Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure.

OBJECTIVE: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as 'Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). METHODS: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). RESULTS: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. CONCLUSION: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this 'new HF syndrome'.

Combining loop and thiazide diuretics for acute heart failure across the estimated glomerular filtration rate spectrum: A post-hoc analysis of the CLOROTIC trial.

AIMS: In patients with acute heart failure (AHF), the addition of hydrochlorothiazide (HCTZ) to furosemide improved diuretic response in the CLOROTIC trial. This work aimed to evaluate if these effects differ across the estimated glomerular filtration rate (eGFR) spectrum. METHODS AND RESULTS: This post-hoc analysis of the CLOROTIC trial analysed 230 patients with AHF and explored the influence of eGFR on primary and secondary endpoints. The median eGFR was 43 ml/min/1.73 m2 (range 14-109) and 23% had eGFR ≥60 ml/min/1.73 m2 (group 1), 24% from 45 to 59 ml/min/1.73 m2 (group 2), and 53% <45 ml/min/1.73 m2 (group 3). Patients treated with HCTZ had greatest weight loss at 72 h in all three groups, but patients in group 1 had a significantly greater response (-2.1 kg [-3.0 to 0.5]), compared to patients in groups 2 (-1.3 kg [-2.3 to 0.2]) and 3 (-0.1 kg [-1.3 to 0.4]) (p-value for interaction = 0.246). At 96 h, the differences in weight were -1.8 kg (-3.0 to -0.3), -1.4 kg (-2.6 to 0.3), and -0.5 kg (-1.3 to -0.1) in groups 1, 2, and 3, respectively (p-value for interaction = 0.256). There were no significant differences observed with the addition of HCTZ in terms of diuretic response, mortality or rehospitalizations, or safety endpoints (impaired renal function, hyponatraemia, and hypokalaemia) among the three eGFR groups (all p-values for interaction were no significant). CONCLUSION: The addition of eGFR-adjusted doses of oral HCTZ to loop diuretics in patients with AHF improved diuretic response across the eGFR spectrum. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT01647932; EudraCT number: 2013-001852-36.

[Etiology and clinical management of anemia in heart failure. GESAIC Study]. / Etiología y tratamiento de la anemia en la insuficiencia cardíaca. Estudio GESAIC.

BACKGROUND AND OBJECTIVE: Studies about anemia in heart failure (HF) tend to link the anemia to a cardio-renal dysfunction, and its syndromic value is seldom evaluated. Our objective was to assess the etiology and clinical management of anemia in HF patients in a hospital setting. PATIENTS AND METHOD: Initial cross-sectional analysis of a multi-center and prospective cohort of patients with HF and anemia. Anemia was defined according to the WHO criteria; the Modification of Diet in Renal Disease equation was used to assess glomerular filtration and the etiology of anemia was defined according to common criteria. RESULTS: We evaluated 228 patients, with a median age of 79.1 years and 59.65% women. Iron deficiency anemia was present in 36,8% of patients and anemia of chronic disease in 30.3%. Of note, 12.7% cases did not meet any etiological criteria. The main factor associated with iron deficiency was anti-platelet therapy (OR=1.99; 95% CI, 1.16-1.68) and the main factors associated with anemia of chronic disease were the use of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA-II) (OR=3.29; 95% CI, 1.36-7.94). The main factor associated with undefined anemia was initial heart failure (OR=5.41; 95% CI, 1.65-17.65). On the other hand, 8.1% of patients required transfusion, 6% were treated with erythropoietin and 25.3% were treated with iron. Both age (OR=1.04; 95% CI, 1-1.08) and hemoglobin level at admission (OR=1.81; 95% CI, 1.46-2.25) were associated with active treatment for anemia. CONCLUSIONS: A clinical study of anemia in patients with HF can establish an etiological diagnosis in 70% of cases, resulting in a more effective treatment.

Etiología y tratamiento de la anemia en la insuficiencia cardíaca. Estudio GESAIC / Etiology and clinical management of anemia in heart failure. GESAIC study

Fundamento y objetivo: Los trabajos sobre anemia en la insuficiencia cardíaca (IC) tienden a aceptar la anemia como una disfunción cardiorrenal combinada, sin realizar estudios etiológicos, omitiendo su carácter sindrómico. Nuestro objetivo es conocer el perfil etiológico y el tratamiento de la anemia en la IC en el medio hospitalario. Pacientes y método: Análisis transversal inicial de una cohorte multicéntrica de pacientes con IC y anemia recogidos de forma prospectiva. Utilizamos los criterios de la Organización Mundial de la Salud (OMS) para definir anemia, la ecuación Modification of Diet in Renal Disease (MDRD) para el cálculo del filtrado glomerular y unos criterios comunes para definir la etiología de la anemia. Resultados: Se incluyó a 228 pacientes, con edad media de 79,1 años, y el 59,65% mujeres. El 36,8% tenía anemia ferropénica y el 30,3% anemia de enfermedad crónica. En el 12,7% de los casos no se llegó a ningún diagnóstico etiológico. La variable con mayor potencia asociada a anemia ferropénica fue el tratamiento previo con antiagregantes (odds ratio [OR]=1,99; intervalo de confianza [IC] del 95%, 1,13¿3,53) y para anemia de enfermedad crónica, los bloqueadores del sistema renina angiotensina (SRA) (OR=3,29; IC del 95%, 1,36¿7,94). La anemia sin diagnóstico se asociaba con IC en su inicio (OR=5,41; IC del 95%, 1,65¿17,65). Recibió transfusión el 8,1% de los pacientes; un 6%, eritropoyetina, y el 25,3%, suplementos de hierro. La edad (OR=1,04; IC del 95%, 1¿1,08) y un valor más bajo de hemoglobina al ingreso (OR=1,81; IC del 95%, 1,46¿2,25) determinaron una actitud activa de tratamiento. Conclusiones: Un protocolo clínico de estudio de la anemia en la IC permite en un 70% de los casos un diagnóstico etiológico y un tratamiento más eficaz (AU)

Background and objective: Studies about anemia in heart failure (HF) tend to link the anemia to a cardio-renal dysfunction, and its syndromic value is seldom evaluated. Our objective was to assess the etiology and clinical management of anemia in HF patients in a hospital setting. Patients and method: Initial cross-sectional analysis of a multi-center and prospective cohort of patients with HF and anemia. Anemia was defined according to the WHO criteria; the Modification of Diet in Renal Disease equation was used to assess glomerular filtration and the etiology of anemia was defined according to common criteria. Results: We evaluated 228 patients, with a median age of 79.1 years and 59.65% women. Iron deficiency anemia was present in 36,8% of patients and anemia of chronic disease in 30.3%. Of note, 12.7% cases did not meet any etiological criteria. The main factor associated with iron deficiency was anti-platelet therapy (OR=1.99; 95% CI, 1.16¿1.68) and the main factors associated with anemia of chronic disease were the use of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA-II) (OR=3.29; 95% CI, 1.36¿7.94). The main factor associated with undefined anemia was initial heart failure (OR=5.41; 95% CI, 1.65¿17.65). On the other hand, 8.1% of patients required transfusion, 6% were treated with erythropoietin and 25.3% were treated with iron. Both age (OR=1.04; 95% CI, 1¿1.08) and hemoglobin level at admission (OR=1.81; 95% CI, 1.46¿2.25) were associated with active treatment for anemia. Conclusions: A clinical study of anemia in patients with HF can establish an etiological diagnosis in 70% of cases, resulting in a more effective treatment (AU)