ABSTRACT
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.
Subject(s)
Heart Failure , Tetrazoles , Humans , Tetrazoles/pharmacology , Tetrazoles/therapeutic use , Stroke Volume , Treatment Outcome , Valsartan/pharmacology , Valsartan/therapeutic use , Heart Failure/drug therapy , Heart Failure/epidemiology , Chronic Disease , Aminobutyrates/pharmacology , Aminobutyrates/therapeutic use , Drug Combinations , Registries , Angiotensin Receptor Antagonists/adverse effectsABSTRACT
Intracardiac thrombus is a potentially life-threatening condition, with a high risk of embolic complications. Although vitamin K antagonists have been traditionally used for the treatment of intracardiac thrombus, they have relevant disadvantages that limit their use. Rivaroxaban is a once daily oral anticoagulant, currently indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, and for the prevention and treatment of venous thromboembolism. We present the case of a 78-year-old man with nonvalvular atrial fibrillation, heart failure and creatinine clearance of 40 ml/min, anticoagulated with rivaroxaban 15 mg/day as the patient had very difficult access to hematologic controls. The transthoracic echocardiogram showed dilated left ventricle, severe left ventricular dysfunction and two images of thrombus, which disappeared after 4 weeks of treatment with rivaroxaban. To our knowledge, this is the first case reported regarding the resolution of left ventricular thrombosis with rivaroxaban.
Subject(s)
Heart Diseases/drug therapy , Morpholines/administration & dosage , Thiophenes/administration & dosage , Thrombosis/drug therapy , Aged , Dose-Response Relationship, Drug , Echocardiography , Factor Xa Inhibitors/administration & dosage , Follow-Up Studies , Heart Diseases/diagnostic imaging , Heart Ventricles , Humans , Male , Rivaroxaban , Thrombosis/diagnostic imagingABSTRACT
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