Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.569
Filtrar
1.
Arch Cardiovasc Dis ; 113(5): 303-307, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32362433

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions. AIM: We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France. METHODS: We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures. RESULTS: Before containment (02-16 March 2020), the nine participating intensive cardiac care units admitted 4.8±1.6 patients per day, versus 2.6±1.5 after containment (17-22 March 2020) (rank-sum test P=0.0006). CONCLUSIONS: We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Pandemias , Admisión del Paciente/estadística & datos numéricos , Atención al Paciente/normas , Neumonía Viral/epidemiología , Enfermedad Aguda , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/terapia , Francia/epidemiología , Asignación de Recursos para la Atención de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Humanos , Infarto del Miocardio/terapia , Atención al Paciente/estadística & datos numéricos , Neumonía Viral/terapia
2.
Medicine (Baltimore) ; 99(17): e19895, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332663

RESUMEN

The relationship between various categories of blood pressure (BP), subtypes of hypertension, and development of cardiovascular disease (CVD) have not been extensively studied. Therefore, our study aimed to explore this relationship in a random population sample of men born in 1943, living in Sweden and followed over a 21-year period.Participants were examined for the first time in 1993 (age 50 years), where data on medical history, concomitant diseases, and general health were collected. The examination was repeated in 2003 and with additional echocardiography also in 2014. Classification of participants according to their BP at the age of 50 years was as follows: optimal-normal BP (systolic blood pressure [SBP] <130 and diastolic BP [DBP] <85 mmHg), high-normal BP (130 ≤ SBP < 140, 85 ≤ DBP < 90 mmHg), isolated systolic-diastolic hypertension (ISH-IDH) (SBP ≥140 and DBP <90 or SBP <140 and DBP ≥90 mmHg), and systolic-diastolic hypertension (SDH) (SBP ≥140 and DBP ≥90 mmHg).During the follow-up, the incidence of heart failure (HF), CVD, and coronary heart disease were all lowest for those with optimal-normal BP. Participants with high-normal BP showed greater wall thickness and left ventricular mass index, larger LV size and larger left atrial size when compared with the optimal-normal BP group. Furthermore, those with high-normal BP, ISH-IDH, and SDH had a higher risk of CVD than those with optimal-normal BP. The adjusted relative risk of CVD was highest for SDH (hazard ratio [HR] 1.95; 95% confidence interval [95% CI] 1.37-2.79), followed by ISH-IDH (HR 1.34; 95% CI 0.93-1.95) and high-normal BP (HR 1.31; 95% CI 0.91-1.89).Over a 21-year follow-up, the participants with high-normal BP or ISH-IDH had a higher relative risk of CVD than those with optimal-normal BP.


Asunto(s)
Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/clasificación , Análisis de Varianza , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Estudios de Seguimiento , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/clasificación , Infarto del Miocardio/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Suecia/epidemiología
3.
Rev. clín. esp. (Ed. impr.) ; 220(2): 135-138, mar. 2020.
Artículo en Español | IBECS | ID: ibc-186427

RESUMEN

Existe una asociación bidireccional entre la insuficiencia cardiaca (IC) y la diabetes mellitus tipo 2 (DM2) que hace que la combinación de ambas enfermedades en un mismo paciente haya pasado a tener un incremento exponencial. Dicha combinación, parte de múltiples causas comunes que llevan a vías fisiopatológicas que resultan en un efecto deletéreo de la DM2 sobre la IC. La consecuencia clínica inevitable es que ante dicha situación el paciente presente peor clínica y peor pronóstico que el paciente con IC sin DM2. Por todo ello debemos tener en cuenta cómo tratar la DM2 en pacientes con IC, y cómo tratar la IC en pacientes con DM2. En esta revisión se hace hincapié en los últimos datos publicados al respecto


