Influencia de la presión arterial al inicio de las descompensaciones en el pronóstico de pacientes con insuficiencia cardiaca / Influence of blood pressure at the beginning of decompensations in the prognosis of patients with heart failure

Fundamento y objetivo: Existe una relación inversa entre las cifras de presión arterial en las descompensaciones y el pronóstico de la insuficiencia cardiaca (IC). Las características de esta relación no son bien conocidas. El objetivo del estudio fue analizar si esta relación se mantiene en una cohorte no seleccionada de pacientes con IC y si el tratamiento la modifica. Material y métodos: Estudio prospectivo de cohortes de pacientes ingresados por IC descompensada en un servicio de Medicina Interna y seguidos ambulatoriamente en una consulta monográfica. Los pacientes fueron agrupados en función de la presión arterial sistólica (PAS) y diastólica (PAD); se analizaron las características clínicas, la mortalidad global y los reingresos al primer, tercer y sexto mes de seguimiento. Resultados: Se incluyeron 221 pacientes tras un ingreso índice por IC. Media de edad: 79,5 años (DE 8,09); varones: 115. No hubo diferencias significativas en las características basales de los pacientes en función de los cuartiles de PAS. Los pacientes con menor PAS (Q1) tenían mayor mortalidad (20%, p<0,05). No se encontraron diferencias para la PAD. Sin embargo, el análisis de Kaplan-Meier mostró una mayor mortalidad global en los pacientes con menor PAS y PAD (log-rank=0,011 y 0,041, respectivamente). Las características del tratamiento farmacológico no diferían entre los grupos del estudio. Conclusión: En pacientes con IC no seleccionados, las cifras elevadas de PAS al ingreso se asocian con una menor mortalidad durante el seguimiento. El tratamiento farmacológico de la IC no parece influir en la relación inversa entre la PAS al ingreso y la mortalidad (AU)

Background and objective: An inverse relationship has been described between blood pressure and the prognosis in heart failure (HF). The characteristics of this relationship are not well unknown. The objective of this study was to determine if this relationship is maintained in a non-selected cohort of patients with HF and if it can be modified by treatment. Material and methods: Prospective study of cohorts including patients hospitalized for decompensated HF in Internal Medicine departments and followed as outpatients in a monographic consultation. Patients were classified according to their levels of systolic (SBP) and diastolic blood pressure (DBP). Clinical characteristics, all-cause mortality and readmissions after the first, third and sixth month of follow-up were analysed. Results: Two hundred and twenty-one patients were included after their admission to the hospital for acute HF. Mean patient age was 79.5 years(SD 8.09); 115 patients were male. No significant differences between SBP quartiles and basal characteristics were found. Patients with lower SBP (Q1) had higher mortality rates (20%, P<.05). No significant differences between mortality/readmissions and DBP were found. However, the Kaplan-Meier analysis showed higher all-cause mortality rates for the group of patients with lower SBP and DBP (log-rank=0.011 and 0.041, respectively). The pharmacological treatment did not differ significantly between both study groups. Conclusion: For non-selected patients suffering HF, higher SBP upon the admission is associated with significantly lower all-cause mortality rates during follow-up. Pharmacological treatment of HF does not seem to influence this inverse relationship between SBP at admission and patient mortality (AU)

Influence of blood pressure at the beginning of decompensations in the prognosis of patients with heart failure. / Influencia de la presión arterial al inicio de las descompensaciones en el pronóstico de pacientes con insuficiencia cardiaca.

BACKGROUND AND OBJECTIVE: An inverse relationship has been described between blood pressure and the prognosis in heart failure (HF). The characteristics of this relationship are not well unknown. The objective of this study was to determine if this relationship is maintained in a non-selected cohort of patients with HF and if it can be modified by treatment. MATERIAL AND METHODS: Prospective study of cohorts including patients hospitalized for decompensated HF in Internal Medicine departments and followed as outpatients in a monographic consultation. Patients were classified according to their levels of systolic (SBP) and diastolic blood pressure (DBP). Clinical characteristics, all-cause mortality and readmissions after the first, third and sixth month of follow-up were analysed. RESULTS: Two hundred and twenty-one patients were included after their admission to the hospital for acute HF. Mean patient age was 79.5 years(SD 8.09); 115 patients were male. No significant differences between SBP quartiles and basal characteristics were found. Patients with lower SBP (Q1) had higher mortality rates (20%, P<.05). No significant differences between mortality/readmissions and DBP were found. However, the Kaplan-Meier analysis showed higher all-cause mortality rates for the group of patients with lower SBP and DBP (log-rank=0.011 and 0.041, respectively). The pharmacological treatment did not differ significantly between both study groups. CONCLUSION: For non-selected patients suffering HF, higher SBP upon the admission is associated with significantly lower all-cause mortality rates during follow-up. Pharmacological treatment of HF does not seem to influence this inverse relationship between SBP at admission and patient mortality.

Conciliación de la medicación: una responsabilidad compartida / Medication reconciliation: a shared responsibility

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[Vasoactive and inotropic drugs in acute heart failure]. / Fármacos vasoactivos e inotrópicos en la insuficiencia cardíaca aguda.

Vasoactive and inotropic drugs provide effective symptomatic and hemodynamic relief in the short term but can increase mortality in the long-term. Consequently, their use should be restricted to the indications described in clinical practice guidelines. The present article reviews the main drugs and the available evidence on their use.

Fármacos vasoactivos e inotrópicos en la insuficiencia cardíaca aguda / Vasoactive and inotropic drugs in acute heart failure

Los fármacos vasoactivos en inotrópicos proporcionan un eficaz alivio sintomático y hemodinámico a corto plazo, aunque a largo plazo su uso puede aumentar la mortalidad, por lo que su utilización debe estar restringida a las indicaciones que de ellos hacen las guías de práctica clínica. En este capítulo se revisan los principales fármacos y las evidencias que de ellos disponemos (AU)

Vasoactive and inotropic drugs provide effective symptomatic and hemodynamic relief in the short term but can increase mortality in the long-term. Consequently, their use should be restricted to the indications described in clinical practice guidelines. The present article reviews the main drugs and the available evidence on their use (AU)

Propeptide of procollagen type I (PIP) and outcomes in decompensated heart failure.

BACKGROUND: Changes in extracellular matrix are recognized as a contributing factor in the cardiac remodeling process. Several studies have addressed the value of turnover markers of collagen as predictors of death or new heart failure episodes. The aim of the present study was to evaluate the relationship between peripheral serum concentration of propeptide of procollagen type I (PIP) and outcomes in patients with decompensated heart failure. METHODS: A total of 111 patients admitted to our Unit between September 2000 and May 2003 for decompensated heart failure were analyzed. Death from any cause or due to heart failure and readmission were considered primary endpoints. RESULTS: The mean PIP concentration was 80.84+/-36.40 ng/mL. The PIP serum level was significantly higher among those patients who suffered some endpoint during follow-up (88.12+/-37.31 ng/mL vs 73.13+/-34.06 ng/mL; p=0.029). Twenty-five (22.52%) of the 111 patients died during the 21 months of follow-up, and 54 (48.6%) were readmitted with new bouts of heart failure. Using Cox proportional hazards regression analyses, serum PIP levels, systolic dysfunction, and diabetes mellitus were identified as independent predictors of death. Serum PIP levels, age, and sex were independent predictors of new heart failure episodes and readmission. CONCLUSION: A single serum measurement of PIP seems to have prognostic value in patients with decompensated heart failure. Accordingly, patients with higher values of PIP at decompensation are at a higher risk of death or readmission during follow-up.