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1.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31629690

RESUMO

INTRODUCTION AND OBJECTIVES: Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. METHODS: We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). RESULTS: The mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P <.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). CONCLUSIONS: After an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.

2.
Am J Med ; 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31422111

RESUMO

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.

3.
Rev. esp. cardiol. (Ed. impr.) ; 72(8): 616-624, ago. 2019. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET1-4480

RESUMO

Introducción y objetivos: Los pacientes con insuficiencia cardiaca en tratamiento con antagonistas de la vitamina K (AVK) por fibrilación auricular no valvular (FANV) a menudo presentan valores alterados de la razón internacional normalizada (INR). El objetivo es evaluar la asociación entre la INR al ingreso por insuficiencia cardiaca y el riesgo de mortalidad en el seguimiento. Métodos: Estudio observacional retrospectivo en el que se evaluó la INR al ingreso de 1.137 pacientes consecutivos con insuficiencia cardiaca aguda en tratamiento con AVK por FANV. Esta se categorizó en: INR en rango óptimo (INR = 2-3, n = 210), infraterapéutica (INR < 2, n = 660) o supraterapéutica (INR > 3, n = 267). La asociación independiente entre INR y mortalidad se evaluó mediante cálculo restringido de las diferencias en tiempos de supervivencia media, dado que la INR no cumple la condición de proporcionalidad de riesgos de mortalidad. Resultados: Tras una mediana de 2,15 [0,71-4,29] años, fallecieron 495 pacientes (43,5%). En el análisis multivariable, tanto la INR infraterapéutica como la supraterapéutica se asociaron con un mayor riesgo de mortalidad, con unas diferencias en tiempos de supervivencia media a 5 años de -0,50 años (IC95%,-0,77 a -0,23; p < 0,001) y -0,40 años (IC95%, -0,70 a -0,11; p = 0,007) con respecto a los pacientes con INR 2-3. Conclusiones: La INR fuera de rango óptimo al ingreso de los pacientes con insuficiencia cardiaca aguda en tratamiento con AVK por FANV se asocia de manera independiente con un mayor riesgo de mortalidad en el seguimiento a largo plazo


Introduction and objectives: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. Methods: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR < 2, n = 660), and supratherapeutic (INR > 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, restricted mean survival time differences were used to evaluate the association among INR categories and the risk of all-cause mortality. Results: During a median [interquartile range] follow-up of 2.15 years [0.71-4.29], 495 (43.5%) patients died. On multivariable analysis, both patients with subtherapeutic and supratherapeutic INR showed higher risks of all-cause mortality, as evidenced by their restricted mean survival time differences at 5 years' follow-up: -0.50; 95%CI, -0.77 to -0.23 years; P < .001; and -0.40; 95%CI, -0.70 to -0.11 years; P = .007, respectively, compared with INR 2-3. Conclusions: In acute heart failure patients on treatment with VKA for NVAF, INR values out of normal range at admission were independently associated with a higher long-term mortality risk

4.
Am J Cardiol ; 124(4): 567-572, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31204033

RESUMO

In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heart failure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index of RV to PC coupling. Thus, we hypothesized that TAPSE/PASP would be a predictor of readmission burden in HFpEF. One thousand one hundred and twenty seven consecutive HFpEF patients discharged for acute HF were included. In 367 patients (32.6%), PASP could not be accurately measured by echocardiography, leaving the final sample size to be 760 patients. Negative binomial regression method was used to evaluate the association between TAPSE/PASP ratio and recurrent admissions. Mean age of the cohort was 75.6 ± 9.7 years and 68.3% were women. At a median (interquartile range) follow-up of 2.0 (2.9) years, 352 (46.3%) patients died and 1,214 readmissions were registered in 482 patients (63.4%), being 506 of them HF-related. There was a stepwise increase in the rates of all-cause and HF readmissions by decreasing TAPSE/PASP ratio. After multivariable adjustment, TAPSE/PASP <0.36 was associated with a higher risk of HF-related recurrent admissions (incidence rate ratio [IRR] 1.51, 95% confidence interval [CI], 1.01 to 2.24; p = 0.040), whereas patients in the lowest quintile (TAPSE/PASP <0.28) exhibited the highest risk of both all-cause and HF-related recurrent admissions (IRR 1.40, 95% CI 1.04 to 1.87, p = 0.025; and IRR 1.85, 95% CI 1.22 to 2.80, p = 0.004, respectively). In conclusion, TAPSE/PASP ratio, as a noninvasive index of RV-PC coupling, emerges as a strong predictor of recurrent hospitalizations in HFpEF.

