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Bagudá JDJ, León RC, Gómez JJG, Pachón M, Artaza JG, Mateo VM, Pérez VE, Manjavacas ÁMI, Gándara NR, Álvarez-García J, Ramos JGS, Agudo CA, Manuel Rubín López J, Gallego AM, Fernández SL, Torres LG, Martínez JG, Negrín NM, Maqueda JR, Ramos MC, María Medina Gil J, Rus CDD, Jiménez FJB, Madrazo I, Molina BD, Marcos MC, Duthil ADR, Cordero D, Fernández ABM, Conde LP, Torres MFA, Castellano NP, Arias MA, Bolao IG, Infante ED, Campari M, Ynsaurriaga FA, Jiménez JFD, Valsecchi S, Bodes RS. Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00148-8. [PMID: 38697283 DOI: 10.1016/j.rec.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/17/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION AND OBJECTIVES The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. METHODS The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. RESULTS We analyzed 392 patients (aged 69 ± 10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P < .001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39 ± 0.89 pre- and 0.18 ± 0.57 postadoption (P < .001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P < .001). The mean number of visits per patient was 0.47 ± 1.11 pre- and 0.16 ± 0.51 postadoption (P < .001). CONCLUSIONS A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.
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Affiliation(s)
- Javier De Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Salud y Deporte, Universidad Europea de Madrid, Madrid, Spain.
| | - Rocío Cózar León
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan J Gavira Gómez
- Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Pachón
- Unidad de Arritmias, Hospital Universitario de Toledo, Toledo, Spain
| | - Josebe Goirigolzarri Artaza
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | - Jesús Álvarez-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Cristina Aguilera Agudo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José Manuel Rubín López
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Alfonso Macías Gallego
- Servicio de Cardiología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Silvia López Fernández
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Luis González Torres
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Elche Vinalopó, Elche, Alicante, Spain
| | - Juan Gabriel Martínez
- Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Natalia Marrero Negrín
- Servicio de Cardiología, Hospital Insular-Materno Infantil Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Javier Ramos Maqueda
- Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - José María Medina Gil
- Servicio de Cardiología, Hospital Insular-Materno Infantil Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos De Diego Rus
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Elche Vinalopó, Elche, Alicante, Spain
| | - Francisco José Bermúdez Jiménez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Inés Madrazo
- Servicio de Cardiología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - David Cordero
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Laura Peña Conde
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Nicasio Pérez Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Miguel A Arias
- Unidad de Arritmias, Hospital Universitario de Toledo, Toledo, Spain
| | - Ignacio García Bolao
- Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | | | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan F Delgado Jiménez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Rafael Salguero Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Blazquez-Bermejo Z, Quiroga B, Casado J, de la Espriella R, Trullàs JC, Romero-González G, Rubio-Gracia J, Díez J, Núñez J, de Sequera P, Recio-Mayoral A, Pérez-Silvestre J, Cobo Marcos M. Practical Approaches to the Management of Cardiorenal Disease beyond Congestion. Cardiorenal Med 2024; 14:235-250. [PMID: 38432220 DOI: 10.1159/000538125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is very common, leads to increased morbidity and mortality, and poses diagnostic and therapeutic difficulties. There is a risk-treatment paradox, such that patients with the highest risk are treated with lesser disease-modifying medical therapies. SUMMARY In this document, different scientific societies propose a practical approach to address and optimize cardiorenal therapies and related comorbidities systematically in chronic cardiorenal disease beyond congestion. Cardiorenal programs have emerged as novel models that may assist in delivering coordinated and holistic management for these patients. KEY MESSAGES (1) Cardiorenal disease is a ubiquitous entity in clinical practice and is associated with numerous barriers that limit medical treatment. (2) The present article focuses on the practical approaches to managing chronic cardiorenal disease beyond congestion to overcome some of these barriers and improve the treatment of this high-risk population.
