Sex and age differences in fragility in a heart failure population.

BACKGROUND: Heart failure (HF) patients have a high degree of fragility and dependence from physical, cognitive and psychological points of view, and are a mainly geriatric population. AIM: To detect the existence of fragility in all patients treated in a Heart Failure Unit and to evaluate age and sex differences. METHODS: All patients underwent a basic geriatric evaluation to detect possible loss of autonomy for doing basic and instrumental activities, cognitive deterioration, emotional disturbance or social risk. RESULTS: Three hundred sixty patients (mean age 65.2 years, 41.7% > or = 70 years, 27.5% women) were evaluated. Fragility was detected in 41.7% of patients, being more prevalent in patients > or = 70 years (p<0.001) and in women (p<0.001). A Barthel Index < 90 was found in 22.5% of patients and an anomalous OARS Scale was found in 18.3%. Pfeiffer test's score was abnormal in 7.8% of patients. A positive depression response in abbreviate GDS was observed in 29.7%. All items analysed were more prevalent in patients > or = 70 years and in women, with the unexpected exception of depression symptoms that were as prevalent in younger as in older patients. CONCLUSION: Fragility is common in patients with heart failure, even in younger patients, and can be detected easily using standardised geriatric scales. Prevalence of fragility was significantly higher in older patients and in women, although the presence of depression symptoms was as prevalent in younger as in older patients.

[Prognostic significance of hemoglobin levels in patients with heart failure]. / Significado pronóstico de los valores de hemoglobina en pacientes con insuficiencia cardíaca.

INTRODUCTION AND OBJECTIVES: To evaluate the prognostic significance of hemoglobin (Hb) levels in terms of 1-year mortality and hospital admissions due to heart failure (HF) during the first year of follow-up after the first visit to an outpatient HF unit. PATIENTS AND METHOD: Survival status and HF-related hospital admission rate at 1 year were analyzed for 337 patients admitted between August 2001 and March 2003. Plasma Hb level was measured at the first visit to the unit. RESULTS: 28 patients (8%) died and there were 158 HF-related hospital admissions in 66 patients. Plasma Hb level correlated strongly with survival at 1 year, and was 13.0 +/- 1.7 g/dL in patients who were alive after this time, versus 11.7 +/- 1.6 g/dL (P < .001) in patients who died. Plasma Hb level also correlated with HF-related need for hospital admission, and was 13.1 +/- 1.7 g/dL in patients who were not hospitalized, versus 12.2 +/- 1.7 g/dL (P < .001) in patients with at least one hospital admission. In the multivariate logistic regression analysis plasma Hb level remained statistically associated both with 1-year survival and with the need for HF-related hospital admission. On the basis of a cutoff value for anemia of Hb < 12 g/dL, 30% of the patients had anemia. One-year mortality was 17% in patients with anemia and 5% in patients without anemia (P < .001). Among patients without anemia, 31% had at least one HF-related hospital admission, whereas only a 15% of the patients without anemia needed to be hospitalized for HF (P = .001). CONCLUSIONS: Plasma Hb levels correlated inversely with mortality and with HF-related hospital admissions at 1 year. The prevalence of anemia (Hb < 12 g/dL) in the population with HF studied here was high and had independent prognostic value.

[Reduction in heart failure hospitalization rate during the first year of follow-up at a multidisciplinary unit]. / Reducción de los ingresos por insuficiencia cardíaca en el primer año de seguimiento en una unidad multidisciplinaria.

