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Anguita Gamez M, Esteban A, Bonilla JL, Garcia M, Bernal JL, Del Prado N, Fernandez Perez C, Gomez Doblas JJ, Perez Villacastin J, Marin F, Elola FJ, Anguita Sanchez M. Clinical features and short-term prognosis in the very elderly, >90 year-old, patients hospitalized with heart failure. A population-based study (2016–2019). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2537] [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
Heart failure (HF) is a main health problem in western countries, and a major cause of hospitalizations and death, particularly in older people. Few data are available about clinical features and prognosis of very old patients, those aged 90 or more years.
Purpose
To analyse the clinical features and short-term prognosis (in-hospital mortality and 30-day readmission rate) of patients aged 90 or more years hospitalized with HF in Spain in the last years.
Methods
We conducted a retrospective analysis of patients discharged with an ICD-10 main diagnosis of HF from the Spanish National Health System (SNHS) public hospitals between 2016 and 2019, using as source of data the Minimum Basic Data Set of the SNHS. A comparison of clinical profile, in-hospital mortality and 30-day cardiovascular readmission rate between patients aged 75 to 89 years and those with 90 or more years was performed.
Results
From 2016 to 2019, 354,792 episodes of people older than 74-year and principal diagnosis of HF were included, being 59.2% female. Mean age of the whole population was 85.2±5.5 years, crude in-hospital mortality rate was 12.7% and crude cardiovascular 30-day readmission rate, 11.8%. The very older patients' subgroup (90 or more year-old) comprised 78.777 patients (22.2%). Table 1 shows the differences in clinical features between these patients and those aged 75 to 89 (77.8%). Patients aged 90 or more years were female in a higher proportion and showed a higher prevalence of cognitive impairment and renal failure, but a lower prevalence of most comorbidities (coronary artery revascularization, valve heart disease, cancer, diabetes mellitus, chronic liver disease). The diagnosis of previous myocardial infarction, stroke and systemic hypertension was similar in both groups (Table 1). Crude 30-day cardiovascular readmission rate was slightly but significantly lower in the oldest subgroup (10.9% vs 12%, p<0.001), while crude in-hospital mortality was higher (18.5% vs 11%, p<0.001).
Conclusions
Patients aged 90 or more years represents almost a fourth part of elderly patients hospitalized with HF in Spain within the last years. In general, prevalence of comorbidities and associated heart disease was similar or lower, but in-hospital mortality was twice higher, as compared with less older patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Esteban
- University Hospital Severo Ochoa, Cardiology , Leganes , Spain
| | - J L Bonilla
- Hospital San Juan de la Cruz, Cardiology , Ubeda , Spain
| | - M Garcia
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - J L Bernal
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - N Del Prado
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - C Fernandez Perez
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
| | - J J Gomez Doblas
- Virgin of Victory University Hospital, Cardiology , Malaga , Spain
| | | | - F Marin
- University Hospital Virgen de la Arrixaca, Cardiology , Murcia , Spain
| | - F J Elola
- Interhospital Foundation for Cardiovascular Research, Fundacion IMAS , Madrid , Spain
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Esteban Fernandez A, Anguita M, Bonilla JL, Anguita M, Ruesgas R, Molina M, Garcia M, Bernal JL, Del Prado N, Fernandez Perez C, Marin F, Perez Villacastin J, Gomez Doblas JJ, Fernandez Rozas I, Elola FJ. 1-year hospital readmissions due to cardiovascular causes after a heart failure episode in elderly patients in Spain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1044] [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
The prevalence of heart failure (HF) increases with age, one of the leading causes of hospitalization and death in the elderly. However, there are little data about the long-term readmission rate of elderly patients after an episode of HF admission in Spain.
Purpose
Study 1-year hospital readmissions due to cardiovascular causes in patients ≥75 years discharged to a hospital due to HF in Spain.
Methods
We performed a retrospective analysis of the Minumum basic dataset of Spain, including all episodes of HF discharged from public hospitals in Spain between 2016 and 2019. The codification was made with ICD-10. We selected patients ≥75 years with HF as the principal diagnosis. We analyzed predictors of readmissions 365 days after the index episode of HF hospitalization with Poisson regression.
Results
236,463 index episodes of HF in>75 years were included. 59.1% were female, and the mean age was 85 (SD 5.6) years. 35.0% had HF-pef, 4.3% HF-ref, and 60.7% had unknown LVEF HF.
39.6% of patients had at least one readmission (mean 1.7 readmissions by year for these patients), with no differences in sex or age. Patients with non-cardiovascular comorbidities (renal failure, chronic lung disorders, and severe hematological disorders) as well as coronary atherosclerosis and diabetes were more likely to be readmitted (Table 1).
Conclusions
After a hospital discharge for HF in patients ≥75 years, the crude ratio of readmission due to cardiovascular causes at 1-year was 39.6%. Readmissions were more likely in patients with non-cardiovascular comorbidities, predominantly renal, hematological, and chronic respiratory disorders, and those with diabetes and coronary atherosclerosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Anguita
- University Hospital Reina Sofia , Cordoba , Spain
| | - J L Bonilla
- Hospital San Juan de la Cruz , Ubeda , Spain
| | - M Anguita
- Hospital Clinico San Carlos , Madrid , Spain
| | - R Ruesgas
- Severo Ochoa Hospital , Leganes , Spain
| | - M Molina
- Severo Ochoa Hospital , Leganes , Spain
| | | | | | | | | | - F Marin
- Virgen of the Arrixaca University Hospital , Murcia , Spain
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Luna M, Cruzado Alvarez C, Perez Cabeza AI, Robles Mezcua A, Martinez Carmona JD, Diaz Exposito A, Gomez Doblas JJ, Jimenez Rubio C, Morcillo Hidalgo L, Garcia Pinilla JM. Analysis of telephone demand in a heart failure unit: something more than a simple call. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3023] [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
Introduction
Specific care programs for HF patients significantly reduce readmissions, which is why they are recommended in clinical practice guidelines with the highest level of evidence. Telephone assistance is a service offered to patients within these programs.
Purpose
The main objective was to evaluate the most frequent reasons for consultation and the ability to resolve them after the call.
Methods
This is a descriptive, retrospective study of all the telephone consultations registered between June 2020 and January 2021. The calls are attended by the HF consultation nurse, commenting with Cardiology on those that imply changes in the pharmacological treatment.
Sociodemographic and clinical variables, reasons for the call and their frequency were collected. Categorical variables were expressed as percentages and quantitative variables as means ± standard deviation.
Results
During the analyzed period, 1.608 consultations were attended, 494 were telephone calls, which represents 31% of the overall activity of the nursing consultation. 423 consultations were analyzed, 55.7% (235) reactive, and 44.3% (187) proactive. 72.5% of the patients were under follow-up by the nurse, compared to 27.5% who had completed drug titration.
The mean age was 65 (± 12.3) years, 65.6% were men, 98.4% had a caregiver, 77% of the patients had an LVEF <40%, Charlson modified mean 4.7 (± 3.6) and 92.3% were on treatment with beta-blockers, 89.1% with ACE inhibitors/ARBs/ARNI and 82.3% with MRA. The mean number of drugs per patient was 8.6 (± 3).
Reasons for the reactive calls were in 46% of the cases the consultation of symptoms, 20% to consult doubts about the treatment or procedures, 16% for problems related to the prescription of pharmacological treatment and 14% for the appointment management.
Reasons for proactive calls were 40% for symptoms control, 30.5% for appointment management, 27.3% for drug titration and 2.1% related to other causes.
When the reason for consultation was the appearance of symptoms, the mean number of calls required was 1.4 (± 0.8), 77.6% of the calls were solved through the telephone, 16.4% required a face-to-face visit in the nursing consultation and 2.7% were referred to the emergency room. Queries related to doubts, problems with the prescription or appointment management were solved in a single telephone consultation.