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Affiliation(s)
- Zorba Blazquez-Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Cardiorenal Working Group of the Spanish Society of Cardiology, Madrid, Spain
| | - Borja Quiroga
- IIS-La Princesa, Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
- Cardiorenal Medicine Group (CaReSEN) of the Spanish Society of Nephrology, Madrid, Spain
| | - Jesús Casado
- Department of Internal Medicine, Hospital Universitario de Getafe, Madrid, Spain
- Heart Failure and Atrial Fibrillation Working Group of the Spanish Society of Internal Medicine, Madrid, Spain
| | - Rafael de la Espriella
- Cardiorenal Working Group of the Spanish Society of Cardiology, Madrid, Spain
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Universidad de Valencia, Valencia, Spain
| | - Joan Carles Trullàs
- Heart Failure and Atrial Fibrillation Working Group of the Spanish Society of Internal Medicine, Madrid, Spain
- Department of Internal Medicine, Hospital dOlot i Comarcal de la Garrotxa, Olot, 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), Vic, Barcelona, Spain
| | - Gregorio Romero-González
- Cardiorenal Medicine Group (CaReSEN) of the Spanish Society of Nephrology, Madrid, Spain
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Hospital Universitario Germans Trias I Pujol, Badalona, Spain
| | - Jorge Rubio-Gracia
- Heart Failure and Atrial Fibrillation Working Group of the Spanish Society of Internal Medicine, Madrid, Spain
- Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Javier Díez
- Cardiorenal Medicine Group (CaReSEN) of the Spanish Society of Nephrology, Madrid, Spain
- Center of Applied Medical Research and School of Medicine, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de la Enfermedades Cardiovasculares (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Julio Núñez
- Cardiorenal Working Group of the Spanish Society of Cardiology, Madrid, Spain
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Universidad de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de la Enfermedades Cardiovasculares (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Patricia de Sequera
- Department of Nephrology, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Recio-Mayoral
- Cardiorenal Working Group of the Spanish Society of Cardiology, Madrid, Spain
- Department of Cardiology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Pérez-Silvestre
- Heart Failure and Atrial Fibrillation Working Group of the Spanish Society of Internal Medicine, Madrid, Spain
- Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Cardiorenal Working Group of the Spanish Society of Cardiology, Madrid, Spain
- Centro de Investigación Biomédica en Red de la Enfermedades Cardiovasculares (CIBERCV), Carlos III Institute of Health, Madrid, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro (IDIPHISA), Madrid, Spain
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Formiga F, Nuñez J, Castillo Moraga MJ, Cobo Marcos M, Egocheaga MI, García-Prieto CF, Trueba-Sáiz A, Matalí Gilarranz A, Fernández Rodriguez JM. Diagnosis of heart failure with preserved ejection fraction: a systematic narrative review of the evidence. Heart Fail Rev 2024; 29:179-189. [PMID: 37861854 PMCID: PMC10904432 DOI: 10.1007/s10741-023-10360-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a common condition in clinical practice, affecting more than half of patients with HF. HFpEF is associated with morbidity and mortality and with considerable healthcare resource utilization and costs. Therefore, early diagnosis is crucial to facilitate prompt management, particularly initiation of sodium-glucose co-transporter 2 inhibitors. Although European guidelines define HFpEF as the presence of symptoms with or without signs of HF, left ventricular EF ≥ 50%, and objective evidence of cardiac structural and/or functional abnormalities, together with elevated natriuretic peptide levels, the diagnosis of HFpEF remains challenging. First, there is no clear consensus on how HFpEF should be defined. Furthermore, diagnostic tools, such as natriuretic peptide levels and resting echocardiogram findings, are significantly limited in the diagnosis of HFpEF. As a result, some patients are overdiagnosed (i.e., elderly people with comorbidities that mimic HF), although in other cases, HFpEF is overlooked. In this manuscript, we perform a systematic narrative review of the diagnostic approach to patients with HFpEF. We also propose a comprehensible algorithm that can be easily applied in daily clinical practice and could prove useful for confirming or ruling out a diagnosis of HFpEF.
