1
|
Yun S, Casado J, Pérez-Silvestre J, Salamanca P, Llàcer P, Quirós R, Ruiz-Hueso R, Méndez M, Manzano L, Formiga F. Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary. Rev Clin Esp 2024:S2254-8874(24)00056-0. [PMID: 38614320 DOI: 10.1016/j.rceng.2024.04.009] [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] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.
Collapse
Affiliation(s)
- S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Atención a la Insuficiencia Cardíaca Comunitaria, Servicios de Cardiología y Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - J Pérez-Silvestre
- Servicio de Medicina Interna, UMIPIC, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Salamanca
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - P Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - R Quirós
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain; RICAPPS, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Spain
| | - R Ruiz-Hueso
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Méndez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
2
|
Conde-Martel A, Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Llácer P, Salamanca-Bautista P, Manzano L, Formiga F. Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial. Rev Clin Esp 2024; 224:67-76. [PMID: 38215973 DOI: 10.1016/j.rceng.2023.11.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/25/2023] [Indexed: 01/14/2024]
Abstract
AIMS The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex. METHODS This is a post-hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96 h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. The influence of sex on primary, secondary and safety outcomes was evaluated. RESULTS One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96 h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all p-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR [95%CI]: 8.68 [3.41-24.63]) than men (OR [95%CI]: 2.5 [0.99-4.87]), p = 0.027. There were no differences in mortality or rehospitalizations at 30/90 days. CONCLUSION Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013-001852-36.
Collapse
Affiliation(s)
- A Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - J C Trullàs
- Internal Medicine Department, Hospital d'Olot i Comarcal de la Garrotxa, Girona, Spain; Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Barcelona, Spain
| | - J L Morales-Rull
- Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomédica (IRBLleida), Lleida, Spain
| | - J Casado
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - M Carrera-Izquierdo
- Internal Medicine Department, Complejo Hospitalario de Soria, Paseo Santa Bárbara, Soria, Spain
| | - M Sánchez-Marteles
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Aragón Research Health Institutte (IIS Aragon), Zaragoza, Spain
| | - P Llácer
- Internal Medicine Department, Hospital de Manises, Valencia, Spain
| | - P Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - L Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - F Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| |
Collapse
|
3
|
Romera-Liebana L, Urbina-Juez A, Micó-Pérez RM, Mediavilla Bravo JJ, Marco Martinez A, Gómez-Peralta F, Cubo-Romano P, Formiga F. Assessment of frailty in the person with type 2 diabetes mellitus: Expert analysis. Rev Clin Esp 2023; 223:552-561. [PMID: 37722562 DOI: 10.1016/j.rceng.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION People with type 2 diabetes mellitus (DM2) have a higher prevalence of frailty compared to those without DM2. However, there is a lack of consensus on the diagnosis and clinical management of frail individuals with DM2. OBJECTIVES This study aims to identify limitations and current needs in the use of the frailty concept in PCDM2 (people with DM2), as well as define and evaluate the dimensions that should be included in its routine clinical assessment. METHODS A multidisciplinary team of eight health professionals from different hospitals in Spain participated in a process based on the nominal group technique. RESULTS The study identified eight limitations in the assessment of frailty in PCDM2, categorized by importance, and 10 unmet needs related to the diagnosis and follow-up of the disease. Additionally, seven dimensions were identified that should be included in the definition of frail individuals with DM2, prioritized by importance and novelty. CONCLUSIONS This article aims to increase knowledge and usage of the frailty concept in individuals with DM2 within the medical community. It also suggests the potential for future projects to develop a consensus definition of frailty tailored to this specific group.
Collapse
Affiliation(s)
- L Romera-Liebana
- Unidad Homecare, Atención Domiciliaria de Cuidados Paliativos y Atención a la Cronicidad, Teladoc Health, Barcelona, Spain
| | - A Urbina-Juez
- Unidad Atención Primaria de Sopela, Organización Sanitaria Integrada de Uribe, Sopela, Spain
| | - R M Micó-Pérez
- Departamento de Salud Xátiva-Ontinyent, Centro Fontanars dels Alforins, Valencia, Spain
| | | | - A Marco Martinez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Toledo, Toledo, Spain
| | - F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, Spain
| | - P Cubo-Romano
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Spain
| | - F Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain.
| |
Collapse
|
4
|
Fernández-Rodríguez JM, Casado J, Formiga F, González-Franco A, Arévalo JC, Beltrán M, Cerqueiro González JM, Llàcer P, Manzano L, Morales-Rull JL, Pérez Silvestre J, Conde-Martel A. Executive summary of the 2023 update on the consensus regarding basic conduct during hospital admission for patients with acute heart failure. Rev Clin Esp 2023; 223:499-509. [PMID: 37507048 DOI: 10.1016/j.rceng.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Acute heart failure (AHF) is associated with significant morbidity and mortality and it stands as the primary cause of hospitalization for individuals over the age of 65 in Spain. This document outlines the main recommendations as follows: (1) Upon admission, it is crucial to conduct a comprehensive assessment, taking into account the patient's standard treatment and comorbidities, as these factors determine the prognosis of the disease. (2) During the initial hours of hospital care, prioritizing decongestive treatment is essential. It is recommended to adopt an early staged diuretic therapeutic approach based on the patient's response. (3) In order to manage patients in the stable phase, it is advisable to consider initiating and/or adjusting evidence-based drug treatments such as sacubitril/valsartan or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta blockers, aldosterone antagonists, and SGLT2 inhibitors. (4) Upon hospital discharge, utilizing a checklist is recommended to optimize the patient's management and identify the most efficient options for ensuring continuity of care post-discharge.
