Influencia del grado de anemia en el pronóstico de los pacientes de edad avanzada con insuficiencia cardíaca (Estudio SPAN-HF) / Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study)

Objetivo:Evaluar si un valor óptimo de hemoglobina sostenido en los 3 meses posteriores al ingreso por descompensación de insuficiencia cardíaca (IC) reduce la morbimortalidad durante los 12 meses posteriores a un ingreso por IC aguda.Pacientes y método:Estudio retrospectivo de los 1408 pacientes mayores de 65 años incluidos en el registro RICA divididos en 3 grupos: sin anemia (grupo A), anemia recuperada (grupo B) y anemia persistente (grupo C), según los niveles de hemoglobina en el ingreso y a los 3 meses tras el alta. Se construyeron curvas de Kaplan-Meier, comparando los grupos mediante la prueba de log-rank y se realizó un modelo de regresión de Cox para analizar la supervivencia.Resultados:Se incluyeron 578 (41,1%), 299 (21,2%) y 531 (37,7%) en los grupos A, B y C, respectivamente. Registramos un total de 768 muertes y reingresos. Hubo 23 (4%), 12 (4%) y 49 (9,2%) (p=0,001) individuos que fallecieron debido a la IC, y 154 (27%), 73 (24%) y 193 (36%) (p<0,001) reingresaron por esta patología, respectivamente. Los pacientes con anemia persistente tuvieron un riesgo superior de fallecimiento (RR: 1,29; IC95% de 1,04-1,61; p=0,024) o reingreso (1,92; IC95% de 1,16-3,19; p=0,012) por IC.Conclusiones:La anemia persistente en los meses posteriores a un ingreso por IC aumenta la morbimortalidad en el año posterior.

Objective:To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF.Patients and method:Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival.Results:578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF.Conclusions:Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year. (AU)

[Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study)]. / Influencia del grado de anemia en el pronóstico de los pacientes de edad avanzada con insuficiencia cardíaca (Estudio SPAN-HF).

OBJECTIVE: To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. PATIENTS AND METHOD: Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. RESULTS: 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF. CONCLUSIONS: Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.

[Complementary treatment of acute heart failure in patients with diabetes, chronic obstructive pulmonary disease or anemia]. / Tratamiento complementario de la insuficiencia cardíaca aguda en el paciente con diabetes, enfermedad pulmonar obstructiva crónica o anemia.

Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF.

Tratamiento complementario de la insuficiencia cardíaca aguda en el paciente con diabetes, enfermedad pulmonar obstructiva crónica o anemia / Complementary treatment of acute heart failure in patients with diabetes, chronic obstructive pulmonary disease or anemia

La diabetes, la enfermedad pulmonar obstructiva crónica (EPOC) y la anemia son comorbilidades con elevada prevalencia e impacto en la insuficiencia cardíaca (IC). El pronóstico de la IC aguda empeora considerablemente ante la presencia de estas comorbilidades. Los pacientes diabéticos tienen mayor probabilidad de desarrollar clínica de IC, y tanto el tratamiento de la diabetes como el de la IC aguda se ven alterados ante la coexistencia de ambas entidades. Los objetivos glucémicos en pacientes con IC aguda no están bien definidos, pero podrían comportarse con una curva en U. La hiperglucemia de estrés en pacientes con IC aguda no diabéticos también tiene un efecto muy deletéreo en el pronóstico a medio plazo. La interrelación entre EPOC e IC aguda dificulta la fase diagnóstica al compartir síntomas, signos y estudios complementarios. El tratamiento de la IC aguda también se ve modulado por la presencia de la EPOC. La anemia es muy prevalente y, a menudo, es la causa directa de la descompensación de la IC, siendo la ferropenia la etiología más frecuente. Las terapias de reposición de hierro, concretamente la disposición de preparados de administración intravenosa, han contribuido a mejorar el pronóstico de la IC aguda (AU)

Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF (AU)

Impact of weight loss on mortality in chronic heart failure: findings from the RICA Registry.

BACKGROUND: Obesity increases the risk of heart failure (HF), but a significant survival benefit in obese patients has been described once they have been diagnosed with HF. There is little information about the effects of weight loss among patients with HF. We aimed to assess the frequency of weight loss in patients with HF from the RICA Registry and whether weight loss is associated with mortality. METHODS: We investigated weight changes in 731 patients with HF and analysed the effect of weight loss of 5% or more of their baseline bodyweight during follow-up. RESULTS: 419 (57.3%) patients lost weight during follow-up but only 152 (20.8%) lost at least 5% of the baseline bodyweight. We did not find significant differences in demographic, clinical, functional and analytical parameters between patients with and without weight loss or 5% or more of their bodyweight. We observed a significant improvement in the mean NYHA functional class value and a non-significant improvement in the LVEF in all patients. A significant decrease in the natriuretic peptide levels was only observed in the patients who lost weight. Survival rates at 1year follow-up for patients with and without weight loss or 5% or more were 75.7% (95% CI: 67.1-84.3%) and 77.1% (95% CI: 72.8-81.4%), respectively (p=0.92). Re-admission rates for patients with and without weight loss were 52.7% (95% CI: 42.9-62.43%) and 50.0% (95% CI: 45.3-54.7%), respectively (p=0.34). CONCLUSIONS: Significant weight loss occurred in 20.8% of patients with HF. Weight loss was not associated with mortality or readmission.

Enfermedad pulmonar obstructiva crónica en pacientes ingresados por insuficiencia cardiaca. Resultados del Grupo para el Estudio y Significado de la Anemia en la Insuficiencia Cardiaca (GESAIC) / Chronic obstructive pulmonary disease on inpatients with heart failure. GESAIC study results

Fundamento y objetivo: La relevancia clínica de la insuficiencia cardiaca (IC) y de la enfermedad pulmonar obstructiva crónica (EPOC) en un mismo enfermo no está bien establecida. El objetivo de este trabajo fue estudiar la prevalencia de EPOC en pacientes ingresados por IC, definir su perfil clínico y la relación con el tratamiento con bloqueadores beta. Pacientes y método: Análisis de una cohorte prospectiva de pacientes ingresados en 15 servicios de Medicina Interna desde octubre de 2005 hasta marzo de 2006. El diagnóstico de EPOC se estableció por criterios clínicos o espirometría. Se recogieron datos sobre el tratamiento neurohormonal antes, durante y tras el ingreso hospitalario. Se utilizó la prueba de ji al cuadrado y la t de Student. Con las variables significativas se construyó un modelo de regresión logística. En todos los casos se consideró una significación bilateral para p<0,05. Resultados: Se incluyó a 391 pacientes, con una prevalencia de EPOC del 25,1%. En dos tercios de los pacientes se estableció el diagnóstico solo por criterios clínicos. El 23,5% de los enfermos tenía un estadio moderado o grave de EPOC. En el analisis bivariante se relacionó la presencia de EPOC con el sexo masculino (p<0,05), mayor índice de Charlson y mayor sobrepeso (p=0,04 ambos). En el tratamiento con bloqueadores beta adrenérgicos, solo la fracción de eyección del ventrículo izquierdo (p=0,03) y el tratamiento previo (p<0,001) tuvieron significación estadística en el modelo de regresión logística. La prescripción de betabloqueadores en el alta fue del 27,6%. Conclusiones: La prevalencia de EPOC es elevada en IC, y el perfil es el de un hombre de edad avanzada, con elevada comorbilidad y sobrepeso. El tratamiento con betabloqueadores se condiciona por el deterioro de la función ventricular, sin relación con la EPOC

Background and objective: The clinical relevance of Heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the same patient is not well established. We decided to study the prevalence of COPD in patients admitted due to HF, to define their clinical profile and the relationship with adrenergic beta-blockers (BB) treatment. Patients and method: Prospective cohort of inpatients with HF admitted in 15 Internal Medicine Services from October 2005 to March 2006. Diagnosis of COPD was established according to clinical criteria or spirometry. Data about neurohormonal treatment (before, during the admission, and at discharge) were collected. Statistical analyses were performed using Ji square test and T Student test. A logistic regression model was designed with data. P<0.05 being considered statistically significant. Rokesults: About 391 patients were included . CPOD was present in 25.1% of patients. In two thirds of patients, the COPD diagnosis was established by clinical criteria. Regarding GOLD, 23.5% of patients had moderate or severe COPD severity. Bivariate analysis showed that male (<0.05), poor Charlson's Index and overweight (p=0.04 both) had all relationship with COPD. The regression model indicated that only left ventricular ejection fraction (LVEF) and BB treatment before admission had statistical significance (p=0.03 and p<0.001 respectively). At discharge, 27,6% of patients received BB. Conclusions: COPD in HF patients is common and most frequent patients are aged men high comorbidity and overweight. BB treatment is conditioned by LVEF, without relationship with COPD severity (AU)

[Chronic obstructive pulmonary disease on inpatients with heart failure. GESAIC study results]. / Enfermedad pulmonar obstructiva crónica en pacientes ingresados por insuficiencia cardiaca. Resultados del Grupo para el Estudio y Significado de la Anemia en la Insuficiencia Cardiaca (GESAIC).

BACKGROUND AND OBJECTIVE: The clinical relevance of Heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the same patient is not well established. We decided to study the prevalence of COPD in patients admitted due to HF, to define their clinical profile and the relationship with adrenergic beta-blockers (BB) treatment. PATIENTS AND METHOD: Prospective cohort of inpatients with HF admitted in 15 Internal Medicine Services from October 2005 to March 2006. Diagnosis of COPD was established according to clinical criteria or spirometry. Data about neurohormonal treatment (before, during the admission, and at discharge) were collected. Statistical analyses were performed using Ji square test and T Student test. A logistic regression model was designed with data. P<0.05 being considered statistically significant. RESULTS: About 391 patients were included . CPOD was present in 25.1% of patients. In two thirds of patients, the COPD diagnosis was established by clinical criteria. Regarding GOLD, 23.5% of patients had moderate or severe COPD severity. Bivariate analysis showed that male (<0.05), poor Charlson's Index and overweight (p=0.04 both) had all relationship with COPD. The regression model indicated that only left ventricular ejection fraction (LVEF) and BB treatment before admission had statistical significance (p=0.03 and p<0.001 respectively). At discharge, 27,6% of patients received BB. CONCLUSIONS: COPD in HF patients is common and most frequent patients are aged men high comorbidity and overweight. BB treatment is conditioned by LVEF, without relationship with COPD severity.

Anemia como predictor de mortalidad en la insuficiencia cardíaca / Anemia as a predictor of mortality in heart failure

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