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Affiliation(s)
- Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain.
| | - Julio Nuñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia-España, Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, Fundación de Investigación INCLIVA, Valencia, Spain
| | | | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Angel Trueba-Sáiz
- Medical Affairs Department, Eli Lilly and Company España, Alcobendas, Madrid, Spain
| | | | - José María Fernández Rodriguez
- Área Cardiorrenometabólica del Servicio de Medicina Interna del Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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4
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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Llàcer P, Pomares A, Fort A, Ponz de Antonio I, Méndez A, Blázquez-Bermejo Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, Zegrí I, García Pinilla JM, Montero Hernández E, Castro A, Soler MJ, Górriz JL, Bascompte Claret R, Fluvià-Brugués P, Manzano L, Núñez J. Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry. Rev Esp Cardiol (Engl Ed) 2024; 77:50-59. [PMID: 37217135 DOI: 10.1016/j.rec.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. METHODS From October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. RESULTS The median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. CONCLUSIONS In this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.
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Affiliation(s)
- Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Pau 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, Alcalá de Henares, Madrid, Spain
| | - Antonia Pomares
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aleix Fort
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Ana Méndez
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Jorge Rubio Gracia
- Servicio de Medicina Interna, Hospital Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | | | - Isabel Zegrí
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esther Montero Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - María José Soler
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Ramón Bascompte Claret
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
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Formiga F, Nuñez J, Moraga MJC, Marcos MC, Egocheaga MI, García-Prieto CF, Trueba-Sáiz A, Gilarranz AM, Rodriguez JMF. Correction to: Diagnosis of heart failure with preserved ejection fraction: a systematic narrative review of the evidence. Heart Fail Rev 2024; 29:301. [PMID: 37953396 PMCID: PMC10904464 DOI: 10.1007/s10741-023-10365-8] [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: 11/14/2023]
Affiliation(s)
- Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain.
| | - Julio Nuñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia-España, Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, Fundación de Investigación INCLIVA, Valencia, Spain
| | | | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Angel Trueba-Sáiz
- Medical Affairs Department, Eli Lilly and Company España, Alcobendas, Madrid, Spain
| | | | - José María Fernández Rodriguez
- Área Cardiorrenometabólica del Servicio de Medicina Interna del Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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6
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Bonanad C, Buades JM, Leiva JP, De la Espriella R, Marcos MC, Núñez J, García-Llana H, Facila L, Sánchez R, Rodríguez-Osorio L, Alonso-Babarro A, Quiroga B, Bompart Berroteran D, Rodríguez C, Maidana D, Díez J. Consensus document on palliative care in cardiorenal patients. Front Cardiovasc Med 2023; 10:1225823. [PMID: 38179502 PMCID: PMC10766370 DOI: 10.3389/fcvm.2023.1225823] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
There is an unmet need to create consensus documents on the management of cardiorenal patients since, due to the aging of the population and the rise of both pathologies, these patients are becoming more prevalent in daily clinical practice. Chronic kidney disease coexists in up to 40%-50% of patients with chronic heart failure cases. There have yet to be consensus documents on how to approach palliative care in cardiorenal patients. There are guidelines for patients with heart failure and chronic kidney disease separately, but they do not specifically address patients with concomitant heart failure and kidney disease. For this reason, our document includes experts from different specialties, who will not only address the justification of palliative care in cardiorenal patients but also how to identify this patient profile, the shared planning of their care, as well as knowledge of their trajectory and the palliative patient management both in the drugs that will help us control symptoms and in advanced measures. Dialysis and its different types will also be addressed, as palliative measures and when the decision to continue or not perform them could be considered. Finally, the psychosocial approach and adapted pharmacotherapy will be discussed.