Collapse
Affiliation(s)
- J M Fernández-Rodríguez
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A González-Franco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J C Arévalo
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M Beltrán
- Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz, Spain
| | | | - P Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - L Manzano
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Unidad Insuficiencia Cardiaca Paciente Crónico y Edad Avanzada, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
5
|
Formiga F, Rodríguez-Mañas L. Diabetes mellitus tipo 2 en las personas de edad avanzada o frágiles. Aspectos a tener en cuenta. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.06.003] [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: 11/27/2022]
|
6
|
Formiga F, Rodríguez-Mañas L. Type 2 diabetes mellitus in elderly or frail individuals. Topics to be considerer. Rev Clin Esp 2022; 222:506. [DOI: 10.1016/j.rceng.2022.06.003] [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] [Received: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
|
7
|
Formiga F, Chivite D. Heart failure and cognitive impairment: Are we fully alert? Rev Clin Esp 2022; 222:S2254-8874(22)00011-X. [PMID: 35283059 DOI: 10.1016/j.rceng.2021.12.001] [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] [Received: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- F Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - D Chivite
- Servicio de Medicina Interna, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
8
|
Camafort M, Jhund P, Formiga F, Castro-Salomó A, Arévalo-Lorido J, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M, Camafort Babkowski M, Arévalo Lorido JC, Sobrino Martínez J, Manzano Espinosa L, Arias Jiménez JL, Gómez Cerezo J, Francisco J, Díez Manglano J, Aramburu Bodas O, Grau Amorós J, Montero Peréz-Barquero M, Torres Cortada G, Trullàs Vila JC, Varela Aguilar JM, Martínez de las Cuevas G, Salgado Ordóñez F, Méndez Bailón M, Ribas Pizá N. Utilidad pronóstica de las cifras ambulatorias de presión arterial en pacientes de edad avanzada con insuficiencia cardíaca. Resultados del estudio DICUMAP. Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
9
|
Camafort M, Jhund PS, Formiga F, Castro-Salomó A, Arévalo-Lorido JC, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M. Prognostic value of ambulatory blood pressure values in elderly patients with heart failure. Results of the DICUMAP study. Rev Clin Esp 2021; 221:433-440. [PMID: 34130947 DOI: 10.1016/j.rceng.2020.11.010] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ambulatory blood pressure monitoring (ABPM) has demonstrated value in the prognostic assessment of hypertensive patients with heart failure (HF) with or without other cardiovascular diseases. The objective of this study was to evaluate whether ABPM can identify subjects with HF with a worse prognosis. METHODS AND RESULTS Prospective multicenter study that included clinically stable outpatients with HF. All patients underwent ABPM. A total of 154 patients from 17 centers were included. Their mean age was 76.8 years (± 8.3) and 55.2% were female. In total, 23.7% had HF with a reduced ejection fraction (HFrEF), 68.2% were in NYHA functional class II, and 19.5% were in NYHA functional class III. At one year of follow up, there were 13 (8.4%) deaths, of which 10 were attributed to HF. Twenty-nine patients required hospitalization, of which 19 were due to HF. The presence of a non-dipper BP pattern was associated with an increased risk for readmission or death at one year of follow-up (25% vs. 5%; p=.024). According to a Cox regression analysis, more advanced NYHA functional class (hazard ratio 3.51; 95% CI 1.70-7.26; p=.001; for NYHA class III vs. II) and a higher proportional nocturnal reduction in diastolic BP (hazard ratio 0.961; 95%CI 0.926-0.997; p=.032 per 1% diastolic BP reduction) were independently associated with death or readmission at one year. CONCLUSION In older patients with chronic HF, a non-dipper BP pattern measured by ABPM was associated with a higher risk of hospitalization and death due to HF.
Collapse
Affiliation(s)
- M Camafort
- Unidad de Insuficiencia Cardíaca, Servicio de Medicina Interna-ICMiD, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
| | - P S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - A Castro-Salomó
- Servicio de Medicina Interna, Hospital Sant Joan, Universidad Rovira i Virgili, Reus, Spain
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Regional de Zafra, Badajoz, Spain
| | - J Sobrino-Martínez
- Servicio de Medicina Interna, Hospital l'Esperit Sant, Santa Coloma de Gramanet, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J Díez-Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
| | - Ó Aramburu
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | | |
Collapse
|
10
|
Fernández Rodríguez JM, Casado J, Formiga F, González-Franco A, Arévalo JC, Beltrán M, Cerqueiro González JM, Llàcer P, Manzano L, Morales-Rull JL, Silvestre JP, Conde-Martel A. Consensus on basic conduct during the hospital admission of patients with acute heart failure. Rev Clin Esp 2021; 221:283-296. [PMID: 32139076 DOI: 10.1016/j.rce.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
Acute heart failure (AHF) is a highly prevalent clinical entity in individuals older than 45years in Spain. AHF is associated with significant morbidity and mortality and is the leading cause of hospitalisation for individuals older than 65years in Spain, a quarter of whom die within 1year of the hospitalisation. In recent years, there has been an upwards trend in hospitalisations for AHF, which increased 76.7% from 2003 to 2013. Readmissions at 30days for AHF have also increased (from 17.6% to 22.1%), at a relative mean rate of 1.36% per year, with the consequent increase in the use of resources and the economic burden for the healthcare system. The aim of this document (developed by the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine) is to guide specialists on the most important aspects of treatment and follow-up for patients with AHF during hospitalisation and the subsequent follow-up. The main recommendations listed in this document are as follows: (1)At admission, perform a comprehensive assessment, considering the patient's standard treatment and comorbidities, given that these determine the disease prognosis to a considerable measure. (2)During the first few hours of hospital care, decongestive treatment is a priority, and a staged diuretic therapeutic approach based on the patient's response is recommended. (3)To manage patients in the stable phase, consider starting and/or adjusting evidence-based drug treatment (e.g., sacubitril/valsartan or angiotensin-converting enzyme inhibitors/angiotensinII receptor blockers, beta blockers and aldosterone antagonists). (4)At hospital discharge, use a checklist to optimise the patient's management and identify the most efficient options for maintaining continuity of care after discharge.
