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López-García L, Lorenzo-Villalba N, Molina-Puente JI, Kishta A, Sanchez-Sauce B, Aguilar-Rodriguez F, Bernanbeu-Wittel M, Muñoz-Rivas N, Soler-Rangel L, Fernández-Carmena L, Andrès E, Deodati F, Trapiello-Valbuena F, Casasnovas-Rodríguez P, López-Reboiro ML, Méndez-Bailon M. Clinical Characteristics and Prognostic Impact of Short Physical Performance Battery in Hospitalized Patients with Acute Heart Failure-Results of the PROFUND-IC Registry. J Clin Med 2023; 12:5974. [PMID: 37762915 PMCID: PMC10531733 DOI: 10.3390/jcm12185974] [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: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency. OBJECTIVES To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale. METHODS Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan-Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared. RESULTS A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60-29.80); OR: 3.9; 95%CI (1.30-11.60); OR: 6.01; 95%CI (1.90-18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05). CONCLUSIONS Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.
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Affiliation(s)
- Lidia López-García
- Facultad de Enfermería, Universidad Complutense, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Juan Igor Molina-Puente
- Servicio de Medicina Interna, Complejo Hospitalario de Ávila, 05004 Avila, Spain; (J.I.M.-P.); (A.K.)
| | - Aladin Kishta
- Servicio de Medicina Interna, Complejo Hospitalario de Ávila, 05004 Avila, Spain; (J.I.M.-P.); (A.K.)
| | - Beatriz Sanchez-Sauce
- Servicio de Medicina Interna, Hospital Universitario Fundación de Alcorcón, 28922 Madrid, Spain
| | | | | | - Nuria Muñoz-Rivas
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Llanos Soler-Rangel
- Servicio de Medicina Interna, Hospital Infanta Sofia, 28702 San Sebastián de los Reyes, Spain
| | | | - Emmanuel Andrès
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Francesco Deodati
- Servicio de Medicina Interna, Hospital Infanta Cristina, 28981 Parla, Spain
| | | | | | | | - Manuel Méndez-Bailon
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Méndez-Bailón M, Iguarán-Bermúdez R, López-García L, Sánchez-Sauce B, Pérez-Mateos P, Barrado-Cuchillo J, Villar-Martínez M, Fernández-Castelao S, García-Klepzig JL, Fuentes-Ferrer ME, García-García A, Vilacosta I, de Miguel-Yanes JM, Casas-Rojo JM, Calvo-Manuel E, Andres E, Lorenzo-Villalba N. Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure. Medicina (Kaunas) 2021; 57:medicina57111150. [PMID: 34833368 PMCID: PMC8618627 DOI: 10.3390/medicina57111150] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/− 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/− 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508–0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results.
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Affiliation(s)
- Manuel Méndez-Bailón
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Rosario Iguarán-Bermúdez
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Lidia López-García
- Servicio de Cardiología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.L.-G.); (I.V.)
| | - Beatriz Sánchez-Sauce
- Servicio de Medicina Interna, Fundación Hospital Alcorcón Alcorcón, 28922 Madrid, Spain;
| | - Pablo Pérez-Mateos
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Julia Barrado-Cuchillo
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Miguel Villar-Martínez
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Santiago Fernández-Castelao
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Jose Luis García-Klepzig
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Manuel Enrique Fuentes-Ferrer
- Servicio de Medicina Preventiva, Instituto de Investigación San Carlos (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Alejandra García-García
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.G.-G.); (J.M.d.M.-Y.)
| | - Isidre Vilacosta
- Servicio de Cardiología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.L.-G.); (I.V.)
| | - José María de Miguel-Yanes
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.G.-G.); (J.M.d.M.-Y.)
| | | | - Elpidio Calvo-Manuel
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence:
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Estañol B, Guraieb-Chain P, Williams-Le-Roux R, López-García L, Delgado-García G. Areflexia in Holmes-Adie syndrome: A sign in search of its pathophysiology. Neurophysiol Clin 2017; 47:437-439. [PMID: 28939242 DOI: 10.1016/j.neucli.2017.08.001] [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: 06/20/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bruno Estañol
- Laboratory of Clinical Neurophysiology, National Institute of Medical Sciences and Nutrition, 14080 Mexico City, Mexico.
| | - Paola Guraieb-Chain
- Laboratory of Clinical Neurophysiology, National Institute of Medical Sciences and Nutrition, 14080 Mexico City, Mexico
| | - Ricardo Williams-Le-Roux
- Laboratory of Clinical Neurophysiology, National Institute of Medical Sciences and Nutrition, 14080 Mexico City, Mexico
| | - Lidia López-García
- Laboratory of Clinical Neurophysiology, National Institute of Medical Sciences and Nutrition, 14080 Mexico City, Mexico
| | - Guillermo Delgado-García
- Division of Neurology, National Institute of Neurology and Neurosurgery, 14269 Mexico City, Mexico
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