There is a bidirectional association between heart failure (HF) and type 2 diabetes mellitus (DM2), which has resulted in an exponential increase in the combination of the 2 diseases in a single patient. This combination is one of many common causes that lead to the pathophysiological pathways resulting in the deleterious effect of DM2 on HF. The inevitable clinical consequence is that, when faced with this situation, patients present worse symptoms and a poorer prognosis than patients with HF but without DM2. We should therefore consider how to treat DM2 in patients with HF and how to treat HF in patients with DM2. In this review, we highlight the latest published data on this issue


Asunto(s)
Humanos , Insuficiencia Cardíaca/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Metformina/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Insuficiencia Cardíaca/complicaciones , Hemoglobina A Glucada/análisis , Factores de Riesgo , Susceptibilidad a Enfermedades/epidemiología , Estado Prediabético/complicaciones
4.
Am J Surg ; 219(4): 578-582, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32081411

RESUMEN

INTRODUCTION: The aim of this study was to evaluate patient factors that contribute to increased incidence of early onset rectal cancer and analyze the short-term surgical outcomes of patients undergoing surgery. METHODS: A 2-year review (2015-2016) of the ACS-NSQIP included patients with rectal cancer who underwent surgical management. Patients were stratified into early-onset RC (<50-years) and late-onset RC (≥50-years). RESULTS: We included a total of 7538 patients in the analysis. Overall, 14% of the patients had early-onset RC. Patients with early-onset RC were more likely to be Black and Hispanic. Additionally, they were more likely to present with higher TNM stages. Patients with early-onset RC had lower 30-day complications and lower 30-day mortality. There was no difference between the two groups regarding hospital length of stay or 30-day readmission. On regression analysis, there was no difference between the two groups regarding patient outcomes. CONCLUSIONS: Racial disparities do exist in the incidence of RC. Young patients tend to have more aggressive disease, however, surgical outcomes between the two groups are comparable.


Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Adulto , Anciano , Índice de Masa Corporal , Comorbilidad , Grupos de Población Continentales/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Disnea/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Hipertensión/epidemiología , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Diálisis Renal/estadística & datos numéricos , Sepsis/epidemiología , Fumar/epidemiología , Estados Unidos/epidemiología , Pérdida de Peso
5.
PLoS One ; 15(1): e0224135, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940350

RESUMEN

BACKGROUND: The ability to predict risk allows healthcare providers to propose which patients might benefit most from certain therapies, and is relevant to payers' demands to justify clinical and economic value. To understand the robustness of risk prediction models for heart failure (HF), we conducted a systematic literature review to (1) identify HF risk-prediction models, (2) assess statistical approach and extent of validation, (3) identify common variables, and (4) assess risk of bias (ROB). METHODS: Literature databases were searched from March 2013 to May 2018 to identify risk prediction models conducted in an out-of-hospital setting in adults with HF. Distinct risk prediction variables were ranked according to outcomes assessed and incorporation into the studies. ROB was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS: Of 4720 non-duplicated citations, 40 risk-prediction publications were deemed relevant. Within the 40 publications, 58 models assessed 55 (co)primary outcomes, including all-cause mortality (n = 17), cardiovascular death (n = 9), HF hospitalizations (n = 15), and composite endpoints (n = 14). Few publications reported detail on handling missing data (n = 11; 28%). The discriminatory ability for predicting all-cause mortality, cardiovascular death, and composite endpoints was generally better than for HF hospitalization. 105 distinct predictor variables were identified. Predictors included in >5 publications were: N-terminal prohormone brain-natriuretic peptide, creatinine, blood urea nitrogen, systolic blood pressure, sodium, NYHA class, left ventricular ejection fraction, heart rate, and characteristics including male sex, diabetes, age, and BMI. Only 11/58 (19%) models had overall low ROB, based on our application of PROBAST. In total, 26/58 (45%) models discussed internal validation, and 14/58 (24%) external validation. CONCLUSIONS: The majority of the 58 identified risk-prediction models for HF present particular concerns according to ROB assessment, mainly due to lack of validation and calibration. The potential utility of novel approaches such as machine learning tools is yet to be determined. REGISTRATION NUMBER: The SLR was registered in Prospero (ID: CRD42018100709).