Collapse
Affiliation(s)
- J M Fernández Rodríguez
- Servicio de Medicina Interna, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - F Formiga
- Servicio de Medicina Interna, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A González-Franco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, España
| | - J C Arévalo
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
| | - M Beltrán
- Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz, España
| | | | - P Llàcer
- Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, España
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, España
| | - J L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Unidad Insuficiencia Cardiaca Paciente Crónico y Edad Avanzada, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, España.
| |
Collapse
|
11
|
Fernández Rodríguez JM, Casado J, Formiga F, González-Franco Á, Arévalo JC, Beltrán M, Cerqueiro González JM, Llàcer P, Manzano L, Morales-Rull JL, Pérez Silvestre J, Conde-Martel A. Consensus on basic conduct during the hospital admission of patients with acute heart failure. Rev Clin Esp 2021; 221:283-296. [PMID: 33998516 DOI: 10.1016/j.rceng.2020.01.010] [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] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
Acute heart failure (AHF) is a highly prevalent clinical entity in individuals older than 45 years in Spain. AHF is associated with significant morbidity and mortality and is the leading cause of hospitalisation for individuals older than 65 years in Spain, a quarter of whom die within 1 year of the hospitalisation. In recent years, there has been an upwards trend in hospitalisations for AHF, which increased 76.7% from 2003 to 2013. Readmissions at 30 days for AHF have also increased (from 17.6% to 22.1%), at a relative mean rate of 1.36% per year, with the consequent increase in the use of resources and the economic burden for the healthcare system. The aim of this document (developed by the Heart Failure and Atrial Fibrillation Group of the Spanish Society of Internal Medicine) is to guide specialists on the most important aspects of treatment and follow-up for patients with AHF during hospitalisation and the subsequent follow-up. The main recommendations listed in this document are as follows: 1) At admission, perform a comprehensive assessment, considering the patient's standard treatment and comorbidities, given that these determine the disease prognosis to a considerable measure. 2) During the first few hours of hospital care, decongestive treatment is a priority, and a staged diuretic therapeutic approach based on the patient's response is recommended. 3) To manage patients in the stable phase, consider starting and/or adjusting evidence-based drug treatment (e.g., sacubitril/valsartan or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta blockers and aldosterone antagonists). 4) At hospital discharge, use a checklist to optimise the patient's management and identify the most efficient options for maintaining continuity of care after discharge.
Collapse
Affiliation(s)
- J M Fernández Rodríguez
- Servicio de Medicina Interna, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, Spain
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Á González-Franco
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J C Arévalo
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
| | - M Beltrán
- Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz, Spain
| | | | - P Llàcer
- Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Unidad Insuficiencia Cardíaca Paciente Crónico y Edad Avanzada, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain.
| |
Collapse
|
12
|
Delgado JF, Cepeda JM, Llorens P, Jacob J, Comín J, Montero M, Miró Ò, López de Sá E, Manzano L, Martín-Sánchez FJ, Formiga F, Masip J, Pérez-Calvo JI, Herrero-Puente P, Manito N. Consensus on improving the comprehensive care of patients with acute heart failure. Rev Clin Esp 2021; 221:163-168. [PMID: 38108502 DOI: 10.1016/j.rce.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
Collapse
Affiliation(s)
- J F Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Facultad de Medicina UCM, CIBERCV, Madrid, España.
| | - J M Cepeda
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Alicante), España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; ISABIAL Alicante; Universitat Miguel Hernández, Elche (Alicante), España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Comín
- Servicio de Cardiología, Hospital del Mar (IMAS), Barcelona, España
| | - M Montero
- IMIBIC, Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ò Miró
- Área de Urgencias, Hospital Clínic de Barcelona; Grupo de Investigación Urgencias: Procesos y Patologías, IDIBAPS; Universitat de Barcelona, Barcelona, España
| | - E López de Sá
- Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario La Paz, Madrid, España
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Masip
- Unidad de Cuidados Intensivos, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Universidad de Barcelona, Sant Joan Despí (Barcelona), España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Central Universitario Lozano Blesa, Zaragoza, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - N Manito
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| |
Collapse
|
13
|
Delgado J, Cepeda JM, Llorens P, Jacob J, Comín J, Montero M, Miró Ò, López de Sá E, Manzano L, Martín-Sánchez FJ, Formiga F, Masip J, Pérez-Calvo JI, Herrero-Puente P, Manito N. Consensus on improving the comprehensive care of patients with acute heart failure. Rev Clin Esp 2021; 221:163-168. [PMID: 33998466 DOI: 10.1016/j.rceng.2020.12.001] [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] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
Collapse
Affiliation(s)
- J Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Facultad de Medicina UCM, CIBERCV, Madrid, Spain.
| | - J M Cepeda
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Alicante), Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; ISABIAL Alicante; Universitat Miguel Hernández, Elche (Alicante), Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J Comín
- Servicio de Cardiología, Hospital del Mar (IMAS), Barcelona, Spain
| | - M Montero
- IMIBIC, Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic de Barcelona; Grupo de Investigación Urgencias: Procesos y Patologías, IDIBAPS; Universitat de Barcelona, Barcelona, Spain
| | - E López de Sá
- Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario La Paz, Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J Masip
- Unidad de Cuidados Intensivos, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Universidad de Barcelona, Sant Joan Despí (Barcelona), Spain
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Central Universitario Lozano Blesa, Zaragoza, Spain
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - N Manito
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | | |
Collapse
|
14
|
Arenas Miquélez A, Requena Calleja MA, Gullón A, Pose Reino A, Formiga F, Camafort M, Cepeda Rodrigo JMO, Mostaza JM, Suárez Fernández C, Díez-Manglan J. Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. Nonavasc Registry. J Nutr Health Aging 2020; 24:981-986. [PMID: 33155625 DOI: 10.1007/s12603-020-1418-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF). DESIGN Prospective, multicenter cohort study. SETTING Internal medicine departments in Spain. PARTICIPANTS Inpatients >75 years with NVAF. MEASUREMENTS We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up. RESULTS We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p<0.001). The CONUT score (HR, 1.076; 95%CI 1.009-1.148; p=0.025), the Charlson index (HR, 1.080; 95%CI 1.017-1.148; p=0.013) and the presence of pressure ulcers (HR, 1.700; 95%CI 1.028-2.810; p=0.039) were independently associated with increased mortality at one year of follow-up. The prescription of oral anticoagulants at discharge was associated with lower mortality (HR, 0.440; 95%CI 0.304-0.638; p<0.001). CONCLUSIONS More than a third of elderly patients hospitalized with NVAF have a moderate to high nutritional risk. These patients have greater mortality at the end of one year.
Collapse
Affiliation(s)
- A Arenas Miquélez
- Jesús Díez-Manglano, Duquesa Villahermosa 163, 8º D, 50009 Zaragoza, Spain, , Phone +34976466910, ORCID: 0000-0002-3132-2171
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Formiga F, Tarazona-Santabalbina FJ. La importancia de identificar factores intrínsecos modificables de riesgo de caídas para implementar precozmente medidas preventivas. Rev Osteoporos Metab Miner 2020. [DOI: 10.4321/s1889-836x2020000300001] [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: 11/11/2022] Open
|
16
|
Arenas Miquélez A, Requena Calleja MA, Gullón A, Pose Reino A, Formiga F, Camafort M, Cepeda Rodrigo JM, Mostaza JM, Fernández CS, Díez-Manglano J. Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. NONAVASC Registry. J Nutr Health Aging 2020. [DOI: 10.1007/s12603-020-1507-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
17
|
Formiga F, Polo J, Fernández de Cabo S, Arumí D. Why are antithrombotic drugs not prescribed to octogenarian patients with atrial fibrillation at risk of stroke? Semergen 2020; 46:392-399. [PMID: 32234282 DOI: 10.1016/j.semerg.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In non-valvular atrial fibrillation (NVAF) patients at risk of stroke, anticoagulant drugs are less likely to be received by older patients than younger patients. In this study, an attempt is made to discover whether the reasons reported by physicians for denying anticoagulant drugs prescription differ between older and younger atrial fibrillation patients. MATERIALS AND METHODS A retrospective, cross-sectional, multicentre study was conducted from October 2014 to July 2015. The study comprised patients aged ≥18 years diagnosed with NVAF, with a moderate to high stroke risk (CHADS2 score ≥2). Patients were stratified according to age (<80 and ≥80 years). RESULTS A total of 1309 NVAF patients were evaluated, of whom 40.1% were ≥80 years old. Older patients were predominantly women with higher mean time since diagnosis of AF, with a higher rate of permanent NVAF, and with higher thromboembolic risk. In patients for whom physicians decided not to prescribe any anticoagulant agents, the following reasons were significantly more frequent in patients aged ≥80 years compared to younger patients: cognitive impairment, perceived high bleeding risk, falls, difficult access to monitoring, non-neoplastic terminal illness, and perceived low thromboembolic risk. Uncontrolled hypertension was a significantly more frequent reason for non-prescription of anticoagulant agents in patients aged <80 year. CONCLUSIONS Octogenarian patients with NVAF and a moderate to high risk of stroke had a different as regards reasons for not being prescribed anticoagulant agents, which should be taken into account in order to improve.
Collapse
Affiliation(s)
- F Formiga
- Internal Medicine Service of the Hospital Universitari de Bellvitge, IDIDELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J Polo
- Cañaveral Health Center, Cáceres, Spain
| | | | - D Arumí
- Medical Department, Pfizer, Madrid, Spain
| |
Collapse
|
18
|
Formiga F, Camafort M, Carrasco Sánchez F. Heart failure and diabetes: The confrontation of two major epidemics of the 21st century. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.01.014] [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: 10/27/2022]
|
19
|
Rodríguez-Queraltó O, Formiga F, Carol A, Llibre C, Martínez-Sellés M, Marín F, Díez-Villanueva P, Sanchis J, Bonanad C, Corbí M, Aboal J, Angel Perez-Rivera J, Alegre O, Bernal E, Vicent L, Ariza-Solé A. Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes. J Nutr Health Aging 2020; 24:723-729. [PMID: 32744568 DOI: 10.1007/s12603-020-1409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. DESIGN Observational prospective study. SETTING Multicenter registry conducted in 44 hospitals in Spain. PARTICIPANTS Consecutive patients with ACS aged 80≥years. MEASUREMENTS A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. RESULTS A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). CONCLUSIONS Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.
Collapse
Affiliation(s)
- O Rodríguez-Queraltó
- Albert Ariza Solé. Cardiology Department. Bellvitge University Hospital, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat. Barcelona. Spain, Email address: , Fax Number +34932607618; Telephone number +34932607924
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado M, Escalante E, Lumbreras C, Tarrida A. Prognostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.06.008] [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: 11/27/2022] Open
|
21
|
Requena Calleja M, Arenas Miquélez A, Díez-Manglano J, Gullón A, Pose A, Formiga F, Mostaza J, Cepeda J, Suárez C. Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Trullàs J, Formiga F, Casado J, González-Franco A. Inicio, mantenimiento y retirada del tratamiento modificador de la enfermedad durante una descompensación por insuficiencia cardiaca aguda. Rev Clin Esp 2019; 219:464-466. [DOI: 10.1016/j.rce.2019.05.009] [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] [Received: 04/15/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
|
23
|
Trullàs J, Formiga F, Casado J, González-Franco A. Initiation, maintenance and withdrawal of disease-modifying treatment during an acute heart failure decompensation. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.05.006] [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: 10/26/2022]
|
24
|
Vera Sainz A, Diez Villanueva P, Ariza Sole A, Formiga F, Lopez Palop R, Marin F, Vidan M, Martinez Selles M, Salamanca J, Sionis A, Garcia Pardo H, Bueno H, Sanchis J, Abu Assi E, Alfonso F. P6264Mitral regurgitation and prognosis after non-ST-segment elevation myocardial infarction in very old patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0864] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) after acute coronary syndromes is associated with adverse prognosis. However, the prognostic impact of MR in older patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI) has not been well addressed.
Methods
The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Echocardiography performed during admission quantified mitral valve parameters in 497 patients, who were classified according to mitral regurgitation (MR) status in two groups: significant (moderate or severe) or no significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6-months.
Results
Mean age was 84.3±4.1 years, 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with patients without significant MR these patients had lower systolic blood pressure (132±28 vs 141±27 mmHg), higher heart rate (82±21 vs 74±17 bpm), worse Killip class (≥II 49.5% vs 22.5%), lower ejection fraction (47±14% vs 55±11%), higher pulmonary pressure (42±15 vs 35±11 mmHg), as well as more frequent new onset atrial fibrillation (16.4% vs 7.2%) (all p values=0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs 1.3%, p=0.04) and longer hospital stay (median 8 [5–12] vs 6 [4–10] days, p=0.002),and higher mortality/readmission at 6 months (HR 1,54, 95% CI 1.09–2.18). However, after adjusting for potential confounders, this last association was not significant.