5.
Int J Cardiol ; 291: 83-88, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30955879

RESUMO

BACKGROUND: Functional tricuspid regurgitation (TR) is a common echocardiographic finding in patients with heart failure (HF), and its role in disease progression and prognosis stratification is becoming increasingly relevant in recent years. However, data regarding its association with the burden of HF-readmission is scarce. In this work, we sought to evaluate the association between TR severity and HF-related readmissions following a hospitalization for acute heart failure (AHF). METHODS: We prospectively included a cohort of 2101 patients admitted with the diagnosis of AHF. TR severity was assessed using a multiparametric integrative approach, and classified as none, mild, moderate, and severe. We used negative binomial regression to identify the association between TR grade and HF-related recurrent admissions. The risk associated to severity of TR was expressed as incidence rate ratio (IRR). RESULTS: At a median follow-up of 2.53 years (IQR: 1.03-4.36), 978 (46.5%) patients died, and 1657 HF-readmissions occurred in 842 patients (40.0%). The proportion of patients with two or more admissions was 18.4%. The proportion of patients with moderate to severe TR was 17.2%. There was a stepwise increase in the incidence of readmissions from none to severe TR. After multivariable adjustment, only patients with severe TR were independently associated with higher risk of recurrent HF admissions (IRR = 1.34, CI 95%: 1.05-1.71; p = .019). CONCLUSIONS: In patients with AHF, severe functional TR is independently associated with an increased risk of long-term recurrent HF hospitalizations.

6.
Rev. esp. cardiol. (Ed. impr.) ; 72(4): 288-297, abr. 2019. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET1-4278

RESUMO

Introducción y objetivos: No se dispone de tratamientos farmacológicos que demuestren reducir la morbimortalidad asociada en pacientes con insuficiencia cardiaca y función sistólica conservada (IC-FEc). El objetivo del presente estudio fue evaluar si en pacientes con IC-FEc, el entrenamiento de la musculatura inspiratoria (EMI), la electroestimulación muscular funcional (EMF) o la combinación de ambas (EMI + EMF) puede mejorar la capacidad funcional, calidad de vida, parámetros de disfunción diastólica o biomarcadores a las 12 y 24 semanas. Métodos: Un total de 61 pacientes estables con IC-FEc (clase funcional de la New York Heart Association II-III) se aleatorizaron (1:1:1:1) a recibir un programa de 12 semanas de EMI, EMF, o EMI + EMF frente a tratamiento médico estándar (control). El objetivo primario fue evaluar el cambio en el consumo máximo de oxígeno. Los objetivos secundarios fueron los cambios en la calidad de vida, parámetros ecocardiográficos y biomarcadores. Se utilizó un modelo lineal mixto para comparar los cambios entre los diferentes grupos. Resultados: La edad media fue 74 +/- 9 años y la proporción de mujeres fue del 58%. El test de consumo máximo de oxígeno fue de 9,9 +/- 2,5ml/min/kg. A las 12 semanas, con respecto al grupo control, el incremento medio de consumo máximo de oxígeno fue de 2,98, 2,93 y 2,47 para EMI, EMF y EMI + EMF, respectivamente (p < 0,001). Este incremento se mantuvo a las 24 semanas (1,95, 2,08 y 1,56, respectivamente; p < 0,001). Resultados similares se observaron en la puntuación del cuestionario de calidad de vida (p < 0,001). Conclusiones: En los pacientes con IC-FEc e importante reducción de la capacidad funcional, tanto el EMI como la EMF se asocian con una marcada mejoría de la capacidad funcional y la calidad de vida


