RESUMO
BACKGROUND: Limited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure. OBJECTIVES: The authors evaluated eGFR dynamics using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation and its prognostic significance in a real-world cohort over a 15-year follow-up. METHODS: A prospective observational registry of ambulatory heart failure outpatients was conducted, with regular eGFR assessments at baseline and on a 3-month schedule for ≤15 years. Urgent kidney function assessments were excluded. Locally weighted error sum of squares curves were plotted for predefined subgroups. Multivariable longitudinal Cox regression analyses were conducted to assess associations with all-cause and cardiovascular death. RESULTS: A total of 2,672 patients were enrolled consecutively between August 2001 and December 2021. The average age was 66.8 ± 12.6 years, and 69.8% were men. Among 40,970 creatinine measurements, 28,634 were used for eGFR analysis, averaging 10.7 ± 8.5 per patient. Over the study period, a significant decline in eGFR was observed in the entire cohort, with a slope of -1.70 mL/min/1.73 m2 per year (95% CI: -1.75 to -1.66 mL/min/1.73 m2 per year). Older patients, those with diabetes, a preserved ejection fraction, a higher baseline eGFR, elevated hospitalization rates, and those who died during follow-up experienced more pronounced decreases in the eGFR. Moreover, the decrease in kidney function correlated independently with all-cause mortality and cardiovascular death. CONCLUSIONS: These findings highlight the sustained decline in eGFR over 15 years in patients with heart failure, with variations based on clinical characteristics, and emphasize the importance of regular eGFR monitoring in this population.
Assuntos
Taxa de Filtração Glomerular , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/mortalidade , Masculino , Feminino , Taxa de Filtração Glomerular/fisiologia , Idoso , Seguimentos , Estudos Prospectivos , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/complicações , Causas de Morte/tendências , Sistema de Registros , Volume Sistólico/fisiologia , Creatinina/sangue , Creatinina/metabolismoRESUMO
Introducción y objetivos: La insuficiencia cardiaca (IC) se asocia a una alta tasa de reingreso en los 30 días posteriores al alta. Las estrategias para reducir los reingresos han mostrado, en general, resultados moderados. Hemos desarrollado una consulta multidisciplinaria estructurada ambulatoria para pacientes ancianos y frágiles tras el alta de un ingreso por IC (STOP-HF-Clinic), con el objetivo de reducir estas tasas de reingreso. Métodos: Estudio prospectivo que incluye a todos los pacientes dados de alta de medicina interna o geriatría tras una hospitalización por IC. Intervención: visita presencial temprana (antes de 7 días), educación sobre IC por enfermería, titulación del tratamiento y administración de medicamentos intravenosos cuando fuera necesario. El riesgo de reingreso a 30 días se calculó utilizando la puntuación de riesgo CORE-HF. También se estudió el impacto de la carga de reingresos a 30 días en la atención sanitaria regional comparando la tasa de reingresos en el área de referencia de la STOP-HF-Clinic (∼250.000 personas) con la del resto del Servei Català de la Salut (CatSalut) (∼7,5 millones de personas) durante 2 periodos de tiempo, antes de la STOP-HF-Clinic (2012-2013) y después (2014-2015). Resultados: De febrero de 2014 a junio de 2016, se incluyó a 518 pacientes consecutivos (media de edad, 82 años; índice de Barthel, 70; índice de Charlson, 5,6; riesgo a 30 días de reingreso según la puntuación CORE-HF, 26,5%). La tasa de reingreso a 30 días por todas las causas observadas fue del 13,9% (reducción del riesgo relativo, el 47,5%), y la tasa de reingreso por IC a 30 días observada fue del 7,5%. El registro del CatSalut incluyó 65.131 ingresos índice por IC, con 9.267 reingresos a 30 días por todas las causas y 6.686 por IC. La tasa de reingresos a 30 días se redujo significativamente en el área de referencia de la STOP-HF-Clinic en 2014-2015 en comparación con 2012-2013 (p < 0,001), a expensas principalmente de la reducción de los reingresos por IC. Conclusiones: La STOP-HF-Clinic, iniciativa que podría aplicarse sin demora en otros lugares, es una valiosa intervención para reducir la carga total de reingresos prematuros de los pacientes con IC mayores y frágiles (AU)