INTRODUCTION AND OBJECTIVES: Heart failure leads to frequent hospital readmissions. The aim of this study was to assess how receiving attention at our multidisciplinary unit influenced hospitalization for heart failure. We compared the number of admissions in the year preceding attendance with that in the first year of follow-up. PATIENTS AND METHOD: In total, 366 patients were admitted between August 2001 and June 2003. Of these, 332 were still alive and could be assessed clinically 1 year later. The most common etiologies were ischemic heart disease in 60%, and dilated cardiomyopathy in 10%. RESULTS: The number of admissions in the year preceding attendance was 246, while that during the first year of follow-up was 125, which corresponds to a statistically significant reduction of 49% (P<.001). The reduction was even greater (54%, P<.001), when only patients who were hospitalized more than once in the preceding year were analyzed. Moreover, in addition to the improvements noted during follow-up in patients' understanding of the disease and in several aspects of self-care, the increase in treatment use was also remarkable: beta-blocker use increased from 53% to 70%, spironolactone use from 20% to 30%, and statin use from 36% to 58%. CONCLUSIONS: The number of hospital admissions for heart failure among patients who received attention at our multidisciplinary unit was significantly less in the first year of follow-up than in the year preceding attendance. This reduction was probably due to educational and pharmacologic interventions and to closer follow-up.

[Prognostic significance of diabetes in a heart failure population: one year mortality and heart failure related hospital admission]. / Significado pronóstico de la diabetes mellitus en una población con insuficiencia cardíaca: mortalidad e ingreso por insuficiencia cardíaca al cabo de un año.

BACKGROUND AND OBJECTIVE: The relationship between diabetes mellitus and heart failure is not fully established. The aim of the study was to assess the prevalence of diabetes and its prognostic significance, considering mortality and the need of hospital admission due to heart failure during the first year of follow-up, in an outpatient population with heart failure attended in a specialized Unit. PATIENTS AND METHOD: We studied 362 patients -73% men; mean age (standard deviation) 65.3 (10.9) years-. Mean ejection fraction was 32.2% (12.7%). Patients were in New York Heart Association functional class I (5%), II (47%), III (43%) and IV (5%). RESULTS: One-hundred forty-three out of 362 patients were diabetic (39.5%). Thirty patients (8%) died and 70 (19%) needed to be hospitalized due to heart failure during the first year of follow-up. One year mortality was 5% in non-diabetic patients and 13.3% in diabetic patients (p = 0.005). 13.2% of non-diabetic patients suffered at least one episode of heart failure needing hospital admission, whereas 28.7% of diabetic patients needed to be hospitalized at least once (p < 0.001). In the multivariate regression analysis, diabetes remained statistically associated both with mortality and with the need of heart failure related hospital admission. CONCLUSIONS: Diabetes significantly correlated with a higher one year mortality as well as with a greater need of hospital admission due to heart failure. Prevalence of diabetes in a general population with heart failure was high.

[Use of the Minnesota Living With Heart Failure Quality of Life Questionnaire in Spain]. / Aplicación en España del cuestionario sobre calidad de vida "Minnesota Living With Heart Failure" para la insuficiencia cardíaca.

INTRODUCTION AND OBJECTIVES: Quality of life is an important end-point in heart failure studies, as well as mortality and hospitalization rates. The Minnesota Living With Heart Failure Questionnaire is the instrument used most widely to evaluate quality of life in research studies. We used this questionnaire to evaluate quality of life in a general population attended by a heart failure unit in Spain. PATIENTS AND METHOD: 326 patients seen for the first time at the unit were evaluated. We analyzed the relationship between the questionnaire score and different clinical and demographic factors. RESULTS: The median global score on the Minnesota Living With Heart Failure Questionnaire was relatively low (28). We found a strong correlation (P<.001) between the score and functional class, sex (women had higher scores), and diabetes. We also found a correlation between the score and number of hospital admissions in the previous year (P<.001), anemia (P<.001) and etiology (P=.01), and a weak trend toward higher scores with increasing age (P=.04). The highest scores were observed in patients with valve disease disorders (43), and the lowest were seen in patients with alcoholic cardiomyopathy (20) and ischemic heart disease (24). We found no correlation with time of evolution of heart failure or with left ventricular ejection fraction. CONCLUSIONS: The scores on the Minnesota Living With Heart Failure Questionnaire in a general population attended by a heart failure unit in Spain were relatively low. However, we found a strong correlation between this score and functional class, and also between this score and number of admissions in the previous year. These results suggest that the questionnaire adequately reflects the severity of the disease.