Conclusions
Significant MR is seen in about one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, which is mainly determined by their clinical characteristics.
Collapse
Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | | | - A Ariza Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | - R Lopez Palop
- University Hospital San Juan de Alicante, Alicante, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Vidan
- University Hospital Gregorio Maranon, Madrid, Spain
| | | | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| |
Collapse
|
25
|
Soler Costa M, Nunez J, Ruiz V, Bonanad C, Formiga F, Valero E, Martinez Selles M, Marin F, Ruescas A, Garcia Blas S, Minana G, Abu-Assi E, Bueno H, Ariza-Sole A, Sanchis J. 5877Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0081] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities.
Purpose
Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients.
Methods
The study group consisted of 1 training (n=920, 76±7 years) and 1 testing (n=532; 84±4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis.
Results
A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR=1.90, 95% CI 1.20–3.03, p=0.006); 2 comorbidities (16% mortality, HR=1.29, 95% CI 0.81–2.04, p=0.30); and 0–1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic= 0.80) and calibration (Hosmer-Lemeshow test, p=0.20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic=0.80; Hosmer-Lemeshow test, p=0.70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR=2.37, 95% CI 1.25–4.49, p=0.008; 2 comorbidities: 14% mortality, HR=1.59, 95% CI 0.82–3.07, p=0.20; 0–1 comorbidities: 7.5% reference category).
Kaplan-Meyer curves for mortality
Conclusion
A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS
Acknowledgement/Funding
This work was supported by grants from Spain's Ministry of Economy and Competitiveness through the Carlos III Health Institute
Collapse
Affiliation(s)
- M Soler Costa
- University Hospital Clinic of Valencia, Valencia, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - V Ruiz
- University of Valencia, Facultad de Enfermería, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Valencia, Spain
| | - F Formiga
- University Hospital of Bellvitge, Unitat de Medicina Geriátrica, Barcelona, Spain
| | - E Valero
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - A Ruescas
- University of Valencia, Fisioterapia, Valencia, Spain
| | - S Garcia Blas
- University Hospital Clinic of Valencia, Valencia, Spain
| | - G Minana
- University Hospital Clinic of Valencia, Valencia, Spain
| | - E Abu-Assi
- Hospital Alvaro Cunqueiro, Cardiology, Vigo, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| |
Collapse
|
26
|
Esteve Pastor MA, Martin E, Alegre O, Castillo Dominguez JC, Formiga F, Martinez-Selles M, Diez-Villanueva P, Sanchis J, Ariza-Sole A, Marin F. P2525Relationship of Charlson Comorbidity Index with adverse events in elderly patients with Acute Coronary Syndromes: an analysis from LONGEVO-SCA Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0854] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Elderly patients with Acute Coronary Syndromes (ACS) are under-represented in clinical trials and they have higher risk of new due their comorbidities. Charlson Comorbidity Index (CCI) is an established tool for evaluating the burden of comorbidity status and a high score of CCI is related with an increased risk of death.
Purpose
The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients admitted by an ACS.
Methods
The prospective multicenter LONGEVO-SCA included unselected elderly patients (≥80 years old) hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities, comparing the relationship between quartiles of CCI and adverse events at 6 months follow-up of CCI.
Results
We analyzed 520 patients (mean age 84.4±3.6 years; 320 (61.5%) male). 196 (37.6%) were classified into Q1, 105 (20.2%) into Q2, 93 (17.9%) into Q3 and 126 (24.2%) into Q4. No differences were observed in treatment at discharge across different quartiles for aspirin (p=0.648), beta-blockers (p=0.908) or statins (p=0.756). We observed a significant increase for all-cause mortality [9 (4.8%) vs 10 (10.2%) vs 11 (12.0%) vs 32 (26.0%); p<0.001] and readmissions [36 (18.4%) vs 21 (20%) vs 33 (35.5%) vs 48 (38.1%); p<0.001] respectively from Q1 to Q4. After Cox multivariate regression analysis, CCI was independently associated with mortality or readmissions [HR 1.15, 95% CI (1.06–1.26); p=0.001] and patients into high quartile had 6-fold risk of mortality [HR 6.19, 95% CI (2.95–12.99); p<0.001]. Kaplan Meier analysis showed that patients in the highest quartiles had significantly worse prognosis during the follow-up with high risk of all-cause mortality and readmissions (both p<0.001).
Event Free Survival according Charlson
Conclusions
In LONGEVO-SCA registry, we validated for the first time CCI as an independent factor related with adverse events. Patients into high quartiles of CCI had significantly worse prognosis during the follow-up and elderly patients into Q4 had 6-fold risk of mortality compared to Q1 patients.
Collapse
Affiliation(s)
- M A Esteve Pastor
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - E Martin
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - O Alegre
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | | | | | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| |
Collapse
|
27
|
Esteve Pastor MA, Marin E, Alegre O, Castillo Dominguez JC, Formiga F, Martinez-Selles M, Diez-Villanueva P, Sanchis J, Ariza-Sole A, Marin F. P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0471] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown.
Purpose
The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS).
Methods
The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI.
Results
We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001).
Event Free Survival according Charlson
Conclusions
Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.
Collapse
Affiliation(s)
- M A Esteve Pastor
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - E Marin
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - O Alegre
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | | | | | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| |
Collapse
|
28
|
Esteve Pastor MA, Martin E, Alegre O, Castillo Dominguez JC, Formiga F, Martinez-Selles M, Diez-Villanueva P, Sanchis J, Ariza-Sole A, Marin F. P2530Frailty assessment in atrial fibrillation patients with acute coronary syndromes: a subanalysis from LONGEVO-SCA registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0859] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Different studies have observed a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular diseases.Several scores have been developed to assess frailty in elderly patients. The FRAIL scale is a bed-side and easy tool that evaluates 5 items: fatigue, resistance, ambulation, concomitant diseases and weight loss. However, the evaluation of frailty status in AF patients with ACS is scarce.
