1
|
Bonilla Palomas JL, Morgado García de Polavieja JI, Padilla Pérez M, Rangel-Sousa D, Castro Fernández A, López Aguilera J, Ortiz Cortés C, Torres Calvo F. What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges. Expert Rev Cardiovasc Ther 2023:1-10. [PMID: 37347231 DOI: 10.1080/14779072.2023.2215985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce. AREAS COVERED A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed. EXPERT OPINION Worsening HF can be defined as situations where the patient's HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data.
Collapse
Affiliation(s)
| | | | | | - Diego Rangel-Sousa
- Heart Failure and Heart Transplantation Unit. Cardiology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - José López Aguilera
- Heart Failure Unit. Cardiology Department, Hospital Reina Sofía, Córdoba, Spain
| | | | | |
Collapse
|
2
|
Esteban-Fernández A, Gómez-Otero I, López-Fernández S, Santamarta MR, Pastor-Pérez FJ, Fluvià-Brugués P, Pérez-Rivera JÁ, López López A, García-Pinilla JM, Palomas JLB, Bonet LA, Cobo-Marcos M, Mateo VM, Llergo JT, Fernández VA, Vives CG, de Juan Bagudá J, Benedicto AM, de Polavieja JIM, Solla-Ruiz I, Solé-González E, Cardona M, Olaetxea JR, Cortés CO, Dosantos VM, López AG, Amao E, Sánchez BC, Torres EA, Carrillo VG, García-Fuertes D, Ridocci-Soriano F. Influence of the medical treatment schedule in new diagnoses patients with heart failure and reduced ejection fraction. Clin Res Cardiol 2023:10.1007/s00392-023-02241-0. [PMID: 37341769 DOI: 10.1007/s00392-023-02241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Abstract
AIMS Heart failure (HF) guidelines recommend treating all patients with HF and reduced ejection fraction (HFrEF) with quadruple therapy, although they do not establish how to start it. This study aimed to evaluate the implementation of these recommendations, analyzing the efficacy and safety of the different therapeutic schedules. METHODS AND RESULTS Prospective, observational, and multicenter registry that evaluated the treatment initiated in patients with newly diagnosed HFrEF and its evolution at 3 months. Clinical and analytical data were collected, as well as adverse reactions and events during follow-up. Five hundred and thirty-three patients were included, selecting four hundred and ninety-seven, aged 65.5 ± 12.9 years (72% male). The most frequent etiologies were ischemic (25.5%) and idiopathic (21.1%), with a left ventricular ejection fraction of 28.7 ± 7.4%. Quadruple therapy was started in 314 (63.2%) patients, triple in 120 (24.1%), and double in 63 (12.7%). Follow-up was 112 days [IQI 91; 154], with 10 (2%) patients dying. At 3 months, 78.5% had quadruple therapy (p < 0.001). There were no differences in achieving maximum doses or reducing or withdrawing drugs (< 6%) depending on the starting scheme. Twenty-seven (5.7%) patients had any emergency room visits or admission for HF, less frequent in those with quadruple therapy (p = 0.02). CONCLUSION It is possible to achieve quadruple therapy in patients with newly diagnosed HFrEF early. This strategy makes it possible to reduce admissions and visits to the emergency room for HF without associating a more significant reduction or withdrawal of drugs or significant difficulty in achieving the target doses.
Collapse
Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Universidad Internacional de Valencia, Madrid, Spain.
- Valencian Internacional University, Valencia, Spain.
| | - Inés Gómez-Otero
- Cardiology Service, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia López-Fernández
- Cardiology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | | | - Francisco J Pastor-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Paula Fluvià-Brugués
- Cardiology Service, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - José-Ángel Pérez-Rivera
- Cardiology Service, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de La Salud, Universidad Isabel I, Burgos, Spain
| | | | - José Manuel García-Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | | | | | - Marta Cobo-Marcos
- Cardiology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Virgilio Martínez Mateo
- Cardiology Service, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Cristina Goena Vives
- Cardiology Service, Hospital de Mendaro, Mendaro, Gipuzkoa, Spain
- Instituto de Investigación Biodonostia, Donostia, Gipuzkoa, Spain
| | - Javier de Juan Bagudá
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Alba Maestro Benedicto
- Cardiology Service, Hospital de la Santa Creu I Sant Pau, IIB SANT PAU, Barcelona, Spain
| | | | - Itziar Solla-Ruiz
- Cardiology Service, Hospital Universitario de Donostia, San Sebastián, Spain
| | | | - Montserrat Cardona
- Cardiology Service, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Victor Martínez Dosantos
- Cardiology Service, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Antonio Gámez López
- Cardiology Service, Hospital General de Valdepeñas, Valdepeñas, Ciudad Real, Spain
| | - Elvis Amao
- Cardiology Service, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | - Borja Casas Sánchez
- Cardiology Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | | | - Francisco Ridocci-Soriano
- Cardiology Service, Hospital General Universitario de Valencia, Valencia, Spain
- Departamento de Medicina, Universitat de Valencia, Valencia, Spain
| |
Collapse
|
3
|
Esteban-Fernández A, Villar-Taibo R, Alejo M, Arroyo D, Bonilla Palomas JL, Cachero M, Joaquin C, Méndez Bailón M, Pérez-Rivera JÁ, Romero-Vigara JC, Somoza G. Diagnosis and Management of Malnutrition in Patients with Heart Failure. J Clin Med 2023; 12:3320. [PMID: 37176761 PMCID: PMC10179706 DOI: 10.3390/jcm12093320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Heart failure is a disease with an increasingly greater prevalence due to the aging population, the development of new drugs, and the organization of healthcare processes. Malnutrition has been identified as a poor prognostic factor in these patients, very often linked to frailty or to other comorbidities, meaning that early diagnosis and treatment are essential. This paper reviews some important aspects of the pathophysiology, detection, and management of malnutrition in patients with heart failure.
