increase in IVC≥2 mm) was associated with greater decongestion (natriuresis, weight, peripheral edemas, and dyspnea) in those with baseline IVC≤21 mm but not when IVC>21 mm (p < 0.05 for all comparisons).ConclusionsIn this cohort of patients with congestive WHF treated with subcutaneous furosemide and VLC, we found a greater increase in short-term IVC in those with IVC ≤21 mm at baseline. In this subset of patients, a 3-h increase in IVC≥2 mm was associated with greater short-term decongestion.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Heart Failure Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- *Correspondence: Julio Núñez ; ; orcid.org/0000-0003-1672-7119
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Palau P, Domínguez E, Sastre C, Martínez ML, Gonzalez C, Bondía E, Albiach C, Núñez J, López L. Effect of a home-based inspiratory muscular training programme on functional capacity in patients with chronic COVID-19 after a hospital discharge: protocol for a randomised control trial (InsCOVID trial). BMJ Open Respir Res 2022; 9:9/1/e001255. [PMID: 35790316 PMCID: PMC9257865 DOI: 10.1136/bmjresp-2022-001255] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Exercise intolerance and fatigue are the most common symptoms in patients with chronic COVID-19 after hospital discharge. Supervised exercise training programmes improve symptoms, but scarce research has been done on home-based exercise programmes on the maximal functional capacity for discharged symptomatic COVID-19 patients. This study evaluates whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity in chronic COVID-19 after hospital admission. Methods and analysis This single-centre, assessor-blinded randomised controlled trial, powered for superiority, seeks to evaluate maximal functional capacity as the primary endpoint. A total of 26 eligible patients with a previous admission for acute respiratory syndrome coronavirus 2 pneumonia (>3 months after hospital discharge) will be randomised (1:1) to receive a 12-week programme of IMT versus usual care alone. A blinded assessor will measure outcomes at baseline and after the intervention (12 weeks). An analysis of variance will be used to compare continuous outcomes among the two-intervention groups. As of 21 March 2022, eight patients have been enrolled. Ethics and dissemination The research ethics committee (Comité Ético de Investigación con Medicamentos de l'Hospital Clínic Universitari de València) approved the protocol following the principles of the Declaration of Helsinki and national regulations (Approval Number: 021/226). Findings will be published in peer-reviewed journals and conference publications. Trial registration number NCT05279430.
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Affiliation(s)
- Patricia Palau
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | | | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | - M Luz Martínez
- Cardiology Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cruz Gonzalez
- Pneumology Department, Hospital Clínico Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Elvira Bondía
- Pneumology Department, Hospital Clínico Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Crtstina Albiach
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | - Laura López
- Physiotherapy Department, Universitat de València, Valencia, Spain
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8
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Palau P, Amiguet M, Domínguez E, Sastre C, Mollar A, Seller J, Pinilla JMG, Larumbe A, Valle A, Doblas JJG, de la Espriella R, Miñana G, Mezcua AR, Santas E, Bodí V, Sanchis J, Pascual-Figal D, Górriz JL, Baýes-Genís A, Núñez J. Short-term Effects of Dapagliflozin on Maximal Functional Capacity in Heart Failure with Reduced Ejection Fraction (DAPA-VO 2 ): A Randomized Clinical Trial. Eur J Heart Fail 2022; 24:1816-1826. [PMID: 35604416 DOI: 10.1002/ejhf.2560] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS This study aimed to evaluate the effect of dapagliflozin on 1 and 3-month maximal functional capacity in patients with stable heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS In this multicenter, randomized, double-blinded clinical trial, 90 stable patients with HFrEF were randomly assigned to receive either dapagliflozin (n=45) or placebo (n=45) (http://clinicaltrials.gov identifier: NCT04197635). The primary outcome was a change in peak oxygen consumption (peakVO2 ) at 1 and 3-month. Secondary endpoints were changes at 1 and 3-month in the distance walked in 6 minutes (6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire -MLHFQ-), and echocardiographic parameters (diastolic function, left chambers volumes, and left ventricular ejection fraction). We used linear mixed regression analysis to compare endpoints changes. Estimates were adjusted for multiple comparisons. The mean age was 67.1 ± 10.7 years, 63 (76.7%) were men, 29 (32.2%) had type-2 diabetes, and 80 (89.9%) were on NYHA II. The baseline means of peakVO2 , 6MWT and MLHFQ were 13.2±3.5 mL/kg/min, 363±110 meters, and 23.1±16.2, respectively. The median (p25%-p75%) of N-terminal pro-brain natriuretic peptide was 1221 pg/ml (889-2100). Most patients were on treatment with sacubitril/valsartan (88.9%), beta-blockers (91.1%), and aldosterone receptor antagonists (74.4%). PeakVO2 significantly increased in patients on treatment with dapagliflozin (1-month: +Δ 1.09 mL/kg/min, CI 95%=0.14-2.04; p=0.021 and 3-month: +Δ 1.06 mL/kg/min, CI 95%=0.07-2.04; p=0.032). Similar positive findings were found when evaluating changes from baseline. We did not find significant differences in secondary endpoints. CONCLUSIONS Among patients with stable HFrEF, dapagliflozin resulted in a significant improvement in peakVO2 at 1 and 3-month.