Conclusions
The most common telephone request when the patient made the call was the worsening of HF symptoms. The telephone consultation is presented as an effective tool in these cases, by favoring the accessibility of patients and avoiding unnecessary trips to the health center.
Funding Acknowledgement
Type of funding sources: None. Table 1. Descriptive details of patientsTable 2. Call reasons
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Affiliation(s)
- M Luna
- University Hospital Virgen de la Victoria, Malaga, Spain
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Luna M, Rodriguez Cordoba A, Rodriguez Capitan J, Martinez Carmona JD, Diaz Exposito A, Marquez Camas P, Garcia Rodriguez L, Palma Marti L, Angullo Gomez M, Doncel Abad MV, Berteli Garcia G, Mendez Natera R, Grande Prada D, Melgar Melgar A, Gomez Doblas JJ. Analysis of LpA levels in young patients after ACS: getting to know less famous risk factors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2478] [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
Introduction
Lipoprotein A (LpA) has been shown to be an emerging risk factor, proposing that values greater than 60 mg/dl increases cardiovascular risk. There are few data about LpA values in young patients who have suffered a major cardiovascular event.
Purpose
The objective of this work was to describe the LpA values observed in young patients admitted for acute coronary syndrome in our center, and subsequently to compare these values according to the patients' previous cardiovascular risk.
Methods
This is a descriptive and observational study, in which all male patients under 65 years and women under 70 years who have suffered STEMI or NSTEMI from November 2019 to February 2021 admitted to our center were consecutively included. In addition to LpA values, the following variables were recollected: age, sex, high blood pressure, diabetes mellitus, dyslipidemia, stroke, chronic kidney injury, smoking, alcoholism, toxics, total cholesterol and SCORE risk.
Results
159 patients were included. The mean of LpA value was 41,08 mg/dl (standard deviation 38, range 1–155, percentile 25th: 9,7; percentile 50th: 28,8; percentile 75th: 59,1). 24,5% presented levels of LpA greater than 60 mg/dl. The percentage of patients with LpA levels >60 mg was 32,4% in low SCORE group and 22,4% in greater than low SCORE group without significant differences.
The table compares the LpA values according to the cardiovascular risk SCORE those patients presented before the acute coronary syndrome (low SCORE vs moderate, high or very high SCORE). As we can see in the table, we found a trend to present higher LpA values in patients with low SCORE risk compared to those with higher than low SCORE risk, without reaching statistical significance.
Conclusions
In a sample of young patients with acute coronary syndrome, the LpA mean was 41,08 mg/dl. 24,5% of patients had values of LpA greater than 60 mg/dl. No significant differences were found according to the SCORE prior to the event, although there was a non-significant trend towards a higher LpA in patients with low SCORE.
Funding Acknowledgement
Type of funding sources: None. Table 1. LpA values
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Affiliation(s)
- M Luna
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | | | | | | | | | | | - L Palma Marti
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | | | | | | | - D Grande Prada
- University Hospital Virgen de la Victoria, Malaga, Spain
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Munoz Garcia AJ, Munoz Garcia M, Munoz Garcia E, Molina Mora MJ, Jimenez Navarro MF, Dominguez Franco AJ, Gomez Doblas JJ, Alonso Briales JH, Hernandez Garcia JM, De Teresa Galvan E. Clinical impact of acute Kidney injury after Transcatheter Aortic Valve Implantation (TAVI) with the corevalve prosthesis in patients with aortic stenosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Munoz Garcia AJ, Munoz Garcia M, Munoz Garcia E, Jimenez Navarro MF, Dominguez Franco AJ, Gomez Doblas JJ, Alonso Briales JH, Rodriguez Bailon I, Hernandez Garcia JM, De Teresa Galvan E. Impact of transcatheter aortic valve implantation in patients with impaired left ventricular systolic function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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