[Prevalence of anemia and its correlation with clinical parameters in patients from a multidisciplinary heart failure unit]. / Anemia y parámetros relacionados en pacientes de una unidad de insuficiencia cardíaca multidisciplinaria.

BACKGROUND AND OBJECTIVE: There is a high prevalence of anemia in patients with heart failure which is related to their outcome. The aim of the study was to evaluate the prevalence of anemia (haemoglobin < 12 g/dl) in patients attended in a Multidisciplinary Heart Failure Unit and to analyze the correlation of hemoglobin levels and the presence of anemia with demographic, clinic, biological and therapeutic parameters. PATIENTS AND METHOD: Between August 2001 and February 2003, 330 patients were attended (mean age [SD], 68.0 [9.3] years). Simple lineal regression, multiple lineal regression, *2 test, Student t test and Kruskal-Wallis test were used for statistical analysis. RESULTS: 30% patients had anemia. We found a significant correlation between plasmatic hemoglobin levels and age, gender, etiology of heart failure, coexistence of diabetes, absence of smoking habit, functional class, quality of life, plasmatic levels of urea, creatinine and cholesterol, treatment with diuretics and nitrates and the absence of treatment with betablockers. Surprisingly, there was no relationship between treatment with angiotensin-converting enzyme inhibitors, antiplatelet drugs or anticoagulants and the presence of low levels of hemoglobin. CONCLUSIONS: The prevalence of anemia in a general population with heart failure is high. Plasmatic hemoglobin levels were related to several parameters, mainly age, gender, functional class and plasmatic levels of urea and cholesterol.

Patient's education by nurse: what we really do achieve?

AIM: To evaluate what is really achieved with nurse education in an outpatient heart failure population. METHOD: The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment. RESULTS: Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35-86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year (p<0.001). Only 28% initially understood the disease; 55% at follow-up (p<0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% (p<0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% (p<0.001), of the action of these pills from 24% to 44% (p<0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% (p<0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively (p<0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% (p<0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly (p=0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found. CONCLUSION: Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.

Nurse evaluation of patients in a new multidisciplinary Heart Failure Unit in Spain.

AIM: To know how compliant patients are, how much they know about their disease and treatment, and how their level of self-care is. METHODS: We performed a short nurse questionnaire during the first visit to a new Heart Failure Unit. RESULTS: Three hundred and twenty-four patients have been evaluated, with a mean age of 65.4 years. Ninety-eight patients (30%) knew and understood the performance of the heart and 85 (29%) understood the disease. Two-hundred and nineteen (67%) knew more than three signs of worsening symptoms. One-hundred and five (32%) knew all the names of the medication they were taking and 74 (23%) knew the action of these medications. Two-hundred and ninety-four (91%) said they were taking all the medication prescribed and 229 (71%) carried on always their written prescription. Sixty-two percent of patients controlled weight only at the medical visit and only 14% controlled weight more than once a week. Fifty-nine (18%) controlled blood pressure more than once a week, while 45% controlled it only at the medical visit. Only 33% of patients were said always to follow sodium restricted diet. The great majority (93%) never smoked and only very rarely took alcohol (83%). While only 18 (6%) performed some kind of physical exercise, the majority (83%) did walking and daily living activities. The 85% of patients with ischemic heart disease knew how to use sublingual nitro-glycerine. When subgroups were analysed, we found significant differences by age, gender and previous specialist management. Younger patients, men and patients referred from the Cardiology outpatient clinic showed a higher level of knowledge and understanding of several aspects of disease and treatment, and performed more physical activities, compared to older patients, women and patients referred from other departments. On the contrary, older patients showed better adherence with sodium restriction, and, as women, better smoking and drinking habits. CONCLUSION: There is a lot of work to do in nurse-guided education of patients with heart failure, although treatment compliance, use of nitro-glycerine and abstinence of smoking and alcohol intake seem to be quite assumed by the majority of our patients. Significant differences in knowledge and behaviour were evident between younger and older patients, between men and women, and relating to previous specialist management. In spite of that, we found no differences in treatment compliance.

Valoración de la calidad de vida en pacientes ancianos con insuficiencia cardíaca mediante el cuestionario Minnesota Living With Heart Failure / Evaluation of quality of life in elderly patients with heart failure through the Minnesota Living With Heart Failure Questionnaire

Introducción: la insuficiencia cardíaca es muy prevalente en la población geriátrica. La disminución de la calidad de vida es, junto con la elevada mortalidad y las frecuentes hospitalizaciones, una característica habitual de este proceso. El cuestionario Minnesota Living With Heart Failure es el instrumento más utilizado para valorarla en los trabajos de investigación. Nuestro objetivo ha sido conocer, mediante ese cuestionario, la calidad de vida de una población geriátrica atendida en una unidad de insuficiencia cardíaca. Material y métodos: se evaluó a 196 pacientes en la primera visita (edad media ± desviación estándar, 75,5 ± 4,6 años). Se analiza la correlación entre la puntuación en el cuestionario y varios factores clínicos, como diversos parámetros de una evaluación geriátrica sistemática. Resultados: la puntuación media fue 30,6 ± 17,4. Se encontró una fuerte correlación (p < 0,001) con la clase funcional, el sexo (puntuaciones más altas en mujeres) y el número de ingresos por insuficiencia cardíaca durante el año previo. Además, también hubo correlación con diabetes (p < 0,01), anemia (p = 0,03) e insuficiencia renal (p = 0,02), una débil tendencia a aumentar con la edad (p = 0,02; r = 0,16) y cierta relación con la etiología (p = 0,04). Por otra parte, se observó fuerte relación (p < 0,001) entre la presencia de fragilidad y el deterioro de la calidad de vida: pacientes frágiles, 39,0 ± 15,6 puntos, frente a 20,5 ± 13,8 en pacientes que no cumplían criterios de fragilidad. Conclusiones: la aplicación del cuestionario Minnesota Living With Heart Failure a una población geriátrica con insuficiencia cardíaca ha mostrado puntuaciones relativamente bajas. El deterioro de la calidad de vida se ha correlacionado de forma muy significativa con la clase funcional, el número de ingresos en el año previo, el sexo femenino y la presencia de fragilidad

Background and objective: heart failure is highly prevalent in the elderly population. Impaired quality of life, together with high mortality and frequent hospitalisations, are characteristic of this process. The Minnesota Living with Heart Failure Questionnaire is the most widely used tool for studying quality of life in research studies. The aim of the present study was to assess quality of life through this questionnaire in an elderly population attended in a heart failure unit. Patients and methods: during the first visit 196 patients (mean age 75.5 ± 4.6 years) were evaluated. We analyzed the relationship between the score obtained in the questionnaire and various clinical and demographic factors, including several parameters of a systematic geriatric evaluation. Results: the mean score was 30.6 ± 17.4. A strong correlation (p < 0.001) was found between the score obtained in the questionnaire and functional class, gender (women had higher scores), and the number of heart failure related hospital admissions in the preceding year. A correlation was also found between the score and the presence of diabetes (p < 0.01), anemia (p = 0.03) and renal insufficiency (p = 0.02), a weak trend to increase with age (p = 0.02, r = 0.16), and some correlation with etiology (p = 0.04). A strong correlation (p < 0.001) was found between the presence of frailty and impaired quality of life (frail patients [39.0 ± 15.6] vs. patients without frailty 20.5 ± 13.8). Conclusions: assessment of quality of life through the Minnesota Living With Heart Failure Questionnaire in an elderly population with heart failure showed relatively low scores. Quality of life impairment was significantly correlated with functional class, the number of heart failure related hospital admissions in the preceding year, female gender, and the presence of frailty