Introduction and objectives: Heart failure (HF) is associated with a high rate of readmissions within 30 days postdischarge. Strategies to lower readmission rates generally show modest results. To reduce readmission rates, we developed a STructured multidisciplinary outpatient clinic for Old and frail Postdischarge patients hospitalized for HF (STOP-HF-Clinic). Methods: This prospective all-comers study enrolled patients discharged from internal medicine or geriatric wards after HF hospitalization. The intervention involved a face-to-face early visit (within 7 days), HF nurse education, treatment titration, and intravenous medication when needed. Thirty-day readmission risk was calculated using the CORE-HF risk score. We also studied the impact of 30-day readmission burden on regional health care by comparing the readmission rate in the STOP-HF-Clinic Referral Area (∼250 000 people) with that of the rest of the Catalan Health Service (CatSalut) (∼7.5 million people) during the pre-STOP-HF-Clinic (2012-2013) and post-STOP-HF-Clinic (2014-2015) time periods. Results: From February 2014 to June 2016, 518 consecutive patients were included (age, 82 years; Barthel score, 70; Charlson index, 5.6, CORE-HF 30-day readmission risk, 26.5%). The observed all-cause 30-day readmission rate was 13.9% (47.5% relative risk reduction) and the observed HF-related 30-day readmission rate was 7.5%. The CatSalut registry included 65 131 index HF admissions, with 9267 all-cause and 6686 HF-related 30-day readmissions. The 30-day readmission rate was significantly reduced in the STOP-HF-Clinic Referral Area in 2014-2015 compared with 2012-2013 (P < .001), mainly driven by fewer HF-related readmissions. Conclusions: The STOP-HF-Clinic, an approach that could be promptly implemented elsewhere, is a valuable intervention for reducing the global burden of early readmissions among elder and vulnerable patients with HF (AU)
Assuntos
Humanos , Continuidade da Assistência ao Paciente , Insuficiência Cardíaca/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/normas , Idoso Fragilizado/estatística & dados numéricos , Equipe de Assistência ao Paciente/tendências , Cuidado Transicional/tendênciasRESUMO
Introducción y objetivos: La influencia de la cinética de la hemoglobina en la insuficiencia cardiaca no se ha establecido por completo. Métodos: Se determinó la hemoglobina en la primera visita y a los 6 meses. La anemia se definió según los criterios de la Organización Mundial de la Salud (hemoglobina < 13 g/dl los varones y < 12 g/dl las mujeres). Según los valores de hemoglobina, se estableció una clasificación de los pacientes como sin anemia (ambas determinaciones normales), con anemia transitoria (anemia en la primera visita, pero no a los 6 meses), con anemia de nueva aparición (inicialmente sin anemia, pero con anemia a los 6 meses) o con anemia permanente (anemia en ambas determinaciones). Resultados: Se incluyó en el estudio a 1.173 pacientes consecutivos (el 71,9% varones; media de edad, 66,8 ± 12,2 años). Se consideró sin anemia a 476 pacientes (40,6%), con anemia transitoria a 170 (14,5%), con anemia de nueva aparición a 147 (12,5%) y con anemia persistente a 380 (32,4%). Durante un seguimiento de 3,7 ± 2,8 años después de la visita realizada a los 6 meses, fallecieron 494 pacientes. En los análisis multivariables generales, la anemia (p < 0,001) y el tipo de anemia (p < 0,001) continuaron siendo factores independientes predictivos de mortalidad por cualquier causa. En comparación con los pacientes sin anemia, aquellos con anemia persistente (hazard ratio [HR] = 1,62; intervalo de confianza del 95% [IC95%], 1,30-2,03; p < 0,001) o con anemia de nueva aparición (HR = 1,39; IC95%, 1,04-1,87; p = 0,03) presentaron más mortalidad, e incluso los pacientes con anemia transitoria mostraron una tendencia similar, aunque sin alcanzar significación estadística (HR = 1,31; IC95%, 0,97-1,77; p = 0,075). Conclusiones: La anemia en especial la persistente y la de nueva aparición y, en menor medida, la anemia transitoria tiene efectos nocivos en la insuficiencia cardiaca (AU)
Introduction and objectives: The influence of hemoglobin kinetics on outcomes in heart failure has been incompletely established. Methods: Hemoglobin was determined at the first visit and at 6 months. Anemia was defined according to World Health Organization criteria (hemoglobin < 13 g/dL for men and hemoglobin < 12 g/dL for women). Patients were classified relative to their hemoglobin values as nonanemic (both measurements normal), transiently anemic (anemic at the first visit but not at 6 months), newly anemic (nonanemic initially but anemic at 6 months), or permanently anemic (anemic in both measurements). Results: A total of 1173 consecutive patients (71.9% men, mean age 66.8 ± 12.2 years) were included in the study. In all, 476 patients (40.6%) were considered nonanemic, 170 (14.5%) had transient anemia, 147 (12.5%) developed new-onset anemia, and 380 (32.4%) were persistently anemic. During a follow-up of 3.7 ± 2.8 years after the 6-month visit, 494 patients died. On comprehensive multivariable analyses, anemia (P < .001) and the type of anemia (P< .001) remained as independent predictors of all-cause mortality. Compared with patients without anemia, patients with persistent anemia (hazard ratio [HR] = 1.62; 95% confidence interval [95%CI], 1.30-2.03; P < .001) and new-onset anemia (HR = 1.39; 95%CI, 1.04-1.87, P= .03) had higher mortality, and even transient anemia showed a similar trend, although without reaching statistical significance (HR = 1.31; 95%CI, 0.97-1.77, P = .075). Conclusions: Anemia, especially persistent and of new-onset, and to a lesser degree, transient anemia, is deleterious in heart failure (AU)
Assuntos
Humanos , Insuficiência Cardíaca/fisiopatologia , Anemia Ferropriva/epidemiologia , Hemoglobinas Glicadas/análise , Prognóstico , MortalidadeRESUMO
Se define como reacción adversa a medicamentos (RAM) cualquier respuesta nociva y no intencionada a un medicamento. Las RAM constituyen una importante causa de morbimortalidad y de aumento de los costes sanitarios. Los sistemas de farmacovigilancia permiten la identificación y prevención de los riesgos asociados al uso de medicamentos, sobre todo de los fármacos de reciente comercialización; detectan señales a partir de datos del registro mundial de RAM y, además, dan soporte a las decisiones adoptadas por las agencias reguladoras de los diferentes países. Solo una minoría de los medicamentos comercializados se retiran del mercado: la hepatotoxicidad es la causa más frecuente. La notificación espontánea de RAM es el método más utilizado, barato y sencillo para reconocer nuevos problemas de seguridad, si bien su principal limitación es la infranotificación. El futuro de la farmacovigilancia y de las RAM pasará por una mayor implicación de los pacientes, médicos, autoridades sanitarias y empresas farmacéuticas y por el uso de las nuevas tecnologías
An adverse drug reaction (ADR) is defined as a response to a medicinal product which is noxious and unintended. ADRs are an important cause of morbidity and mortality and increase health costs. The pharmacovigilance systems allow the identification and prevention of the risks associated with use of a drug, especially of recently marketed drugs; they detect signals from data of the global ADR register and also support decisions taken by regulatory agencies in different countries. Only a few drugs are withdrawn from the market, mainly due to hepatotoxicity. Spontaneous notification of ADR is the cheapest, simplest and most used method to recognize new safety drug problems, under-reporting being its main limitation. The future of pharmacovigilance and ADRs will include a higher involvement of patients, doctors, health authorities and pharmaceutical companies, and the use of new technologies
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Humanos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Farmacovigilância , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Indicadores de Morbimortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificaçãoRESUMO
No disponible
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Antiarrítmicos/uso terapêuticoRESUMO
No disponible
No disponible
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Humanos , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Pneumonia Pneumocócica/complicações , Anemia Hemolítica Autoimune/etiologia , Diagnóstico ClínicoRESUMO
No disponible