Asunto(s)
Diabetes Mellitus/epidemiología , Personal de Salud , Insuficiencia Cardíaca/epidemiología , Pronóstico , Adulto , Anciano , Anciano de 80 o más Años , Factor Natriurético Atrial/genética , Presión Sanguínea , Diabetes Mellitus/fisiopatología , Femenino , Insuficiencia Cardíaca/genética , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico/genética , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología
6.
Postgrad Med ; 132(2): 176-183, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31971043

RESUMEN

Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation.Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). All patients had heart failure (HF), diabetes, or chronic kidney disease (CKD). Patients with end-stage renal disease were excluded. The following outcomes were assessed within 6-months post-patiromer initiation: patiromer utilization (using proportion of days covered); K+ concentration change (pre- vs post-initiation); and RAASi continuation.Results: 288 Veterans with HK were included. Baseline characteristics were: median age 70 years, African-American race 24%, diabetes 83%, HF 32%, CKD 95%, and median K+ concentration 5.7 mmol/L. At 1, 3, and 6 months post-index, the median patiromer PDC was 100%, 66%, and 44%, respectively. K+ concentration reductions post-patiromer initiation were, on average, - 1.0 mmol/L (P < 0.001). At 3-6 months, 71% of patiromer initiators had K+ <5.1 mmol/L and 95% had K+ <5.5 mmol/L. RAASi therapy was continued in >80%-90% of patiromer-treated patients.Conclusions: The real-world utilization results suggest patiromer is used for the chronic management of HK. Clinically relevant K+ concentration reductions were observed at all study time points. The successful management of HK may have contributed to the observed high rate of RAASi therapy continuation. Further research is warranted to corroborate and extend these findings.


Asunto(s)
Hiperpotasemia/tratamiento farmacológico , Hiperpotasemia/epidemiología , Polímeros/uso terapéutico , Factores de Edad , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Grupos de Población Continentales , Diabetes Mellitus/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Polímeros/administración & dosificación , Potasio/sangre , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Factores Sexuales , Estados Unidos , Veteranos
7.
Medicine (Baltimore) ; 99(2): e18517, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914024

RESUMEN

Atrial fibrillation (AF) is an important complication of acute myocardial infarction (AMI). The association between AF and serum lipid profile is unclear and statin use for lowering the incidence of new-onset AF remains controversial. The objective of this study was to investigate whether statins confer a beneficial effect on AF after AMI.Data available in the Taiwan National Health Insurance Research Database on 32886 AMI patients between 2008 and 2011 were retrospectively analyzed. Total 27553 (83.8%) had complete 1-yr follow-up data. Cardiovascular outcomes were analyzed based on the baseline characteristics and AF type (existing, new-onset, or non-AF). AF groups had significantly higher incidence of heart failure (HF), stroke, all-cause death, and major adverse cardiac and cerebrovascular event (MACCE) after index AMI (all P < .05). In contrast, myocardial re-infarction (re-MI) was not significantly different among the three groups (P = .95). Statin use tended to be associated with lower risk of new-onset AF after AMI (HR: 0.935; 95% confidence interval (CI): 0.877-0.998; P = .0427).Existing AF and new-onset AF subgroups had similar cardiovascular outcomes after AMI and were both inferior to the non-AF group. Statin tended to reduce new-onset AF after AMI.