Introduction and objectives: Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. Methods: A total of 61 stable symptomatic patients (New York Heart Association functional class II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes. Results: Mean age and peak exercise oxygen uptake were 74 +/- 9 years and 9.9 +/- 2.5mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 24 weeks (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found. Conclusions: In HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life

7.
Rev Esp Cardiol (Engl Ed) ; 72(4): 288-297, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29551699

RESUMO

INTRODUCTION AND OBJECTIVES: Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. METHODS: A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes. RESULTS: Mean age and peak exercise oxygen uptake were 74 ± 9 years and 9.9 ± 2.5mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 6 months (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found. CONCLUSIONS: In HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life. This trial was registered at ClinicalTrials.gov (Identifier: NCT02638961)..


Assuntos
Exercícios Respiratórios/métodos , Terapia por Estimulação Elétrica/métodos , Insuficiência Cardíaca/terapia , Assistência ao Convalescente , Idoso , Terapia Combinada , Ecocardiografia , Tolerância ao Exercício/fisiologia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Tamanho da Amostra , Volume Sistólico/fisiologia , Inquéritos e Questionários , Resultado do Tratamento
9.
Rev Esp Cardiol (Engl Ed) ; 72(8): 616-624, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30201288

RESUMO

INTRODUCTION AND OBJECTIVES: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. METHODS: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR < 2, n = 660), and supratherapeutic (INR > 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, restricted mean survival time differences were used to evaluate the association among INR categories and the risk of all-cause mortality. RESULTS: During a median [interquartile range] follow-up of 2.15 years [0.71-4.29], 495 (43.5%) patients died. On multivariable analysis, both patients with subtherapeutic and supratherapeutic INR showed higher risks of all-cause mortality, as evidenced by their restricted mean survival time differences at 5 years' follow-up: -0.50; 95%CI, -0.77 to -0.23 years; P < .001; and -0.40; 95%CI, -0.70 to -0.11 years; P = .007, respectively, compared with INR 2-3. CONCLUSIONS: In acute heart failure patients on treatment with VKA for NVAF, INR values out of normal range at admission were independently associated with a higher long-term mortality risk.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/mortalidade , Insuficiência Cardíaca/mortalidade , Medição de Risco/métodos , Vitamina K/antagonistas & inibidores , Doença Aguda , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Causas de Morte/tendências , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Incidência , Coeficiente Internacional Normatizado , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Fatores de Tempo
10.
Cardiovasc Ther ; 36(6): e12465, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30191652

RESUMO

AIMS: Optimal diuretic treatment of patients with refractory congestive heart failure (CHF) remains to be elucidated. In this work, we aimed to evaluate the serial changes of functional class and surrogates of fluid overload (weight and antigen carbohydrate 125) after addition of oral acetazolamide in patients with refractory CHF. Likewise, serial changes in renal function, serum electrolytes and pH were evaluated. METHOD: This is an observational retrospective study in which 25 ambulatory patients with refractory CHF that received acetazolamide in addition to standard intensive diuretic strategy were evaluated. Longitudinal assessment of New York Heart Association (NYHA) functional class and biomarkers was analyzed using joint modelling of longitudinal and survival data. RESULTS: All patients showed NYHA class III/IV at baseline. After prescription of acetazolamide, a total of 125 outpatient visits were recorded [median visits per patient: 6 (IQR = 3-7)] during a median follow-up of 152 days (IQR = 80-353). A significant decrease in NYHA class, weight, and antigen carbohydrate 125 was observed. On the other hand, estimated glomerular filtration rate increased over time. No significant changes in systolic blood pressure, serum sodium, potassium, amino-terminal pro-brain natriuretic peptide, and pH occurred. CONCLUSION: In a cohort of patients with refractory CHF treated with an intensive diuretic treatment, the addition of acetazolamide was associated with improvement in functional class and surrogates of fluid overload.