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Affiliation(s)
- Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Juan M. Buades
- Nephrology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
- Institute for Health Research of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Juan Pablo Leiva
- Support and Palliative Care Team, Hospital Manacor, Palma de Mallorca, Spain
| | - Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Marta Cobo Marcos
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
- Cardiology Department, Hospital Puerta del Hierro, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Biomedical Research Institute (INCLIVA), Valencia, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - Helena García-Llana
- Universidad Internacional de La Rioja (UNIR), La Rioja, Spain
- Centro de Estudios Superiores Cardenal Cisneros, Universidad Pontifica de Comillas, Madrid, Spain
| | - Lorenzo Facila
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Rosa Sánchez
- Nephrology Department, Hospital Universitario General de Villalba, Madrid, Spain
| | | | | | - Borja Quiroga
- Cardiology Department, Consorcio Hospital General de Valencia, Valencia, Spain
| | | | - Carmen Rodríguez
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Javier Díez
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
- Center for Applied Medical Research (CIMA), and School of Medicine, Universidad de Navarra, Pamplona, Spain
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Collado Macián C, Pujol Pocull D, Dominguez F, López-Azor JC, Garcia-Pavia P, Nuñez J, Cobo Marcos M. Case report: Alternative approach for management of refractory volume overload in heart failure: usefulness of venous leg compression. Front Cardiovasc Med 2023; 10:1230980. [PMID: 37840957 PMCID: PMC10570792 DOI: 10.3389/fcvm.2023.1230980] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background Management of patients with refractory congestion, is one of the most important challenges in the field of heart failure (HF). Diuretic therapy remains the most widely used therapy to achieve euvolemia. However, some patients experience fluid overload despite the use of high-dose diuretics and new strategies to overcome diuretic resistance are needed. Case Summary We report an 85 years-old male patient admitted for decompensated HF with persistent tissue fluid overload (peripheral edema) for more than two weeks despite high dose of intravenous furosemide with the combination of other diuretics. At this point, we performed leg venous compression using elastic bandages for three days. After 72 h, edema disappeared, and additional weight loss was achieved (1 kg/day). No side effects were observed and the patient was discharged home euvolemic. Conclusion Venous leg compression may be an alternative therapy in patients with persistent tissue fluid overload resistant to diuretics.
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Affiliation(s)
- Carlos Collado Macián
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
| | - David Pujol Pocull
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Juan Carlos López-Azor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Julio Nuñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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8
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Pascual-Figal DA, Zamorano JL, Domingo M, Morillas H, Nuñez J, Cobo Marcos M, Riquelme-Pérez A, Teis A, Santas E, Caro-Martinez C, Pinilla JM, Rodriguez-Palomares JF, Dobarro D, Restrepo-Córdoba MA, González-Juanatey JR, Bayés Genís A. Impact of dapagliflozin on cardiac remodelling in patients with chronic heart failure: The DAPA-MODA study. Eur J Heart Fail 2023; 25:1352-1360. [PMID: 37211950 DOI: 10.1002/ejhf.2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, specifically left atrial (LA) remodelling, is not well established. METHODS AND RESULTS The DAPA-MODA trial (NCT04707352) is a multicentre, single-arm, open-label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline-directed therapy, except for any sodium-glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core-lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2 ) and LA parameters were similar between LVEF-based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (-6.6% [95% confidence interval -11.1, -1.8], p = 0.008), primarily due to a decrease in reservoir volume (-13.8% [95% confidence interval -22.5, -4], p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (-13.9% [95% confidence interval -18.7, -8.7], p < 0.001), end-diastolic volume (-8.0% [95% confidence interval -11.6, -4.2], p < 0.001) and end-systolic volume (-11.9% [95% confidence interval -16.7, -6.8], p < 0.001) at 180 days. N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed a significant reduction at 180 days (-18.2% [95% confidence interval -27.1, -8.2], p < 0.001), without changes in filling Doppler measures. CONCLUSION Dapagliflozin administration in stable out-setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT-proBNP concentrations.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - J Luis Zamorano
