[Profile of heart failure according to the department of admission. Implications for multidisciplinary management]. / Perfil de la insuficiencia cardíaca en función del servicio de ingreso. Implicaciones para el manejo multidisciplinar.

INTRODUCTION: Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. METHODS: An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. RESULTS: Of a total of 235 patients, 124 (52.7%) were admitted to Internal Medicine, 83 (35.3%) to Cardiology, and 28 (11.9%) to Geriatrics. Mean age was 77.0±20.2 years (Cardiology 71.5±13.5; Internal Medicine 79.2±21.1; Geriatrics 89.9±5.1; p<.001). Preserved ejection fraction was found in 121 (51.5%) patients, and this rate was higher in Internal Medicine (62.5%) and Geriatrics (70.0%) than in Cardiology (31.3%), p<.001. Comorbidity was frequent, especially atrial fibrillation (126; 53.6%), renal disease (89; 37.8%), and chronic obstructive pulmonary disease (65; 27.6%). Infections were the most common decompensating trigger in Internal Medicine (56; 45.2%), and there was often no trigger in Cardiology (45; 54.2%) and Geriatrics (14; 50.0%), p<.0001. The use of renin-angiotensin system inhibitors, beta-blockers, and spironolactone in patients with systolic dysfunction was higher in Cardiology. During the 45 days follow-up, 23 patients (9.9%) were readmitted, which was more frequent in Internal Medicine than in Cardiology (odds ratio 3.0 [95% confidence interval: 1.1 - 8.6], p=.03), with no other significant comparisons. CONCLUSIONS: Patients admitted due to decompensated heart failure are elderly and often have comorbidities. There are major differences between departments as regards age and clinical profile.

Perfil de la insuficiencia cardíaca en función del servicio de ingreso. Implicaciones para el manejo multidisciplinar / Profile of heart failure according to the department of admission. Implications for multidisciplinary management

Introducción. El envejecimiento poblacional ha producido notables cambios en los ingresos por insuficiencia cardíaca. Nuestro objetivo fue comparar las características, comorbilidad, manejo y pronóstico de estos pacientes en tres servicios. Material/métodos. Registro prospectivo de 45 días de duración. Se incluyeron todos los ingresos por insuficiencia cardíaca en Medicina Interna, Cardiología y Geriatría. Resultados. De 235 pacientes, 124 (52,7%) ingresaron en Medicina Interna, 83 (35,3%) en Cardiología y 28 (11,9%) en Geriatría. La edad media fue 77,0±20,2 años (Cardiología 71,5±13,5; Medicina Interna 79,2±21,1; Geriatría 89,9±5,1; p<0,001). La fracción de eyección estaba conservada en 121 pacientes (51,5%) y este porcentaje era mayor en Medicina Interna (62,5%) y Geriatría (70,0%) que en Cardiología (31,3%), p<0,001. En comorbilidad destacaba fibrilación auricular (126; 53,6%), enfermedad renal (89; 37,8%) y enfermedad pulmonar obstructiva crónica (65; 27,7%). Las infecciones fueron el motivo de descompensación más común en Medicina Interna (56; 45,2%) y frecuentemente no tenían desencadenantes los pacientes ingresados en Cardiología (45; 54,2%) y Geriatría (14; 50,0%), p<0,001. La prescripción de inhibidores del sistema renina-angiotensina, betabloqueantes y espironolactona en pacientes con disfunción sistólica fue mayor en Cardiología. A los 45 días de seguimiento 23 pacientes (9,9%) reingresaron y esto fue más frecuente en Medicina Interna que en Cardiología (odds ratio 3,0 [intervalo de confianza 95%: 1,1 a 8,6], p=0,03), sin diferencias significativas para las demás comparaciones entre servicios. Conclusiones. Los pacientes que ingresan por insuficiencia cardíaca tienen edad avanzada y elevada comorbilidad. Existen grandes diferencias entre los servicios en lo relativo a edad y perfil clínico (AU)

Introduction. Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. Methods. An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. Results. Of a total of 235 patients, 124 (52.7%) were admitted to Internal Medicine, 83 (35.3%) to Cardiology, and 28 (11.9%) to Geriatrics. Mean age was 77.0±20.2 years (Cardiology 71.5±13.5; Internal Medicine 79.2±21.1; Geriatrics 89.9±5.1; p<.001). Preserved ejection fraction was found in 121 (51.5%) patients, and this rate was higher in Internal Medicine (62.5%) and Geriatrics (70.0%) than in Cardiology (31.3%), p<.001. Comorbidity was frequent, especially atrial fibrillation (126; 53.6%), renal disease (89; 37.8%), and chronic obstructive pulmonary disease (65; 27.6%). Infections were the most common decompensating trigger in Internal Medicine (56; 45.2%), and there was often no trigger in Cardiology (45; 54.2%) and Geriatrics (14; 50.0%), p<.0001. The use of renin-angiotensin system inhibitors, beta-blockers, and spironolactone in patients with systolic dysfunction was higher in Cardiology. During the 45 days follow-up, 23 patients (9.9%) were readmitted, which was more frequent in Internal Medicine than in Cardiology (odds ratio 3.0 [95% confidence interval: 1.1 - 8.6], p=.03), with no other significant comparisons. Conclusions. Patients admitted due to decompensated heart failure are elderly and often have comorbidities. There are major differences between departments as regards age and clinical profile (AU)