Estimated creatinine clearance: a determinant prognostic factor in heart failure.

BACKGROUND AND OBJECTIVE: Patients with heart failure and overt kidney failure (KF) have poor prognosis. Even mild degrees of kidney dysfunction might have prognostic value. The aim was to assess whether creatinine clearance values estimated with Cockroft formula correlated with survival at 2 years of follow-up in an outpatient heart failure unit population. PATIENTS AND METHOD: 423 patients (72% men), with a mean (standard deviation) age of 65.5 (11) years, were studied. Etiology of heart failure was mainly ischemic heart disease (59.6%). Mean left ventricle ejection fraction was 32.3% (13.3%). Patients were grouped according to stages of chronic kidney disease: $ 90 ml/min; 89-60 ml/min; 59-30 ml/min; 29-15 ml/min, and < 15 ml/min or on dialysis. KF was defined as creatinine clearance < 60 ml/min. RESULTS: Prevalence of KF was 52%. Mortality at 2 years was 3.2% in patients with creatinine clearance >or= 90 ml/min; 13.7% between 89-60 ml/min; 23.7% between 59-30 ml/min; 51% between 29-15 ml/min and 80% in patients with creatinine clearance < 15 ml/min or on dialysis (p < 0.001). Mortality was 30.4% in patients with KF and 10.3% in those without it (p < 0.001). CONCLUSIONS: Creatinine clearance values estimated by Cockroft formula had a highly predictive prognostic value in patients with heart failure. Even mild degrees of kidney function impairment showed higher mortality than normal kidney function values.

Patients' self-care improvement with nurse education intervention in Spain assessed by the European Heart Failure Self-Care Behaviour Scale.

UNLABELLED: The European Heart Failure Self-care Behaviour Scale (EHFScBS) has been developed for assessing patients' self-care level. We used it to assess our patients' self-care progress after a medium-term period of nurse education intervention. PATIENTS AND METHOD: We prospectively studied 151 patients (111 men and 40 women, mean age 65.4+/-11.9 years). All patients were evaluated twice with the EHFScBS: during the first visit to the Unit and after 1 year of nurse educational intervention. RESULTS: Mean score obtained by our patients in the initial evaluation was 24.8+/-7.6. In the second evaluation patients showed a significant (p<0.001) improvement in self-care behaviour (mean score 19.9+/-5.7). Analyzing item by item of the scale, patients show improvement in all items except in four: "If I am short of breath, I take it easy", "I take a rest during the day", "I eat a low salt diet" and "I take my medication as prescribed". CONCLUSIONS: Improvement in self-care behaviour, assessed with the EHFScBS, was achieved with nurse educational intervention in patients without previous heart failure education. However, in our population, this improvement was not obtained in one important aspect such is low salt diet compliance, although punctuation in this item was quite acceptable already initially.

Estimated creatinine clearance: a determinant prognostic factor in heart failure

FUNDAMENTO Y OBJETIVO: Los pacientes con insuficiencia cardíaca e insuficiencia renal (IR) establecidatienen peor pronóstico. Incluso grados leves de disfunción renal pueden tener significadopronóstico. El objetivo del estudio ha sido evaluar si los valores de aclaramiento de creatinina estimados mediante la fórmula de Cockroft se relacionan con la supervivencia a los 2 años de seguimiento en pacientes ambulatorios de una unidad de insuficiencia cardíaca.PACIENTES Y MÉTODO: Se estudió a 423 pacientes (un 72% varones) con una edad media (desviación estándar) de 65,5 (11) años. La etiología de la insuficiencia cardíaca fue principalmente la cardiopatía isquémica (59,6%). La fracción de eyección media del ventrículo izquierdo era del 32,3% (13,3%). Se dividió a los pacientes de acuerdo con los estadios de IR crónica ( 90; 89-60; 59-30; 29-15, y < 15 ml/min o en diálisis). Se consideró que había IR establecida cuando el aclaramiento de creatinina era inferior a 60 ml/min.RESULTADOS: La prevalencia de IR fue del 52%. La mortalidad a los 2 años fue del 3,2% en el grupo con aclaramiento de creatinina 90 ml/min; del 13,7% en el de 89-60 ml/min; del 23,7% en el de 59-30 ml/min; del 51% en el de 29-15 ml/min, y del 80% en pacientes conaclaramiento de creatinina < 15 ml/min o en diálisis (p < 0,001). La mortalidad fue del 30,4% en pacientes con IR y del 10,3% en aquellos sin la enfermedad (p < 0,001).CONCLUSIONES: Los valores de aclaramiento de creatinina estimados por la fórmula de Cockroft mostraron un alto valor pronóstico predictivo en pacientes con insuficiencia cardíaca. Incluso los pacientes con un grado leve de disfunción renal presentaron una mortalidad más elevada que aquellos con valores normales de función renaln

BACKGROUND AND OBJECTIVE: Patients with heart failure and overt kidney failure (KF) have poorprognosis. Even mild degrees of kidney dysfunction might have prognostic value. The aim was to assess whether creatinine clearance values estimated with Cockroft formula correlated with survival at 2 years of follow-up in an outpatient heart failure unit population.PATIENTS AND METHOD: 423 patients (72% men), with a mean (standard deviation) age of 65.5 (11) years, were studied. Etiology of heart failure was mainly ischemic heart disease (59.6%). Mean left ventricle ejection fraction was 32.3% (13.3%). Patients were grouped according to stages of chronic kidney disease: 90 ml/min; 89-60 ml/min; 59-30 ml/min; 29-15 ml/min,and < 15 ml/min or on dialysis. KF was defined as creatinine clearance < 60 ml/min.RESULTS: Prevalence of KF was 52%. Mortality at 2 years was 3.2% in patients with creatinineclearance 90 ml/min; 13.7% between 89-60 ml/min; 23.7% between 59-30 ml/min; 51% between 29-15 ml/min and 80% in patients with creatinine clearance < 15 ml/min or on dialysis (p < 0.001). Mortality was 30.4% in patients with KF and 10.3% in those without it (p <0.001).CONCLUSIONS: Creatinine clearance values estimated by Cockroft formula had a highly predictiveprognostic value in patients with heart failure. Even mild degrees of kidney function impairmentshowed higher mortality than normal kidney function values