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | | | - Julio Nuñez
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Riquelme-Pérez
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - Albert Teis
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cesar Caro-Martinez
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
| | - Jose Manuel Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jose F Rodriguez-Palomares
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Dobarro
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Álvaro Cunqueiro, IIS Galicia Sur, Vigo, Spain
| | | | - J Ramón González-Juanatey
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Bayés Genís
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
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9
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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Zegrí I, Pomares A, Llácer P, Fort A, Rodríguez Chavarri A, Méndez A, Blázquez Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, García Pinilla JM, Soler MJ, Garrido González R, Górriz JL, González Rico M, Castro A, Núñez J. Sex differences in Cardiorenal Syndrome: Insights from CARDIOREN Registry. Curr Heart Fail Rep 2023:10.1007/s11897-023-00598-x. [PMID: 37222949 DOI: 10.1007/s11897-023-00598-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE OF THE WORK Although sex-specific differences in heart failure (HF) or kidney disease (KD) have been analyzed separately, the predominant cardiorenal phenotype by sex has not been described. This study aims to explore the sex-related differences in cardiorenal syndrome (CRS) in a contemporary cohort of outpatients with HF. FINDINGS An analysis of the Cardiorenal Spanish registry (CARDIOREN) was performed. CARDIOREN Registry is a prospective multicenter observational registry including 1107 chronic ambulatory HF patients (37% females) from 13 Spanish HF clinics. Estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 was present in 59.1% of the overall HF population, being this prevalence higher in the female population (63.2% vs. 56.6%, p = 0.032, median age: 81 years old, IQR:74-86). Among those with kidney dysfunction, women displayed higher odds of showing HF with preserved ejection fraction (HFpEF) (odds ratio [OR] = 4.07; confidence interval [CI] 95%: 2.65-6.25, p < 0.001), prior valvular heart disease (OR = 1.76; CI 95%:1.13-2.75, p = 0.014), anemia (OR: 2.02; CI 95%:1.30-3.14, p = 0.002), more advanced kidney disease (OR for CKD stage 3: 1.81; CI 95%:1.04-3.13, p = 0.034; OR for CKD stage 4: 2.49, CI 95%:1.31-4.70, p = 0.004) and clinical features of congestion (OR:1.51; CI 95%: 1.02-2.25, p = 0.039). On the contrary, males with cardiorenal disease showed higher odds of presenting HF with reduced ejection fraction (HFrEF) (OR:3.13; CI 95%: 1.90-5.16, p < 0.005), ischemic cardiomyopathy (OR:2.17; CI 95%: 1.31-3.61, p = 0.003), hypertension (OR = 2.11; CI 95%:1.18-3.78, p = 0.009), atrial fibrillation (OR:1.71; CI 95%: 1.06-2.75, p = 0.025), and hyperkalemia (OR:2.43, CI 95%: 1.31-4.50, p = 0.005). In this contemporary registry of chronic ambulatory HF patients, we observed sex-related differences in patients with combined heart and kidney disease. The emerging cardiorenal phenotype characterized by advanced CKD, congestion, and HFpEF was predominantly observed in women, whereas HFrEF, ischemic etiology, hypertension, hyperkalemia, and atrial fibrillation were more frequently observed in men.
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Affiliation(s)
- Marta Cobo Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Isabel Zegrí
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonia Pomares
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain. Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - Aleix Fort
- Department of Cardiology, Hospital Universitari Dr. Josep Trueta., Girona, Spain
| | | | - Ana Méndez
- Department of Cardiology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Zorba Blázquez
- Department of Cardiology, Hospital Universtiario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Rubio Gracia
- Department of Internal Medicine, Hospital Universitario Lozano Blesa, University of Zaragoza, Saragossa, Spain
| | | | | | - Maria Jose Soler
- Department of Nephrology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Ramón Garrido González
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Jose Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Miguel González Rico
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Almudena Castro
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.