Assuntos
Acetazolamida/administração & dosagem , Diuréticos/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Acetazolamida/efeitos adversos , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Antígeno Ca-125/sangue , Diuréticos/efeitos adversos , Estudos de Viabilidade , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Perda de Peso/efeitos dos fármacos
11.
Clin Cardiol ; 41(4): 476-480, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29663436

RESUMO

BACKGROUND: Sodium-glucose linked transporter 2 inhibition recently emerged as a promising therapy for reducing the risk of heart failure (HF) in patients with type 2 diabetes mellitus (T2DM). However, there is a lack of data endorsing its role in symptomatic HF patients. We sought to evaluate the short-term effects of empagliflozin on maximal exercise capacity in these patients. HYPOTHESIS: We postulate tretament with empagliflozin may improve functional capacity in patients with T2DM and established HF. METHODS: Nineteen T2DM patients with symptomatic HF were prospectively included and underwent cardiopulmonary exercise testing before and 30 days after initiation of empagliflozin therapy. A mixed-effects model for repeated measures was used. RESULTS: Median patient age was 72 years (interquartile range, 60-79 years); 42.1% were in New York Heart Association class III. Baseline mean (± SD) peak oxygen consumption (peak VO2 ) was 10.9 ± 4.0 mL/min/kg. Peak VO2 increased significantly at 30 days (∆: +1.21 [0.66 to 1.76] mL/min/kg; P < 0.001). A significant improvement in ventilatory efficiency during exercise, 6-minute walking distance, and quality of life, and a reduction in antigen carbohydrate 125, were also found. Estimated glomerular filtration rate and natriuretic peptides did not significantly change. CONCLUSIONS: In this pilot study, empagliflozin was associated with 1-month improvement in exercise capacity in T2DM patients with symptomatic HF. This beneficial effect was also found for other surrogates of severity.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Tolerância ao Exercício/efeitos dos fármacos , Glucosídeos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idoso , Compostos Benzidrílicos/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Glucosídeos/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/efeitos dos fármacos , Projetos Piloto , Estudos Prospectivos , Ventilação Pulmonar/efeitos dos fármacos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
12.
Rev. esp. cardiol. (Ed. impr.) ; 71(4): 250-256, abr. 2018. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-171752

RESUMO

Introducción y objetivos. La insuficiencia cardiaca con fracción de eyección conservada (IC-FEc) es un síndrome muy prevalente con alto riesgo de morbilidad y mortalidad. Hasta la fecha, la evidencia acerca del papel del consumo máximo de oxígeno (VO2máx) para predecir la carga de morbilidad en la IC-FEc es escasa. El objetivo de este estudio es evaluar la relación entre el VO2máx y el riesgo de ingresos recurrentes de los pacientes con IC-FEc. Métodos. A un total de 74 pacientes con IC-FEc sintomáticos y clínicamente estables, se les realizó una prueba de esfuerzo cardiopulmonar entre junio de 2012 y mayo de 2016. Se utilizó el método de regresión binomial negativa para determinar la asociación entre el porcentaje de VO2máx predicho (%VO2máx-p) y los ingresos recurrentes. Las estimaciones del riesgo se informaron como tasas de incidencia. Resultados. La media de edad era 72,5 ± 9,1 años, el 53% eran mujeres y todos los pacientes estaban en clase funcional II-III de la New York Heart Association. La media de VO2máx y la mediana de %VO2máx-p fueron 10 ± 2,8 ml/min/kg y el 60% (47-67) respectivamente. Durante un seguimiento medio de 276 [intervalo intercuartílico, 153-1.231] días, se registraron 84 hospitalizaciones por cualquier causa de 31 pacientes (41,9%). También se determinó un total de 15 muertes (20,3%). En un análisis multivariable, teniendo en cuenta la mortalidad como evento terminal, el %VO2máx-p mantuvo la asociación independiente y lineal con el riesgo de ingresos recurrentes. Así, y modelado como continuo, una disminución del 10% del %VO2máx-p aumentó en un 32% el riesgo de ingresos recurrentes (IRR = 1,32; IC95%, 1,03-1,68; p = 0,028). Conclusiones. En los pacientes de edad avanzada con IC-FEc sintomáticos, el %VO2máx-p predice los ingresos recurrentes por todas las causa (AU)


