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Eur J Intern Med ; 67: 89-96, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331793


OBJECTIVE: To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination. METHOD: We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality. RESULTS: A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67-3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04-1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04-1.70); (p = 0.021) for the RD-Hk group. CONCLUSIONS: The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination.

Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345


BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

Arch Cardiovasc Dis ; 112(6-7): 390-399, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31014989


BACKGROUND: The absence of cardiac troponin (cTn) determination in an episode of acute heart failure (AHF) is frequent. The characteristics of these patients are not well known; nor is it known whether they have a better prognosis than patients in whom cTn is determined. AIM: The objective of the EAHFE-TROPICA3 study was to analyse the characteristics of patients consulting for AHF in whom cTn was not determined (nocTn), and to evaluate the relationship of cTn determination (wcTn) with patient outcomes. METHODS: This was an analysis of the multipurpose prospective EAHFE registry of patients with AHF consulting at the emergency departments of 34 Spanish hospitals. RESULTS: Data from 8850 patients with AHF were analysed; cTn was not determined in 4216 of these patients (47.6%), who had a lower prevalence of ischaemic heart disease, more frequent use of loop diuretics at baseline, a greater rate of oedema in the acute episode, more frequent history of heart failure, and less use of angiotensin-converting enzyme inhibitors or aldosterone receptor antagonists and beta-blockers at baseline. Compared with the wcTn group, the nocTn group had the same in-hospital mortality (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 0.98-1.50), mortality at 30 days (adjusted OR 1.07, 95% CI 0.90-1.28) and reconsultation at 30 days (adjusted OR 0.90, 95% CI 0.80-1.02). CONCLUSIONS: Patients presenting with AHF with and without cTn determination have different characteristics. These differences are not related to a better prognosis.

Insuficiência Cardíaca/diagnóstico , Troponina/sangue , Biomarcadores/sangue , Fármacos Cardiovasculares/uso terapêutico , Nível de Saúde , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Humanos , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Espanha , Fatores de Tempo
Clin Res Cardiol ; 108(6): 622-633, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30426240


AIMS: To investigate whether the presence of atrial fibrillation (AF) is independently associated with adverse short-term outcomes in patients diagnosed with acute heart failure (AHF) in the emergency department (ED). METHODS: We performed a secondary analysis of patients included in the EAHFE registries 4&5. Patients were divided by the presence of sinus rhythm (SR) or AF at ED arrival. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the 30-day post-discharge combined endpoint of ED revisit or hospitalisation due to AHF and all-cause mortality. We recorded 54 independent variables that can affect outcomes. Cox regression was used to investigate adjusted significant associations between AF and outcomes. Analyses were repeated according to whether AF was previously known and whether AF was considered responsible for the AHF episode. RESULTS: We analysed 6045 ED visits (mean age 80.4 years, 55.9% women), 3644 (60.3%) with AF. The cumulative 30-day mortality was 9.4%, and the adverse combined endpoint (ACE) was 25.9% (ED revisit with and without hospitalisation were 16.5 and 8.9% and death occurred in 4.7%). No differences were found in outcomes of AHF patients with SR and AF, and among the latter group, no differences were found depending on whether AF was considered responsible for the AHF episode. Patients with previously known AF had significantly lower 30-day mortality and higher post-discharge ACE rates, although these differences disappeared after adjustment for confounders HR 0.782, 95% CI 0.590-1.037, p = 0.087; and HR 1.131, 95% CI 0.924-1.385, p = 0.234). CONCLUSION: The coexistence of AF does not impact the short-term outcomes of patients diagnosed with AHF in the ED.