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10
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Álvarez-García J, Cristo Ropero MJ, Iniesta Manjavacas ÁM, Díez-Villanueva P, Esteban-Fernández A, de Juan Bagudá J, Rivas-Lasarte M, Taibo Urquía M, Górriz-Magaña J, Cobo Marcos M, Goirigolzarri-Artaza J, Iglesias Del Valle D, Bover Freire R, Beltrán Herrera C, Villa A, Campuzano Ruiz R, Martínez-Sellés M. Do Women Physicians Accept and Follow Heart Failure Guidelines More Than Men? Curr Heart Fail Rep 2023:10.1007/s11897-023-00597-y. [PMID: 37022560 DOI: 10.1007/s11897-023-00597-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW Our aim was to assess the degree of acceptance of the European Clinical Practice Guidelines (CPG) on heart failure (HF) among Spanish physicians according to sex. This was a cross-sectional study, employing Google Forms, conducted by a group of HF experts from the Region of Madrid (Spain), between November 2021 and February 2022, among specialists and residents of Cardiology, Internal Medicine, and Primary Care from Spain. RECENT FINDINGS A total of 387 physicians-173 women (44.7%)-from 128 different centers completed the survey. Compared to men, women were significantly younger (38.2 ± 9.1 years vs. 40.6 ± 11.2 years; p = 0.024) and had fewer years of clinical practice (12.1 ± 8.1 years vs. 14.5 ± 10.7 years; p = 0.014). Briefly, women and men had a positive opinion of the guidelines and thought that implementing quadruple therapy is feasible in less than 8 weeks. Women followed more frequently than men the new paradigm of "4 pillars at lowest doses" and considered more frequently the establishment of quadruple therapy before implanting a cardiac device. Although they agreed about "low blood pressure" as the major limitation for achieving quadruple therapy in heart failure with reduced ejection fraction, there were discrepancies on the second most frequent barrier, and women were more proactive when initiating SGLT2 inhibitors. In a large survey including nearly 400 doctors from all over Spain to provide real-world opinion on 2021 ESC HF Guidelines and experience with SGLT2 inhibitors, women follow more frequently the new paradigm of "4 pillars at lowest doses", consider more frequently the establishment of quadruple therapy before implanting a cardiac device, and were more proactive when initiating SGLT2 inhibitors. Further studies confirming an association of sex with a better compliance of HF guidelines are needed.
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Affiliation(s)
- Jesús Álvarez-García
- Cardiology Department, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario Ramón Y Cajal, Madrid, Spain.
| | | | - Ángel Manuel Iniesta Manjavacas
- Cardiology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | - Javier de Juan Bagudá
- Cardiology Department, Hospital Universitario, Instituto de Investigación Sanitaria Hospital, 12 de Octubre12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain Department of Medicine, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, Madrid, Spain
| | - Mercedes Rivas-Lasarte
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Mikel Taibo Urquía
- Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Górriz-Magaña
- Cardiology Department, Hospital Central de La Defensa Gómez-Ulla, Madrid, Spain
| | - Marta Cobo Marcos
- Cardiology Department, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario Ramón Y Cajal, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | | | - Diego Iglesias Del Valle
- Cardiology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Ramón Bover Freire
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Adolfo Villa
- Cardiology Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.
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11
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de la Espriella R, Marcos MC, Ronco C, Banerjee D, González M, Górriz JL, Quiroga B, Soler MJ, Díez J, Núñez J. Practical approaches to building up a cardiorenal clinic. Clin Kidney J 2022; 16:780-792. [PMID: 37151411 PMCID: PMC10157785 DOI: 10.1093/ckj/sfac258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
The population with concomitant heart and kidney disease (often termed “cardiorenal” disease) is expected to grow, significantly impacting public health and health care utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated, and specialized care would be a positive shift toward improving patient outcomes and optimizing healthcare resources. This document aims to define the organizational aspects and the key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.