Introduction and objectives. Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. Methods. A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. Results. The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8 mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). Conclusions. In symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission (AU)


Assuntos
Humanos , Volume Sistólico/fisiologia , Insuficiência Cardíaca/diagnóstico , Fluxo Expiratório Máximo/fisiologia , Oximetria , Hospitalização/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Teste de Esforço/estatística & dados numéricos
13.
ESC Heart Fail ; 5(4): 579-585, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29573575

RESUMO

AIMS: The mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF) are not yet elucidated. Chronotropic incompetence has emerged as a potential mechanism. We aimed to evaluate whether heart rate (HR) response to exercise is associated to functional capacity in patients with symptomatic HFpEF. METHODS AND RESULTS: We prospectively studied 74 HFpEF patients [35.1% New York Heart Association Class III, 53% female, age (mean ± standard deviation) 72.5 ± 9.1 years, and 59.5% atrial fibrillation]. Functional performance was assessed by peak oxygen consumption (peak VO2 ). The mean (standard deviation) peak VO2 was 10 ± 2.8 mL/min/kg. The following chronotropic parameters were calculated: Delta-HR (HR at peak exercise - HR at rest), chronotropic index (CI) = (HR at peak exercise - resting HR)/[(220 - age) - resting HR], and CI according to the equation developed by Keteyian et al. (CIK) (HR at peak exercise - HR at rest)/[119 + (HR at rest/2) - (age/2) - 5 - HR at rest]. In a bivariate setting, peak VO2 was positively and significantly correlated with Delta-HR (r = 0.35, P = 0.003), CI (r = 0.27, P = 0.022), CIK (r = 0.28, P = 0.018), and borderline with HR at peak exercise (r = 0.22, P = 0.055). In a multivariable linear regression analysis that included clinical, analytical, echocardiographic, and functional capacity covariates, the chronotropic parameters were positively associated with peak VO2 . We found a linear relationship between Delta-HR and peak VO2 (ß coefficient of 0.03; 95% confidence interval: 0.004-0.05; P = 0.030); conversely, the association among CIs and peak VO2 was exponentially shaped. CONCLUSIONS: In patients with chronic HFpEF, the HR response to exercise was positively associated to patient's functional capacity.


Assuntos
Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Volume Sistólico/fisiologia , Idoso , Ecocardiografia , Teste de Esforço , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Estudos Prospectivos
14.
Circulation ; 137(13): 1320-1330, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29025765

RESUMO

BACKGROUND: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. METHODS: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. RESULTS: The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3±0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001). CONCLUSIONS: Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.


Assuntos
Insuficiência Cardíaca/patologia , Potássio/sangue , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Hiperpotassemia/complicações , Hiperpotassemia/patologia , Hipopotassemia/complicações , Hipopotassemia/patologia , Masculino , Pessoa de Meia-Idade , Potenciometria , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Risco , Análise de Sobrevida
15.
Rev Esp Cardiol (Engl Ed) ; 71(4): 250-256, 2018 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28666951

RESUMO

INTRODUCTION AND OBJECTIVES: Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. METHODS: A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. RESULTS: The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). CONCLUSIONS: In symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission.


