What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges.

INTRODUCTION: Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce. AREAS COVERED: A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed. EXPERT OPINION: Worsening HF can be defined as situations where the patient's HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data.

Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry.

INTRODUCTION AND OBJECTIVES: Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors. METHODS: This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment. RESULTS: Hyperkalemia (K+> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia. CONCLUSIONS: This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment.

Optimal pharmacological treatment and adherence to medication in secondary prevention of cardiovascular events in Spain: Results from the CAPS study.

INTRODUCTION: Despite the large amount of evidence supporting the use of antiplatelet agents, beta-blockers, angiotensin antagonists, and lipid-lowering statins in patients with stable coronary artery disease, several studies have documented underprescription of optimal medical treatment (OMT) in Spain. AIMS: The present study aimed to describe the current trend of pharmacological prescription in secondary prevention treatment for cardiovascular diseases (CVDs) in a Spanish cohort. METHODS: This study was a multicenter, observational, cross-sectional study (CAPS study, FER-CAR-2014-01) in the context of only one visit. Adherence levels to the prescribed medication, the reasons for not prescription of each medication, the existence of possible associations between sociodemographic features, different CVDs, and different drugs with treatment compliance were also analyzed in patients who have suffered cardiovascular effects. RESULTS: Six hundred and twelve patients (68.5±10.7 years old; 78% males) were included. OMT was prescribed in 40.8% of the patients. The main reason for not prescribing was due to the physician's discretion. Adherence to medication, measured by the Morisky-Green questionnaire, was 45.8%, and it was positively related to the presence of coronary events (OR 1.80; 95% CI: 1.05-3.21) but not with any drug type. Moreover, a higher educational background implied a higher percentage of adherence to medication. Finally, nonadherent patients were prescribed more daily medicine intakes. CONCLUSIONS: Low adherence to guideline-oriented treatment as well as low adherence to medication was found by a self-reported questionnaire. Enhancing adherence to guideline-recommended therapy and reducing treatment complexity seem to be reasonable strategies to improve adherence to secondary prevention medications.

[How many patients admitted for heart failure are eligible for cardiac resynchronization therapy? Analysis of the Andalusian Heart Failure Registry (RAIC) study]. / Cuántos pacientes ingresados por insuficiencia cardiaca son elegibles para terapia de resincronización cardiaca? Análisis del estudio RAIC (Registro Andaluz de Insuficiencia Cardiaca).

INTRODUCTION AND OBJECTIVES: The objective was to determine what percentage of patients admitted for heart failure met criteria for cardiac resynchronization therapy. METHODS: The study involved registry data on heart failure admissions at 16 public hospitals in Andalusia, Spain between May and July 2004. Criteria for cardiac resynchronization therapy from American College of Cardiology and American Heart Association guidelines were applied: a left ventricular ejection fraction < or = 0.35, New York Heart Association functional class III or IV, and a QRS interval > 120 ms. Outcome was evaluated at 3 months. Multivariate (i.e., logistic regression) analysis was used to identify independent variables associated with meeting resynchronization therapy criteria. RESULTS: The study included 674 patients (43.3% women, mean age 71[11] years). Of these, 5.6% met resynchronization therapy criteria at admission. There was no significant difference in the cardiovascular event rate at 3 months between patients who met resynchronization therapy criteria and those who did not (34.2% vs 23.4%, respectively). Admitting hospital (odds ratio [OR]=0.30, 95% confidence interval [CI], 0.11-0.79), ischemic etiology (OR=2.71, 95% CI, 1.26-5.81), the presence of left bundle branch block (OR=14.97, 95% CI, 5.95-37.64), and mitral regurgitation (OR=4.18, 95% CI, 1.93-9.04) were all independently associated with meeting resynchronization therapy criteria at both admission and short-term follow-up. CONCLUSIONS: The percentage of patients who met cardiac resynchronization therapy criteria was small, but their short-term prognosis was poor. A number of clinical variables associated with meeting resynchronization therapy criteria were identified.

[Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-2001)]. / Pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Resultados durante un período de 15 años (1987-2001).

INTRODUCTION AND OBJECTIVES: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. PATIENTS AND METHOD: We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. RESULTS: Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. CONCLUSIONS: Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.