Prevalence, Related Factors and Association of Left Bundle Branch Block With Prognosis in Patients With Acute Heart Failure: a Simultaneous Analysis in 3 Independent Cohorts.

OBJECTIVES: To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF). METHODS AND RESULTS: We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%-14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89-1.17), 1.15 (0.95-1.38) and 1.32 (0.94-1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88-1.14), 1.14 (0.92-1.40) and 1.26 (0.84-1.89). These results were consistent in sensitivity analyses. CONCLUSIONS: Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry.

AIM: To determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM and if these conditions confer a worse patient prognosis. METHODS AND RESULTS: Cohort study based on the RICA Spanish Heart Failure Registry, a multicentre, prospective registry that enrols patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index, haemoglobin levels, estimated glomerular filtration rate and systolic blood pressure. A total of 1934 patients were analysed: 907 had T2DM (mean age 78.4 ± 7.6 years) and 1027 did not (mean age 81.4 ± 7.6 years). The analysis resulted in four clusters in patients with T2DM and three in the reminder. All clusters of patients with T2DM showed higher BMI and more kidney disease and anaemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, P = .001). CONCLUSIONS: Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared with those without T2DM.

Troponin T in acute heart failure: clinical implications and prognosis in the Spanish National Registry on Heart Failure.

BACKGROUND: Elevated troponin in heart failure has been associated with worse prognosis, but there are differences in the design and results of published studies. Our objective was to determine the association of troponin T with mortality and readmissions in patients with acute heart failure in clinical practice conditions. METHODS: We included patients from the RICA registry who were hospitalized for acute heart failure. They were classified into 3 groups according to troponin T levels: normal, intermediate and high (<0.02, 0.02-0.049 and ≥ 0.05 ng/mL, respectively). Survival was studied by Kaplan-Meier curves and the association of variables was tested by Cox regression analysis. RESULTS: A total of 406 patients was included. Average age was 76.9 (76.0-77.7) years. Hypertensive heart disease was the most common etiology. Left ventricular ejection fraction was <45% in 22.1% of the patients. The group with elevated troponin T had higher proportions of women, systolic dysfunction, renal failure and anemia, a lower body mass index and longer hospital stay. At one year, patients with elevated troponin T had higher mortality than patients with normal troponin (35.5 vs. 13.9%, p<0.001). The composite event (mortality and readmissions) was also more frequent (51.6 vs. 30.9%, p<0.001), but there were no differences in readmissions alone. Troponin T ≥ 0.02 ng/mL was independently associated with mortality. CONCLUSIONS: Elevated troponin T levels are common in patients with heart failure in clinical practice and are associated with increased mortality and events after one year of follow-up.

[Delayed diagnosis of HIV infection in the Spanish VACH cohort [1997-2002]]. / Diagnóstico tardío de la infección por el virus de la inmunodeficiencia humana en la Cohorte VACH (1997-2002).

OBJECTIVE: To study the prevalence of delayed diagnosis of HIV infection and associated factors. METHODS: A cross sectional study of patients included in the Spanish VACH cohort who had been diagnosed with HIV infection between 1997 and 2002 was performed. Delayed diagnosis was defined as patients diagnosed with HIV infection and AIDS simultaneously or within the first month after the first positive serologic test, or those with a first CD4+ cell count below 200/ml. The epidemiological characteristics of these patients were compared with those of the remaining patients RESULTS: Of 2,820 new cases of HIV infection, delayed diagnosis was found in 506 (18%). These patients differed from the remaining patients in their lower mean age and higher HIV viral load, as well as in their distribution by sex (higher proportion of males), occupational status, history of incarceration in prison, and HIV-risk transmission group. The median survival during follow-up was significantly lower among AIDS patients with a delayed diagnosis. CONCLUSIONS: Delayed diagnosis remains a cause for concern in our environment, due to its magnitude and its association with mortality. Some epidemiological characteristics provide clues to guide future programs directed at increasing information and improving prevention.

Diagnóstico tardío de la infección por el virus de la inmunodeficiencia humana en la Cohorte VACH (1997-2002) / Delayed diagnosis of HIV infection in the Spanish VACH cohort [1997-2002]

Objetivo: Estudiar la prevalencia del diagnóstico tardío (DT) de la infección por el virus de la inmunodeficiencia humana (VIH) y sus factores asociados. Métodos: Estudio transversal sobre los pacientes incluidos en la cohorte VACH cuya infección por el VIH hubiese sido diagnosticada entre 1997 y 2002. Consideramos DT los casos diagnosticados de sida concomitantemente o dentro del primer mes desde la primera serología positiva, o con recuento de CD4+ < 200/ml. Comparamos sus características epidemiológicas con las de los demás pacientes. Resultados: De 2.820 nuevos casos de infección por el VIH, 506 (18%) tuvieron DT. Éstos difirieron del resto en su menor edad media, mayor carga viral y en su distribución por sexos (mayor proporción de hombres), situación laboral, antecedentes penitenciarios y grupo de riesgo. La mediana de supervivencia durante el seguimiento fue menor en el grupo de DT. Conclusiones: El DT continúa siendo un problema preocupante por su magnitud y asociación con la mortalidad. Algunas características epidemiológicas proporcionan indicios para orientar futuros programas de información y prevención

Objective: To study the prevalence of delayed diagnosis of HIV infection and associated factors. Methods: A cross sectional study of patients included in the Spanish VACH cohort who had been diagnosed with HIV infection between 1997 and 2002 was performed. Delayed diagnosis was defined as patients diagnosed with HIV infection and AIDS simultaneously or within the first month after the first positive serologic test, or those with a first CD4+ cell count below 200/ml. The epidemiological characteristics of these patients were compared with those of the remaining patients Results: Of 2,820 new cases of HIV infection, delayed diagnosis was found in 506 (18%). These patients differed from the remaining patients in their lower mean age and higher HIV viral load, as well as in their distribution by sex (higher proportion of males), occupational status, history of incarceration in prison, and HIV-risk transmission group. The median survival during follow-up was significantly lower among AIDS patients with a delayed diagnosis. Conclusions: Delayed diagnosis remains a cause for concern in our environment, due to its magnitude and its association with mortality. Some epidemiological characteristics provide clues to guide future programs directed at increasing information and improving prevention

[Integral control of risk factors in patients of high and very high cardiovascular risk in Spain. CIFARC project]. / Control integral de los factores de riesgo en pacientes de alto y muy alto riesgo cardiovascular en España. Estudio CIFARC.

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the percentage of patients with high and very high cardiovascular risk, with their risk factors globally well controlled (hypertension, dyslipemia, diabetes mellitus, tobacco and obesity). PATIENTS AND METHOD: Transversal study of ambulatory patients of internal medicine with an estimated cardiovascular risk high or very high (Framingham stratification scale over 20% in ten years). We evaluated the degree of control of their cardiovascular risk factors attending to the recommendations provided by recent international guidelines (WHO/ISH, JNC-VI, NCEP-ATP-III, ADA). RESULTS: We studied 2,264 patients (53.7% males; mean age: 66.1 +/- 11.5 years; 74.6% hypertensive, 61.1% dyslipidemic, 59.8% type 2 diabetes, 31.1% smokers, 38.0% obese and 36.7% in secondary prevention). Control of hypertension was achieved in 34.5%, dyslipidemia in 50.3% and diabetes in 35.5%. Global control of every risk factor was achieved in 6.9% (in 10.2% if we exclude obesity since it is not a risk factor used for cardiovascular stratification). Factors independently associated with a bad integral control were: diabetes (OR = 0.33; 95%CI: 0.23-0.47), dyslipidemia (OR = 0.34; 95%CI: 0.24-0.48), proteinuria (OR = 0.36; 95%CI: 0.18-0.71). Factors independently associated with a better cardiovascular control were: male sex (OR = 1.67; 95%CI: 1.18-2.38), ventricular hypertrophy (OR = 1.62; 95%CI: 1.15-2.30) and the number of exploratory tests (OR = 1.01; 95%CI: 1.01-1.08). CONCLUSIONS: Only 6.9% of patients with a high or very high cardiovascular risk have all their principal risk factors under control. The presence of diabetes, dyslipidemia or proteinuria predisposed to a worse control and the number of complementary tests performed to the patients was related to a better control.

Control integral de los factores de riesgo en pacientes de alto y muy alto riesgo cardiovascular en España. Estudio CIFARC / Integral control of risk factors in patients of high and very high cardiovascular risk in Spain. CIFARC project

FUNDAMENTO Y OBJETIVO: El objetivo del presente estudio es determinar el porcentaje de pacientes con alto riesgo cardiovascular que tienen controlados de forma global todos sus factores de riesgo mayores (hipertensión arterial, hipercolesterolemia, diabetes mellitus, tabaco y obesidad). PACIENTES Y MÉTODO: Estudio transversal sobre pacientes ambulatorios de medicina interna, mayores de 18 años y con riesgo cardiovascular alto o muy alto (según la escala de Framingham, superior al 20% a los 10 años). Se evaluó el grado de control de los factores de riesgo cardiovascular (hipertensión arterial, diabetes mellitus, colesterol unido a lipoproteínas de baja densidad, tabaquismo y obesidad) según las definiciones de control de la Organización Mundial de la Salud/Sociedad Internacional de Hipertensión, Joint National Committee VI, National Cholesterol Education Program-Adult Treatment Panel III y American Diabetes Association. RESULTADOS: Se estudió a 2.264 pacientes (el 53,7% eran varones), con una edad media (desviación estándar) de 66,1 (11,5) años. El 74,6% eran hipertensos; el 61,1%, dislipémicos; el 59,8%, diabéticostipo 2; el 31,1%, fumadores; el 38%, obesos, y el 36,7% se hallaba en prevención secundaria. El control de la hipertensión arterial fue del 34,5%; el de la dislipemia, del 50,3%; y el de la diabetes mellitus, del 35,5%. El control de todos los factores de riesgo de forma global fue del 6,9% (y del 10,2% si se excluye la obesidad). Los factores relacionados de forma independiente con un mal control integral fueron la diabetes mellitus (odds ratio [OR] = 0,33; intervalo de confianza [IC] del 95%,0,23-0,47), la dislipemia (OR = 0,34; IC del 95%, 0,24-0,48) y la existencia de proteinuria (OR =0,36; IC del 95%, 0,18-0,71); se relacionaron con un mejor control integral el sexo varón (OR =1,67; IC del 95%, 1,18-2,38), la hipertrofia ventricular izquierda (OR = 1,62; IC del 95%, 1,15-2,30) y la realización de pruebas complementarias (OR = 1,01; IC del 95%, 1,01-1,08). CONCLUSIONES: Solamente el 6,9% de los pacientes de alto o muy alto riesgo cardiovascular tienen controladoslos 5 principales factores de riesgo mayores. La existencia de diabetes mellitus, dislipemia o proteinuria predisponen a un mal control integral de dichos factores, mientras que el número de exploraciones complementarias realizadas se asocia con un mejor control

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the percentage of patients with high and very high cardiovascular risk, with their risk factors globally well controlled (hypertension,dyslipemia, diabetes mellitus, tobacco and obesity). PATIENTS AND METHOD: Transversal study of ambulatory patients of internal medicine with an estimated cardiovascular risk high or very high (Framingham stratification scale over 20% in ten years). We evaluated the degree of control of their cardiovascular risk factors attending to the recommendations provided by recent international guidelines (WHO/ISH, JNC-VI, NCEP-ATP-III, ADA). RESULTS: We studied 2,264 patients (53.7% males; mean age: 66.1 ± 11.5 years; 74.6% hypertensive, 61.1% dyslipidemic, 59.8% type 2 diabetes, 31.1% smokers, 38.0% obese and 36.7%in secondary prevention). Control of hypertension was achieved in 34.5%, dyslipidemia in 50.3% and diabetes in 35.5%. Global control of every risk factor was achieved in 6.9% (in 10.2% if we exclude obesity since it is not a risk factor used for cardiovascular stratification). Factors independently associated with a bad integral control were: diabetes (OR = 0.33; 95%CI: 0.23-0.47), dyslipidemia(OR = 0.34; 95%CI: 0.24-0.48), proteinuria (OR = 0.36; 95%CI: 0.18-0.71). Factors independently associated with a better cardiovascular control were: male sex (OR = 1.67; 95%CI: 1.18-2.38),ventricular hypertrophy (OR = 1.62; 95%CI: 1.15-2.30) and the number of exploratory tests (OR =1.01; 95%CI: 1.01-1.08).CONCLUSIONS: Only 6.9% of patients with a high or very high cardiovascular risk have all their principal risk factors under control. The presence of diabetes, dyslipidemia or proteinuria predisposed to a worse control and the number of complementary tests performed to the patients was related to a better control

Inhibidores de la fusión: una nueva alternativa en el tratamiento de la infección por el virus de la inmunodeficiencia humana / Inhibitors of fusion. A new alternative in the treatment of HIV infection

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