Collapse
Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Department, Severo Ochoa University Hospital, Calle Orellana s/n, 28911 Madrid, Spain
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Rocío Villar-Taibo
- Endocrinology Department, Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain;
| | - Mirian Alejo
- Endocrinology Department, Hospital El Bierzo, 24404 Ponferrada, Spain;
| | - David Arroyo
- Nephrology Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain;
| | | | - Montserrat Cachero
- Endocrinology Department, Germans Trias i Pujol Hospital, 08916 Badalona, Spain; (M.C.); (C.J.)
| | - Clara Joaquin
- Endocrinology Department, Germans Trias i Pujol Hospital, 08916 Badalona, Spain; (M.C.); (C.J.)
| | - Manuel Méndez Bailón
- Internal Medicine Department, San Carlos Clinical University Hospital, 28034 Madrid, Spain;
| | - José Ángel Pérez-Rivera
- Cardiology Department, Burgos University Hospital, 09006 Burgos, Spain;
- Faculty of Health Sciences, Isabel I University, 09003 Burgos, Spain
| | | | - Gema Somoza
- Geriatric Department, Gregorio Marañón University Hospital, 28007 Madrid, Spain;
| |
Collapse
|
4
|
Esteban Fernández A, Recio Mayoral A, González Franco A, Núñez Villota J, Mirabet S, Rubio Gracia J, González Costello J, Bonilla Palomas JL, Escobar Cervantes C. Optimizing the management of patients with worsening heart failure: beyond heart failure hospitalization. Expert Opin Pharmacother 2023; 24:705-713. [PMID: 36961877 DOI: 10.1080/14656566.2023.2195540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Worsening heart failure (HF) is associated with a high risk of death and HF hospitalization. AREAS COVERED A systematic search was conducted on PubMed (MEDLINE), using the MeSH terms [Heart failure] + [Worsening] + [Treatment] + [Vulnerable period] up to February 2023. Original data from clinical trials, and observational studies were critically analyzed. EXPERT OPINION Although the vulnerable period has been traditionally limited to the first 6 months after HF hospitalization, the fact is that there are other clinical scenarios in which the patient is particularly vulnerable. These vulnerable patients may also include those that require parenteral administration of diuretics in the day hospital or emergency department, those in which the increase of oral diuretic dose in an outpatient setting is needed to relief congestive symptoms, as well as those that remain symptomatic despite treatment. On the other hand, HF is a complex disease in which different neurohormonal systems are involved. Therefore, to actually reduce the HF burden, a comprehensive management, targeting all the neurohormonal systems that are involved in the pathogenesis of HF, through the use of those drugs that have demonstrated to positively modify the clinical course of HF, is needed.
Collapse
Affiliation(s)
| | | | | | - Julio Núñez Villota
- Cardiology Department, Hospital Clínico Universitario de Valencia; Universidad de Valencia, INCLIVA, CIBER Cardiovascular, Valencia, Spain
| | - Sonia Mirabet
- Cardiology Department, Hospital de Sant Pau, CIBERCV, Barcelona, Spain
| | - Jorge Rubio Gracia
- Internal Medicine Department. Hospital Clínico Universitario Lozano Blesa. University of Zaragoza, Spain
| | - José González Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | |
Collapse
|
5
|
Escobar Cervantes C, Esteban Fernández A, Recio Mayoral A, Mirabet S, González Costello J, Rubio Gracia J, Núñez Villota J, González Franco Á, Bonilla Palomas JL. Identifying the patient with heart failure to be treated with vericiguat. Curr Med Res Opin 2023; 39:661-669. [PMID: 36897009 DOI: 10.1080/03007995.2023.2189857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The pathophysiology of heart failure with reduced ejection fraction (HFrEF) is a complex process in which a number of neurohormonal systems are involved. Targeting only some of these systems, but not all, translates into a partial benefit of HF treatment. The nitric oxide-soluble guanylate cyclase (sGC)-cGMP pathway is impaired in HF, leading to cardiac, vascular and renal disturbances. Vericiguat is a once-daily oral stimulator of sGC that restores this system. No other disease-modifying HF drugs act on this system. Despite guidelines recommendations, a substantial proportion of patients are not taking all recommended drugs or when taking them, they do so at low doses, limiting their potential benefits. In this context, treatment should be optimized considering different parameters, such as blood pressure, heart rate, renal function, or potassium, as they may interfere with their implementation at the recommended doses. The VICTORIA trial showed that adding vericiguat to standard therapy in patients with HFrEF significantly reduced the risk of cardiovascular death or HF hospitalization by 10% (NNT 24). Furthermore, vericiguat does not interfere with heart rate, renal function or potassium, making it particularly useful for improving the prognosis of patients with HFrEF in specific settings and clinical profiles.