Purpose
The aim of this study was to analyze the management of elderly patients with AF and ACS and the predictive value of frailty for adverse events.
Methods
The prospective multicentre LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. In this substudy, we divided patients according to rhythm status (AF or sinus rhythm [SR]) and to frail status. We validated the predictive performance of FRAIL scores for adverse events at 6 months follow-up.
Results
We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis and 145 (27.3%) patients were frail. Frail AF patients had higher risk of global mortality [HR 2.61, (95% CI 1.28–5.31; p=0.008)], readmissions [HR 2.28, (95% CI 1.37–3.80); p=0.002)] and the composite endpoint [HR 2.28, (95% CI 1.44–3.60); p<0.001)] compared with non-frail SR patients. After multivariate adjustment, Frail score [HR 1.41; 95% CI (1.02–1.97); p=0.040] was independently associated with mortality. Kaplan Meier analysis showed that frail AF patients had significantly worse prognosis during the follow-up with high risk of global mortality (log rank p=0.024) and readmission (log rank p<0.001) followed closely by those frail SR patients.
Event Free Survival according Frailty
Conclusions
In the LONGEVO-SCA registry, frail AF patients have 2-fold risk of adverse events compared to non-frail SR patients. Frailty status was an independent condition associated with high risk of adverse events at 6 months of follow-up.
Collapse
Affiliation(s)
- M A Esteve Pastor
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - E Martin
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - O Alegre
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | | | - F Formiga
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | | | | | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - F Marin
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| |
Collapse
|
29
|
Esteve Pastor MA, Martin E, Alegre O, Castillo Dominguez JC, Formiga F, Martinez-Selles M, Diez-Villanueva P, Sanchis J, Ariza-Sole A, Marin F. P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0506] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss.
Purpose
The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores.
Methods
The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores.
Results
We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table)
C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value.
Conclusions
This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.
Collapse
Affiliation(s)
- M A Esteve Pastor
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - E Martin
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - O Alegre
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | | | | | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| |
Collapse
|
30
|
Vera Sainz A, Diez Villanueva P, Ariza Sole A, Formiga F, Martinez Selles M, Alegre O, Sanchis J, Marin F, Vidan M, Lopez Palop R, Abu Assi E, Bueno H, Alfonso F. P1563CHA2DS2-VASc score predicts mortality and readmission in octogenarian patients with non-ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0323] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We ought to study if this score predicts outcomes in elderly patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI).
Methods
The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Data to calculate CHA2DS2-VASc Score were available in 523 patients (98.3%). They were classified according to CHA2DS2-VASc Score: group 1 (score 0–4), and 2 (5–9). We studied outcomes in terms of mortality or readmission at 6 months follow-up.
Results
A total of 266 patients (51%) had a high CHA2DS2-VASc Score (group 2). They were more often women, with more cardiovascular risk factors like hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, p=0.001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment and frailty) and Charlson index were worse in this group (all, p=0.001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, p=0.001), and developed new onset AF more often during admission (12.4% vs. 6.6%, p=0,024). At six months follow-up, patients in group 2 had higher reinfarction, all cause mortality, and mortality or readmission rates (all, p=0.001). (Table) A CHA2DS2-VASc Score >4 predicted mortality (HR 2,60 [95% CI 1,48–4,55], p<0,001) (Figure 1) and was associated with mortality or readmission at 6 months (HR 2.07 [CI 95% 1.51–2.84], p<0.001).
CHADS VASC2 0–4 (n=257) CHADS >4 (n=266) p Geriatric syndromes Barthel Index 94 (13) 85 (22) 0.001 Lawton brody 6.2 (2) 4.9 (3) 0.001 Charlson Index 1.5 (1) 3.3 (2) 0.001 Cognitive impairment 0.001 No 201 (79.1) 155 (58.7) Mild 49 (19.3) 100 (37.9) Severe 4 (1.6) 9 (3.4) Nutritional risk (MNA-SF*) 122 (48) 149 (57.1) 0.040 Frailty (FRAIL scale) 0.001 Non-frail 111 (43.2) 69 (25.9) Prefrail 102 (39.7) 101 (38) Frail 44 (17.1) 96 (36.1) Outcomes at 6 months Reinfarction 26 (6.9) 16 (13.9) 0.018 Mortality or readmission 111 (28.9) 60 (50.4) 0.001 All cause mortality 38 (9.9) 24 (20.2) 0.003
Conclusions
A CHA2DS2-VASc sore>4 is present in half of octogenarians with NSTEMI and is associated with a poor outcome.
Collapse
Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | | | - A Ariza Sole
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - F Formiga
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | | | - O Alegre
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Vidan
- University Hospital Gregorio Maranon, Madrid, Spain
| | - R Lopez Palop
- University Hospital San Juan de Alicante, Alicante, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| |
Collapse
|
31
|
Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Escalante E, Lumbreras C, Tarrida A. Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:57-63. [PMID: 31377157 DOI: 10.1016/j.recot.2019.06.007] [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] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001). CONCLUSIONS Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
Collapse
Affiliation(s)
- A Gamboa-Arango
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
| | - E Duaso
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - F Formiga
- Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - P Marimón
- Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
| | - M Sandiumenge
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - M T Salgado
- Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
| | - E Escalante
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - C Lumbreras
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - A Tarrida
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| |
Collapse
|
32
|
Beà M, Formiga F. ¿Existen diferencias en el manejo de la diabetes mellitus 2 en pacientes crónicos complejos respecto a los no crónicos complejos? Semergen 2019; 45:208-210. [DOI: 10.1016/j.semerg.2018.10.003] [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] [Received: 07/19/2018] [Revised: 09/16/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
|
33
|
Masip J, Formiga F, Fernández-Castañer M, Fernández P, Comín-Colet J, Corbella X. Primera hospitalización por insuficiencia cardiaca: mortalidad hospitalaria y perfil del paciente. Rev Clin Esp 2019; 219:130-140. [DOI: 10.1016/j.rce.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
|
34
|
Masip J, Formiga F, Fernández-Castañer M, Fernández P, Comín-Colet J, Corbella X. First hospital admission due to heart failure: In-hospital mortality and patient profile. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.09.007] [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: 11/28/2022]
|
35
|
Formiga F, Camafort M, Carrasco Sánchez FJ. Heart failure and diabetes: The confrontation of two major epidemics of the 21st century. Rev Clin Esp 2019; 220:135-138. [PMID: 30878139 DOI: 10.1016/j.rce.2019.01.009] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
There is a bidirectional association between heart failure (HF) and type 2 diabetes mellitus (DM2), which has resulted in an exponential increase in the combination of the 2 diseases in a single patient. This combination is one of many common causes that lead to the pathophysiological pathways resulting in the deleterious effect of DM2 on HF. The inevitable clinical consequence is that, when faced with this situation, patients present worse symptoms and a poorer prognosis than patients with HF but without DM2. We should therefore consider how to treat DM2 in patients with HF and how to treat HF in patients with DM2. In this review, we highlight the latest published data on this issue.
Collapse
Affiliation(s)
- F Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - M Camafort
- Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - F J Carrasco Sánchez
- Unidad de Gestión Clínica de Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jimenez, Huelva, España; Grupo de Trabajo Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna
| |
Collapse
|
36
|
Franco J, Formiga F, Corbella X, Conde-Martel A, Llácer P, Álvarez Rocha P, Ormaechea Gorricho G, Satué J, Soler Rangel L, Manzano L, Montero-Pérez-Barquero M, Anarte L, Aramburu O, Arévalo-Lorido J, Carrascosa S, Carrera M, Cepeda J, Cerqueiro J, Conde-Martel A, Dávila M, Díez-Manglano J, Epelde F, Formiga F, Franco J, García-Escrivá D, González Franco A, Llàcer P, López-Castellanos G, Manzano L, Montero-Pérez-Barquero M, Muela A, Pérez-Silvestre J, Quesada M, Roca B, Ruíz-Ortega R, Satué J, Soler-Rangel L, Trullàs J. Insuficiencia cardiaca aguda de novo: características clínicas y mortalidad al año en el Registro Español de Insuficiencia Cardiaca Aguda. Med Clin (Barc) 2019; 152:127-134. [DOI: 10.1016/j.medcli.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/20/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
|
37
|
Grau Amorós J, Formiga F, Aramburu Bodas O, Armengou Arxe A, Conde Martel A, Quesada Simón M, Oropesa Juanes R, Satué Bartolomé J, Dávila Ramos M, Montero Pérez-Barquero M, Anarte L, Aramburu O, Arévalo-Lorido J, Armengou A, Brase A, Carrascosa S, Carrera M, Casado J, Cerqueiro J, Conde A, Dávila M, Díez-Manglano J, Epelde F, Formiga F, Franco J, Gallego J, García-Escrivá D, González-Franco A, Grau J, Guisado M, Herrero A, Llacer P, López-Castellanos G, Manzano L, Martínez-Zapico A, Montero-Pérez-Barquero M, Muela A, Oropesa R, Pérez-Bocanegra C, Pérez-Calvo J, Pérez-Silvestre J, Quesada M, Quirós R, Rodríguez-Ávila E, Ruiz-Laiglesia F, Ruiz-Ortega R, Salamanca P, Sánchez-Marteles M, Satué J, Serrado A, Suárez I, Trullàs J. Hemoconcentración como predictor de supervivencia al año de ingreso por insuficiencia cardiaca aguda en el registro RICA. Rev Clin Esp 2019; 219:1-9. [DOI: 10.1016/j.rce.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/04/2023]
|
38
|
Grau Amorós J, Formiga F, Aramburu Bodas O, Armengou Arxe A, Conde Martel A, Quesada Simón M, Oropesa Juanes R, Satué Bartolomé J, Dávila Ramos M, Montero Pérez-Barquero M, Anarte L, Aramburu O, Arévalo-Lorido J, Armengou A, Brase A, Carrascosa S, Carrera M, Casado J, Cerqueiro J, Conde A, Dávila M, Díez-Manglano J, Epelde F, Formiga F, Franco J, Gallego J, García-Escrivá D, González-Franco A, Grau J, Guisado M, Herrero A, Llacer P, López-Castellanos G, Manzano L, Martínez-Zapico A, Montero-Pérez-Barquero M, Muela A, Oropesa R, Pérez-Bocanegra C, Pérez-Calvo J, Pérez-Silvestre J, Quesada M, Quirós R, Rodríguez-Ávila E, Ruiz-Laiglesia F, Ruiz-Ortega R, Salamanca P, Sánchez-Marteles M, Satué J, Serrado A, Suárez I, Trullàs J. Hemoconcentration as a prognostic factor after hospital discharge in acute heart failure in the RICA registry. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.07.004] [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]
|
39
|
Chivite D, Franco J, Formiga F, Salamanca-Bautista P, Manzano L, Conde-Martel A, Arévalo-Lorido J, Suárez-Pedreira I, Casado-Cerrada J, Montero-Pérez-Barquero M. The short-term prognostic value of C-reactive protein in elderly patients with acute heart failure. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.04.019] [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]
|
40
|
Polo García J, Vargas Ortega D, Formiga F, Unzueta I, Fernández de Cabo S, Chaves J. Profiling of patients with non-valvular atrial fibrillation and moderate-to-high risk of stroke not receiving oral anticoagulation in Spain. Semergen 2018; 45:396-405. [PMID: 30573367 DOI: 10.1016/j.semerg.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In non-valvular atrial fibrillation (NVAF) with embolic risk, the guidelines recommend oral anticoagulation (OAC), although not all patients receive it. In this study, an attempt is made to identify these patients, and to study factors related to non-anticoagulation. MATERIAL AND METHODS Non-interventional, cross-sectional, multicentre study was performed on a population of patients ≥18 years with a NVAF diagnosis, moderate-high embolic risk (CHADS2 score≥2), not treated with OAC. Atrial fibrillation (AF) prevalence was also collected. RESULTS AF prevalence was 4.5%, and 80.7% of the patients had NVAF (20.0% did not receive OAC). A total of 1310 non-OAC-treated patients were included (51.8% male, mean age: 76.0 years). The mean time since AF diagnosis was 58.4 months. The main therapeutic decision for stroke prevention was prescription of antiplatelet agents (82.4%, n=1078), and the main reasons were: patient refusal to monitoring (37.3%), high bleeding risk (31.1%), uncontrolled hypertension (27.9%), and frequent falls (27.6%). The mean CHA2DS2-VASc score was 4.6, and the HAS-BLED was 2.7 (55.9% of patients scoring HAS-BLED≥3). The most common thromboembolic risk factors were: hypertension (89.1%), age≥75 years (61.5%); the haemorrhagic factors: use of drugs increasing the bleeding risk (41.2%), uncontrolled blood pressure (33.7%). CONCLUSIONS About 20% of Spanish NVAF patients do not receive OAC in the clinical practice and are treated with antiplatelet agents, which do not reduce haemorrhagic risk. Most patients do not clearly show a contraindication to OACs, particularly considering that there are other available options (direct oral anticoagulant drugs [DOACs]).
Collapse
Affiliation(s)
- J Polo García
- Centro de Salud Cañaveral, Calle Doctor Boticario Jiménez 32, 10820 Cáceres, Spain.
| | - D Vargas Ortega
- Unidad de Hospitalización del Hospital de Alta Resolución el Toyo, Camino de la Botica s/n, 04131 Almería, Spain
| | - F Formiga
- Servicio de Medicina Interna del Hospital Bellvitge, Carrer de la Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Unzueta
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
| | - S Fernández de Cabo
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
| | - J Chaves
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
| |
Collapse
|
41
|
Riera-Mestre A, Formiga F. Medication regimen complexity: A new challenge. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.06.006] [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: 10/28/2022]
|
42
|
|
43
|
Vicent Alaminos L, Ariza-Sole A, Alegre O, Sanchis J, Lopez Palop R, Formiga F, Gonzalez-Salvado V, Bueno H, Vidan MT, Diez Villanueva P, Abu-Assi E, Fernandez-Aviles F, Martinez-Selles M. P2247Elderly females with acute coronary syndrome present frailty and readmissions more frequently than males. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2247] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - O Alegre
- University Hospital Trias i Pujol, Barcelona, Spain
| | - J Sanchis
- University Hospital San Juan de Alicante, Alicante, Spain
| | - R Lopez Palop
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | - V Gonzalez-Salvado
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - M T Vidan
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| | | | | | | | | |
Collapse
|
44
|
Carrasco-Sánchez F, Carretero-Gómez J, Gómez-Huelgas R, Garcia-Ordoñez M, Pardo-Ortega M, de Escalante-Yanguela B, Mateos-Polo L, Formiga F, Ena J. Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.02.014] [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: 10/16/2022]
|
45
|
|
46
|
Carrasco-Sánchez FJ, Carretero-Gómez J, Gómez-Huelgas R, Garcia-Ordoñez MA, Pardo-Ortega MV, de Escalante-Yanguela B, Mateos-Polo L, Formiga F, Ena J. Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. Rev Clin Esp 2018; 218:223-231. [PMID: 29661504 DOI: 10.1016/j.rce.2018.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/11/2018] [Accepted: 02/28/2018] [Indexed: 12/12/2022]
Abstract
AIMS Hospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. METHODS We conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. RESULTS Among 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. CONCLUSIONS SH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.
Collapse
Affiliation(s)
| | - J Carretero-Gómez
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario, Málaga, España; CIBER de Fisiopatología de la Obesidad y la Nutrición, España
| | | | | | | | | | - F Formiga
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - J Ena
- Hospital de la Marina Baixa, la Vila Joiosa, Alicante, España
| | | |
Collapse
|
47
|
Affiliation(s)
- J Franco
- Department of Internal Medicine, Hospital Quiron Dexeus, Barcelona, Spain
| | - F Medina
- Department of Internal Medicine, Hospital Quiron Dexeus, Barcelona, Spain and Department of Internal Medicine, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - F Formiga
- Department of Internal Medicine, Hospital Bellvitge, Barcelona, Spain
| | - J Huerta
- Department of Internal Medicine, Hospital Quiron Dexeus, Barcelona, Spain
| | - G Arbe
- Department of Internal Medicine, Hospital Quiron Dexeus, Barcelona, Spain
| | - A Charte
- Department of Internal Medicine, Hospital Quiron Dexeus, Barcelona, Spain
| |
Collapse
|
48
|
Chivite D, Formiga F. Nonagenarians in Internal Medicine: Another 21st century epidemic. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.01.001] [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: 10/18/2022]
|
49
|
Gómez-Huelgas R, Gómez Peralta F, Rodríguez Mañas L, Formiga F, Puig Domingo M, Mediavilla Bravo JJ, Miranda C, Ena J. [Treatment of type 2 diabetes mellitus in elderly patients]. Rev Esp Geriatr Gerontol 2018; 53:89-99. [PMID: 29439834 DOI: 10.1016/j.regg.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail.
Collapse
Affiliation(s)
- R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA); CIBER de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III; Sociedad Española de Medicina Interna (SEMI).
| | - F Gómez Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España; Sociedad Española de Diabetes (SED)
| | - L Rodríguez Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, España; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III; Sociedad Española de Medicina Geriátrica (SEMEG)
| | - F Formiga
- Unidad de Geriatría, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Sociedad Española de Geriatría y Gerontología (SEGG)
| | - M Puig Domingo
- Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III; Sociedad Española de Endocrinología y Nutrición (SEEN)
| | - J J Mediavilla Bravo
- Centro de Salud Burgos Rural, Burgos, España; Sociedad Española de Medicina General (SEMERGEN)
| | - C Miranda
- Centro de Salud Buenavista, Toledo, España; Sociedad Española de Médicos Generales y de Familia (SEMG)
| | - J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, La Vila Joiosa, Alicante, España; Sociedad Española de Medicina Interna (SEMI)
| |
Collapse
|
50
|
Chivite D, Formiga F. Nonagenarios en Medicina Interna: otra epidemia del siglo XXI. Rev Clin Esp 2018; 218:70-71. [DOI: 10.1016/j.rce.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/07/2018] [Indexed: 11/25/2022]
|