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | | | | | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Jose Manuel Garcia Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Ainoha Larumbe
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Jose Gómez Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Ainhoa Robles Mezcua
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jose Luis Górriz
- Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Antonio Baýes-Genís
- CIBER Cardiovascular.,Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
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9
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Miñana G, Lorenzo M, Ramirez de Arellano A, Wächter S, de la Espriella R, Sastre C, Mollar A, Núñez E, Bodí V, Sanchis J, Bayés-Genís A, Núñez J. Incidence, Treatment and Clinical Impact of Iron Deficiency in Chronic Heart Failure: A Longitudinal Analysis. J Clin Med 2022; 11:jcm11092559. [PMID: 35566684 PMCID: PMC9100536 DOI: 10.3390/jcm11092559] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
In patients with heart failure (HF), iron deficiency (ID) is a well-recognized therapeutic target; information about its incidence, patterns of iron repletion, and clinical impact is scarce. This single-centre longitudinal cohort study assessed the rates of ID testing and diagnosis in patients with stable HF, patterns of treatment with intravenous iron, and clinical impact of intravenous iron on HF rehospitalization risk. We included 711 consecutive outpatients (4400 visits) with stable chronic HF from 2014 to 2019 (median [interquartile range] visits per patient: 2 [2−7]. ID was defined as serum ferritin <100 µg/L, or 100−299 µg/L with transferrin saturation (TSAT) < 20%. During a median follow-up of 2.20 (1.11−3.78) years, ferritin and TSAT were measured at 2230 (50.7%) and 2183 visits (49.6%), respectively. ID was found at 846 (37.9%) visits, with ferritin and TSAT available (2230/4400), and intravenous iron was administered at 321/4400 (7.3%) visits; 233 (32.8%) patients received intravenous iron during follow-up. After multivariate analyses, iron repletion at any time during follow-up was associated with a lower risk of recurrent HF hospitalization (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.28−0.88; p = 0.016). Thus, ID was a frequent finding in patients with HF, and its repletion reduced the risk of recurrent HF hospitalizations.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | | | - Sandra Wächter
- Medical Department, Viforpharma Group, 8152 Zurich, Switzerland;
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, 28029 Madrid, Spain;
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
- Correspondence: or ; Tel.: +34-617551562; Fax: +34-963862658
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10
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Palau P, Seller J, Domínguez E, Sastre C, Ramón JM, de La Espriella R, Santas E, Miñana G, Bodí V, Sanchis J, Valle A, Chorro FJ, Llácer P, Bayés-Genís A, Núñez J. Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol 2021; 78:2042-2056. [PMID: 34794685 DOI: 10.1016/j.jacc.2021.08.073] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart failure with preserved ejection fraction (HFpEF), yet β-blockers are commonly used in HFpEF despite the lack of robust evidence. OBJECTIVES This study aimed to evaluate the effect of β-blocker withdrawal on peak oxygen consumption (peak Vo2) in patients with HFpEF and chronotropic incompetence. METHODS This is a multicenter, randomized, investigator-blinded, crossover clinical trial consisting of 2 treatment periods of 2 weeks separated by a washout period of 2 weeks. Patients with stable HFpEF, New York Heart Association functional classes II and III, previous treatment with β-blockers, and chronotropic incompetence were first randomized to withdrawing from (arm A: n = 26) versus continuing (arm B: n = 26) β-blocker treatment and were then crossed over to receive the opposite intervention. Changes in peak Vo2 and percentage of predicted peak Vo2 (peak Vo2%) measured at the end of the trial were the primary outcome measures. To account for the paired-data nature of this crossover trial, linear mixed regression analysis was used. RESULTS The mean age was 72.6 ± 13.1 years, and most of the patients were women (59.6%) in New York Heart Association functional class II (66.7%). The mean peakVo2 and peak Vo2% were 12.4 ± 2.9 mL/kg/min, and 72.4 ± 17.8%, respectively. No significant baseline differences were found across treatment arms. Peak Vo2 and peak Vo2% increased significantly after β-blocker withdrawal (14.3 vs 12.2 mL/kg/min [Δ +2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4% [Δ +11.7%]; P < 0.001, respectively). CONCLUSIONS β-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic incompetence. β-blocker use in HFpEF deserves profound re-evaluation. (β-blockers Withdrawal in Patients With HFpEF and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; NCT03871803; 2017-005077-39).