Assuntos
Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Consumo de Oxigênio/fisiologia , Idoso , Teste de Esforço/métodos , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Recidiva , Volume Sistólico/fisiologia
16.
Rev. esp. cardiol. (Ed. impr.) ; 70(12): 1067-1073, dic. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-169305

RESUMO

Introducción y objetivos: El tratamiento óptimo de pacientes con insuficiencia cardiaca aguda (ICA) y síndrome cardiorrenal tipo 1 (SCR-1) no está bien definido. La hipoperfusión arterial y la congestión venosa tienen un papel fundamental en la fisiopatología del SCR-1. El antígeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diurético de pacientes con SCR-1. Métodos: Ensayo clínico multicéntrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulación basada en la evaluación clínica y bioquímica habitual, o b) estrategia basada en CA125: dosis altas de diuréticos si CA125 > 35 U/ml y bajas en caso contrario. El objetivo principal es el cambio en la función renal a las 24 y las 72 h tras el comienzo del tratamiento. Como objetivos secundarios: a) cambios clínicos y bioquímicos a las 24 y las 72 h, y b) cambios en la función renal y eventos clínicos mayores a 30 días. Resultados: Los resultados de este estudio aportarán datos relevantes sobre la utilidad del CA125 para guiar el tratamiento diurético en el SCR-1. Además, permitirá ampliar el conocimiento de la fisiopatología de esta compleja entidad clínica. Conclusiones: La hipótesis del presente estudio es que las concentraciones de CA125 aumentadas pueden identificar a una población de pacientes con SCR-1 para quienes una estrategia diurética más intensa puede ser beneficiosa. Por el contrario, las concentraciones bajas de esta glucoproteína seleccionarían a los pacientes para los que serían perjudiciales las dosis altas de diuréticos (AU)


Introduction and objectives: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72 hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72 hours, and b) renal function changes and major clinical events at 30 days. Results: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. Conclusions: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses (AU)


Assuntos
Humanos , Insuficiência Cardíaca/terapia , Nefropatias/complicações , Biomarcadores , Diuréticos/uso terapêutico , Insuficiência Cardíaca/complicações , Análise Estatística
17.
Am J Cardiol ; 120(8): 1344-1348, 2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-28823484

RESUMO

Functional mitral regurgitation (FMR) is a common finding in patients with acute heart failure (AHF) and reduced left ventricular ejection fraction (heart failure and reduced ejection fraction [HFrEF]). However, its clinical impact remains unclear. We aimed to evaluate the association between the severity of FMR after clinical stabilization and short-term adverse outcomes after a hospitalization for AHF. We prospectively included 938 consecutive patients with HFrEF discharged after a hospitalization for AHF, after excluding those with organic valve disease, congenital heart disease, or aortic valve disease. FMR was assessed semiquantitatively by color Doppler analysis of the regurgitant jet area, and its severity was categorized as none or mild (grade 0 or 1), moderate (grade 2), or severe (grade 3 or 4). FMR was assessed at 120 ± 24 hours after admission. The primary end point was the composite of all-cause mortality and rehospitalization at 90 days. At discharge, 533 (56.8%), 253 (26.9%), and 152 (16.2%) patients showed none-mild, moderate, and severe FMR. At the 90-day follow-up, 161 patients (17.2%) either died (n = 49) or were readmitted (n = 112). Compared with patients with none or mild FMR, rates of the composite end point were higher for patients with moderate and severe FMRs (p <0.001). After the multivariable adjustment, those with moderate and severe FMRs had a significantly higher risk of reaching the end point (hazard ratio = 1.50, 95% confidence interval 1.04 to 2.17, p = 0.027; and hazard ratio = 1.63, 95% confidence interval 1.07 to 2.48, p = 0.023, respectively). In conclusion, FMR is a common finding in patients with HFrEF, and its presence, when moderate or severe, identifies a subgroup at higher risk of adverse clinical outcomes at short term.