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Infarto del Miocardio/complicaciones , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/fisiopatología , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Taiwán/epidemiología
8.
Mayo Clin Proc ; 95(1): 124-133, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31902407

RESUMEN

OBJECTIVES: To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular diseases in a community population. PATIENTS & METHODS: Cross-sectional survey of residents randomly selected through the Rochester Epidemiology Project, 45 years or older, of Olmsted County as of June 1, 1997, through September 30, 2000. Responders (2042) underwent assessment of systolic and diastolic function using echocardiography. The current analyses included all participants with DM and were compared with a group of participants without DM matched 1:2 for age, sex, hypertension, and coronary artery disease. Baseline characteristics and laboratory and echocardiography findings between groups were compared along with rates of mortality due to various cardiovascular conditions. RESULTS: We identified 116 participants with DM and 232 matched participants without DM. Those with DM had a higher body mass index and plasma insulin and serum glucose levels. Although left ventricular ejection fractions were similar, E/e' ratio (9.7 vs 8.5; P=.001) was higher in DM vs non-DM. During a follow-up of 10.8 (interquartile range, 7.8-11.7) years, participants with DM had a higher incidence of heart failure (HF); hazard ratio, 2.1; 95% confidence limits, 1.2-3.6; P=.01) and 10-year Kaplan-Meier rate of 21% (22 of 116) vs 12% (24 of 232) compared with those without DM. We also examined the subgroup of participants without diastolic dysfunction. In this subgroup, those with DM had an increased risk for HF; hazard ratio, 2.5; 95% confidence limits, 1.0-6.3; P=.04). CONCLUSION: In this cohort, participants with DM have an increased incidence of HF over a 10-year follow-up period even in the absence of underlying diastolic dysfunction. These findings suggest that DM is an independent risk factor for the development of HF and supports the concept of DM cardiomyopathy.


Asunto(s)
Diabetes Mellitus , Insuficiencia Cardíaca , Volumen Sistólico , Función Ventricular Izquierda , Glucemia/análisis , Índice de Masa Corporal , Estudios Transversales , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Ecocardiografía Doppler/métodos , Ecocardiografía Doppler/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Insulina/análisis , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Mortalidad , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo
9.
Heart Fail Clin ; 16(1): 121-130, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735310

RESUMEN

Understanding the role of sex- and gender-related factors, when dealing with a global growing epidemic such as heart failure, is a much needed and unmet goal for health care providers and scientists in order to design targeted strategies, aimed at improving both clinical and patient reported outcomes measures in women and men with heart failure. The present review provides an overview of the current available evidence on sex- and gender-related differences in heart failure.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Salud Global , Humanos , Morbilidad/tendencias , Distribución por Sexo , Factores Sexuales , Tasa de Supervivencia/tendencias
10.
Heart Fail Clin ; 16(1): 33-44, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735313

RESUMEN

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are both common causes of breathlessness and often conspire to confound accurate diagnosis and optimal therapy. Risk factors (such as aging, smoking, and obesity) and clinical presentation (eg, cough and breathlessness on exertion) can be very similar, but the treatment and prognostic implications are very different. This review discusses the diagnostic challenges in individuals with exertional dyspnea. Also highlighted are the prevalence, clinical relevance, and therapeutic implications of a concurrent diagnosis of COPD and HF.


Asunto(s)
Disnea/etiología , Insuficiencia Cardíaca/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Comorbilidad , Disnea/diagnóstico , Disnea/fisiopatología , Electrocardiografía , Salud Global , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Radiografía Torácica , Factores de Riesgo , Espirometría
11.
Heart Fail Clin ; 16(1): 45-51, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735314

RESUMEN

Sleep-disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne-Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (EF), increased arrhythmia burden, and increased mortality. Continuous positive airway pressure therapy improves short-term and long-term outcomes in HF patients. Adaptive servoventilation (ASV) therapy in patients with low-EF HF with predominant CSA is not recommended. Ongoing trials are evaluating whether ASV will have a role in SDB treatment. Phrenic nerve stimulation is an emerging treatment option that has shown promising outcomes. All HF patients should be screened for SDB.


Asunto(s)
Insuficiencia Cardíaca/complicaciones , Síndromes de la Apnea del Sueño/etiología , Sueño/fisiología , Función Ventricular Izquierda/fisiología , Salud Global , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Incidencia , Síndromes de la Apnea del Sueño/epidemiología , Síndromes de la Apnea del Sueño/fisiopatología , Tasa de Supervivencia/tendencias
12.
Heart Fail Clin ; 16(1): 71-80, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735317

RESUMEN

Obesity has reached worldwide epidemic proportions, adversely impacting health on a global scale. Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Studies and meta-analyses have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with lean patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean and muscle mass, and weight loss, for the prevention and treatment of compared with in patients with concomitant obesity.


