Réplica de los autores a la carta: Escalas de riesgo en insuficiencia cardiaca aguda / Risk scores in acute heart failure

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[Prognostic factors on mortality in patients admitted to hospital with heart failure]. / Factores predictores de mortalidad en pacientes hospitalizados por insuficiencia cardíaca.

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. METHODS: Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. RESULTS: In-hospital mortality was 16%.The independent predictors were: age >75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?<0.001); cognitive impairment (HR?=?2.45, 95%?IC: 1.22-4.90, p?=?0.011); creatinine levels >1.16 mg/dl on admission (HR?=?1.59, 95%?IC: 1.12-2.24, p?=?0.009); systolic blood pressure >140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?<0.001); and number of diagnostics >10 on discharge (HR?=?1. 49, 95%?IC: 1.03-2.16, p?=?0.033). CONCLUSIONS: Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF.

Factores predictores de mortalidad en pacientes hospitalizados por insuficiencia cardíaca / Prognostic factors on mortality in patients admitted to hospital with heart failure

FUNDAMENTO: La insuficiencia cardíaca (IC) es la primera causa de hospitalización en países occidentales, con una mortalidad creciente. El objetivo fue describir los posibles factores pronósticos de mortalidad en pacientes hospitalizados por IC. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte de 202 pacientes consecutivos hospitalizados por IC, y seguidos durante un período máximo de 5 años. Se analizaron variables basales epidemiológicas y clínicas y su relación con la mortalidad hospitalaria y a largo plazo. RESULTADOS: La mortalidad durante el episodio índice de hospitalización fue del 16%. Las variables predictoras independientes de la mortalidad hospitalaria fueron: edad >75 años (HR = 2,68; IC 95%: 1,65-4,36; p = 0,001), presencia de deterioro cognitivo (HR = 2,77; IC 95%: 1,40-5,48; p = 0,004), índice de Barthel >60 (HR = 0,54; IC 95%: 0,37-0,78; p = 0,009), creatinina >1,16 mg/dL al ingreso (HR = 1,57; IC 95%: 1,12-2,20; p = 0,009) y >10 diagnósticos al alta (HR = 1,64; IC 95%: 1,14-2,36; p = 0,007). La mortalidad global acumulada a los 12, 24, 36 y 48 meses fue del 43%, 51%, 67% y 70%, respectivamente, y sus predictores independientes fueron: edad >75 años (HR = 2,55; IC 95%: 1,56-4,15; p <0,001), deterioro cognitivo al ingreso (HR = 2,45; IC 95%: 1,22-4,90; p = 0,011), creatinina >1,16 mg/dL al ingreso (HR = 1,59; IC 95%: 1,12-2,24; p = 0,009), presión arterial sistólica <140 mm Hg al ingreso (HR = 0,56; IC 95%: 0,40-0,80; p <0,001) y >10 diagnósticos al alta (HR = 1,49; IC 95%: 1,03-2,16; p = 0,033). CONCLUSIONES: Existen variables relacionadas con la mortalidad hospitalaria y a largo plazo que podrían ayudar a un mejor manejo de estos pacientes

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. METHODS: Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. RESULTS: In-hospital mortality was 16%.The independent predictors were: age >75 years (HR = 2.68, 95% IC: 1.65-4.36, p = 0.001); cognitive impairment (HR = 2.77, 95% IC: 1.40-5.48, p = 0.004); Barthel index ≥60 (HR = 0.54, 95% IC: 0.37-0.78, p = 0,009); creatinine levels >1.16 mg/dl at admission (HR = 1.57, 95% IC: 1.12-2.20, p = 0.009); and number of diagnostics >10 on discharge (HR = 1. 64, 95% IC: 1.14-2.36, p = 0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR = 2.55, 95% IC: 1.56-4.15, p <0.001); cognitive impairment (HR = 2.45, 95% IC: 1.22-4.90, p = 0.011); creatinine levels >1.16 mg/dl on admission (HR = 1.59, 95% IC: 1.12-2.24, p = 0.009); systolic blood pressure >140 mm Hg on admission (HR = 0.56, 95% IC: 0.40-0.80, p <0.001); and number of diagnostics >10 on discharge (HR = 1. 49, 95% IC: 1.03-2.16, p = 0.033). CONCLUSIONS: Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF