Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica 2012

Comparative analysis of heart failure management in two different media rural versus urban. (ALBAPIC Study)

OBJECTIVE

To know the epidemiological, clinical and therapeutic characteristics of patients with a diagnosis of HF treated in primary care of 2Health Areas of Albacete, Zone 5 A (characteristics of the Urban Center) and Casas Ibañez (characteristics of the Rural Center) as well as to highlight The main differences between the two.

METHOD

Descriptive and cross-sectional study, corresponding to the first phase of the ALBAPIC study. All patients in the area who met the inclusion criteria have been registered: Having a diagnosis of HF in the TURRIANO program (consultation program in Primary Care of Castilla la Mancha). Demographic-anthropometric and clinical characteristics, analytical data, complementary diagnostic examinations, therapeutic guidelines and hospitalizations were recorded for 12 months prior to inclusion. A physical examination and electrocardiographic and biochemical controls were performed at the inclusion visit.

RESULTS

384 patients diagnosed with HF in both Health Zone (161 in urban areas and 223 in rural areas) have participated. Average age 82.24±10.51 years (81.24±9.59 years in urban areas and 83.37±11 years in rural areas with significant differences P<.005, 54.3% are women (54% in urban areas and 54.7% in rural areas) We have an incidence of CI of 1% in urban areas and 1.8% in rural areas. The prevalence of CVRF has that hypertension above all and dyslipidemia are the most frequent, with differences depending on the environment in which they live. In the rural environment there are higher rates of heart disease. Patients with HF have a high number of concomitant chronic diseases, being between 4 and 6 more than 60% of cases in the urban environment and between 1 and 4 in the rural environment. Approximately 14% also have an oncological disease in the urban environment compared to 21% in the rural. According to the exploration and analytical data, the main variables are acceptably controlled, the lipid parameters in the rural center being worse controlled. The average number of drugs prescribed by each patient was 6.3 in rural and 7.2 urban. As for the treatments they are taking, it is observed that diuretics and statins.

CONCLUSIONS

There is an acceptable control of cardiovascular risk factors in both media, there being differences in the diagnostic methods and treatments used.

Estimated plasma volume and mortality: analysis from NHANES 1999-2014

BACKGROUND

While estimated plasma volume (ePV) has been studied in some diseases, such as heart failure, the relationship between ePV and all-cause or cause-specific mortality remains unexplored. Therefore, we investigated the association between ePV and all-cause, cardiovascular (CV), and cancer-related mortality among adults in the US.

METHOD

We used the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and included participants older than 18 years. Mortality data were obtained from the National Death Index and matched to the NHANES participants. ePV was derived using Strauss formula. Cox proportional hazard models were fit to estimate hazard ratios for all-cause and cause-specific mortality without and with adjustment for potential confounders.

RESULTS

Of the 42,705 participants, 5194 died (1121 CV deaths) during mean follow-up of 8.0 (range 0-16.7) years. Mean ± SD age and ePV of the participants were 47.2 ± 19.4 years and 4.2 ± 0.84, respectively. In unadjusted models, 1 unit increase in ePV was associated with 29%, 32%, and 16% increased risk in all-cause (HR 1.29; 95% CI 1.24, 1.35), CV (HR 1.32; 95% CI 1.22, 1.43), and cancer-related (HR 1.16; 95% CI 1.05, 1.27) mortality. Risk remained high in adjusted models (all-cause HR 1.24; 95% CI 1.18, 1.30; CV HR 1.22; 95% CI 1.11, 1.34; cancer-specific HR 1.24; 95% CI 1.10, 1.39). When comparing the highest and lowest ePV quartiles, similar results were noted (adjusted all-cause HR 1.64; 95% CI 1.45, 1.86; CV HR 1.52; 95% CI 1.19, 1.93; cancer HR 1.85; 95% CI 1.38, 2.49).

CONCLUSION

An increase in ePV was associated with increased all-cause and cause-specific mortality. Further studies are needed to explore the mechanism of this relationship and translation into a better outcome.

Influence of Intravenous Nitrate Treatment on Early Mortality Among Patients With Acute Heart Failure. NITRO-EAHFE Study

INTRODUCTION AND OBJECTIVES

There is little evidence on the prognostic influence of intravenous nitrates in patients with acute heart failure. Our purpose was to determine the influence of this treatment on early mortality and new visits.

METHODS

Prospective, multicenter cohort study of patients with acute heart failure in an emergency room during 2 periods (May 2009 and November-December 2011). Patients with systolic blood pressure > 110mmHg were included, grouped according to whether they received intravenous nitroglycerin or not. Endpoints were mortality at 3, 7, 14, and 30 days and new visits at 30 days. The propensity score was estimated by logistic regression to determine the prognostic influence of the treatment.

RESULTS

We included 3178 of 4897 individuals. A total of 308 (9.7%) had died within 30 days and 465 (17%) attended new visits. The mean (standard deviation) age was 79.5 (10.0) years, and 796 (25%) patients received intravenous nitrates. After matching, there were 685 individuals in each group. The hazard ratio for 30-day mortality with nitrates was 1.21 (95% confidence interval, 0.87-1.70) and was 0.93 for new visits (95% confidence interval, 0.71-1.22). The results were similar for mortality at 3, 7, and 14 days (hazard ratio = 1.05 [95% confidence interval, 0.56-1.96], hazard ratio = 1.20 [95% confidence interval, 0.74-1.94], and hazard ratio = 1.23 [95% confidence interval, 0.82-1.84], respectively). In the presence of hypertensive pulmonary edema, the nitrates group showed a hazard ratio of 0.88 (95% confidence interval, 0.47-1.63) for 30-day mortality.

CONCLUSIONS

Intravenous nitrates do not influence early mortality or new visits in patients with acute heart failure.

Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms

Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure.

[The heart failure patient: a case report]

Given its prevalence, high mortality rate, morbidity, chronicity and use of resources, heart failure (HF) is a priority issue from a social and health standpoint, due to the ageing population and to lack of adherence to and the complexity of treatment. For these reasons, an individualized care plan needs to be established to meet the real and potential needs of the patient diagnosed with HF. A clinical case is presented of a patient admitted to the Cardiology Critical Care (CCC) unit of a tertiary hospital. A patient care plan was prepared following the steps of the scientific method and relying on the NANDA taxonomy, and the NOC and NIC to design goals and nursing interventions, respectively.

Epidemiology of heart failure in Spain over the last 20 years

Heart failure is a major health care problem in Spain, although its precise impact is unknown due to the lack of data from appropriately designed studies. In contrast with the 2% prevalence of heart failure elsewhere in Europe and in the United States, studies in Spain report figures of 5%, probably because of methodological limitations. Heart failure consumes enormous quantities of health care resources; it is the first cause of hospitalization in persons aged 65 years or older and represents 3% of all hospital admissions and 2.5% of health care costs. There are two patterns of heart failure: one with preserved systolic function, more often associated with high blood pressure, and another with depressed systolic function, more often associated with ischemic heart disease. In 2010, heart failure accounted for 3% of all deaths in men and for 10% of all deaths in women. In recent years, the mortality rate from heart failure has gradually fallen. The rise in hospital admissions for heart failure and the decrease in mortality from this cause could partly be explained by temporary changes in diagnostic coding, but there is evidence that the reduced mortality could also be due to adherence to clinical practice guidelines.