Asunto(s)
Estado de Salud , Insuficiencia Cardíaca/etiología , Obesidad/complicaciones , Volumen Sistólico/fisiología , Índice de Masa Corporal , Salud Global , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Obesidad/fisiopatología , Prevalencia , Pronóstico , Factores de Riesgo
13.
Maturitas ; 131: 34-39, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31787145

RESUMEN

AIMS: Early age at menarche has been reported to be associated with increased risks of developing type 2 diabetes (T2D) and coronary heart disease (CHD) in adulthood, but a late menarche has also been found to be associated with an increased risk of CHD. Both T2D and CHD are important risk factors for developing heart failure (HF). We examined the relationship between age at menarche (AAM) and HF incidence in women from the European Prospective Investigation into Cancer and Nutrition - Netherlands (EPIC-NL) cohort study. METHODS AND RESULTS: The EPIC-NL cohort comprised 28,504 women aged 20-70 years at baseline (1993-1997). Mean age at menarche was 13.3 (standard deviation 1.6) years. During a median follow-up of 15.2 years HF occurred in 631 women. Cox proportional hazard regression models, stratified by cohort and adjusted for potential confounders, were used to investigate the associations between AAM and HF incidence. After confounder adjustment, each year of older age at menarche was associated with a 5% lower risk of HF (hazard ratio 0.95 (95% CI, 0.91-1.00), p-value 0.048). Further adjusting for body mass index (BMI), prevalent CHD, hypertension, or prevalent T2D as potential mediators between early menarche and risk of HF attenuated the associations between AAM and risk of HF to non-significance. CONCLUSION: Older AAM reduced the risk of HF in this study. BMI, prevalent CHD, hypertension and prevalent T2D seemed to mediate this association. Future research with a longer follow-up should establish whether there is an independent effect of AAM on HF risk. Also, further phenotyping of HF cases is necessary to enable whether the associations differ for the various subtypes of HF.


Asunto(s)
Factores de Edad , Enfermedad Coronaria/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Insuficiencia Cardíaca/epidemiología , Menarquia , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Niño , Enfermedad Coronaria/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Hipertensión/epidemiología , Incidencia , Estudios Longitudinales , Persona de Mediana Edad , Países Bajos/epidemiología , Fenotipo , Prevalencia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
14.
Vasc Health Risk Manag ; 15: 533-538, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31824165

RESUMEN

Purpose: Real-world data may provide insight into relationships between high triglycerides (TG), a modifiable cardiovascular (CV) risk factor, and increased heart failure (HF) risk. Patients and methods: This retrospective administrative claims analysis included statin-treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months to March 2016. Patients with TG ≥150 mg/dL and a comparator cohort with TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL were included. A sub-analysis was conducted in patients with TG 200-499 mg/dL. Hazard ratios (HR) were calculated from multivariate analyses controlled for patient characteristics and comorbidities using Cox proportional hazard modeling. New diagnosis of HF required diagnosis in the follow-up period without prior evidence of HF. Results: Multivariate analyses revealed a 19% higher rate of new HF diagnosis in the TG ≥150 mg/dL cohort (HR=1.192; 95% confidence interval [CI]=1.134-1.252; P<0.001; n=24,043) and a 24% higher rate in the TG 200-499 mg/dL sub-cohort (HR=1.235; 95% CI=1.160-1.315; P<0.001; n=11,657), each versus the comparator cohort (n=30,218). Conclusion: In a real-world analysis of statin-treated patients with high CV risk, elevated and high TG were significant predictors of new HF diagnosis.


