Clinical characteristics of heart failure patients with mid-range ejection fraction.

BACKGROUND: We aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction. METHODS: We conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010-2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (<40%), HFmrEF (40-49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics. RESULTS: The mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes. CONCLUSION: HFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.

Sex Differences in Comorbidity, Therapy, and Health Services' Use of Heart Failure in Spain: Evidence from Real-World Data.

Heart failure (HF) is becoming increasingly prevalent and affects both men and women. However, women have traditionally been underrepresented in HF clinical trials. In this study, we aimed to analyze sex differences in the comorbidity, therapy, and health services' use of HF patients. We conducted a cross-sectional study in Aragón (Spain) and described the characteristics of 17,516 patients with HF. Women were more frequent (57.4 vs. 42.6%, p < 0.001) and older (83 vs. 80 years, p < 0.001) than men, and presented a 33% lower risk of 1-year mortality (p < 0.001). Both sexes showed similar disease burdens, and 80% suffered six or more diseases. Some comorbidities were clearly sex-specific, such as arthritis, depression, and hypothyroidism in women, and arrhythmias, ischemic heart disease, and COPD in men. Men were more frequently anti-aggregated and anti-coagulated and received more angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers, whereas women had more angiotensin II antagonists, antiinflammatories, antidepressants, and thyroid hormones dispensed. Men were admitted to specialists (79.0 vs. 70.6%, p < 0.001), hospital (47.0 vs. 38.1%, p < 0.001), and emergency services (57.6 vs. 52.7%, p < 0.001) more frequently than women. Our results highlight the need to conduct future studies to confirm the existence of these differences and of developing separate HF management guidelines for men and women that take into account their sex-specific comorbidity.

Neumonía adquirida en la comunidad en un hospital terciario español: ¿cómo se comporta en pacientes provenientes de residencia? / Community acquired pneumonia in a Spanish tertiary hospital: how does it work in patients from residence?

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Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records.

OBJECTIVES: To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality. DESIGN: Observational retrospective population study based on electronic health records. SETTING: EpiChron Cohort (Aragón, Spain). PARTICIPANTS: All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients' electronic health records until 31 December 2011. PRIMARY OUTCOME: We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality. RESULTS: Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality. CONCLUSIONS: Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.

Insuficiencia cardiaca en una unidad de medicina interna en Aragón / Heart failure in an internal medicine unit in Aragón

Introducción y objetivos: La insuficiencia cardíaca (IC) es un motivo frecuente de ingreso en los Servicios de Medicina Interna. En este estudio analizamod las características epidemiológicas, métodos diagnósticos y tratamiento de los pacientes con IC ingresados en un Servicio de Medicina Interna. Métodos. Se revisaron las historias clínicas de los pacientes ingresados en una Unidad de Medicina Interna a lo largo de un año y se seleccionaron aquellos pacientes con diagnóstico de IC. Resultados. Las características epidemiológicas de este grupo fueron similares a las de otros pacientes ingresados en otros servicios de Medicina Interna de nuestro entorno, destacando la elevada edad, el predominio del sexo femenino y una importante comorbilidad asociada. Se realizó ecocardiograma en el 41,8% de los pacientes sin diagnóstico previo de IC. Aplicando técnicas de análisis multivariante no se identificaron variables que condicionarasn una menor aplicación de la ecocardiografía. La no determinación de la fracción de eyección se relacionó con una menor prescripción de inhibidores del enzima conversor de la angiotensina (IECA) (OR: 9.409, p<0,01). No se encontraron diferencias en el tratamiento con IECA y beta bloqueantes en función de la edad, sexo o etiología de la IC. La edad se asoció con una menor prescripción de tratamiento anticoagulante en pacientes con fibrilación auricular (OR 1.27; p<0,01). Los pacientes de edad elevada permanecieron menos días ingresados que aquellos más jóvenes (p<0,05). Conclusión. Se objetivo una infrautilización de la ecocardiografía así como una baja prescripción de IECA. Lo diferente de las características de estos pacientes con respecto a los que participan en los ensayos clínicos hacen que las conclusiones de estos sean difíciles de llevar a la práctica diaria

Background and objetives. Heart failure (HF) is an important cause of admission at Internat Medicine Units. In this survey we asses the epidemiological features and management of patients with heart failure in an Internal Medicine Unit. Methods. We reviewed medical records of patients admitted at Internal Medicine Unit for a year and we selected patients with diagnosis of HF. Results. Epidemiological features in this group were similar to patients admitted in others Internal Medicine Units in our country. High age, sex female predominance and Associated diseases were more noteworthy features. Echocardiogram was performed in 41.8% of patients without previous diagnosis of heart failure. Multivariate analysis did not found features that to explain a less application of echocardiography. In patients without echocardiography, angiotensin converting enzyme (ACE) inhibitors prescription was less than patients in who echocardiography was performed (OR: 9.409, p<0,01). Age, sex or etiology of HF were not associated with a significantly different prescription of ACE inhibitors and beta blockers. Age was associated with no anticoagulant prescription in patients with atrial fibrillation (OR 1.27; p<0,01). Elderly patients were discharged earlier than young patients (p<0.05). Conclusion. Under utilization of echocardiography and poor prescription of ACE inhibitors were verified. This fact result in a Epidemiological features of these patients are different than ones in patients included in clinical trials. Thus, their conclusions are difficult to apply in diary clinical practice

[Cardiac injury after indirect lightning strike]. / Alteraciones cardíacas en la fulguración por impacto indirecto.

Lightning strike is one of the most frequent causes of death due to natural phenomena. In such cases, cardiac injury is the main cause of death, with type of lesion varying by type of impact. We report the case of a 29-year-old woman who was struck indirectly by lightning. Upon hospital admission, she showed both the echocardiographic disturbances characteristic of direct impact and electrocardiographic disturbances. Both types of change resolved spontaneously. After describing the case, we briefly review the literature on echo and electrocardiographic disturbances after lightning strike.