RESUMEN
The last decade has brought tremendous interest in the problem of cardiogenic shock. However, the mortality rate of this syndrome approaches 50%, and other than prompt myocardial revascularization, there have been no treatments proven to improve the survival of these patients. The bulk of studies have been in patients with acute myocardial infarction, and there is little evidence to guide the clinician in those patients with heart failure cardiogenic shock (HF-CS). An International Society for Heart and Lung Transplant consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals) with vast clinical and published experience in CS, representing 42 centers worldwide. This consensus report summarizes the results of a premeeting survey answered by participants and the breakout sessions where predefined clinical issues were discussed to achieve consensus in the absence of robust data. Key issues discussed include systems for CS management, including the "hub-and-spoke" model vs a tier-based network, minimum levels of data to communicate when considering transfer, disciplines that should be involved in a "shock team," goals for mechanical circulatory support device selection, and optimal flow on such devices. Overall, the document provides expert consensus on some important issues facing practitioners managing HF-CS. It is hoped that this will clarify areas where consensus has been reached and stimulate future research and registries to provide insight regarding other crucial knowledge gaps.
Asunto(s)
Insuficiencia Cardíaca , Infarto del Miocardio , Humanos , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Choque Cardiogénico/diagnóstico , Insuficiencia Cardíaca/cirugía , Infarto del Miocardio/terapiaRESUMEN
RESUMEN Objetivos: Describir las características clínicas, el impacto en la calidad de vida, la clase funcional (CF), el número de internaciones y la supervivencia de los pacientes que ingresaron a un hospital de día (HD) de insuficiencia cardíaca (IC). Material y métodos: Se analizaron en forma retrospectiva aquellos pacientes que ingresaron a un HD para la infusión de hierro, furosemida, levosimendán o la combinación de estos dos últimos fármacos, durante un período de 3 años. Las variables analizadas, al inicio y a los 6 meses, fueron la CF (NYHA), la prueba de marcha de 6 minutos (PM6M) y calidad de vida mediante el cuestionario de Minnesota (MLHFQ). El número de internaciones por IC fue comparado con el del año previo al ingreso al HD y la supervivencia fue evaluada al año de seguimiento. Resultados: Se observó una mejoría significativa de la CF en los 4 grupos, y del número de internaciones por IC en los primeros 3. Conclusiones: El desarrollo del HD puede modificar el presente y futuro de esta población.
ABSTRACT Objectives: To describe the clinical characteristics, impact on quality of life, functional class (FC), number of hospitalizations, and survival rate of patients with heart failure (HF) enrolled in an outpatient heart failure clinic (HFC). Methods: Patients enrolled in a HFC for infusion of iron, furosemide, levosimendan -or the combination of these two drugsover a 3-year period were retrospectively analyzed. Baseline and 6-month variables were FC (NYHA), 6-minute walk test (6MWT) and quality of life using the Minnesota questionnaire (MLHFQ). The number of HF hospitalizations was compared with that of the year prior to HFC enrollment, and survival was assessed at 1-year follow-up. Results: A significant improvement in FC was observed in all four groups, and a decrease of HF hospitalizations in the first three. Conclusions: Outpatient HFC development can change the present and future of this population.
