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Background: Heart failure (HF) and atrial fibrillation (AF) represent conditions that commonly coexist. The impact of AF in HF has yet to be well studied in Latin America. This study aimed to characterize the sociodemographic and clinical features, along with patients' outcomes with AF and HF from the Colombian Heart Failure Registry (RECOLFACA). Methods: Patients with ambulatory HF and AF were included in RECOLFACA, mainly with persistent or permanent AF. A 6-month follow-up was performed. Primary outcome was all-cause mortality. To assess the impact of AF on mortality, we used a logistic regression model. A P value of < 0.05 was considered significant. All statistical tests were two-tailed. Results: Of 2,528 patients with HF in the registry, 2,514 records included information regarding AF diagnosis. Five hundred sixty (22.3%) were in AF (mean age 73 ± 11, 56% men), while 1,954 had no AF (mean age 66 ± 14 years, 58% men). Patients with AF were significantly older and had a different profile of comorbidities and implanted devices compared to non-AF patients. Moreover, AF diagnosis was associated with lower quality of life score (EuroQol-5D), mainly in mobility, personal care, and daily activity. AF was prevalent in patients with preserved ejection fraction (EF), while no significant differences in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were observed. Although higher mortality was observed in the AF group compared to individuals without AF (8.9% vs. 6.1%, respectively; P = 0.016), this association lost statistical significance after adjusting by age in a multivariate regression model (odds ratio (OR): 1.35; 95% confidence interval (CI): 0.95 - 1.92). Conclusions: AF is more prevalent in HF patients with higher EF, lower quality of life and different clinical profiles. Similar HF severity and non-independent association with mortality were observed in our cohort. These results emphasize the need for an improved understanding of the AF and HF coexistence phenomenon.
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INTRODUCTION: Chronic kidney disease (CKD) represents one of the most frequent comorbidities observed in heart failure (HF) patients and has been observed to increase this population's risk of adverse outcomes. Nevertheless, evidence analyzing kidney dysfunction in HF is scarce in Latin American populations. We aimed to analyze the prevalence of kidney dysfunction and assess its association with mortality in patients diagnosed with HF enrolled in the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of the different categories of eGFR in mortality risk. A p value of <0.05 was considered significant. All statistical tests were two-tailed. RESULTS: From the total 2,514 evaluated patients, 1,501 (59.7%) patients had moderate kidney dysfunction (eGFR <60 mL/min/1.73 m2), while 221 (8.8%) patients were classified as having a severe kidney dysfunction (eGFR <30 mL/min/1.73 m2). Patients with lower kidney function were most commonly males, had higher median age, and reported a higher prevalence of cardiovascular comorbidities. Moreover, different patterns of medications prescription were observed when comparing CKD versus non-CKD patients. Finally, eGFR <30 mL/min/1.73 m2 was significantly associated with a higher mortality risk compared to eGFR >90 mL/min/1.73 m2 status (HR: 1.87; 95% CI, 1.10-3.18), even after an extensive adjustment by relevant covariates. CONCLUSION: CKD represents a prevalent condition in the setting of HF. Patients with CKD and HF present with multiple sociodemographic, clinical, and laboratory differences compared with those only diagnosed with HF and present a significantly higher risk of mortality. A timely diagnosis and optimal treatment and follow-up of CKD in the setting of HF may improve the prognosis of these patients and prevent adverse outcomes.
Assuntos
Insuficiência Cardíaca , Insuficiência Renal Crônica , Masculino , Adulto , Humanos , Prognóstico , Colômbia/epidemiologia , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/diagnósticoRESUMO
La coleoterapia (consumo de larvas de Ulomoides Dermestoides), ha sido utilizado en medicina alternativa para tratar diferentes patologías crónicas como artritis, diabetes o cáncer. Su uso ha incrementado en Suramérica en los últimos años ganando aceptación. Presentamos el caso de una mujer de 64 años con purpura palpable en extremidades y fiebre que aparece durante el consumo de las larvas. Fue diagnosticado una vasculitis de hipersensibilidad la cual resolvió después de suspender el consumo de las larvas e iniciar corticosteroides. Esta es la primera asociación entre coleoterapia y purpura palpable que se ha descrito en la literatura destacando el potencial riesgo de eventos adversos generados por tratamientos de medicina alternativa
Ingestion of Ulomoides Dermestoides "beetle-peanut" has been used in alternative medicine to treat different chronic diseases such as arthritis, diabetes or cancer. Its use has increased in South America in recent years with acceptance. We present the case of a 64-year-old woman with palpable purpura in limbs and fever that appears during ingestion of the beetles. A hypersensitivity vasculitis was diagnosed which resolved after suspending ingestion of the beetles and initiating corticosteroids. The present case shows the potential risk of adverse events generated by alternative medicine treatments. This is the first association between Ingestion of Ulomoides dermestoides "beetle-peanut" and palpable purpura which has been described in the literature
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El síndrome de Gardner-Diamond o púrpura psicógena es una vasculopatía de presunto origen autoinmune que se caracteriza por una reacción cutánea localizada, asociada a situaciones de estrés emocional. Se presenta el caso de una paciente con lesiones equimóticas, dolorosas y de aparición intermitente, relacionadas con diversos eventos estresores, que habían sido manejadas como manifestación de lupus
Gardner-Diamond syndrome or psychogenic purpura is an vasculopathy characterized by a localized cutaneous reaction, associated with episodes of emotional stress or mental illness as trigger factors. A case of a female patient with multiple, intermittent, nodular, ecchymotic and painful lesions related to various stressing events that was treated as lupus is reported below