Assuntos
Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Insuficiência da Valva Mitral/etiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Doença Aguda , Idoso , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Prognóstico , Estudos Prospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendências
18.
Eur J Intern Med ; 42: 61-66, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28400077

RESUMO

INTRODUCTION AND OBJECTIVES: In patients admitted for acute heart failure (AHF), optimal length of stay (LOS) remains controversial. Longer hospitalizations are associated with worse prognosis, but little is known about short hospitalizations. The aim of this work was to evaluate the relationship between LOS and the risk of short-term readmission in patients discharged after a hospitalization for AHF. METHODS: We included 2110 consecutive patients. The independent associations between LOS and unplanned 10, 15 and 30-day readmissions were evaluated by Cox regression analysis adjusted for competing events. LOS was categorized as LOS1: ≤4days, LOS2: 5-7days, LOS3: 8-10days, and LOS4: >10days. RESULTS: The mean age was 73±11years and 52.6% exhibited left ventricle ejection fraction≥50%. The median (IQR) LOS was 7 (5-11) days. At 10, 15 and 30-day follow-up, 130 (6.2%), 181 (8.6%), and 282 (13.4%) unplanned readmissions were registered. Rates of 10 and 15-day readmission among LOS categories showed a J-shaped pattern with lower rates for those in LOS2 and higher at the both extremes (p=0.001). At 30-day, only longer stays showed higher rates of readmission (p=0.002). In the multivariate analysis, the U-shaped curve remained significant for 10 and 15-day readmissions (p<0.05). Compared to LOS2, LOS1, LOS3 and LOS4 showed about two-fold increased risk. At 30-day only longer stays showed a borderline and modest increase of risk. CONCLUSIONS: Shorter and longer stays are associated with the risk of very early readmissions after an episode of AHF. These associations are marginal for 30-day readmissions.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Espanha , Fatores de Tempo , Função Ventricular Esquerda
19.
Int J Cardiol ; 241: 407-410, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28455131

RESUMO

Pulmonary hypertension (PH) is a strong predictor of mortality in patients with heart failure (HF). However, the relationship between PH, through echocardiographic pulmonary artery pressure (PASP) estimation, and the risk of HF rehospitalizations remains unclear. METHODS: We prospectively included 2343 consecutive patients discharged for acute heart failure (AHF). PH was estimated by echocardiography through PASP determination during the index admission. Patients were categorized as follows across PASP: non-measurable, normal (≤35mmHg), mild (36-45mmHg), moderate (46-60mmHg), or severe PH (>60mmHg). Negative binomial regression method was used to evaluate the association between PASP and recurrent HF hospitalizations across preserved (HFpEF: ≥50%), mid-range (HFmrEF: 40-49%) and reduced ejection fraction (HFrEF: <40%). RESULTS: Mean age of the cohort was 72.8±11.2years, 1187 (50.5%) were women, and 1252 (53.4%) and 410 (17.5%) showed HFpEF and HFmrEF, respectively. At a median (interquartile range) follow-up of 2.3 (0.8-4.5) years, we registered 1114 (47.6%) deaths, and 1834 HF-related rehospitalizations in 943 (40.2%) patients. After multivariable adjustment, and compared to patients with normal PASP, severe PH exhibited an independent higher risk of recurrent HF admissions only in HFpEF (IRR=1.66; 95% confidence interval (CI), 1.16-2.38; p=0.005), whereas in HFmrEF patients there was a non-significant trend to higher HF readmissions (IRR: 1.73; 95% CI, 0.85-3.55; p=0.132). Severe PH was not related with recurrent hospitalizations in HFrEF (IRR: 1.19; 95% CI, 0.66-2.14; p=0.553). CONCLUSIONS: Echocardiography-derived PASP evaluated during an episode of AHF is related to HF readmission burden, particularly in those patients with HFpEF.


