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AIMS: Renal function is an important prognostic factor in heart failure. The aim of this study was to compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease-Epidemiology Collaboration equation (CKD-EPI) and the abbreviated Modification of Diet in Renal Disease (MDRD-4) equation for long-term all-cause mortality in patients admitted for acute decompensated heart failure (ADHF) with both preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF). METHODS AND RESULTS: We evaluated patients included in the Spanish National Registry of Heart Failure (RICA). RICA is a multicentre, prospective, cohort study that included patients admitted to the Internal Medicine units with ADHF. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI and MDRD-4 equations. A total of 1805 patients admitted for ADHF were studied (52% women; median age 80 years, interquartile range 73.9-84.6 years); of these, 1044 (58%) had HF-PEF. eGFR values were lower with the CKD-EPI formula than with the MDRD-4 formula (51 ml/min/1.73 m(2) vs. 55.7 ml/min/1.73 m(2) ; p < 0.001). The two formulas provided independent prognostic information over long-term follow-up, in both HF-PEF and HF-REF patients. However, in HF-PEF patients, CKD-EPI equation was associated with a significant improvement in reclassification analyses (net reclassification improvement 6.78%; p = 0.009). CONCLUSIONS: In this clinical cohort of ADHF patients, eGFR as calculated by both the CKD-EPI and the MDRD-4 formulas offered similar prognostic information, irrespective of ejection fraction status, but in HF-PEF patients specifically, the CKD-EPI formula seems to improve clinical risk stratification as compared with MDRD-4.
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Tasa de Filtración Glomerular/fisiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Renal Crónica/fisiopatología , Volumen Sistólico/fisiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVES: Cardiac amyloidosis (CA) is a common pathology in elderly patients that usually presents as heart failure (HF). However, it is not clear whether CA associated with HF has a worse prognosis compared with HF due to other etiologies. MATERIAL AND METHODS: Prospective, observational cohort study that recruited patients ≥65 years of age with HF in 30 Spanish centers. The cohort was divided according to whether the patients had AC or not. Patients were followed for 1â¯year. RESULTS: A total of 484 patients were included in the analysis. The population was elderly (median 86 years) and 49% were women CA was present in 23.8 % of the included patients. In the CA group, there was a lower prevalence of diabetes mellitus and valvular disease. At one year of follow-up, mortality was significantly more frequent in patients with CA compared to those without (33.0 vs.14.9%, pâ¯<â¯0.001). However, there were no differences between both groups in visits to the emergency room or readmissions. In the multivariate analysis, the variables that were shown to predict all-cause mortality at one year of follow-up were chronic kidney disease (HR 1.75 (1.01-3.05) pâ¯0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) pâ¯<â¯0.001), confusion (HR 2.05 (1.01-4.17), pâ¯0.048), and the presence of CA (HR 1.77 (1.11-2.84), pâ¯0.017). CONCLUSION: The presence of CA in elderly patients with HF is related to a worse prognosis at one year of follow-up. Early diagnosis of the pathology and multidisciplinary management can help improve patient outcomes.
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INTRODUCTION: The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP). AIMS: To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM. METHODS: The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm. RESULTS: 103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p = 0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97-0.87, p = 0.04), and hemoglobin (HR 0.65, 95% CI 0.71-0.63, p = 0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions. CONCLUSIONS: Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion.
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Presión Sanguínea , Diabetes Mellitus Tipo 2/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Volumen Sistólico , Función Ventricular Izquierda , Anciano , Anciano de 80 o más Años , Anemia/mortalidad , Anemia/fisiopatología , Monitoreo Ambulatorio de la Presión Arterial , Análisis por Conglomerados , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Masculino , Readmisión del Paciente , Pronóstico , Sistema de Registros , Factores de Riesgo , España/epidemiología , Factores de TiempoRESUMEN
OBJECTIVE: Several studies have reported that a higher degree of hemoconcentration in patients admitted for the treatment of acute heart failure (HF) constitutes a favorable prognostic factor in the year following the index episode. The objective of this study was to evaluate whether the highest degree of hemoconcentration at 3 months after admission for HF is also a prognostic factor for mortality and/or readmission in the 12 months after admission. PATIENTS AND METHOD: The hemoconcentration group was the upper quartile of the sample distributed according to hemoglobin increase at month 3 after discharge with respect to hemoglobin at the time of admission for HF in a multicenter prospective cohort of 1,659 subjects with HF. RESULTS: The mean follow-up until the first event was 294 days, and a total of 487 deaths and 1,125 readmissions were recorded. The hemoconcentration group had a lower risk of mortality or readmission for any cause (RR=0.75, 95% CI: 0.51-1.09 and RR=0.86, 95% CI: 0.70-1.05), although statistical significance was lost after multivariate analysis, while it was retained for other factors with recognized negative impact on the prognosis of patients with HF, such as age and functional class. CONCLUSIONS: The degree of hemoconcentration at 3 months after admission for HF is not prognostic of readmission or death in the subsequent year.
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We report a 71 years old man suffering from transient ischemic attack associated with a calcinosis cerebri (Fahr's disease). Arterial hypertension was the unique vascular risk factor disclosed.
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Encefalopatías/complicaciones , Calcinosis/complicaciones , Disartria/etiología , Ataque Isquémico Transitorio/etiología , Anciano , Encefalopatías/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Clopidogrel , Disartria/tratamiento farmacológico , Humanos , Ataque Isquémico Transitorio/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
HISTORY AND OBJECTIVES: To analyze the differential clinical characteristics according to gender of patients with heart failure in terms of etiology, comorbidity, triggers, treatment, hospital stay and overall mortality at one year. PATIENTS AND METHOD: We employed data from the RICA registry, a multicenter prospective cohort of patients hospitalized in internal medicine departments for heart failure, with a follow-up of one year. We analyzed the differences between the gender in terms of the etiology of the heart disease, comorbidity, triggers, left ventricle ejection fraction, functional state, mental condition, treatment, length of stay and mortality at 1 year. RESULTS: A total of 1772 patients (47.2% men) were included. The women were older than the men (p<.001) and had a higher prevalence of hypertension, obesity, chronic kidney disease, atrial fibrillation and preserved left ventricle ejection fraction (p<.001). The men's medical history had a predominance of myocardial infarction, chronic obstructive pulmonary disease, peripheral arteriopathy (p<.001) and anemia (p=.02). In the women, a hypertensive etiology was predominant, followed by valvular. The main triggers were hypertension and atrial fibrillation. Treatment with beta-blockers, ACEIs and/or ARBs did not differ by sex. The women had poorer functional capacity (p<.001), according to the Barthel index. After adjusting for age and other prognostic factors, the mortality at one year was lower among the women (RR: 0.69; 95% CI 0.53-0.89; p=.004). CONCLUSIONS: HF in women occurs at a later age and with different comorbidities. The hypertensive and valvular etiology is predominant, with preserved left ventricle ejection fraction, and the age-adjusted mortality is lower than in men.
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OBJECTIVES: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). BACKGROUND: The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. METHODS: We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. RESULTS: A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. CONCLUSION: Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.
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Presión Sanguínea/fisiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , España/epidemiologíaAsunto(s)
Calcitonina/deficiencia , Menopausia , Osteoporosis/sangre , Anciano , Femenino , Humanos , Persona de Mediana Edad , PeriodicidadAsunto(s)
Calcio/metabolismo , Cálculos Renales/metabolismo , Compuestos de Magnesio , Adulto , Anciano , Calcio/sangre , Calcio/orina , Femenino , Humanos , Concentración de Iones de Hidrógeno , Magnesio/metabolismo , Masculino , Persona de Mediana Edad , Oxalatos/orina , Hormona Paratiroidea/orina , Fosfatos/metabolismo , Estruvita , Ácido Úrico/metabolismoRESUMEN
INTRODUCTION AND OBJECTIVES: There is a great variability in the prevalence of anemia in heart failure (HF) according to cohort based studies where the majority of patients have depressed left ventricular ejection fraction (LVEF). Our study has aimed to evaluate the prevalence of anemia in HF within the usual hospital clinical practice. METHODS: An initial analysis was made of a prospective cohort of inpatients with HF admitted during 3 months in 15 Internal Medicine Services including all health system levels. We used the World Health Organization (WHO) criteria to define anemia (hemoglobin [Hb] < 12 g/l in women and < 13 g/l in men) and a value > or = 45% as preserved LVEF. RESULTS: A total of 391 patients with an average age of 77.9 +/- 9.4; 239 women (61.1%). The 52.7% of the cases had anemia. Regarding multiple associated factors to anemia in the bivariant analysis, the regression model indicated the following variables: preserved LVEF (odds ratio [OR] 3.03), not being HF debut (OR 1.85), glomerular filtration (OR 0.97), functional class III-IV of the New York Heart Association (NYHA) (OR 0.53), arterial vascular disease (OR 0.41), antiaggregant treatment (OR 0.56) and treatment with nitrites (OR 0.48). CONCLUSION: Prevalence of anemia in HF is very high in usual clinical practice, that most frequently occurs in subjects with preserved LVEF.