ABSTRACT
Introducción La congestión persistente tras el alta por insuficiencia cardiaca (IC) se asocia a mayor riesgo de reingresos, siendo necesaria su valoración de forma precisa. Material y métodos Un total de 82 pacientes incluidos tras el alta por IC con el objetivo de caracterizar de forma sencilla y semicuantitativa el grado de congestión pulmonar y sus cambios, describiendo la relación entre dichos hallazgos y el manejo diurético. Resultados En la visita postalta, pese a la ausencia de congestión clínica en la mayoría de pacientes, la mitad presentaba algún grado de congestión pulmonar por ecografía. Tras valoración ecográfica y clínica en esta visita inicial se bajó el diurético en 50 pacientes (60%), se mantuvo igual en 16 (20%) y se aumentó en el resto. En los 45 pacientes sin congestión ecográfica, la bajada de diuréticos se intentó en el 80% siendo exitosa esta estrategia en la mayoría de ellos. Conclusiones La ecografía pulmonar, usando métodos de cuantificación sencillos, permite su incorporación real a nuestra práctica clínica ayudándonos en la toma de decisiones. (AU)
Introduction Persistent congestion after heart failure (HF) discharge is associated with a higher risk of readmissions. Material and methods Eighty-two patients included after HF discharge. The aim of the study was to characterize semiquantitatively the degree of pulmonary congestion and its changes, describing the relationship between these findings and diuretic management. Results On the first visit, despite the absence of clinical congestion in the majority of patients, half of the had some degree of pulmonary congestion by ultrasound. After global assessment in this initial visit (clinical and ultrasound) the diuretic was lowered in 50 patients (60%), kept the same in 16 (20%) and it was increased in the rest. In the 45 patients without ultrasound congestion, diuretic reduction was attempted in 80%, being this strategy successful in the majority of them. Conclusions Lung ultrasound, using simple quantification methods, allows its real incorporation into clinical practice, helping us in the decision making process. (AU)
Subject(s)
Humans , Heart Failure , Pulmonary Edema , Ultrasonography , Prospective StudiesABSTRACT
INTRODUCTION: Persistent congestion after heart failure (HF) discharge is associated with a higher risk of readmissions. MATERIAL AND METHODS: eighty-two patients included after HF discharge. The aim of the study was to characterize semiquantitatively the degree of pulmonary congestion and its changes, describing the relationship between these findings and diuretic management. RESULTS: On the first visit, despite the absence of clinical congestion in the majority of patients, half of the had some degree of pulmonary congestion by ultrasound. After global assessment in this initial visit (clinical and ultrasound) the diuretic was lowered in 50 patients (60%), kept the same in 16 (20%) and it was increased in the rest. In the 45 patients without ultrasound congestion, diuretic reduction was attempted in 80%, being this strategy successful in the majority of them. CONCLUSIONS: Lung ultrasound, using simple quantification methods, allows its real incorporation into clinical practice, helping us in the decision making process.
Subject(s)
Heart Failure , Pulmonary Edema , Humans , Diuretics/therapeutic use , Patient Discharge , Prevalence , Pulmonary Edema/complications , Pulmonary Edema/epidemiology , Lung , Heart Failure/complications , PrognosisABSTRACT
BACKGROUND: Little information is available regarding the consequences of steroid withdrawal following heart transplantation (HT) in Spain. METHODS: We analyzed the records of 1068 patients (81.6% men) who underwent HT between 2000 and 2005 in 13 Spanish centers who were aged ≥ 18 years and who survived at least 1 year. Death rates and Kaplan-Meier survival curves for 1 to 5 years post-HT were compared among four groups: groups A and B, patients on steroids throughout the first 5 years post-HT at dosages of ≤ 5 mg/d between 1-year and 5-year follow-up (group A; n = 148), or >5 mg/d for some part of this period (group B; n = 578). Groups C and D were patients from whom steroids were at some point withdrawn including group D (n = 73) with and group C (n = 269) without subsequent reintroduction into the maintenance regimen. RESULTS: Steroids were withdrawn at 1.6 ± 0.9 years post-HT in group C, and 1.7 ± 1.2 years post-HT in group D. The death rate between 1- and 5-year follow-up (deaths per 1000 person-years) was 44.3% (95% confidence interval 26.2-62.5) in group A, 42.6% (33.7-51.4) in group B, 30.5% (19.6-41.4) in group C, and 47.8% (21.8-73.7) in group D. There was no significant difference among them or among Kaplan-Meier survival curves of the four groups (P = .34 in both cases). Comparison of combined groups C + D with groups A + B showed no evidence of a greater mortality among combined groups C + D. CONCLUSIONS: The late withdrawal of steroids following HT was not associated with increased mortality.