Collapse
Affiliation(s)
| | | | | | - Sonia Mirabet
- Cardiology Department, Hospital de Sant Pau, Barcelona, Spain
| | - José González Costello
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BIOHEART-Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Spain
- Ciber Cardiovascular (CIBERCV), Instituto Salud Carlos III, Madrid, Spain
| | - Jorge Rubio Gracia
- Internal Medicine Department, Hospital Clínico Univeristario Lozano Blesa, University of Zaragoza, Spain
| | - Julio Núñez Villota
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Universidad de Valencia, INCLIVA, CIBER Cardiovascular, Valencia, Spain
| | | | | |
Collapse
|
6
|
Anguita Sánchez M, Bonilla Palomas JL, García Márquez M, Bernal Sobrino JL, Elola Somoza FJ, Marín Ortuño F. Tendencias temporales de las tasas de frecuentación y mortalidad hospitalaria de la insuficiencia cardiaca en España por edad y sexo (2003-2018). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
7
|
Anguita Sánchez M, Bonilla Palomas JL, García Márquez M, Bernal Sobrino JL, Elola Somoza FJ, Marín Ortuño F. Temporal trends in hospitalization and in-hospital mortality rates due to heart failure by age and sex in Spain (2003-2018). Rev Esp Cardiol (Engl Ed) 2021; 74:993-996. [PMID: 34176775 DOI: 10.1016/j.rec.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Manuel Anguita Sánchez
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain.
| | | | - María García Márquez
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal Sobrino
- Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | | |
Collapse
|
8
|
Anguita Sánchez M, Bonilla Palomas JL, García Márquez M, Bernal Sobrino JL, Fernández Pérez C, Elola Somoza FJ. Temporal trends in hospitalizations and in-hospital mortality in heart failure in Spain 2003-2015: differences between autonomous communities. Rev Esp Cardiol (Engl Ed) 2020; 73:1075-1077. [PMID: 32800487 DOI: 10.1016/j.rec.2020.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Manuel Anguita Sánchez
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Servicio de Cardiología, Hospital Quirón Salud, Córdoba, Spain.
| | | | | | - José Luis Bernal Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández Pérez
- Servicio de Cardiología, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | | |
Collapse
|
9
|
Anguita Sánchez M, Bonilla Palomas JL, García Márquez M, Bernal Sobrino JL, Fernández Pérez C, Elola Somoza FJ. Tendencias temporales en ingresos y mortalidad hospitalaria por insuficiencia cardiaca en España, 2003-2015: diferencias por comunidades autónomas. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Pimentel Quezada Y, Bonilla Palomas JL, Gámez López AL, Moreno Conde M, López Ibáñez MC, Gallego de la Sacristana López-Serrano Á. Has the clinical profile of patients with nonvalvular atrial fibrillation treated with rivaroxaban changed in the last 5 years of use? Future Cardiol 2018; 14:47-53. [PMID: 29848089 DOI: 10.2217/fca-2018-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To analyze the evolution of clinical profile of patients with nonvalvular atrial fibrillation treated with rivaroxaban. METHODS Retrospective study in which patients treated with rivaroxaban were divided into two groups according to the data in which the initial prescription was performed (November 2012-December 2013 and January 2014-January 2017). RESULTS 211 patients (mean age 76.7 ± 9.2 years; CHA2DS2-VASc 3.8 ± 1.5; HAS-BLED 2.0 ± 0.8.) were included. Age and bleeding risk were higher in those subjects in which the prescription started earlier. Rates of stroke/TIA, major bleeding and intracranial hemorrhage were 2.3/4.2/0.6 events/100 patient-years, respectively. CONCLUSION Although, the initial prescription of rivaroxaban was mainly performed in very elderly patients and/or with a higher bleeding risk, this has been extended to the overall nonvalvular atrial fibrillation population.
Collapse
Affiliation(s)
- Yesenia Pimentel Quezada
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Juan Luis Bonilla Palomas
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Antonio Luis Gámez López
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Mirian Moreno Conde
- Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | | | | |
Collapse
|
11
|
Gámez López AL, Bonilla Palomas JL, Granados AL. An unusual case of cardiac resynchronization therapy non-responder: the reel syndrome. Europace 2010; 12:778. [PMID: 20410043 DOI: 10.1093/europace/euq112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|