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | | | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Jose María Ramón
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Rafael de La Espriella
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - F Javier Chorro
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Pau Llácer
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain; Internal Medicine Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain.
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11
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Civera J, de la Espriella R, Heredia R, Miñana G, Santas E, Conesa A, Mollar A, Sastre C, Martínez A, Villaescusa A, Núñez J. Efficacy and Safety of Subcutaneous Infusion of Non-formulated Furosemide in Patients with Worsening Heart Failure: a Real-World Study. J Cardiovasc Transl Res 2021; 15:644-652. [PMID: 34642870 PMCID: PMC9213343 DOI: 10.1007/s12265-021-10173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the efficacy (short-term changes in surrogates of decongestion) and safety following the ambulatory administration of subcutaneous furosemide (SCF) in patients with WHF. Fifty-five ambulatory patients were treated with SCF administered by an elastomeric pump for at least 72 h. Surrogates of congestion were assessed at baseline, 72 h, and 30 days. Spot urinary sodium (uNa+) was assessed at baseline, 24-48-72 h, and 30 days. The median (IQI) of NT-proBNP and uNa+ at baseline was 5218 pg/mL (2856-10878) and 68±3 mmol/L, respectively. Following administration of SCF (median dose of 100 mg/daily), we found a sustained increase in uNa+ during the first 72 h of treatment compared to baseline, paralleled with evidence of decongestion at 72 h, and 30 days. No significant safety concerns were observed. SCF was an effective and safe diuretic strategy for outpatient congestion management.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain. .,Departamento de Medicina, Universitat de València, Valencia, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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12
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Sanchis J, Sastre C, Ruescas A, Ruiz V, Valero E, Bonanad C, García-Blas S, Fernández-Cisnal A, González J, Miñana G, Núñez J. Randomized Comparison of Exercise Intervention Versus Usual Care in Older Adult Patients with Frailty After Acute Myocardial Infarction. Am J Med 2021; 134:383-390.e2. [PMID: 33228950 DOI: 10.1016/j.amjmed.2020.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adult patients with frailty are rarely involved in rehabilitation programs after myocardial infarction. Our aim was to investigate the benefits of exercise intervention in these patients. METHODS A total of 150 survivors after acute myocardial infarction, ≥70 years and with pre-frailty or frailty (Fried scale ≥1 points), were randomized to control (n = 77) or intervention (n = 73) groups. The intervention consisted of a 3-month exercise program, under physiotherapist supervision, followed by an independent home-based program. The main outcome was frailty (Fried scale) at 3 months and 1 year. Secondary endpoints were clinical events (mortality or any readmission) at 1 year. RESULTS Mean age was 80 years (range = 70-96). In the intervention group, 44 (60%) out of 73 patients participated in the program and 23 (32%) completed it. Overall, there was a decrease in the Fried score in the intervention group at 3 months, with no effect at 1 year. However, in the intention-to-treat analysis, such change did not achieve statistical significance (P = 0.110). Only treatment comparisons made among the subgroups that participated in (P = 0.033) and completed (P = 0.018) the program achieved statistical significance. There were no differences in clinical events. Worse Fried score trajectory along follow-up increased mortality risk (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.24-4.55, P = 0.009) CONCLUSIONS: Recruitment and retention for a physical program in older adult patients with frailty after myocardial infarction was challenging. Frailty status improved in the subgroup that participated in the program, although this benefit was attenuated after shifting to a home-based program. A better frailty trajectory might influence midterm prognosis. (ClinicalTrials.govNCT02715453).
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Arantxa Ruescas
- Departamento de Fisioterapia. Universidad de Valencia, Valencia, Spain
| | - Vicente Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
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13
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Sanchis J, Ruiz V, Sastre C, Bonanad C, Ruescas A, Fernández-Cisnal A, Mollar A, Valero E, Blas SG, González J, Pernias V, Miñana G, Núñez J, Ariza-Solé A. Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome. Mayo Clin Proc Innov Qual Outcomes 2020; 4:642-648. [PMID: 33367209 PMCID: PMC7749270 DOI: 10.1016/j.mayocpiqo.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome. Methods A total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality. Results Mean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; P<.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; P=.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; P<.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; P=.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; P=.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; P=.001) in comparison with the model using clinical covariates alone. Conclusion Frailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicent Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Arancha Ruescas
- Departamento de Fisioterapia, Universidad de Valencia, Valencia, Spain
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Sergio García Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicente Pernias
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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14
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Lorenzo M, de la Espriella R, Miñana G, Núñez G, Santas E, Núñez E, Heredia R, Mollar A, Civera J, Villaescusa A, Sastre C, Conesa A, Bonanad C, Bayés-Genís A, Núñez J. Clinical profile and 1-year clinical outcomes of super elderly patients admitted with acute heart failure. Eur J Intern Med 2020; 81:78-82. [PMID: 32553586 DOI: 10.1016/j.ejim.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is scarce information about the clinical profile and prognosis of acute heart failure (AHF) at the extreme ranges of age. We aimed to evaluate the 1-year death (all-cause mortality and HF-death) and HF-rehospitalizations of patients ≥85 years admitted for AHF. METHODS We prospectively evaluated a cohort of 3054 patients admitted with AHF from 2007 to 2018 in a third-level center. Age was categorized per 10-year categories (<65 years; 65-74 years, 75-84 years, and ≥85 years). The risk of mortality and HF-rehospitalizations across age categories was evaluated with Cox regression analysis and Cox regression adapted for competing events as appropriate. RESULTS The mean age was 73.6 ± 11.2 years, 48.9% were female, and 52.8% had preserved left ventricular ejection fraction (HFpEF). A total of 414 (13.6%) patients were ≥85 years. Among this group of age, female sex and HFpEF phenotype were more frequent. At 1-year follow-up 667 all-cause deaths (22,1%), 311 HF-deaths (10.1%) and 693 HF-hospitalizations (22,7%) were recorded. After multivariable adjustment, and compared to patients <65 years, a stepwise increased risk of all-cause mortality and HF-death was found for each decade increase in age, especially for patients ≥85 years (HR=3.47; 95% CI: 2.49 - 4.84, p<0.001, HR=3.31; 95% CI: 1.95 - 5.63; p<0.001, respectively). This subgroup of patients also showed an increased risk of HF-rehospitalization (HR=1.58; 95% CI: 1.16 - 2.16, p=0.004). CONCLUSIONS Super elderly patients admitted with AHF showed a dramatically increased risk of 1-year death. This subset of patients also shown an increased risk of 1-year HF-readmission.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain; CIBER Cardiovascular
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Jose Civera
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain; CIBER Cardiovascular.
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15
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Palau P, Domínguez E, Seller J, Sastre C, Bayés-Genís A, Núñez J. Chronotropic Incompetence Predicts Distance Walked in Six-Minute Walk Test in Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 26:1024-1025. [PMID: 32846204 DOI: 10.1016/j.cardfail.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
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16
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Palau P, Seller J, Domínguez E, Gómez I, Ramón JM, Sastre C, de la Espriella R, Santas E, Miñana G, Chorro FJ, González-Juanatey JR, Núñez J. Beta-blockers withdrawal in patients with heart failure with preserved ejection fraction and chronotropic incompetence: Effect on functional capacity rationale and study design of a prospective, randomized, controlled trial (The Preserve-HR trial). Clin Cardiol 2020; 43:423-429. [PMID: 32073676 PMCID: PMC7244302 DOI: 10.1002/clc.23345] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background The pathophysiology of heart failure with preserved ejection fraction (HFpEF) is complex and multifactorial. Chronotropic incompetence (ChI) has emerged as a crucial pathophysiological mechanism. Beta‐blockers, drugs with negative chronotropic effects, are commonly used in HFpEF, although current evidence does not support its routine use in these patients. Hypothesis We postulate beta‐blockers may have deleterious effects in HFpEF and ChI. This work aims to evaluate the short‐term effect of beta‐blockers withdrawal on functional capacity assessed by the maximal oxygen uptake (peakVO2) in patients with HFpEF and ChI. Methods This is a prospective, crossover, randomized (1:1) and multicenter study. After randomization, the clinical and cardiac rhythm will be continuously registered for 30 days. PeakVO2 is assessed by cardiopulmonary exercise testing (CPET) at 15 and 30 days in both groups. Secondary endpoints include quality of life, cognitive, and safety assessment. Patients with stable HFpEF, functional class New York Heart Association (NYHA) II‐III, chronic treatment with beta‐blockers, and ChI will be enrolled. A sample size estimation [alfa: 0.05, power: 90%, a 20% loss rate, and delta change of mean peakVO2: +1.2 mL/kg/min (SD ± 2.0)] of 52 patients is necessary to test our hypothesis. Results Patients started enrolling in October 2018. As January 14th, 2020, 28 patients have been enrolled. It is projected to enroll the last patient at the end of July 2020. Conclusions Optimizing therapy that improves functional capacity remains an unmeet priority in HFpEF. Deprescribing beta‐blockers in patients with HFpEF and ChI seems a plausible intervention to improve functional capacity. This trial is an attempt towards precision medicine in this complex syndrome. Trial registration http://clinicaltrials.gov: NCT03871803.
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Affiliation(s)
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | | | - Inés Gómez
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.,CIBERCV, Madrid, Spain
| | - José María Ramón
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | - Clara Sastre
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | | | - Enrique Santas
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | - Gema Miñana
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | - Francisco J Chorro
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | - José Ramón González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.,CIBERCV, Madrid, Spain
| | - Julio Núñez
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
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17
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Núñez J, Palau P, Sastre C, D'Ascoli G, Ruiz V, Bonanad C, Miñana G, Núñez E, Sanchis J. Sex-differential effect of frailty on long-term mortality in elderly patients after an acute coronary syndrome. Int J Cardiol 2019; 302:30-33. [PMID: 31924393 DOI: 10.1016/j.ijcard.2019.12.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS. METHODS AND RESULTS This is a prospective observational single-center study that included 488 elderly patients (>65 years) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried ≥ 3) and all-cause mortality. The mean age of the sample was 78 ± 7 years; 41% were female and the median Fried score was higher in women [3 (2-3) vs. 2 (1-2) points, p < 0.001]. At a median follow-up of 3.12 years (IQR:1.38-5.13), 182 deaths (37.3%) were registered. The association of Fried ≥ 3 with mortality varied across sex (p-value for interaction = 0.022). In males, Fried ≥ 3 was independently associated with all-cause death (HR = 1.89; CI 95%:1.25-2.85, p = 0.003). However, it showed a neutral effect on women (HR = 0.92; CI 95%:0.57-1.49, p = 0.726). CONCLUSIONS In this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS.
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Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular
| | - Patricia Palau
- Servicio de Cardiología, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular
| | - Giulio D'Ascoli
- Division of Cardiology, University of Rome Tor Vergata, Italy
| | - Vicente Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular.
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18
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Sanchis J, Ruiz V, Bonanad C, Sastre C, Ruescas A, Díaz M, Rodríguez E, Valero E, García-Blas S, Carratalá A, Núñez E, Núñez J. Growth differentiation factor 15 and geriatric conditions in acute coronary syndrome. Int J Cardiol 2019; 290:15-20. [PMID: 31130280 DOI: 10.1016/j.ijcard.2019.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/07/2019] [Revised: 04/11/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) is a marker of cell senescence. Age is a well-known determinant of GDF-15 levels, yet no study has analyzed the relationship between geriatric conditions and GDF-15. We hypothesize that geriatric conditions reflecting biological age might be stronger determinants of GDF-15 than chronological age in elderly patients with acute coronary syndrome. METHODS A total of 208 patients (mean age = 78.3 ± 7.0 years) were included. Prior to discharge, a thorough geriatric assessment was performed and GDF-15 measured. Predictors of GDF-15 (transformed by its natural logarithm) were determined with linear regression. Furthermore, Cox regression was used for the analysis of all-cause mortality. The median follow-up was 728 days. RESULTS Median GDF-15 concentration was 2432 pg/ml. In multivariate analysis, frailty (Fried score, p = 0.001), and comorbidity (Charlson index, p = 0.003) were independent determinants of lnGDF-15 while age was not significant (p = 0.17). Other covariates included in the model were male gender (p = 0.017), diabetes (p = 0.169), Killip class ≥2 (p = 0.046) and glomerular filtration rate (p = 0.001). The Fried score and Charlson index provided significant incremental value in the R2 model (0.362 vs 0.447; p = 0.0001). A total of 66 (32%) patients died. LnGDF-15 was a significant mortality predictor (HR = 1.82, 95% CI 1.12-2.94, p = 0.015) along with the Fried score (p = 0.013) and the Charlson index (p = 0.030). CONCLUSIONS Geriatric conditions are strong determinants of GDF-15 levels on top of age in acute coronary syndromes. Furthermore, GDF-15 was associated with mortality independently of geriatric status. Geriatric assessment and GDF-15 are complementary tools.
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Affiliation(s)
- Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
| | - Vicente Ruiz
- Facultat d'Infermeria, Universitat de València, València, Spain
| | - Clara Bonanad
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Clara Sastre
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arantxa Ruescas
- Departament de Fisioteràpia, Universitat de València, València, Spain
| | - Macarena Díaz
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Enrique Rodríguez
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Ernesto Valero
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Sergio García-Blas
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arturo Carratalá
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Eduardo Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Julio Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
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19
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Becam J, Gaulier JM, Baillif-Couniou V, Sastre C, Piercecchi MD, Leonetti G, Pélissier-Alicot AL. MDMA-related deaths: About 3 cases. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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González-D'Gregorio J, Miñana G, Núñez J, Núñez E, Ruiz V, García-Blas S, Bonanad C, Mollar A, Valero E, Amiguet M, Sastre C, Sanchis J. Iron deficiency and long-term mortality in elderly patients with acute coronary syndrome. Biomark Med 2018; 12:987-999. [PMID: 30043644 DOI: 10.2217/bmm-2018-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM We evaluated the relationship between iron deficiency (ID) and long-term mortality risk in elderly patients with acute coronary syndrome (ACS). METHODS In this prospective observational study, we included 252 patients older than 65 years with ACS. Transferrin saturation (TSAT) and ferritin were collected before discharge. RESULTS Mean age, hemoglobin and GRACE score were 78 ± 7 years, 12.4 ± 1.8 g/dl and 138.8 ± 25.3, respectively, 112(44.4%) patients were women, and 151(59.9%) presented ID. During the follow-up, 121 (48%) patients died. Mortality rates among TSAT quartiles were: 2.38, 1.60, 0.90 and 0.95 × 10 person-years for Q1TSAT to Q4TSAT, respectively (p < 0.001) and did not differ across ferritin quartiles (p = 0.601), whereas ID definition was borderline associated (p = 0.060). Adjusted TSAT levels remained inverse, nonlinearly associated with long-term mortality risk (p < 0.001), with an exponential increased-risk from values about 20% and below. CONCLUSION Lower TSAT levels were independently associated with increased mortality risk in these patients.
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Affiliation(s)
| | - Gema Miñana
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Vicente Ruiz
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Sergio García-Blas
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Anna Mollar
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Ernesto Valero
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Martina Amiguet
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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21
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Baillif-Couniou V, Ameline A, Kintz P, Boval C, Adalian P, Delteil C, Sastre C, Léonetti G, Pélissier-Alicot AL. Expertise toxicologique en conditions extrêmes : quand les vêtements sont la seule matrice disponible…. Toxicologie Analytique et Clinique 2018. [DOI: 10.1016/j.toxac.2018.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Gonzalez J, Nunez J, Ruiz V, Bonanad C, Valero E, Sastre C, Ruescas A, Mollar A, Garcia Blas S, Minana G, Carratala A, Sanchis J. P2516Low relative lymphocyte count as a marker of frailty in patients with acute coronary syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Sanchis J, Ruiz V, Bonanad C, Valero E, Ruescas-Nicolau MA, Ezzatvar Y, Sastre C, García-Blas S, Mollar A, Bertomeu-González V, Miñana G, Núñez J. Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome. Mayo Clin Proc 2017; 92:934-939. [PMID: 28389067 DOI: 10.1016/j.mayocp.2017.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/20/2017] [Accepted: 01/27/2017] [Indexed: 01/17/2023]
Abstract
The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain.
| | - Vicente Ruiz
- CIBER-CV, University of Valencia, Valencia, Spain; Nursing School, University of Valencia, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain
| | - Ernesto Valero
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain
| | | | - Yasmin Ezzatvar
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain
| | | | - Gema Miñana
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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24
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Affiliation(s)
- C. Sastre
- Brookhaven National Laboratory, Upton, New York
| | - G. Price
- Brookhaven National Laboratory, Upton, New York
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25
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Affiliation(s)
- C. Sastre
- Brookhaven National Laboratory Upton, New York
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Baillif-Couniou V, Sastre C, Hennart B, Dhaenens MC, Allorge D, Gaulier JM, Artaud A, Lebreton C, Piercecchi-Marti MD, Léonetti G, Pélissier-Alicot AL. Décès sous méthadone chez une adolescente : apport de la pharmacogénétique à l’identification des causes du décès. Toxicologie Analytique et Clinique 2017. [DOI: 10.1016/j.toxac.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Sastre C, Richeval C, Wiart JF, Baillif-Couniou V, Desfeux J, Lebreton-Chakour C, Allorge D, Gaulier JM, Léonetti G, Pélissier-Alicot AL. Décès par surdosage en oxycodone chez une enfant de 11ans. Toxicologie Analytique et Clinique 2016. [DOI: 10.1016/j.toxac.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Baillif-Couniou V, Gaulier JM, Retornaz K, Dubus JC, Bosdure E, Alloin AL, Fromonot J, Guieu R, Sastre C, Leonetti G, Pelissier-Alicot AL. Administration volontaire de lithium chez un enfant de 4 mois. Toxicologie Analytique et Clinique 2015. [DOI: 10.1016/j.toxac.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Sastre C, Baillif-Couniou V, Cheze M, Deveaux M, Kintz P, Piercecchi-Marti M, Leonetti G, Pelissier-Alicot AL. O39: Death by self-mutilation after cannabis consumption in a patient with cortical dysplasia. Toxicologie Analytique et Clinique 2014. [DOI: 10.1016/s2352-0078(14)70047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Berland-Benhaïm C, Giocanti D, Bartoli C, Sastre C, Leonetti G, Pelissier-Alicot A. Medication misuse and abuse: duties and responsibilities of dispensing pharmacists. Med Sci Law 2011; 51:49-55. [PMID: 21595422 DOI: 10.1258/msl.2010.010089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Misuse of medications can have major consequences for the consumer or patient's health. In the case of a drug delivered only on medical prescription, the misuse usually results from an error or negligence on the part of the prescribing doctor and/or the pharmacist dispensing the medication. But whereas, under French Law, doctors are regularly prosecuted for their irresponsibility, pharmacists frequently avoid any legal charges. This is even more surprising in view of the fact that French Legislation controls the practice of pharmacy very strictly. The authors discuss four cases that illustrate this issue and present a study of comparative pharmaceutical law requirements.
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Affiliation(s)
- C Berland-Benhaïm
- Service de Médecine Légale, Faculté de Médecine, Université de La Méditerranée, F-13385 Marseille Cedex 05, France.
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31
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Johnson A, Burkhalter SB, Carneiro RL, Diener P, Gasc JP, Greenwood N, Hames R, Lewis RB, Linares OF, Ross EB, Sastre C, Guedes M. Reductionism in Cultural Ecology: The Amazon Case [and Comments and Reply]. Current Anthropology 1982. [DOI: 10.1086/202869] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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33
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Sastre C. Security Seals for Safeguards. NUCL TECHNOL 1974. [DOI: 10.13182/nt74-a31447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. Sastre
- Brookhaven National Laboratory, Upton, New York 11973
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34
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Bartels WC, Bingham CD, Lerner MW, Reed RE, Montmollin JMD, Sellers TA, Sampson TE, Fehlau PE, Worth GM, Henry CN, Jackson DD, Rein JE, Waterbury GR, Sastre C, Barsali S, Bovalini R, Fineschi F, Guerrini B, Lanza S, Mazzini M, Mirandola R, Schuske CL, Dickinson D, Altschuler SJ, Tuck G, Walker TJ. Authors. NUCL TECHNOL 1974. [DOI: 10.13182/nt74-a31439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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