Significado pronóstico de los valores de hemoglobina en pacientes con insuficiencia cardíaca / Prognostic significance of hemoglobin levels in patients with heart failure

Introducción y objetivos. Evaluar el valor pronóstico de las concentraciones de hemoglobina (Hb) en relación con la mortalidad y con los ingresos hospitalarios por insuficiencia cardíaca (IC) al año de la primera visita a la Unidad de IC. Pacientes y método. Conocemos la situación vital y los ingresos por IC al año en 337 pacientes admitidos entre agosto de 2001 y marzo de 2003. Las concentraciones de Hb se recogieron en la primera visita. Resultados. Fallecieron 28 (8%) pacientes y hubo 158 ingresos por IC en 66 pacientes. Los valores de Hb se asociaron con la mortalidad a 1 año (pacientes vivos, 13,0 ± 1,7 g/dl; pacientes fallecidos, 11,6 ± 1,7 g/dl; p < 0,001) y con la necesidad de ingresar por IC (pacientes sin ingresos, 13,1 ± 1,7 g/dl; pacientes con al menos un ingreso, 12,2 ± 1,7 g/dl; p < 0,001). En el análisis multivariable, los valores de Hb mantuvieron la significación estadística. Definida la anemia como Hb < 12 g/dl, el 30% de los pacientes estaba anémico. La mortalidad al año fue del 17% en los pacientes anémicos y del 5% en el grupo sin anemia (p < 0,001). El 31% de los pacientes con anemia tuvo al menos un ingreso hospitalario por IC, mientras que sólo el 15% de los pacientes no anémicos precisó ingresar (p = 0,001). Conclusiones. Los valores de Hb se asocian inversamente con la mortalidad y los ingresos por IC en el primer año de seguimiento. La prevalencia de anemia en nuestra población con IC es elevada y tiene valor pronóstico independiente

Introduction and objectives. To evaluate the prognostic significance of hemoglobin (Hb) levels in terms of 1-year mortality and hospital admissions due to heart failure (HF) during the first year of follow-up after the first visit to an outpatient HF unit. Patients and method. Survival status and HF-related hospital admission rate at 1 year were analyzed for 337 patients admitted between August 2001 and March 2003. Plasma Hb level was measured at the first visit to the unit. Results. 28 patients (8%) died and there were 158 HF-related hospital admissions in 66 patients. Plasma Hb level correlated strongly with survival at 1 year, and was 13.0 ± 1.7 g/dL in patients who were alive after this time, versus 11.7 ± 1.6 g/dL (P<.001) in patients who died. Plasma Hb level also correlated with HF-related need for hospital admission, and was 13.1 ± 1.7 g/dL in patients who were not hospitalized, versus 12.2 ± 1.7 g/dL (P<.001) in patients with at least one hospital admission. In the multivariate logistic regression analysis plasma Hb level remained statistically associated both with 1-year survival and with the need for HF-related hospital admission. On the basis of a cutoff value for anemia of Hb < 12 g/dL, 30% of the patients had anemia. One-year mortality was 17% in patients with anemia and 5% in patients without anemia (P<.001). Among patients without anemia, 31% had at least one HF-related hospital admission, whereas only a 15% of the patients without anemia needed to be hospitalized for HF (P=.001). Conclusions. Plasma Hb levels correlated inversely with mortality and with HF-related hospital admissions at 1 year. The prevalence of anemia (Hb < 12 g/dL) in the population with HF studied here was high and had independent prognostic value

Significado pronóstico de la diabetes mellitus en una población con insuficiencia cardíaca: mortalidad e ingreso por insuficiencia cardíaca al cabo de un año / Prognostic significance of diabetes in a heart failure population: one year mortality and heart failure related hospital admission

Fundamento y objetivo: La relación entre la diabetes mellitus y la insuficiencia cardíaca no está bien establecida. El objetivo del estudio ha sido analizar la prevalencia y el significado pronóstico de la diabetes en una población con insuficiencia cardíaca atendida en una unidad especializada, valorando la mortalidad y la necesidad de ingresar por insuficiencia cardíaca al año de seguimiento. Pacientes y método: Se ha estudiado a 362 pacientes (un 73% varones) con edad media (desviación estándar) de 65,3 (10,9) años. La fracción de eyección media era de 32,2 (12,7%). La clase funcional de la New York Heart Association era I en el 5% de los casos, II en el 47%, III en el 43% y IV en el 5%. Resultados: El 39,5% (n = 143) de los pacientes eran diabéticos. Durante el primer año de seguimiento fallecieron 30 pacientes (8%) y 70 (19%) precisaron ingresar por insuficiencia cardíaca. La mortalidad a un año fue del 5% en los no diabéticos y del 13,3% en los diabéticos (p = 0,005). El 13,2% de los no diabéticos requirió ingresar al menos una vez por insuficiencia cardíaca, hecho que sucedió en el 28,7% de los diabéticos (p < 0,001). En el análisis de regresión múltiple la diabetes mantuvo la significación estadística tanto para la mortalidad como para la necesidad de ingresar por insuficiencia cardíaca. Conclusiones: La prevalencia de la diabetes en la población con insuficiencia cardíaca estudiada fue elevada. La diabetes se relacionó con una mayor mortalidad y con mayor necesidad de ingresar por insuficiencia cardíaca

Background and objective: The relationship between diabetes mellitus and heart failure is not fully established. The aim of the study was to assess the prevalence of diabetes and its prognostic significance, considering mortality and the need of hospital admission due to heart failure during the first year of follow-up, in an outpatient population with heart failure attended in a specialized Unit. Patients and method: We studied 362 patients ­73% men; mean age (standard deviation) 65.3 (10.9) years­. Mean ejection fraction was 32.2% (12.7%). Patients were in New York Heart Association functional class I (5%), II (47%), III (43%) and IV (5%). Results: One-hundred forty-three out of 362 patients were diabetic (39.5%). Thirty patients (8%) died and 70 (19%) needed to be hospitalized due to heart failure during the first year of follow-up. One year mortality was 5% in non-diabetic patients and 13.3% in diabetic patients (p = 0.005). 13.2% of non-diabetic patients suffered at least one episode of heart failure needing hospital admission, whereas 28.7% of diabetic patients needed to be hospitalized at least once (p < 0.001). In the multivariate regression analysis, diabetes remained statistically associated both with mortality and with the need of heart failure related hospital admission. Conclusions: Diabetes significantly correlated with a higher one year mortality as well as with a greater need of hospital admission due to heart failure. Prevalence of diabetes in a general population with heart failure was high

Reducción de los ingresos por insuficiencia cardíaca en el primer año de seguimiento en una unidad multidisciplinaria / Reduction in heart failure hospitalization rate during the first year of follow-up at a multidisciplinary unit

Introducción y objetivos. La insuficiencia cardíaca conlleva un alto índice de reingresos hospitalarios. El objetivo del estudio ha sido evaluar qué efecto producía en las hospitalizaciones por insuficiencia cardíaca el hecho de ser atendido en nuestra Unidad. Para ello hemos comparado el número de ingresos por esta enfermedad en el año precedente y durante el primer año de seguimiento. Pacientes y método. Entre agosto de 2001 y junio de2003 se ingresó a 366 pacientes, de los cuales 332 permanecían vivos y con situación clínica conocida al año. La etiología más frecuente era la cardiopatía isquémica(60%), seguida de la miocardiopatía dilatada (10%).Resultados. El número de ingresos en el año precedente fue de 246, mientras que durante el año de seguimiento ha sido de 125. La diferencia es estadísticamente significativa, con una reducción en el número de ingresos del 49% (p < 0,001). Ésta fue aún mayor en los pacientes con más de 1 ingreso en el año precedente (54%; p <0,001). Durante el seguimiento, además de la mejoría observada en el nivel de comprensión de la enfermedad yen algunos aspectos del autocuidado, cabe destacar el incremento conseguido en el tratamiento con bloqueadores beta (del 53 al 70%), espironolactona (del 20 al 30%) y estatinas (del 36 al 58%).Conclusiones. Los ingresos por insuficiencia cardíaca en el primer año de seguimiento de los pacientes atendidos en nuestra Unidad se han reducido de forma muy significativa respecto al año precedente, probablemente gracias a las intervenciones educativa y farmacológica realizadas, así como al seguimiento más próximo

Introduction and objectives. Heart failure leads to frequent hospital readmissions. The aim of this study was to assess how receiving attention at our multidisciplinary unit influenced hospitalization for heart failure. We compared the number of admissions in the year preceding attendance with that in the first year of follow-up. Patients and method. In total, 366 patients were admitted between August 2001 and June 2003. Of these,332 were still alive and could be assessed clinically 1year later. The most common etiologies were is chemicheart disease in 60%, and dilated cardiomyopathy in10%.Results. The number of admissions in the year preceding attendance was 246, while that during the first year of follow-up was 125, which corresponds to a statistically significant reduction of 49% (P<.001). The reduction was even greater (54%, P<.001), when only patients who were hospitalized more than once in the preceding year were analyzed. Moreover, in addition to the improvements noted during follow-up in patients’ understanding of the disease and in several aspects of self-care, the increase in treatment use was also remarkable: beta-blocker use increased from 53% to 70%, spironolactone use from 20% to 30%, and statin use from 36% to 58%.Conclusions. The number of hospital admissions for heart failure among patients who received attention at our multidisciplinary unit was significantly less in the first year of follow-up than in the year preceding attendance. This reduction was probably due to educational and pharmacologic interventions and to closer follow-up

Aplicación en España del cuestionario sobre calidad de vida "Minnesota Living With Heart Failure" para la insuficiencia cardíaca / Use of the "Minnesota Living With Heart Failure" quality of life questionnaire in Spain

Introducción y objetivos. La calidad de vida es, junto con la mortalidad y las hospitalizaciones, un objetivo importante en los estudios sobre insuficiencia cardíaca. El cuestionario "Minnesota Living With Heart Failure" es el instrumento más extensamente utilizado para valorarla en los trabajos de investigación. Nuestro objetivo ha sido conocer la calidad de vida mediante este cuestionario en una población general atendida en una unidad de insuficiencia cardíaca. Pacientes y método. Se evaluó a 326 pacientes en la primera visita. Hemos analizado la correlación entre la puntuación obtenida y diversos factores clínicos y demográficos. Resultados. La puntuación global fue relativamente baja (28). Encontramos una fuerte correlación (p < 0,001) con la clase funcional, el sexo (puntuaciones más altas en mujeres) y la diabetes. Hallamos también correlación con el número de ingresos durante el año previo (p < 0,001), la anemia (p < 0,001) y la etiología (p = 0,01), y una débil tendencia a aumentar con la edad (p = 0,04).Las puntuaciones más altas se observaron en pacientes valvulares (43) y las más bajas en pacientes con cardiopatía alcohólica (20) e isquémica (24). No hallamos correlación con el tiempo de evolución ni con la fracción de eyección de ventrículo izquierdo. Conclusiones. La aplicación del "Minnesota Living With Heart Failure" a una población general con insuficiencia cardíaca ha mostrado puntuaciones relativamente bajas. A pesar de ello, hemos encontrado una correlación importante de la puntuación obtenida con la clase funcional y con el número de ingresos en el año previo, lo que sugiere que el cuestionario refleja correctamente el grado de severidad de la enfermedad (AU)