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Affiliation(s)
- Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA) , Valencia , Spain
| | - Marta Cobo Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA) , Madrid , Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV) , Madrid , Spain
| | - Claudio Ronco
- Department of Medicine, University of Padova , Padova , Italy
- International Renal Research Institute of Vicenza (IRRV) , Vicenza , Italy
- Department of Nephrology, San Bortolo Hospital , Vicenza , Italy
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals National Health Service Foundation Trust , London , UK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St Georges, University of London , London , UK
| | - Miguel González
- Department of Nephrology, Hospital Clínico Universitario de Valencia (INCLIVA) , Valencia , Spain
- Department of Medicine , Universitat de Valencia, Valencia , Spain
| | - José Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario de Valencia (INCLIVA) , Valencia , Spain
- Department of Medicine , Universitat de Valencia, Valencia , Spain
| | - Borja Quiroga
- Department of Nephrology, Hospital Universitario de la Princesa , Madrid , Spain
| | - María José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Nephrology and Kidney Transplant Research Group, Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV) , Madrid , Spain
- Department of Cardiology, University of Navarra Clinic , Pamplona, Spain
- Department of Nephrology, University of Navarra Clinic , Pamplona, Spain
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra , Pamplona, Spain
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA) , Valencia , Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV) , Madrid , Spain
- Department of Medicine , Universitat de Valencia, Valencia , Spain
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12
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Vela Martín P, Matutano Muñoz A, Sánchez Ortiz D, Domínguez F, Royuela A, Cobo Marcos M. CANDI study: chlorthalidone vs acetazolamide in patients with diuretic resistance in acute heart failure. Rev Esp Cardiol (Engl Ed) 2022; 76:477-480. [PMID: 36493956 DOI: 10.1016/j.rec.2022.11.007] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Paula Vela Martín
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Andrea Matutano Muñoz
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - David Sánchez Ortiz
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Fernando Domínguez
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain; Grupo de Miocardiopatías Hereditarias, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana Royuela
- Unidad de Bioestadística, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Spain
| | - Marta Cobo Marcos
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
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13
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Soto JEDV, Parra JC, López CEM, Marcos MC, Romero IS, Forteza A. First report of Brevundimonas aurantiaca human infection: infective endocarditis on aortic bioprostheses and supracoronary aortic graft acquired by water dispenser of domestic refrigerator. Int J Infect Dis 2022; 122:8-9. [PMID: 35568369 DOI: 10.1016/j.ijid.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/26/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022] Open
Abstract
Infective endocarditis (IE) is a feared life-threatening complication that requires a multidisciplinary approach. Although a variety of microorganisms have caused IE, Brevundimonas aurantiaca human infection has never been reported previously. To our knowledge, this is the first reported case of endocarditis and human infection due to B. aurantiaca.
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Affiliation(s)
| | - Jorge Calderon Parra
- Infectious Disease department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Marta Cobo Marcos
- Cardiology department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Microbiology department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alberto Forteza
- Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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14
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Mullens W, Martens P, Testani JM, Tang WHW, Skouri H, Verbrugge FH, Fudim M, Iacoviello M, Franke J, Flammer AJ, Palazzuoli A, Barragan PM, Thum T, Marcos MC, Miró Ò, Rossignol P, Metra M, Lassus J, Orso F, Jankowska EA, Chioncel O, Milicic D, Hill L, Seferovic P, Rosano G, Coats A, Damman K. Renal effects of guideline directed medical therapies in heart failure - a consensus document from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:603-619. [PMID: 35239201 DOI: 10.1002/ejhf.2471] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, University Hasselt, Belgium.,Cleveland Clinic, Cleveland, Ohio, United States of America
| | | | | | - Hadi Skouri
- American University of Beirut Medical Center-Beirut, Lebanon
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussel, Jette, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marat Fudim
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Andreas J Flammer
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences Le Scotte Hospital Siena, Italy.,School of Nursing and Midwifery, Queen's University, Belfast, Northern Ireland
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.,Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Marta Cobo Marcos
- Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Patrick Rossignol
- Université de Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116, and F-CRIN INI-CRCT, Nancy, France
| | | | - Johan Lassus
- Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital
| | | | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University AND Institute of Heart Diseases, University Hospital in Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Petar Seferovic
- Universi Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia
| | | | | | - Kevin Damman
- University of Groningen, University Medical Center Groningen, The Netherlands
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15
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de la Espriella R, Santas E, Zegri Reiriz I, Górriz JL, Cobo Marcos M, Núñez J. Quantification and treatment of congestion in heart failure: A clinical and pathophysiological overview. Nefrologia 2022; 42:145-162. [PMID: 36153911 DOI: 10.1016/j.nefroe.2021.04.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 06/16/2023] Open
Abstract
Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion assessment, monitoring, and treatment represent a real challenge in daily clinical practice. This document reviewed historical and contemporary evidence of available methods for determining volume status and discuss pharmacological aspects and pathophysiological principles that underlie diuretic use.
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Affiliation(s)
- Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain
| | - Isabel Zegri Reiriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Luis Górriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universidad de Valencia, Spain
| | - Marta Cobo Marcos
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; CIBER Cardiovascular, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Spain.
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16
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de la Espriella R, Santas E, Zegri Reiriz I, Górriz JL, Cobo Marcos M, Núñez J. Quantification and Treatment of Congestion in Heart Failure: A Clinical and Pathophysiological Overview. Nefrologia 2021; 42:S0211-6995(21)00114-4. [PMID: 34289940 DOI: 10.1016/j.nefro.2021.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/11/2021] [Revised: 02/27/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023] Open
Abstract
Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion assessment, monitoring, and treatment represent a real challenge in daily clinical practice. This document reviewed historical and contemporary evidence of available methods for determining volume status and discuss pharmacological aspects and pathophysiological principles that underlie diuretic use.
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Affiliation(s)
- Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España
| | - Isabel Zegri Reiriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - José Luis Górriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Departamento de Medicina, Universidad de Valencia, España
| | - Marta Cobo Marcos
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; CIBER Cardiovascular, España
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Departamento de Medicina, Universidad de Valencia, España; CIBER Cardiovascular, España.
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17
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/CT with 18F-FDG in suspected intracardiac device-related infections: analysis of performance and diagnostic usefulness. Rev Esp Cardiol (Engl Ed) 2021; 74:238-246. [PMID: 32471719 DOI: 10.1016/j.rec.2020.01.026] [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] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/24/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality. METHODS Retrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT. RESULTS We included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection. CONCLUSIONS PET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.
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Affiliation(s)
- Begoña Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Víctor Castro Urda
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Servicio de Medicina Interna (Infectología), Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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18
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/TC con 18F-FDG en la sospecha de infección asociada a dispositivos intracardiacos: rendimiento y utilidad diagnóstica. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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García Pinilla JM, Díez-Villanueva P, Bover Freire R, Formiga F, Cobo Marcos M, Bonanad C, Crespo Leiro MG, Ruiz García J, Díaz Molina B, Enjuanes Grau C, García L, Rexach L, Esteban A, Martínez-Sellés M. Documento de consenso y recomendaciones sobre cuidados paliativos en insuficiencia cardiaca de las Secciones de Insuficiencia Cardiaca y Cardiología Geriátrica de la Sociedad Española de Cardiología. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.06.024] [Citation(s) in RCA: 3] [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: 12/12/2022]
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20
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García Pinilla JM, Díez-Villanueva P, Bover Freire R, Formiga F, Cobo Marcos M, Bonanad C, Crespo Leiro MG, Ruiz García J, Díaz Molina B, Enjuanes Grau C, García L, Rexach L, Esteban A, Martínez-Sellés M. Consensus document and recommendations on palliative care in heart failure of the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2019; 73:69-77. [PMID: 31761573 DOI: 10.1016/j.rec.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022]
Abstract
Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.
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Affiliation(s)
- José Manuel García Pinilla
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ramón Bover Freire
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Clara Bonanad
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María G Crespo Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Juan Ruiz García
- Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Cristina Enjuanes Grau
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluisa García
- Servicio de Cardiología, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Lourdes Rexach
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alberto Esteban
- Servicio de Cardiología, Hospital Universitario de Móstoles, Madrid, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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