Asunto(s)
Dislipidemias/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Triglicéridos/sangre , Reclamos Administrativos en el Cuidado de la Salud , Anciano , Biomarcadores/sangre , Bases de Datos Factuales , Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología , Regulación hacia Arriba
15.
Artículo en Inglés | MEDLINE | ID: mdl-31878281

RESUMEN

Heart failure (HF) represents an important cardiovascular complication of type 2 diabetes mellitus (T2DM) associated with substantial morbidity and mortality, and is emphasized in recent cardiovascular outcome trials (CVOTs) as a critical outcome for patients with T2DM. Treatment of T2DM in patients with HF can be challenging, considering that these patients are usually elderly, frail and have extensive comorbidities, most importantly chronic kidney disease. The complexity of medical regimens, the high risk clinical characteristics of patients and the potential of HF therapies to interfere with glucose metabolism, and conversely the emerging potential of some antidiabetic agents to modulate HF outcomes, are only some of the challenges that need to be addressed in the framework of a team-based personalized approach. The presence of established HF or the high risk of developing HF in the future has influenced recent guideline recommendations and can guide therapeutic decision making. Metformin remains first-line treatment for overweight T2DM patients at moderate cardiovascular risk. Although not contraindicated, metformin is no longer considered as first-line therapy for patients with established HF or at risk for HF, since there is robust scientific evidence that treatment with other glucose-lowering agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) should be prioritized in this population due to their strong and remarkably consistent beneficial effects on HF outcomes.


Asunto(s)
Anticoagulantes/uso terapéutico , Actitud del Personal de Salud , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Médicos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
16.
Nat Commun ; 10(1): 5830, 2019 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-31862877

RESUMEN

Heart failure (HF) is a major public health problem characterized by inability of the heart to maintain sufficient output of blood. The systematic characterization of circulating proteins across different stages of HF may provide pathophysiological insights and identify therapeutic targets. Here we report application of aptamer-based proteomics to identify proteins associated with prospective HF incidence in a population-based cohort, implicating modulation of immunological, complement, coagulation, natriuretic and matrix remodeling pathways up to two decades prior to overt disease onset. We observe further divergence of these proteins from the general population in advanced HF, and regression after heart transplantation. By leveraging coronary sinus samples and transcriptomic tools, we describe likely cardiac and specific cellular origins for several of the proteins, including Nt-proBNP, thrombospondin-2, interleukin-18 receptor, gelsolin, and activated C5. Our findings provide a broad perspective on both cardiac and systemic factors associated with HF development.


Asunto(s)
Insuficiencia Cardíaca/sangre , Trasplante de Corazón , Proteoma/análisis , Adulto , Anciano , Aptámeros de Péptidos/metabolismo , Biomarcadores/sangre , Biomarcadores/metabolismo , Seno Coronario/metabolismo , Seno Coronario/patología , Femenino , Perfilación de la Expresión Génica , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteoma/metabolismo , Proteómica/métodos , Factores de Riesgo
17.
Med. clín (Ed. impr.) ; 153(12): 454-459, dic. 2019. graf, tab
Artículo en Inglés | IBECS | ID: ibc-188455

RESUMEN

Objective: Birth month and climate affect lifetime disease risk, while the underlying mechanisms remain largely elusive. It is vital to investigate the risks of coronary artery disease (CAD) and its complications in patients born in different months. Methods: A total of 12,263 patient medical records were reviewed from the BioBank of First Affiliated Hospital of Xinxiang Medical University, with 4729 records from patients with CAD (CAD group) and 7534 records from control patients without CAD (control group). Two groups of patients were matched by the propensity score matched method. Birth months were compared between two groups of patients. The relationships between birth month and the numbers of CAD and its complications were also investigated. Interestingly, we also explore the relationship between the birth seasons and the numbers of CAD and its complications. Results: Compared to control, CAD group had greater CAD risks for patients born in November (OR 1.390, 95% CI 1.090-1.772), December (OR 1.358, 95% CI 1.067-1.730), and February (OR 1.332, 95% CI 1.043-1.700) compared to those born in May. Compared to patients born in December, patients born in January to March and May to September had greater risk of heart failure (P<0.05). There was no difference in the incidence of myocardial infarction, conduction block, and atrial fibrillation across birth months (P>0.05). In terms of birth season, patients born in winter have greater CAD risk than those born in spring (OR 1.247, 95% CI 1.075-1.447). And there was no difference in the incidence of CAD complications across with birth seasons (P>0.05). Conclusions: There was a correlation between birth month and CAD. People born in November, December, and February had greater CAD risk, and people born in winter had greater CAD risk. Among CAD patients, those born in January to March and May to September had the greater risk of heart failure