Assuntos
Ecocardiografia/tendências , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/epidemiologia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/epidemiologia , Readmissão do Paciente/tendências , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Pulmonar/diagnóstico por imagem
20.
Rev. esp. cardiol. (Ed. impr.) ; 70(4): 239-246, abr. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-161485

RESUMO

Introducción y objetivos: Las insuficiencias cardiacas con función sistólica conservada y con función sistólica reducida tienen en común el alto riesgo de mortalidad. Sin embargo, no se conocen bien las diferencias entre ambas por lo que respecta a la carga de reingresos hospitalarios con el correr del tiempo. Métodos: Se estudió prospectivamente a una cohorte de 2.013 pacientes consecutivos dados de alta tras una hospitalización por insuficiencia cardiaca aguda. De ellos, 1.082 (53,7%) tenían insuficiencia cardiaca con función sistólica conservada y 931 (46,2%), insuficiencia cardiaca con función sistólica reducida. Se utilizaron análisis de regresión de Cox y de regresión binomial negativa para evaluar los riesgos de muerte y rehospitalizaciones. Resultados: Tras una mediana de seguimiento de 2,36 [intervalo intercuartílico, 0,96-4,65] años, 1.018 pacientes (50,6%) habían fallecido, y se habían registrado 3.804 reingresos de 1.406 pacientes (69,8%). En general, no hubo diferencias entre la insuficiencia cardiaca con función sistólica conservada y la insuficiencia cardiaca con función sistólica reducida en cuanto a mortalidad (16,7 frente a 16,1/100 personas-año; p = 0,794) o tasas de rehospitalización por cualquier causa (62,1 frente a 62,2/100 personas-año; p = 0,944). Tras aplicar un ajuste multivariable, y en comparación con los pacientes con insuficiencia cardiaca y función sistólica reducida, los pacientes con insuficiencia cardiaca y función sistólica conservada mostraron una tasa de reingresos por cualquier causa similar (cociente de tasas de incidencia = 1,04; intervalo de confianza del 95% (IC95%), 0,93-1,17; p = 0,461). Por lo que respecta a las causas específicas, la insuficiencia cardiaca con función sistólica conservada mostró similares riesgos de rehospitalizaciones de causa cardiovascular y por descompensación de insuficiencia cardiaca (cociente de tasas de incidencia = 0,93; IC95%, 0,82-1,06; p = 0,304; y cociente de tasas de incidencia = 0,96; IC95%, 0,83-1,13; p = 0,677), pero el riesgo de reingresos de causa no cardiovascular fue superior (cociente de tasas de incidencia = 1,24; IC95%, 1,04-1,47; p = 0,012). Conclusiones: Tras un ingreso por insuficiencia cardiaca aguda, los pacientes con insuficiencia cardiaca y función sistólica conservada presentan una carga de rehospitalizaciones similar a la de los pacientes con insuficiencia cardiaca y función sistólica reducida. Sin embargo, los pacientes con insuficiencia cardiaca y función sistólica conservada tienen mayor probabilidad de reingresos por causas no cardiovasculares (AU)


Introduction and objectives: Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. Methods: We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. Results: At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients (50.6%) died, and 3804 readmissions were registered in 1406 patients (69.8%). Overall, there were no differences in mortality between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (16.7 vs 16.1 per 100 person-years, respectively; P = 0794), or all-cause repeat hospitalization rates (62.1 vs 62.2 per 100 person-years, respectively; P = .944). After multivariable adjustment, and compared with patients with heart failure with reduced ejection fraction, patients with heart failure with preserved ejection fraction exhibited a similar risk of all-cause readmissions (incidence rate ratio = 1.04; 95%CI, 0.93-1.17; P = .461). Regarding specific causes, heart failure with preserved ejection fraction showed similar risks of cardiovascular and heart failure-related rehospitalizations (incidence rate ratio = 0.93; 95%CI, 0.82-1.06; P = .304; incidence rate ratio = 0.96; 95% confidence interval, 0.83-1.13; P = .677, respectively), but had a higher risk of noncardiovascular readmissions (incidence rate ratio = 1.24; 95%CI, 1.04-1.47; P = .012). Conclusions: Following an admission for acute heart failure, patients with heart failure with preserved ejection fraction have a similar rehospitalization burden to those with heart failure with reduced ejection fraction. However, patients with heart failure with preserved ejection fraction are more likely to be readmitted for noncardiovascular causes (AU)


Assuntos
Humanos , Insuficiência Cardíaca Sistólica/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Recidiva , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Fatores de Risco
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