Fibrilação Atrial/epidemiologia , Insuficiência Cardíaca/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Comorbidade , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
Biomarkers ; 22(3-4): 337-344, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27879165


OBJECTIVE: Evaluate the use of different cardiac troponin (cTn) immunoassays and the prognostic value of increased cTn values in patients diagnosed with acute heart failure (AHF) in the emergency department (ED). METHOD: The epidemiology acute heart failure emergency-TROPonin in acute heart failure2 (EAHFE-TROPICA2) is a retrospective study including patients with AHF admitted in 34 Spanish EDs with cTn values determined in the ED. We studied the prevalence of elevated troponin (value above the established reference limit) for the different types of troponin. We also assessed crude and adjusted primary (1-year all-cause death) and secondary (30 d ED revisit due to AHF) outcomes for every type of cTn and different magnitudes of troponin elevation. RESULTS: We analysed 4705 episodes of AHF. Troponin was elevated in 48.4% of the cases (25.3% in cTnI, 37.9% in cTnT and 82.2% in hs-cTnT). Mortality at one year was higher in patients with elevated troponin (adjusted HR 1.61; CI 95% 1.38-1.88) regardless of the type of cTn determined. Elevated troponin was not related to ED revisit within 30 d after discharge (1.01; 0.87-1.19). CONCLUSIONS: The use of conventional troponin in the ED is useful to predict one-year mortality in patients with AHF. Highly sensitive cTnT (hs-cTnT) elevations less than double the reference value have no impact on patient outcome.

Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Troponina/sangue , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/sangue , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Espanha , Resultado do Tratamento
Rev. multidiscip. gerontol ; 20(2): 51-55, abr.-jun. 2010.
Artigo em Espanhol | IBECS | ID: ibc-80940


Propósito de esta revisión: Recientemente se ha propuesto una nueva categoría de neumonía que engloba a aquellos pacientes con un contacto estrecho con el ámbito sanitario, llamada neumonía asociada al sistema sanitario (NAAS). El propósito de este capítulo es revisar los criterios de NAAS, la epidemiología, microorganismos causales y su susceptibilidad antibiótica, diagnóstico, tratamiento, pronóstico y prevención de la NAAS. Hallazgos recientes: La incidencia de NAAS en pacientes que requieren hospitalización oscila entre el 17 y el 67% según los diversos estudios. La hospitalización en los 90 días previos a la neumonía, recibir hemodiálisis o vivir en un centro sociosanitario son los criterios más frecuentes de relación con el ámbito sanitario. Comparados con la neumonía comunitaria, los pacientes con NAAS tienen una edad más avanzada, presentan más comorbilidades asociadas, mayor riesgo de neumonía aspirativa y de neumonía por gérmenes multirresistentes. Estos pacientes presentan más frecuentemente una antibioterapia inicial inapropiada, mayor tasa de mortalidad y estancias hospitalarias más prolongadas. Conclusiones: Muchos de los pacientes hospitalizados desde el servicio de urgencias tienen NAAS. Es importante identificar los pacientes con neumonía espirativa y aquellos con mayor riesgo de infección por microorganismos multirresistentes, para individualizar el tratamiento antibiótico (AU)

Purpose of review: Pneumonia developing before hospital admission in patients in close contact with the health system was recently termed "healthcare-associated pneumonia" (HCAP). We focus in the recent literature concerning the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for this condition. Recent findings: The reported incidence of HCAP among patients requiring hospitalization for pneumonia ranges from 17% to 67%. Hospitalization with in 90 days before pneumonia, attending a dialysis clinic and residing in a nursing home were the most common criteria for HCAP. Compared with patients with community-acquired pneumonia, those with HCAP are older, have greater co-morbidity, and are more likely to have aspiration pneumonia and pneumonia caused by antibiotic-resistant pathogens. Patients with HCAP also more frequently initially receive an inappropriate antibiotic therapy, have higher case fatality rates and have longer hospital stay. Conclusions: Many patients hospitalized with pneumonia via the emergency department haveHCAP. Physicians should identify patients at increased risk of aspiration pneumonia or infection by multidrug-resistant pathogens to promote a targeted approach when selecting initial antibiotic therapy (AU)

Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Pneumonia/complicações , Pneumonia/diagnóstico , Prognóstico , Comorbidade , /estatística & dados numéricos , /tendências , Corticosteroides/uso terapêutico , Pneumonia Aspirativa/complicações , Pneumonia Aspirativa/epidemiologia , Pneumonia/epidemiologia , Mortalidade/normas , Mortalidade/estatística & dados numéricos