Objetivo: El mes de nacimiento y el clima están relacionados con el riesgo de padecer una enfermedad crónica, aunque siguen desconociéndose en gran medida los mecanismos subyacentes. Resulta fundamental investigar los riesgos de padecer una arteriopatía coronaria (AC) y sus complicaciones en pacientes nacidos en distintos meses. Métodos: Se revisaron un total de 12.263 historias clínicas de pacientes extraídas del Biobanco del primer hospital afiliado de la Universidad Médica de Xinxiang, de las cuales 4.729 correspondían a pacientes con una AC (grupo con AC) y 7.534 correspondían a pacientes control sin una AC (grupo comparativo). Se emparejaron a 2 grupos de pacientes siguiendo el método de pareamiento por puntaje de propensión, y se compararon los meses de nacimiento de los pacientes de ambos grupos. También se investigó la relación existente entre el mes de nacimiento y el número de casos de AC y sus complicaciones. Resulta interesante destacar que también exploramos la relación existente entre las estaciones de nacimiento y el número de casos de AC y sus complicaciones. Resultados: En comparación con los pacientes del grupo comparativo, los pacientes del grupo con AC nacidos en noviembre (razón de posibilidades odds ratio [OR]: 1,390; intervalo de confianza [IC] del 95%: 1,090-1,772), diciembre (OR: 1,358; IC 95%: 1,067-1,730) y febrero (OR: 1,332; IC 95%: 1,043-1,700) presentaban un mayor riesgo de padecer una AC en comparación con los nacidos en mayo. En comparación con los pacientes nacidos en diciembre, los pacientes nacidos entre enero y marzo, y entre mayo y septiembre, presentaron un mayor riesgo de padecer una insuficiencia cardíaca (P<0,05). No se observaron diferencias en la incidencia de infarto de miocardio, bloqueo de la conducción y fibrilación auricular entre los distintos meses de nacimiento (P>0,05). En cuanto a la temporada de nacimiento, los pacientes nacidos en invierno presentaron un mayor riesgo de desarrollar una AC que los nacidos en primavera (OR: 1,247; IC 95%: 1,075-1,447). No se observaron diferencias en la incidencia de complicaciones de la AC entre las distintas temporadas de nacimiento (P>0,05). Conclusiones: Se observó una correlación entre el mes de nacimiento y la AC. Tanto las personas nacidas en los meses de noviembre, diciembre y febrero, como las nacidas en la temporada de invierno presentaron un mayor riesgo de padecer una AC. Entre los pacientes con AC, los nacidos entre enero y marzo, y entre mayo y septiembre, presentaron un mayor riesgo de padecer una insuficiencia cardíaca


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/complicaciones , Puntaje de Propensión , Factores de Riesgo , Clima , Oportunidad Relativa , Intervalos de Confianza , Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Fibrilación Atrial/epidemiología , Correlación de Datos
18.
PLoS One ; 14(12): e0226750, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856265

RESUMEN

PURPOSE: This study examined postoperative heart failure (HF) and respiratory failure (RF) complications and related healthcare utilization for one year following cardiac surgery. METHODS: This study identified adult patients undergoing isolated coronary artery bypass graft (CABG) and/or valve procedures from the Cerner Health Facts® database. It included patients experiencing postoperative HF or RF complications. We quantified healthcare utilization using the frequency of inpatient admissions, emergency department (ED) visits with or without hospital admission, and outpatient visits. We then determined direct hospital costs from the determined healthcare utilization. We analyzed trends over time for both HF and RF and evaluated the association between surgery type and HF complication. RESULTS: Of 10,298 patients with HF complications, 1,714 patients (16.6%) developed persistent HF; of the 10,385 RF patients, 175 (1.7%) developed persistent RF. Healthcare utilization for those with persistent complications over the one-year period following index hospital discharge comprised an average number of the following visit types: Inpatient (1.49 HF; 1.55 RF), Outpatient (2.02, 0.51), ED without hospital admission (0.33, 0.13), ED + Inpatient (0.08, 0.06). Per patient annual costs related to persistent complications of HF and RF were $20,857 and $30,745, respectively. There was a significant association between cardiac surgical type and the incidence of HF, with risk for isolated valve procedures (adjusted OR 2.60; 95% CI: 2.35-2.88) and CABG + valve procedures (adjusted OR 2.38; 95% CI: 2.17-2.61) exceeding risk for isolated CABG procedures. CONCLUSIONS: This study demonstrates that HF and RF complication rates post cardiac surgery are substantial, and complication-related healthcare utilization over the first year following surgery results in significant incremental costs. Given the need for both payers and providers to focus on healthcare cost reduction, this study fills an important gap in quantifying the mid-term economic impact of postoperative cardiac surgical complications.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Costos y Análisis de Costo , Insuficiencia Cardíaca/epidemiología , Complicaciones Posoperatorias/epidemiología , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Insuficiencia Respiratoria/epidemiología , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/economía , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/economía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/economía , Utilización de Procedimientos y Técnicas/economía , Insuficiencia Respiratoria/economía , Estados Unidos
19.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31854243

RESUMEN

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Enfermedad Aguda , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/prevención & control , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Comorbilidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Supervivencia sin Progresión , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo
20.
Pan Afr Med J ; 34: 6, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762875

RESUMEN

Introduction: Heart Failure (HF) is a growing public health concern in Morocco and there is a striking paucity on determinants of severe HF (SHF) in this population. The aim of this study was to identify patients admitted with HF at Ibn Rochd Hospital, Casablanca from 2011 onwards, when electronic record keeping began. Methods: A total of 105 patients underwent a series of cardiological examinations between July 2011 and January 2014. The New York Heart Association (NYHA) criteria was used to evaluate the severity of HF. Patients with NYHA classification gradings of I and II were defined as having moderate HF (MHF) and those graded as III and IV were defined as having a SHF. Univariable and multivariable risk factors associated with SHF were explored using logistic regression. The results were reported following the RECORD (Reporting of studies Conducted using Observational Routinely-collected Data) statement. Results: A total of 24 (33%) patients were identified as having a SHF. Four predictors of SHF were identified in univariate analysis: haemoglobin <12g/dL, neutrophil-to-lymphocyte ratio (NLR) >3, mean corpuscular haemoglobin concentration (MCHC) <32 picolitre, and high density lipoprotein (HDL) <0.35 (mmol/L). Only NLR>3 and HDL <0.35 mmol/L remained independent predictors in multivariable analysis. Patients with NLR >3 were at 6-fold increased odds of SHF [adjusted odds ratio (AOR): 6.78, 95% confidence interval (CI): 1.40-32.80, p=0.017], and those with HDL<0.35 (mmol/L) were at 10-fold increased odds of SHF [AOR: 10.11, 95% CI: 2.26-45.27, p=0.002]. Conclusion: The independent biomarkers of SHF identified in this study provide valuable information to ward clinicians in resource-constrained facilities to identify patients vulnerable to developing severe heart complications.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Hemoglobinas/metabolismo , Linfocitos/metabolismo , Neutrófilos/metabolismo , Anciano , Biomarcadores/metabolismo , Registros Electrónicos de Salud , Femenino , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Factores de Riesgo , Índice de Severidad de la Enfermedad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA